May 30, | nursing, med, NURS, Paper
tina jones HEENT shadow health assessment transcript
Transcript
Started: May 17, 2020 | Total Time:96 min
Hello. My name is xxx. I will be interviewing you today and then conduct a physical exam.
Greet
05/29/20 6:31 PM EDT
Hey.
May i know your name please?
Question
05/29/20 6:31 PM EDT
Tina Jones.
What brings you the the Clinic today Tina?
Question
05/29/20 6:31 PM EDT
My throat has been sore… and itchy. And my nose won’t stop running. These symptoms are driving me nuts.
Am sorry to hear that
Empathize
05/29/20 6:32 PM EDT
I appreciate you telling me that.
How long have you had these symptoms?
Question
05/29/20 6:32 PM EDT
My itchy eyes, runny nose, and sore throat all started a week ago. [AUDIO COMING SOON]
Have you ever had these symptoms before?
Question
05/29/20 6:33 PM EDT
No.
How severe is your sore throat?
Question
05/29/20 6:36 PM EDT
It’s not… terrible. I mean, it hurts a little. Like, mild to moderate. The main thing is that it won’t go away.
Is the sore throat constant
Question
05/29/20 6:36 PM EDT
Yeah, it’s sore pretty much all the time.
can you describe the pain?
Question
05/29/20 6:38 PM EDT
It’s really sore, and it itches a lot, like in the back.
how would you rate te pain on a scale of 0 to 10 ?
Question
05/29/20 6:38 PM EDT
It’s like a 4 out of 10, maybe.
Does the pain radiate?
Question
05/29/20 6:38 PM EDT
No, it’s just in my throat.
What do you think is casing the sore throat?
Question
05/29/20 6:39 PM EDT
At first I thought I was getting sick, or a cold or something, but now it doesn’t seem like that. My throat hasn’t gotten worse, but it’s not going away either.
Does anything make the throat feel better?
Question
05/29/20 6:40 PM EDT
All I’ve done is suck on some throat drops. And I’ve been drinking more water, which helps.
Does anything make the pain worse?
Question
05/29/20 6:41 PM EDT
It’s a little worse in the morning, but that’s really the only pattern I’ve noticed.
Do you have any other symptoms associated with the sore throat? (No matching questions found.)
Question
05/29/20 6:43 PM EDT
do you have any nasal discharge?
Question
05/29/20 6:43 PM EDT
Yes, it won’t stop running!
Do you take any over the counter medications?
Question
05/29/20 6:50 PM EDT
I’ve been trying throat drops lately. In general, I take Tylenol for a headache sometimes, or Advil for cramps, but not often.
How often do you get headaches?
Question
05/29/20 6:51 PM EDT
Maybe once a week? I usually do a lot of my school work at once, so I’ll study for like, 5 or 6 hours. I usually end up with a headache by the end of the night.
How would you rate these headaches?
Question
05/29/20 6:51 PM EDT
Not too bad. . . I’d say about 3. Or a 4 if I really push it.
What helps your headache?
Question
05/29/20 6:51 PM EDT
I just take some acetaminophen. The gel kind, 500 mg. [AUDIO COMING SOON]
Does anything make your headache worse?
Question
05/29/20 6:52 PM EDT
Usually they get worse if I don’t stop studying. I try to take a break when they start most of the time, but if I have a test or something coming up, I just have to try and ignore it.
How long have you had these headaches?
Question
05/29/20 6:52 PM EDT
I’m not sure — Maybe over the last year or so.
Do you take any herbal supplements?
Question
05/29/20 6:53 PM EDT
No, I don’t take anything herbal.
Do you take any prescription medications?
Question
05/29/20 6:53 PM EDT
Do you take vitamins?
Question
05/29/20 7:21 PM EDT
No, I don’t take any vitamins.
Are your immunizations up to date?
Question
05/29/20 7:22 PM EDT
I’m pretty sure I am, yeah.
What side effects did you have with metformin?
Question
05/29/20 7:23 PM EDT
I felt sick and gassy all the time. It was really uncomfortable.
