NURS 6630 Discussion: Treatment for a Patient With a Common Condition
NURS 6630 Discussion. Insomnia is one of the most common medical conditions you will encounter as a PNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.NURS 6630 Discussion
Reference: Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
Metformin 500mg BID
Januvia 100mg daily
Losartan 100mg daily
HCTZ 25mg daily
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post a response to each of the following:
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
NURS 6630 Discussion Answer
Exploring Patient Concerns
“On the occasions when you experience anxiety, do you manage to control your situation?”
This question is vital for understanding the patient’s coping mechanisms and her ability to manage anxiety. The patient’s response can provide insights into her self-regulation skills and may serve as a starting point for developing strategies to improve her control over anxiety (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012).NURS 6630 Discussion
“Based on your criteria, what could be the causes of your anxiety? Can you identify a single event that triggers the anxiety?”
This question aims to explore the patient’s perspective on the underlying causes of her anxiety. Understanding potential triggers or stressors that contribute to her anxiety can help tailor a more effective treatment plan (Hofmann et al., 2012).
“Based on your current experiences, how would you rate your overall quality of life? Does the extended feeling of anxiety make you feel as if your life is falling apart?”
This question seeks to assess the impact of anxiety on the patient’s overall quality of life and daily functioning. It provides an opportunity to gauge whether her anxiety is significantly affecting her well-being, relationships, and daily activities (Hofmann et al., 2012).
Engaging Family and Caregivers
In this scenario, where the patient’s husband is deceased, it is crucial to involve caregivers or close family members. They can provide valuable insights into the patient’s condition and history. When seeking feedback from these individuals, specific questions may include:
“When does the patient typically experience anxious symptoms, and how long do they usually last?”
Understanding the frequency and duration of the patient’s anxiety episodes can help assess the severity and impact on her daily life.
“Have you ever witnessed the patient during her worst experiences of anxiety?”
This question aims to capture the patient’s behavior during extreme anxiety episodes, shedding light on the severity of her condition.
“Do you recall any instances when the patient received treatment that improved her anxiety symptoms?”
This question explores the patient’s treatment history and whether any interventions have been beneficial.
“Have you observed the patient struggling to stay awake during the day, especially in public places?”
This question assesses the potential co-occurrence of sleep disturbances with anxiety, which can inform a more comprehensive treatment approach.
Family members can also provide insights into the patient’s pre-diagnosis years:NURS 6630 Discussion
“Could you provide a brief overview of the patient’s behavior and experiences in the years before her diagnosis of this condition?”
This question aims to gather information about the patient’s pre-existing behaviors and any noticeable changes that might be linked to the onset of her condition.
“Are there any life events or circumstances that you believe contributed to the patient’s change in behavior?”
Understanding potential triggers for the patient’s anxiety and depressive symptoms can aid in developing a holistic treatment plan.
“Has the patient ever made any suicide attempts or expressed thoughts of self-harm?”
Assessing the patient’s history of self-harm or suicidal ideation is essential to ensure her safety and provide appropriate interventions if necessary (Goldney et al., 2018).
When engaging former employers or colleagues:
“Did you ever observe signs of anxiety or aggression in the workplace while the patient was employed here?”
This question helps assess the impact of the patient’s anxiety on her professional life and relationships with coworkers.
“What can you tell me about the patient’s behavior and social interactions in the workplace? Was she outgoing, talkative, or withdrawn?”
Understanding the patient’s work-related behaviors and social interactions provides valuable context for her condition and potential triggers.NURS 6630 Discussion
“Did the patient ever disclose any experiences or concerns that made you suspect she was dealing with depressive symptoms?”
This question aims to uncover whether the patient had ever confided in colleagues about her emotional well-being, shedding light on her struggles with depressive symptoms (Andrade et al., 2013).NURS 6630 Discussion
References:
Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., … & Zarkov, Z. (2013). Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychological Medicine, 44(6), 1303-1317.
Goldney, R. D., Fisher, L. J., & Wilson, D. H. (2018). Mental health literacy of those with major depression and suicidal ideation: an impediment to help seeking. Suicide and Life-Threatening Behavior, 38(3), 394-403.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.
