NURS 6630 Treatment for a Patient With a Common Condition
Walden University NURS 6630 Treatment for a Patient With a Common Condition-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NURS 6630 Treatment for a Patient With a Common Condition assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NURS 6630 Treatment for a Patient With a Common Condition
Whether one passes or fails an academic assignment such as the Walden University NURS 6630 Treatment for a Patient With a Common Condition depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NURS 6630 Treatment for a Patient With a Common Condition
The introduction for the Walden University NURS 6630 Treatment for a Patient With a Common Condition is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for NURS 6630 Treatment for a Patient With a Common Condition
After the introduction, move into the main part of the NURS 6630 Treatment for a Patient With a Common Condition assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NURS 6630 Treatment for a Patient With a Common Condition
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NURS 6630 Treatment for a Patient With a Common Condition
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NURS 6630 Treatment for a Patient With a Common Condition
To better help this patient that is dealing with insomnia there are three questions that I would need to ask. How long have you been on your current medica; regiment? When in the day do you take these medications? When do you typically go to bed every night? The first two questions will allow me to determine if her medications are a contributing factor. The third question will allow me to determine if her depressive condition is a factor. All of these will allow a better understanding of what is occurring and allow the best diagnosis for this patient (NIH, 2022).
To better assess this situation there are individuals in this patient’s life that would need to be consulted. Her husband is recently deceased so I will want to know if she has a brother or sister. Her children would also be a good point of reference. A close friend in her life would also be an informative individual. I would like to know how often they are in contact with this patient. How well does she adhere to her medical regiment? The first question will allow me to assess how good of a support system she has in place when dealing with her depressive disorder. The second will allow me to determine if she is properly taking all her medication (Kryger, MD, FRCP(C), 2023).
The physical exams that would need to be conducted will include a visual assessment of her nasal airway including the septum and her throat. If this patient has a deviated septum, enlarged tonsils or a narrowing in her throat these could be contributing factors. I would also like to have a thyroid function test conducted to determine the level of thyroid hormones in her body. These help to regulate sleep function (Mayo Clinic, 2024).
There are different types of insomnia including primary, secondary, and comorbid. In this case her condition probably falls under the secondary insomnia umbrella. This patient has a history of diabetes and hypertension and she had been experiencing these symptoms before her husband passed away. So, her insomnia is probably caused by her other conditions and has only worsened due to her depression (Fisher, MD, 2019).
The two pharmacologic agents to help this patient’s depression are Citalopram 20 mg once daily and Sertraline 100 mg once per day. Citalopram works by inhibiting the central nervous system’s ability of undertaking a neuronal reuptake of serotonin while Sertraline inhibits its ability to undertake a neuronal uptake of serotonin. For this patient I would choose Citalopram due to it not having the likely hood of trouble with sleeping side effect (Abad & Guilleminault, 2018).
There are several contraindications with this patient and Citalopram. Including the risk of low sodium and potassium levels. This drug increases serotonin levels which can lower both levels in the blood stream. This can lead to confusion, lethargy, and fatigue. I would want to know what her sodium and potassium levels are before prescribing this for her depression (Sanjai, MD, 2021).
I would want to follow up with her after four weeks. I would like to see where her sodium and potassium levels are. She is taking Losartan for her hypertension, so it is recommended that you avoid potassium supplements and food high in potassium. If her potassium levels are lower than desired, it may be necessary to switch her to a drug such as lisinopril which is affecting in treating hypertension with out having to be concerned with the effects of potassium.
References
Abad, V. C., & Guilleminault, C. (2018). Insomnia in elderly patients: Recommendations for pharmacological management. Drugs & Aging, 35(9), 791–817. https://doi.org/10.1007/s40266-018-0569-8
Fisher, MD, K. J. (2019, February 7). Types of insomnia: How to tell them apart and how to treat them. Healthline. https://www.healthline.com/health/types-of-insomnia#types
Kryger, MD, FRCP(C), M. (2023, March 13). Insomnia in the elderly: Causes, symptoms, and treatment. Medical News Today. https://www.medicalnewstoday.com/articles/insomnia-in-the-elderly#summary
Mayo Clinic. (2024). Insomnia – symptoms and causes – mayo clinic. https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167
NIH. (2022, March 24). What is insomnia? National Institute of Health, NHLBI,. https://www.nhlbi.nih.gov/health/insomnia
Sanjai, MD, S. (2021, December 3). Citalopram: Uses, dosage, side effects – drugs.com. Drugs.com. https://www.drugs.com/citalopram.html
Sample Answer 2 for NURS 6630 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
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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.