When you get side effects that you cannot tolerate, you should speak to your doctor for alternatives and also confirm if they react with other medicatiobs
Educate
05/29/20 7:25 PM EDT
Alright, thanks for letting me know.
Are you allergic to medications?
Question
05/29/20 7:28 PM EDT
Yeah, I’m allergic to penicillin.
Do you have seasonal allergies?
Question
05/29/20 7:28 PM EDT
Well, no. I mean, I never had allergies to pollen or anything outdoors like that. . . But my nose is acting just like my sister’s right now, and she’s always had hay fever. I’m starting to think that this is allergies.
Do you have food allergies? Are you allergic to latex? (Clarified to Do you have food allergies?.)
Question
05/29/20 7:29 PM EDT
Nope, no food allergies that I know of. (Clarified to if I have food allergies.)
Do you smoke cigarettes?
Question
05/29/20 7:32 PM EDT
No, I’ve never smoked a cigarette in my life.
Do you take alcohol? (No matching questions found.)
Question
05/29/20 7:32 PM EDT
Do you drink alcohol?
Question
05/29/20 7:33 PM EDT
I do sometimes, yeah, when I go out with my friends.
How many drinks do you take when you go out? (Clarified to How many drinks do you have when you go out at night?.)
Question
05/29/20 7:33 PM EDT
Like, two or three drinks. If I have more than two or three drinks, I feel like hell the next day, so I stop at three. (Clarified to how many alcoholic drinks I have when I go out.)
Thats moderate drinking which is ok.
Educate
05/29/20 7:34 PM EDT
Thanks for telling me.
What type of alcohol do you take?
Question
05/29/20 7:34 PM EDT
I usually get rum and diet Coke. I don’t know why that matters.
Different drinks have different alcohol levels, thats why i asked.
Educate
05/29/20 7:35 PM EDT
OK, I understand.
How is your family medical history?
Question
05/29/20 7:35 PM EDT
My mom has some issues, and I think some of my grandparents did, too.
What health issues does your mother have?
Question
05/29/20 7:35 PM EDT
Mom has high cholesterol and blood pressure, I think. She seems to be doing okay though.
What medical issues does your father have? (Clarified to Tell me about your dad’s health?.)
Question
05/29/20 7:36 PM EDT
He passed last year. (Clarified to what health issues my dad has.)
Am sorry to hear that
Empathize
05/29/20 7:36 PM EDT
Thanks for understanding.
did your father have any medical conditions?
Question
05/29/20 7:37 PM EDT
He had high blood pressure and cholesterol, and diabetes too…the same kind as me.
What health issues does your maternal grandmother have?
Question
05/29/20 7:37 PM EDT
Nana had high blood pressure and cholesterol, I think.
What issues does you maternal grandfather have?
Question
05/29/20 7:38 PM EDT
Poppa died of a heart attack when he was 80. . . he had some blood pressure and cholesterol issues when he was alive, too.
What health issues does you paternal grand mother have?
Question
05/29/20 7:38 PM EDT
Granny’s doing good. She’s still living on her own. She’s slowing down, but we help her out. She lives down the street from us, and she gets around okay. I think she takes some pills, maybe for blood pressure? She might have high cholesterol too. She seems happy.
What health issues does your paternal grandfather have?
Question
05/29/20 7:39 PM EDT
Grandpa Jones had colon cancer, and that caused all kinds of problems for him. Plus, he had high blood pressure, and…I’m pretty sure he had diabetes.
how did you cope with your fathers death?
Question
05/29/20 7:39 PM EDT
Well, right after he died, after the funeral and everything, I just tried to get through that. Mom was having such a hard time, crying a lot, everything made her sad, she was kinda depressed. So I guess at first I just focused on getting things done–groceries, laundry, insurance papers and stuff. Knowing that Mom needed me kinda helped me get through day by day. There was about a month where it was hard for us to get to church. Even getting up and ready for church was too overwhelming. But our church family helped us out, and gave us rides to church and brought meals and all that, so they really helped build us back up. Things were only hard like that for a few months.
