(Solution) NURS 6630 Week 8 Assignment 2: Assessing and Treating Patients with Sleep/Wake Disorders ( a 31-year-old male who presents to the office with a chief complaint of insomnia.)

The provided case study is of 31 years old male who presented to the office with a chief complaint of insomnia. Patient reported progressive worsening of his insomnia symptoms. It is difficult for patient to fall aslee ...

The provided case study is of 31 years old male who presented to the office with a chief complaint of insomnia. Patient reported progressive worsening of his insomnia symptoms. It is difficult for patient to fall asleep and to stay asleep at night. The symptoms started to appear when the patient suffered from an emotional trauma (sudden loss of his fiancé). Patient is a forklift operator at a local chemical company and insomnia is affecting his professional performance. The patient used diphenhydramine but does not like the way it makes him feel the morning after. Past medical history indicated opiate abuse which started when the patient was prescribed hydrocodone/apap for pain management (as he broke his ankle in skiing accident). However, patient has not received prescription for opiate analgesic in 4 years. Currently patient is using alcohol (four beers prior to bed) to fall asleep. Patient is alert and future oriented. Patient denied auditory and visual hallucinations. Reality contact, insight and judgment are all intact. Patient denied suicidal/ homicidal ideation. The pertinent positive information that will impact the decision making when prescribing medication for this patient includes his past medical history (related to opiate abuse), consumption of alcohol, complaining about sleep issues after suffering from emotional trauma (sudden loss of his fiancé) and complaints regarding the after effect of diphenhydramine. It is also important to consider the employment status of patient as insomnia has affected his professional performance, therefore such medications would be recommended that can improve his professional performance by improving his concentration and cognitive abilities. WEEK 8 ASSIGNMENT 2 3 Assessing and Treating Patients with Sleep/Wake Disorders Decision 1 The selected decision one is “Trazodone 50 to 100 mg daily at bedtime”. I selected this decision because Trazodone is an effective drug which is recommended for primary (difficulty in falling asleep or maintaining the sleep cycle) as well as secondary insomnia (insomnia caused by a mental disorder). As the patient reported that he is suffering from sleep issues after the sudden death of his fiancé. This indicates that the patient is suffering from a secondary insomnia. Due to this reason, Trazodone is selected for this patient. According to the study of Jaffer et al. (2017) evidence for the efficacy of trazodone has been repeatedly demonstrated for primary insomnia as well as secondary insomnia including for symptoms that are a result of depression and dementia. The study has also mentioned that Trazodone in low doses (50 to 150 mg/day) possess a good safety profile for the treatment of insomnia. Another study of Wang et al. (2020) has reported that Trazodone is effective in improving concentration and recall abilities. As the patient reported that insomnia is effecting his professional performance as he has fallen asleep on the job due to lack of sleep from the night before. In such cases, it is important to consider the employment status of patient and recommend a drug that can improve his sleep quality along with cognitive skills. Recommending this drug to patient will definitely improve his professional performance because he will be able to concentrate on his work. The patient also reported consumption of alcohol daily, therefore Trazodone is a good decision because Trazodone is recommended in managing sleep disturbances in patients with alcohol use disorder (Kathiresan et al., 2020). Considering- the symptoms presented by the case study-secondary insomnia along with the safety profile of low doses (50 to 150 mg/day), the decision 1 is selected. WEEK 8 ASSIGNMENT 2 4 The option of Zolpidem 10 mg at bedtime was not selected because Zolpidem is associated with sleep related eating disorder and sleep related eating disorder can occur at any dose of Zolpidem. According to the study of Ho et al. (2020) Zolpidem can cause sleep related eating disorder with any dose. This study has also suggested that insomnia is commonly due to underlying disorders (like restless leg syndrome, obstructive sleep apnea and depression). Therefore it is important to control those underlying disorders before initiating Zolpidem. The study reported that discontinuation of Zolpidem has resolved all the cases of sleep related eating disorder. The third option of Hydroxyzine 50 mg daily at bedtime was not considered because Hydroxyzine belongs to the class of anti-histamine as that of diphenhydramine. As the patient reported that he has used diphenhydramine for his sleep issues but doe