Read a selection of your colleagues’ responses.
By Day 6 of Week 7
Respond to at least two of your colleagues on two different days in one of the following ways:
• If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
• If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days and
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
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Week 7 Discussion Rubric
Post by Day 3 of Week 7 and Respond by Day 6 of Week 7
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Week 7 Discussion
Sample Answer 3 for NURS 6630 Treatment for a Patient With a Common Condition
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
- Do you drink caffeinated drinks? If yes, how many do your drink a day and at what time?
Rationale: Caffeine is a stimulant. Individuals who drink caffeine during the day cause a reduction in 6-sulfatoxymelatonin (the main metabolite of melatonin) at night, which leads to sleep disturbance (O’Callaghan et al., 2018). The lack of sleep affects cognitive functioning and psychomotor response (O’Callaghan et al., 2018).
- How many hours of sleep are you getting each night?
Rationale: According to Levenson et al., when a person is living with unpleasant thoughts or worrying excessively, it can lead to sleep disturbances (2015). The decreased sleep can cause the person to worry about not getting enough sleep, leading to more anxiety and insomnia (Levenson et al., 2015).
- Have you had any feelings of depression, hopelessness, or feeling down in the past month?
Rationale: Individuals who have suffered a significant loss are at high risk for depression. Individuals with depression often experience insomnia. This question is one of two that can be used to assess a patient for depression and determine if further treatment is warranted (Assessment of Depression in Adults in Primary Care, 2020). The patient’s husband died ten months ago in the given scenario. If the patient responds positively to this question, it is critical to also assess for suicide risk.
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.
It would be important to gain information from outside sources such as family, friends, and caretakers familiar with the patient’s daily life. If possible, individuals who have been around the patient from before her husband passed until now. You could ask the patient how she got to the appointment and if someone brought her, you could ask if she would be OK with you speaking with them. There are several questions you could ask.
Have you noticed a change in her interest in doing things?
Have you she seemed down or hopeless?
How has she been eating?
Do you know if she is taking her medications or noticed any side effects from her medications?
Have you noticed any anxiety or changes in memory?
Explain what, if any, physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
Upon the initial interview, it is possible to screen the patient for depression. There are several ways this can be done. Practitioners can use the Mini-Mental State Exam MMSE), Geriatric Depression Scale Short Form (SGDS), or the Cornell Scale for Depression in Dementia (CSDD) (Brown et al., 2015). It is important to note that older adults with depression can also have dementia, so screening for dementia would also be important (Brown et al., 2015). The CSDD can detect depression in individuals with cognitive impairment. The SGDS is used because it is fairly easy and short and can detect depression in older adults (Brown et al., 2015). Laboratory testing is also important as many organic illnesses can lead to insomnia and depression. Baseline lab work should include glucose, liver function, complete blood count, Erythrocyte Sedimentation Rate, urea, creatinine, electrolytes, B-12, and Iron studies.
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
A differential diagnosis for depression in an elderly patient could be Vascular Depression. It is found in adults over 60 years of age and with no prior history of depression (Small, 2009). It can be found in patients with hypertension or a history of vascular disease believed to cause inflammation within the vascular system leading to the release of cytokines, especially after a stressful event (Jeon & Kim, 2018). When reviewing the patient’s medications, she is taking bother Losartan and hydrochlorothiazide to manage her hypertension, so the differential diagnosis of Vascular Depression is possible.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s anti-depressant 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.
The patient is currently taking Sertraline 100mg daily. If the patient takes the medication as prescribed, the patient should see improvement in depressive symptoms. The scenario does not state how long the patient has been taking Sertraline. One side effect of SSRIs is that they can cause insomnia. At this time, it is appropriate to consider augmenting the Sertraline with a low dose TCA like trazodone. Research suggests that short-term use of a TCA can improve sleep as soon as the first dose (Wichniak et al., 2017). It is important to remember that when the patient’s depression symptoms improve, the TCA should be lowered or discontinued because it can cause oversedation (Wichniak et al., 2017).