Seems you have a strong support system which is great.
Empathize
05/29/20 7:40 PM EDT
Thanks.
What health conditions does your sister have?
Question
05/29/20 7:41 PM EDT
She’s pretty healthy. She has asthma too, but she almost never has attacks.
what health conditions does your brother have?
Question
05/29/20 7:41 PM EDT
None that I know of. He’s got some extra weight on him, I guess.
Anyone one with an obesity problem in your family?
Question
05/29/20 7:45 PM EDT
No, I don’t think so. My brother and my dad are kind of big, but I wouldn’t say they were obese or anything.
Any one with alcoholism problem in the family?
Question
05/29/20 7:46 PM EDT
One person in the family, my dad’s brother, has an alcohol problem, but we never see him.
What work do you do?
Question
05/29/20 7:47 PM EDT
I’m a supervisor at Mid-American Copy & Ship. I’ve been working there since high school, and I’ve just kept moving up.
Am happy to hear that your job is fine and you are doing well
Empathize
05/29/20 7:47 PM EDT
Thanks for understanding.
What is your highest level of education?
Question
05/29/20 7:48 PM EDT
Well, I’m finishing up my Bachelor’s degree right now.
What is your Major?
Question
05/29/20 7:48 PM EDT
I’m going to get my bachelor’s in accounting.
I really haven’t travelled that much…I’ve always wanted to go to France but I’ve never even been out of the country. I’m always busy with work or school anyway though. We used to go on some family vacations when I was younger, but they were usually just to see some family in other states.
Am sure when you get less busy, you will travel more
Empathize
05/29/20 7:52 PM EDT
I appreciate you saying that.
Have you been wheezing?
Question
05/29/20 7:52 PM EDT
No, I haven’t been wheezing this week.
Please let me examine you now. (No matching questions found.)
Question
05/29/20 7:53 PM EDT
Please let me examine you now.
Educate
05/29/20 7:53 PM EDT
Sure, I think I understand what you mean.
Inspected general face
Exam Action
05/29/20 7:57 PM EDT
Inspected forehead and scalp
Exam Action
05/29/20 7:58 PM EDT
Inspected nose and mouth
Exam Action
05/29/20 7:58 PM EDT
Inspected left side of face
Exam Action
05/29/20 7:58 PM EDT
Inspected back of head
Exam Action
05/29/20 7:58 PM EDT
Inspected right side of face
Exam Action
05/29/20 7:58 PM EDT
Inspected general face
Exam Action
05/29/20 7:58 PM EDT
Inspected right side of face
Exam Action
05/29/20 7:58 PM EDT
Inspected general face
Exam Action
05/29/20 7:58 PM EDT
Inspected nose and mouth
Exam Action
05/29/20 7:58 PM EDT
Inspected forehead and scalp
Exam Action
05/29/20 7:58 PM EDT
Inspected nose and mouth
Exam Action
05/29/20 7:58 PM EDT
Inspected right orbital area and sclera
Exam Action
05/29/20 7:59 PM EDT
Inspected lower conjunctiva
Exam Action
05/29/20 7:59 PM EDT
Inspected upper conjunctiva
Exam Action
05/29/20 8:00 PM EDT
Inspected upper conjunctiva
Exam Action
05/29/20 8:00 PM EDT
Inspected left orbital area and sclera
Exam Action
05/29/20 8:00 PM EDT
Performed otoscopic examination of right naris
Exam Action
05/29/20 8:00 PM EDT
Performed otoscopic examination of left naris
Exam Action
05/29/20 8:01 PM EDT
Performed otoscopic examination of right ear
Exam Action
05/29/20 8:02 PM EDT
Performed otoscopic examination of left ear
Exam Action
05/29/20 8:02 PM EDT
Inspected mouth
Exam Action
05/29/20 8:03 PM EDT
Inspected mouth: pushed tongue left with tongue blade
Exam Action
05/29/20 8:04 PM EDT
Inspect mouth: pushed tongue right with tongue blade
Exam Action
05/29/20 8:04 PM EDT
Inspect mouth: lifted tongue with tongue blade
Exam Action
05/29/20 8:04 PM EDT
