Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (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. 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.

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 (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. 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.

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 I HAVE ATTACHED THE CASE STUDY AND THREE DECISION TREE

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).

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 y

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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 e�ect of an erection lasting approximately 15
minutes after waking

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� Patient states this makes it di�cult to get ready for work or go
downstairs and have co�ee 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 e�ective at 50 mg dose but
sometimes wakes up following day with next-day
drowsiness

� Patient denies auditory/visual hallucinations and is future
oriented

Decision Point Three

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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 e�ect pro�le. 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 e�ects 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.

Start Over (index.html)

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Insomnia
31-year-old Male

BACKGROUND
This week, we examine a 31-year-old male who presents to the o�ce with a chief

complaint of insomnia.

SUBJECTIVE
Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse

over the past 6 months. Per the patient, he has never been a “great sleeper” but is now

having di�culty both falling asleep and staying asleep at night. The problem began

approximately 6 months ago after the sudden loss of his �ancé. The patient states this is

a�ecting his ability to perform his job, which is a forklift operator at a local chemical

company. The patient states he has used diphenhydramine in the past to sleep but does

not like the way it makes him feel the morning after. He states he has fallen asleep on the

job due to lack of sleep from the night before. The patient’s medical record from his

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previous physician states that he has a history of opiate abuse, which began after he

broke his ankle in a skiing accident and was prescribed hydrocodone/apap

(acetaminophen) for acute pain management. The patient has not received a prescription

for an opiate analgesic in 4 years. The patient states recently he has been using alcohol

to help him fall asleep, approximately four beers prior to bed.

MENTAL STATUS EXAM
The patient is alert and oriented to person, place, time, event. He makes good eye

contact and is dressed appropriately for time of year. He denies auditory/visual

hallucinations. Judgement, insight, and reality contact are all intact. Patient denies

suicidal/homicidal ideation, and is future oriented.

Decision Point One
Select what you should do:

Zolpidem: 10 mg daily at bedtime

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Trazodone 50 mg po at bedtime

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Hydroxyzine: 50 mg daily at bedtime

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