Sertraline makes it difficult to keep blood sugar stable. It can also be recommended to switch the anti-depressant to Bupropion. Studies have shown that in patients with diabetes, burproprione successfully treats depression and controls blood sugar levels (Darwish et al., 2018). It would be necessary to monitor the patient’s blood pressure as bupropion can elevate blood pressure (Darwish et al., 2018).
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?
Sertraline is contraindicated in patients taking thioridazine, pimozide, or monoamine oxidase inhibitors, including linezolid or methylene blue, and it should not be taken with other serotonergic medications (Singh & Saadabad, 2020). Buspirone is contradicted in patients with kidney and liver disease as the drug’s effects may increase due to slow kidney or liver removal. Trazadone is contraindicated for anyone taking an MAOI or has taken an MAOI in the past 14 days (Shin & Saadabadi, 2020).
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.
It would be necessary to follow up with the patient in four weeks to see if adding Trazadone improves the patient’s sleep. If there is no improvement in the patient’s sleep or depressive symptoms, it would be time to consider changing the patient’s medication to buspirone.
References
Assessment of depression in adults in primary care [PDF]. (2020). Best Practice Medicine Journal New Zealand. https://bpac.org.nz/magazine/2009/Adultdep/docs/bpjse_adult_dep_assess_pages8- 12.pdf
Brown, E., Raue, P. J., & Halpert, K. (2015). Evidence-based practice guideline: Depression detection in older adults with dementia. Journal of Gerontological Nursing, 41(11), 15– 21. https://doi.org/10.3928/00989134-20151015-03
Darwish, L., Beroncal, E., Sison, M., & Swardfager, W. (2018). Depression in people with type 2 diabetes: Current perspectives. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Volume 11, 333–343. https://doi.org/10.2147/dmso.s106797
Jeon, S., & Kim, Y.-K. (2018). The role of neuroinflammation and neurovascular dysfunction in major depressive disorder. Journal of Inflammation Research, Volume 11, 179–192. https://doi.org/10.2147/jir.s141033
Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://doi.org/10.1378/chest.14-1617
O’Callaghan, F., Muurlink, O., & Reid, N. (2018). Effects of caffeine on sleep quality and daytime functioning. Risk Management and Healthcare Policy, Volume 11, 263–271. https://doi.org/10.2147/rmhp.s156404
Park, L. T., & Zarate, C. A. (2019). Depression in the primary care setting. New England Journal of Medicine, 380(6), 559–568.https://doi.org/10.1056/nejmcp1712493
Shin, J., & Saadabadi, A. (2020). Trazadone. StatPearls. https://doi.org/https://www.ncbi.nlm.nih.gov/books/NBK470560/
Singh, H. K., & Saadabad, A. (2020). Sertraline. StatPearls. https://doi.org/https://www.ncbi.nlm.nih.gov/books/NBK547689/
Small, G. W. (2009). Differential diagnoses and assessment of depression in elderly patients. The Journal of Clinical Psychiatry, 70(12), e47. https://doi.org/10.4088/jcp.8001tx20c
Wichniak, A., Wierzbicka, A., Walęcka, M., & Jernajczyk, W. (2017). Effects of antidepressants on sleep. Current Psychiatry Reports, 19(9). https://doi.org/10.1007/s11920-017-0816-4
Sample Answer for NURS 6630 Treatment for a Patient With a Common Condition
The process of sleeping is important for the body to facilitate recovery, regaining strength, body restoration, discharge of emotions, and consolidation of memory. As such, the average adult must get at least 7 hours of sleep a night (Ellis et al., 2021). Insomnia is a condition characterized by a lack of adequate sleep. It may occur as a primary disorder or as a manifestation of other illnesses be they medical, psychiatric, or surgical. In patients with mood disorders like depression and bipolar, insomnia is a distinct character with the patient being unable to fall asleep or maintain sleep for at least 7 hours (Sweetman et al., 2021). This discussion aims to devise a treatment plan for a patient suffering from insomnia and MDD.