Inspected mouth: depressed tongue with tongue blade
Exam Action
05/29/20 8:04 PM EDT
Inspected front of neck
Exam Action
05/29/20 8:06 PM EDT
Inspected left side of neck
Exam Action
05/29/20 8:06 PM EDT
Inspected back of neck
Exam Action
05/29/20 8:06 PM EDT
Inspected right side of neck
Exam Action
05/29/20 8:06 PM EDT
Inspected back of neck
Exam Action
05/29/20 8:06 PM EDT
Inspected right side of neck
Exam Action
05/29/20 8:07 PM EDT
Inspected front of neck
Exam Action
05/29/20 8:07 PM EDT
Inspected right side of neck
Exam Action
05/29/20 8:07 PM EDT
Inspected front of neck
Exam Action
05/29/20 8:07 PM EDT
Palpated scalp: No balding or thinning hair distribution, no masses, no tenderness reported
Exam Action
05/29/20 8:07 PM EDT
Palpated maxillary sinuses: No tenderness reported
Exam Action
05/29/20 8:08 PM EDT
Palpated frontal sinuses: No tenderness reported
Exam Action
05/29/20 8:08 PM EDT
Palpated temporal arteries bilaterally: Right: no thrill, 2+ / Left: no thrill, 2+
Exam Action
05/29/20 8:08 PM EDT
Palpated right carotid artery: No thrill, 2+
Exam Action
05/29/20 8:10 PM EDT
Palpated left carotid artery: No thrill, 2+
Exam Action
05/29/20 8:10 PM EDT
Palpated jaw: Full range of motion, no popping or clicking
Exam Action
05/29/20 8:11 PM EDT
Palpated axillary lymph nodes: Not palpable
Exam Action
05/29/20 8:11 PM EDT
Palpated supraclavicular lymph nodes: Not palpable
Exam Action
05/29/20 8:12 PM EDT
Palpated lymph nodes of head and neck: Not palpable
Exam Action
05/29/20 8:12 PM EDT
Palpated thyroid gland: No nodules, not enlarged, no irregularities, no tenderness reported
Exam Action
05/29/20 8:12 PM EDT
Auscultated breath sounds in anterior right lower lobe
Exam Action
05/29/20 8:13 PM EDT
Auscultated breath sounds in anterior right middle lobe
Exam Action
05/29/20 8:13 PM EDT
Auscultated breath sounds in anterior right upper lobe
Exam Action
05/29/20 8:13 PM EDT
Auscultated breath sounds in anterior left upper lobe
Exam Action
05/29/20 8:13 PM EDT
Auscultated breath sounds in anterior left mid-chest (upper lobe)
Exam Action
05/29/20 8:13 PM EDT
Auscultated breath sounds in anterior left lower lobe
Exam Action
05/29/20 8:13 PM EDT
Auscultated breath sounds in posterior left upper lobe
Exam Action
05/29/20 8:13 PM EDT
Auscultated breath sounds in posterior left mid-back (lower lobe)
Exam Action
05/29/20 8:13 PM EDT
Auscultated breath sounds in posterior left lower lobe
Exam Action
05/29/20 8:13 PM EDT
Auscultated breath sounds in posterior left lower lobe on side
Exam Action
05/29/20 8:13 PM EDT
Auscultated breath sounds in posterior left lower lobe near spine
Exam Action
05/29/20 8:13 PM EDT
Auscultated breath sounds in posterior right lower lobe near spine
Exam Action
05/29/20 8:14 PM EDT
Auscultated breath sounds in posterior right lower lobe on side
Exam Action
05/29/20 8:14 PM EDT
Auscultated breath sounds in posterior right lower lobe
Exam Action
05/29/20 8:14 PM EDT
Auscultated breath sounds in posterior right mid-back (lower lobe)
Exam Action
05/29/20 8:14 PM EDT
Auscultated breath sounds in posterior right upper lobe
Exam Action
05/29/20 8:14 PM EDT
Auscultated right temporal pulse
Exam Action
05/29/20 8:14 PM EDT
Auscultated left temporal pulse
Exam Action
05/29/20 8:14 PM EDT
Auscultated right carotid pulse
Exam Action
05/29/20 8:15 PM EDT
Auscultated left carotid pulse
Exam Action
05/29/20 8:15 PM EDT
Tested left pupillary reaction with penlight
Exam Action
05/29/20 8:16 PM EDT
Tested right pupillary reaction with penlight
Exam Action
05/29/20 8:16 PM EDT
Follow my finger with just your eyes
Question
05/29/20 8:17 PM EDT
Ok.
