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NURS 6630N WU Wk 7 Dealing with Patients with Insomnia Response Discussion

NURS 6630N WU Wk 7 Dealing with Patients with Insomnia Response Discussion

Question Description

I’m working on a nursing case study and need an explanation to help me study.


Please response to jeane salifu

Discussion for week 7

COLLAPSE

While in the office, there is need to ask her a number of questions. First, she needs to provide information regarding whether she stays with someone in her house at the moment, now that her husband passed on. This is an important question to help in understanding her social need and plan her care appropriately. Lack of family support in elderly patients, especially those under various medications may be associated with nonadherence to drugs (Manias et al., 2019). This leads to the next question. She needs to point out whether or not she has been experiencing any side effects from the medications. The patient is already taking 5 medications and this amounts to a case of polypharmacy. Inappropriate polypharmacy may lead to adverse drug events and jeopardize the patient especially in cases of older patients who suffer from multiple chronic illnesses (Wastesson et al., 2018). The final question that the patient should answer pertains to her substance use if any as well as her behavior before bedtime. She should be able to provide information especially regarding her coffee drinking habits and her activities just before bed. This is information that may help in properly managing her insomnia.

There is need to work with other people in the life of the patient. For example, there is need to contact her children or grandchildren who spend more time with her and are able to provide reliable and appropriate information about the patient. Of course, this should be after the consent of the patient. They should also answer information regarding the sleeping habits of the patient and her behavior before bedtime. They should also provide information about her eyesight especially because the patient is driving herself. At her age, poor vision could be associated with accidents and this needs to be included in the health promotion plan.

The physical examination that the patient should be subjected to should be very normal. This is because there is no specific of focused physical examination that can help in the assessment of insomnia. However, a number of tests can be administered appropriately and they include actigraphy or polysomnography. These are tests that test sleep-wake patterns over time and also measuring activity during sleep. In order to make sure that there is accuracy, there is need to know that questionnaires and sleep diaries are less accurate compared to contact devices and polysomnography (Ibanez et al., 2018).

The differential diagnosis for this patient will be major depressive disorder which cooccurs with insomnia. These are the most appropriate diagnoses and should be prioritized as such. The rationale behind this is because of the endorsement of feelings of depression and the fact that she has been having trouble sleeping. The DSM-5 would be used to confirm the criteria for each diagnosis and this is why more information would be needed. For instance, in order to diagnose depression, the patient should have at least five symptoms with one of them being depressive mood or lack of interest (American Psychiatric Association, 2013).

The most appropriate class of antidepressant for this patient based on her age is SSRI. This should be effective and safer for her than other classes of antidepressants. In a study where more than 4000 elderly residents participated, almost 60% of them were on SSRIs (Giovannini et al., 2020). Fluoxetine or Sertraline could be used. However, for elderly patients a different class needs to be prioritized because of safety ad the fat that it does not interact with other medications as much as other. This is Bupropion. Notably, bupropion, sustained release is mostly used in elderly persons with depression because it has few gastrointestinal side effects. The dose should be 100 mg daily. The ethnicity of the patient is not provided and it is therefore difficult to point out how this factor would affect the use of the drug. The patient should return to the clinic after 4 weeks for follow-up to assess the effectiveness of the drugs in improving her mood and how this affects her problem with sleeping.

References

American Psychiatric Association, & American Psychiatric Association. (2013). DSM 5. American Psychiatric Association, 70.

Giovannini, S., Onder, G., van der Roest, H. G., Topinkova, E., Gindin, J., Cipriani, M. C., … & Liperoti, R. (2020). Use of antidepressant medications among older adults in European long-term care facilities: a cross-sectional analysis from the SHELTER study. BMC geriatrics, 20(1), 1-10

Ibáñez, V., Silva, J., & Cauli, O. (2018). A survey on sleep assessment methods. PeerJ, 6, e4849

Manias, E., Bucknall, T., Hughes, C., Jorm, C., & Woodward-Kron, R. (2019). Family involvement in managing medications of older patients across transitions of care: a systematic review. BMC Geriatrics, 19(1), 1-21.

Wastesson, J. W., Morin, L., Tan, E. C., & Johnell, K. (2018). An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opinion on Drug Safety, 17(12), 1185-1196

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