Case Study
The patient is a recently widowed 75-year-old woman who suffers from DM, hypertension, and MDD. She complains of insomnia. She reports that the MDD and symptoms started after her husband’s passing, 10 months ago. She is on: HCTZ 25mg daily, Losartan 100mg daily, Januvia 100mg daily, Sertraline 100mg daily, and Metformin 500mg BID. She has no suicidal ideation. She is awake, oriented, and alert, her temperature was 98.6 degrees F, her BP is 132/86, her height is 64 inches and her weight is 88kg.
Questions to Ask the Patient
The line of questioning should provide more information about her illness and include:
- Do you have difficulty falling asleep or staying asleep? This would guide the pharmacologic intervention. If the patient is having difficulty falling asleep, a drug with a shorter half-life would be preferred and vice versa (Hassinger et al., 2020).
- What does your average evening consist of? This is to determine the sleep hygiene practices, I would further ask about specific sleep hygiene practices.
- What do you do when you are unable to sleep? This is to determine the patient’s coping mechanisms, and whether they are successful and healthy.
Other Persons to Question
The patient’s close relatives and other individuals who have daily contact with her should be questioned. They would provide insight on the severity of her insomnia and any other symptoms she may be exhibiting but not have insight on.
I would ask about her memory and whether it has deteriorated rapidly. This could point toward the severity of insomnia. Questions on her adherence to her MDD medication would also be asked. The insomnia is likely linked to her MDD; therefore, non-adherence can lead to a recurrence of symptoms (Fang et al., 2019).
Physical Examination and Diagnostic Tests
On physical examination, I would look out for deformities and malformations that would cause obstructive sleep apnea. This is a common cause of insomnia (Ong et al., 2020). In the HEENT examination, I would look for a narrowed throat, hypertrophied tonsils, and a deviated septum. These can all compromise the airflow. I would conduct a thorough neurological examination to determine the presence of neuropathic pain that would contribute to insomnia.
The diagnostic tests of choice are polysomnography and actigraphy. Polysomnography observes various parameters during sleep to note abnormalities allowing for the study of sleep patterns and diagnosis of sleep disorders (Withrow et al., 2019). Actigraphy measures motor activity during sleep to determine the quality of sleep experienced (Withrow et al., 2019).
Differential Diagnosis
The differential diagnoses for this case include sleep apnea, Cheyne Stokes breathing, insomnia due to mental illness, insomnia due to medical illness, and insomnia due to medications.
The most likely diagnosis is insomnia due to mental illness. The patient is suffering from MDD. One of the major symptoms is sleep disturbances, either insomnia or hypersomnia.
Pharmacologic Management of MDD
For the patient in question, Citalopram and Amitriptyline are suitable for the management of MDD. Citalopram (20mg OD) is an SSRI with minimal side effects, the most significant being weight loss. This would prove advantageous for the patient who is already overweight. Further, the bioavailability of this drug is 86% such that a small dose goes a long way (Yang et al., 2019). Amitriptyline (75mg per day in divided doses) is a TCA with a half-life of 62% (Zhai et al., 2020). However, the drug is lipophilic and therefore spread throughout the body across all membranes and barriers. I would choose Citalopram for this patient owing to its bioavailability and weight-reduction properties.
Contraindications of Citalopram
Citalopram is contraindicated in patients who have experienced an allergic reaction to it before due to the potential fatal outcome. It is contraindicated with monoamine oxidase inhibitors due to the risk of developing serotonin syndrome. It is important to wait at least 14 days between doses of citalopram and monoamine oxidase inhibitors to prevent serotonin syndrome (Scotton et al., 2019).
Therapy Checkpoints
The therapy checkpoints must include the therapeutic effects of the drugs administered and the adverse drug reactions experienced. The therapeutic effect of citalopram begins one to four weeks after starting the drug. It is therefore prudent to have the first checkpoint at four weeks at the earliest. Ask about the improvement of symptoms at this time and alter the dose appropriately. Adverse effects of the drug such as dry mouth, nausea, xerostomia, and increased sweating should be probed for.