Tested EOM to the upper right
Exam Action
05/29/20 8:17 PM EDT
Tested EOM to the lower right
Exam Action
05/29/20 8:17 PM EDT
Tested EOM to the lower center
Exam Action
05/29/20 8:17 PM EDT
Tested convergence to the center
Exam Action
05/29/20 8:17 PM EDT
Tested EOM to the upper center
Exam Action
05/29/20 8:17 PM EDT
Tested EOM to the upper left
Exam Action
05/29/20 8:17 PM EDT
Tested EOM to the lower left
Exam Action
05/29/20 8:17 PM EDT
Tell me when you can no loner see
Question
05/29/20 8:18 PM EDT
Ok, I will.
Tested peripheral vision
Exam Action
05/29/20 8:18 PM EDT
Now.
Examined fundus of right eye with ophthalmoscope
Exam Action
05/29/20 8:20 PM EDT
Examined fundus of left eye with ophthalmoscope
Exam Action
05/29/20 8:21 PM EDT
F P
Is the volume the same in both ears or louder in one ear
Question
05/29/20 8:24 PM EDT
Ok.
Same in both ears.
Performed Weber test with tuning fork
Exam Action
05/29/20 8:25 PM EDT
Tell me when you no longer hear the ringing
Question
05/29/20 8:25 PM EDT
Ok, I will.
Now.
F.
Question
05/29/20 8:26 PM EDT
F.
Eight
Question
05/29/20 8:26 PM EDT
Eight.
W.
Question
05/29/20 8:26 PM EDT
W.
Performed whisper test in right ear
Exam Action
05/29/20 8:26 PM EDT
Four
Question
05/29/20 8:26 PM EDT
Four.
R.
Question
05/29/20 8:26 PM EDT
R.
Nine.
Question
05/29/20 8:26 PM EDT
Nine.
Performed whisper test in left ear
Exam Action
05/29/20 8:27 PM EDT
Tested gag reflex with tongue blade
Exam Action
05/29/20 8:27 PM EDT
May 30, | nursing, med, NURS, Paper
Assessing and Treating Patients With Sleep/Wake Disorders -Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult
Assessing and Treating Patients With Sleep/Wake Disorders -Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult
Introduction
The patient, in this case, is a 31-year-old man with insomnia. The condition began six months ago after the sudden death of his wife. He is employed as a forklift operator at a local chemical company, but his health condition has affected his ability to perform his work. The patient claims that he has utilized diphenhydramine for sleeping in the past, but he does not like how he feels the next morning after using the medication. According to the patient’s prior physician’s medical record, he was abusing opiates after injuring his ankle in a skiing accident. The patient’s previous physician prescribed him hydrocodone/APAP (acetaminophen) for acute pain management after the accident. For four years, the individual has not received a prescription for an opiate analgesic. He points out that he has recently consumed approximately four beers to help him fall asleep. The patient is attentive and aware of the person talking to him, location, time, and incident. He maintains eye contact and is dressed appropriately for the season. All aspects of judgment, insight, and reality contact remain intact. The man also denies any suicidal ideas and is focused on the future.
