Treatment for a Patient With a Common Condition

Discussion: Treatment
for a Patient With a Common Condition
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.
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.

Grading Rubric
Response to the Discussion question is
reflective with critical analysis and synthesis representative of knowledge
gained from the course readings for the module and current credible sources.
Thoroughly responds to the Discussion question(s).

Is reflective with critical analysis and synthesis
representative of knowledge gained from the course readings for the module and
current credible sources.

No less than 75% of post has exceptional depth and
breadth.

Supported by at least three current credible
sources. (Dated five yeas or less:
2016-2021)
Main Posting:

Writing
Written clearly and concisely.

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