References
Ellis, J. G., Perlis, M. L., Espie, C. A., Grandner, M. A., Bastien, C. H., Barclay, N. L., Altena, E., & Gardani, M. (2021). The natural history of insomnia: Predisposing, precipitating, coping, and perpetuating factors over the early developmental course of insomnia. Sleep, 44(9), zsab095. https://doi.org/10.1093/sleep/zsab095
Fang, H., Tu, S., Sheng, J., & Shao, A. (2019). Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms, and treatment. Journal of cellular and molecular medicine, 23(4), 2324–2332. https://doi.org/10.1111/jcmm.14170
Hassinger, A. B., Bletnisky, N., Dudekula, R., & El-Solh, A. A. (2020). Selecting a pharmacotherapy regimen for patients with chronic insomnia. Expert opinion on pharmacotherapy, 21(9), 1035–1043. https://doi.org/10.1080/14656566.2020.1743265
Ong, J. C., Crawford, M. R., Dawson, S. C., Fogg, L. F., Turner, A. D., Wyatt, J. K., Crisostomo, M. I., Chhangani, B. S., Kushida, C. A., Edinger, J. D., Abbott, S. M., Malkani, R. G., Attarian, H. P., & Zee, P. C. (2020). A randomized controlled trial of CBT-I and PAP for obstructive sleep apnea and comorbid insomnia: Main outcomes from the MATRICS study. Sleep, 43(9), zsaa041. https://doi.org/10.1093/sleep/zsaa041
Scotton, W. J., Hill, L. J., Williams, A. C., & Barnes, N. M. (2019). Serotonin Syndrome: Pathophysiology, clinical features, management, and potential future directions. International journal of tryptophan research: IJTR, 12, 1178646919873925. https://doi.org/10.1177/1178646919873925
Sweetman, A., Lack, L., McEvoy, R. D., Catcheside, P. G., Antic, N. A., Chai-Coetzer, C. L., Douglas, J., O’Grady, A., Dunn, N., Robinson, J., Paul, D., & Smith, S. (2021). Effect of depression, anxiety, and stress symptoms on response to cognitive behavioral therapy for insomnia in patients with comorbid insomnia and sleep apnea: a randomized controlled trial. Journal of clinical sleep medicine: JCSM: Official publication of the American Academy of Sleep Medicine, 17(3), 545–554. https://doi.org/10.5664/jcsm.8944
Withrow, D., Roth, T., Koshorek, G., & Roehrs, T. (2019). Relation between ambulatory actigraphy and laboratory polysomnography in insomnia practice and research. Journal of sleep research, 28(4), e12854. https://doi.org/10.1111/jsr.12854
Yang, K. C., Stepanov, V., Amini, N., Martinsson, S., Takano, A., Bundgaard, C., Bang-Andersen, B., Sanchez, C., Halldin, C., Farde, L., & Finnema, S. J. (2019). Effect of clinically relevant doses of vortioxetine and citalopram on serotonergic PET markers in the nonhuman primate brain. Neuropsychopharmacology: Official publication of the American College of Neuropsychopharmacology, 44(10), 1706–1713. https://doi.org/10.1038/s41386-019-0442-4
Zhai, Y., Wu, L., Zheng, Y., Wu, M., Huang, Y., Huang, Q., Shentu, J., Zhao, Q., & Liu, J. (2020). Bioequivalence study of amitriptyline hydrochloride tablets in healthy Chinese volunteers under fasting and fed conditions. Drug design, development, and therapy, 14, 3131–3142. https://doi.org/10.2147/DDDT.S258173
Week 7 Discussion
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Edwina Etienne
07/12/2022
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NURS 6630 Assignment Psychiatric Nurse Practitioner
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NURS 6630 Assessing and Treating Patients With challenging Disorders
NURS 6630 Discussion Psychiatric Mental Health
NURS 6630 Discussion The Impact of Ethnicity on Antidepressant Therapy
NURS 6630 treatment of Insomnia
NURS 6630 Post-Traumatic Stress Disorder (PTSD)
NURS 6630 characteristic of generalized anxiety disorder
NURS 6630 Case Study 53-year-old Puerto Rican Female with Comorbid Addiction
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
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 the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
- 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.