Decision One
The treatment should start with Trazodone 10 mg daily at bedtime. Trazodone has been approved as an effective treatment for insomnia. The medicine is effective in lower doses in treating primary and secondary insomnia. Due to its generic availability, the medication is less expensive than newer insomnia medications. Trazodone can also be an effective sleep aid when taken in lower doses. The other reason for selecting the medication is that it is not addictive compared to other insomnia medications such as benzodiazepine class medication such as Valium and Xanax (Yi et al, 2018). The medication can also help the patient improve slow wave sleep, and the medication also has fewer side effects than most of the other medications used in treating insomnia Assessing and Treating Patients With Sleep/Wake Disorders -Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult.
BUY A PLAGIARISM-FREE PAPER HERE
There are various reasons why Zolpidem was not selected. The medication can result in severe allergic reactions in some patients. The various signs of allergic reaction due to the medication include swelling of the face and difficulty in breathing. The other reason is that the sedative effect of the medication is stronger than the other available options. The medication can also make a patient experience severe dizziness and drowsiness, resulting in falls, accidents, and severe injuries. Considering the nature of the patient’s work, the medication is not a good option because it can result in daytime drowsiness and dizziness, making the patient not conduct his job effectively. The medication can also result in a high level of aggressiveness and extroversion that is abnormal compared to the patient’s usual behavior (Jung, 2018). Considering that the patient has confirmed that he takes alcohol, Zolpidem cannot be used in the treatment process because the patient can experience auditory and visual hallucinations associated with strange behavior due to alcohol toxicity. Hydroxyzine 50mg was also not selected due to various. Assessing and Treating Patients With Sleep/Wake Disorders -Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. One of the main reasons is that the medication has a high side effects profile compared to Trazodone. The medication can also lead to daytime sedation, affecting how the patient will perform at work. Hydroxyzine can also result in various side effects such as skin rash, fast heartbeat, difficulty in swallowing, and chest discomfort (Silvestro, 2021).
From the treatment process, I expect that Trazodone will effectively treat the patient’s condition, and he will be able to sleep well. The patient experience an erection, which will last for approximately 15 minutes as a side effect of the medication. Ethical consideration will positively impact the treatment plan and when communicating with the patient. For instance, every decision and action that I will take will be for the fulfillment of the obligation to provide optimal care to the patient.
Decision Two
Explaining to the patient that an erection that lasts for approximately 15 minutes that he is experiencing is not priapism and should end over time, and he should continue taking the current dose. I choose this decision because the medication effectively treats insomnia, and the patient has enough sleep at night. Continuing with the current dose is also important because the patient is not experiencing any severe side effects apart from the prolonged erections and priapism due to its adrenergic blocking activity.
I did not select the decision to discontinue Trazodone and initiate treatment with suvorexant 1o mg at bedtime daily because of various reasons. Trazodone effectively treated the patient’s condition, and the patient did not experience any side effects; hence, changing the medication will negatively impact the treatment process. Initiating treatment with suvorexant is not a good decision. The medication is associated with various side effects such as next-day drowsiness and agitation. There is also limited evidence supporting the safety of using suvorexant in treating insomnia. The medication can cause the patient to become less alert during the day and feel drowsiness, headache, and dizziness. The medication can also result in memory problems or confusion. The patient can experience disturbed sleep as a side effect and have various experiences such as abnormal dreams, nightmares, and hallucinations. The medication can also cause the patient to experience sleep paralysis or even walk in their sleep.
Decreasing the current trazodone dose to 25 mg daily at bedtime is also not a good decision because the current dose of the medication was effective in treating the patient’s condition. Dose reduction can only be implemented when the patient is experiencing severe side effects due to the medication or it is too expensive for the patient to purchase the current dose of the medication (Yi et al, 2018). Considering the effectiveness of the current dose of Trazodone, reducing the dose can reduce the medication’s efficiency in treating insomnia or slow down the treatment process. I expect the patient to experience a further decrease in priapism from the treatment approach, and insomnia will also decrease. In this case, ethical consideration will ensure that I avoid causing harm to the patient.
