please see attachment for instructions 

I have attached a previous clinical decision tree for you to use as guidance

Please see the decision tree case study attached

APA format with intext citation

4-5 scholarly references with in the last 5 years

Plagiarism free with Turnitin report




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. 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.


 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.


31-year-old male who presents to the office with a chief complaint of insomnia.


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 difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting 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 nigh


Anxiety is considered a mental health disorder that is characterized by fear and an increase in emotions. Individuals also report worries and increased fear of failure in the future, and they tend to be more concerned about current events. According to the DSM-5 diagnosis, for an individual to be diagnosed with anxiety disorder, there must be an excess of worries or anxiety for at least six months (Strawn et al., 2018). This case is focused on a case scenario about a 46-year-old client suffering from anxiety.

These case scenarios focus on offering the appropriate treatment for the patient. The treatment process is guided by the three decisions to be made. On a brief history of the case scenario, the client presented to the emergency room following the referral process. He had previously experienced chest tightness, SOB, and myocardia infection was r/o; however, he remains concerned about the future. In addition to daily stress, he is also caring for his aging parent. He struggles with constant worries about his job and has resorted to alcohol as a coping mechanism for his present problems. He has been consuming 3 to 4 beers daily. His current Hamilton Anxiety Rating Scale results are 26, indicating that he has a generalized anxiety disorder (GAD). Therefore, the case scenario offers a practical treatment approach for the patient based on three decisions.

Decision #1: Start Paxil (Paroxetine)10 mg PO daily

Reasons for the decision: this is an FDA-approved medication for anxiety conditions such as GAD, major depressive disorder, panic disorder, and PTSD, among others. The drug helps effectively treat GAD symptoms by decreasing these un-wanting symptoms and allowing an individual to gain control of his life.

           The expected outcomes: Based on the treatment decision above, the patient will report reduced anxiety symptoms. He is expected to register a decrease in chest tightness as well as a decrease in shortness of breath. There will also likely be a decrease in the HAM-A scale rate readings.

Decision #2: increasing the dosage to 20 mg PO daily

Reasons for the decision: Secondary to the patient’s improvement in the symptoms from the previous decision, there is a need to increase the dosage from 10 mg to 20 mg PO daily while monitoring his outcome. Increasing the dosage to 40 mg is not advisable due to potential adverse reactions, which might affect the treatment process. Increasing the dosage to 40 mg is likely to cause poor treatment adherence since the patient is likely to be slightly evasive about the symptoms (Mennin et al., 2018). The treatment adherence is also expected to be affected as the patient can report erection difficulty when the dosage is increased to 40 mg. it is also not advisable to start him on Imipramine 25 mg BI