Decision Three
The patient should continue with the current dose, and he may split the 50mg tablet into two. Decreasing the dose will help in reducing next-day drowsiness. In order to reduce the side effects of the medication, it is crucial to reduce the current dose to a lower dose considering that the medication is effective and the patient is getting better. Taking a lower dose of Trazodone is proven to be similarly effective than a higher dose, with appreciably fewer adverse effects such as decreased drowsiness and potentially improved quality of life.
The decision to discontinue Trazodone and initiate treatment with sonata 10 mg administered during bedtime is not good. This is because Trazadone has been effective in managing the patient’s condition. Initiating therapy with sonata 10 mg will is not a good decision considering the patient operates a vehicle in the chemical industry. This is because one of the major side effects of the sonata is lack of coordination which can lead to an accident, especially when an individual is driving. Other side effects of the medication that can reduce the patient’s quality of life include dizziness, drowsiness, and short-term memory loss. Another reason why treatment with sonata should not be initiated is that the medication is habit forming and can lead to dependency and can also be abused (Reeve & Bailes, 2010). Due to its habit-forming characteristics, it is not advisable to use the medication in long-term treatment, and it has not been proven to be effective in treating patients with long-term insomnia. Considering the patient has a history of alcohol consumption, the medication is not the best option and can result in various withdrawal symptoms if the patient suddenly stops using it.
The decision to discontinue Trazadone and start treatment with hydroxyzine 50 mg at bedtime is also not advisable. Hydroxyzine cannot be clinically significant to the patient considering the medication has a comparatively long half-life of approximately 20 hours (Schiffman et al, 2011). This will result in daytime sedation after sleeping at night. The medication also has a high side effect profile compared to the low side effect profile of Trazodone. Introducing hydroxyzine can also result in other adverse side effects such as Xerostomia and Xerophthalmia. Assessing and Treating Patients With Sleep/Wake Disorders -Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult.
From the treatment approach, I expect the patient condition to become better after another four weeks of using the medication. Priapism will also diminish completely, and the level of drowsiness will decrease because the patient will be using a lower dose than the initial dose. Ethical consideration will be crucial in the treatment process and communication with the patient because it will allow me to minimize the medication’s harm to the patient and focus on promoting good health (Haddad, 2018).
References
Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations.
Jaffer, K. Y., Chang, T., Vanle, B., Dang, J., Steiner, A. J., Loera, N., … & Ishak, W. W. (2017). Trazodone for insomnia: a systematic review. Innovations in clinical neuroscience, 14(7-8), 24.
Jung, M. (2018). Zolpidem overdose: a dilemma in mental health. The Health Care Manager, 37(1), 86-89.
Reeve, K., & Bailes, B. (2010). Insomnia in adults: Etiology and management. The journal for nurse practitioners, 6(1), 53-60.
Schiffman, J., Davis, M., Pierre, J., & Saunders, C. S. (2011). Hydroxyzine: rational choice for inpatients with insomnia. Current Psychiatry, 10(3), 88-89.
Silvestro, S. (2021). Hydroxyzine (Vistaril): dosage, uses, side effects. Drugs.
Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders
Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Assessing and Treating Patients With Sleep/Wake Disorders -Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult . Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders.
Reference: Mayo Clinic. (2020). Sleep disorders. https://www.mayoclinic.org/diseases-conditions/sleep-disorders/symptoms-causes/syc-20354018
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders.
The Assignment: 5 pages
Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Assessing and Treating Patients With Sleep/Wake Disorders -Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature. Assessing and Treating Patients With Sleep/Wake Disorders -Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult
ORDER PAGE
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.
NURS_6630_Week8_Assignment2_Rubric
Grid View
List View
Show Descriptions
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.—
Excellent
Point range: 90–100 9 (9%) – 10 (10%)
Good
Point range: 80–89 8 (8%) – 8 (8%)
Fair
Point range: 70–79 7 (7%) – 7 (7%)
Poor
Point range: 0–69 0 (0%) – 6 (6%)
Decision #1 (1–2 pages)
• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Assessing and Treating Patients With Sleep/Wake Disorders -Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.—
Excellent
Point range: 90–100 18 (18%) – 20 (20%)
Good
Point range: 80–89 16 (16%) – 17 (17%)
Fair
Point range: 70–79 14 (14%) – 15 (15%)
Poor
Point range: 0–69 0 (0%) – 13 (13%)
Decision #2 (1–2 pages)
• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.—
Excellent
Point range: 90–100 18 (18%) – 20 (20%)
Good
Point range: 80–89 16 (16%) – 17 (17%)
Fair
Point range: 70–79 14 (14%) – 15 (15%)
Poor
Point range: 0–69 0 (0%) – 13 (13%)
Decision #3 (1–2 pages)
• Which decision did you select?
• Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Assessing and Treating Patients With Sleep/Wake Disorders -Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult
• Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.—
Excellent
Point range: 90–100 18 (18%) – 20 (20%)
Good
Point range: 80–89 16 (16%) – 17 (17%)
Fair
Point range: 70–79 14 (14%) – 15 (15%)
Poor
Point range: 0–69 0 (0%) – 13 (13%)
Conclusion (1 page)
• Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.—
Excellent
Point range: 90–100 14 (14%) – 15 (15%)
Good
Point range: 80–89 12 (12%) – 13 (13%)
Fair
Point range: 70–79 11 (11%) – 11 (11%)
Poor
Point range: 0–69 0 (0%) – 10 (10%)
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.—
Excellent
Point range: 90–100 5 (5%) – 5 (5%)
Good
Point range: 80–89 4 (4%) – 4 (4%)
Fair
Point range: 70–79 3.5 (3.5%) – 3.5 (3.5%)
Poor
Point range: 0–69 0 (0%) – 3 (3%)
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation—
Excellent
Point range: 90–100 5 (5%) – 5 (5%)
Good
Point range: 80–89 4 (4%) – 4 (4%)
Fair
Point range: 70–79 3.5 (3.5%) – 3.5 (3.5%)
Poor
Point range: 0–69 0 (0%) – 3 (3%)
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.—
Excellent
Point range: 90–100 5 (5%) – 5 (5%)
Good
Point range: 80–89 4 (4%) – 4 (4%)
Fair
Point range: 70–79 3.5 (3.5%) – 3.5 (3.5%)
Poor
Point range: 0–69 0 (0%) – 3 (3%)
Total Points: 100
Name: NURS_6630_Week8_Assignment2_Rubric
Insomnia
31-year-old Male
Decision Point One
Trazodone 50 mg po at bedtime
RESULTS OF DECISION POINT ONE
Patient returns to clinic in 2 weeks
Patient states medication works well but gives him an unpleasant side effect of an erection lasting approximately 15 minutes after waking
Patient states this makes it difficult to get ready for work or go downstairs and have coffee with his girlfriend and daughter in the morning
Patient denies auditory/visual hallucinations and is future oriented
Decision Point Two
Explain that an erection lasting 15 minutes is not considered a priapism and should diminish over time, continue with current dose
RESULTS OF DECISION POINT TWO
Patient returns to clinic in 2 weeks
Patient states priapism has diminished over time
Patient denies auditory/visual hallucinations and is future oriented
Patient states trazodone is effective at 50 mg dose but sometimes wakes up following day with next-day drowsiness
Assessing and Treating Patients With Sleep/Wake Disorders -Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult
Patient denies auditory/visual hallucinations and is future oriented
Decision Point Three
Continue dose. Explain to patient he may split the 50 mg tablet in half. The decreased dose should minimize next-day drowsiness. Follow up in 4 weeks
Guidance to Student
Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. It would not be prudent to prescribe sonata as it carries with it the risk of complex sleep behaviors. Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia.
The patient is presenting with excessive somnolence. It would be prudent to reduce the dose of trazodone by 50% and reassess in 4 weeks. Assessing and Treating Patients With Sleep/Wake Disorders -Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult
