Case Study For Insomnia Essay Paper

Case Study For Insomnia Essay Paper

Decision Tree: Insomnia case

I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree. I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest. The course page suggests writing 1 page per decision â€“ my opinion is that it will be very difficult to justify your treatment decisions and provide scientific evidence in 1 page (especially for decision #1). I do not need you to tell me about the patient or the treatment options available to you â€“ I am very familiar with the cases. Your introductory page should be an overview of the disease state you are treating along with a purpose statement for the assignment. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option – why is it the best option, using clinically relevant data from primary literature (clinical trials, treatment guidelines) and patient specific data AND why you did not choose the other options (with clinically relevant data from primary literature and patient specific data)Case Study For Insomnia Essay Paper.

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Introduction to the case (1 page)

Briefly explain and summarize the disease state you are treating this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.

At each decision point stop to complete the following:

Decision #1 (1.5+ pages)

Which decision did you select?
Why did you select this decision? Support your response with strong scientific evidence discussing efficacy, safety, tolerability and patient outcomes from primary literature (not information from Micromedex, Epocrates or UpToDate) and references. Why did you NOT select the other treatment options available? Again, provide STRONG scientific evidence from the primary literature. Clinical studies or treatment guidelines are a good place to start!
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
What ethical considerations impacted your treatment plan and communication plan with the patient? Case Study For Insomnia Essay Paper

Decision #2 (1+ pages)

Decision #3 (1+ pages)

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. You should provide new data here â€“ not a repeat of the data you used previously in the paper.

After writing up your rationale at each decision point, I would ask yourself the following questions:

Have I provided clinical data from a meta-analysis, case report or clinical trial to support the drug I picked being safe, efficacious and the best choice for this patient? If the answer is NO, youâ€™ll want to start over
Have I provided clinical data, etc. to support a clear rationale as to why the other treatment options are NOT optimal? If the answer is NO, youâ€™ll want to start over
Is the focus of my discussion on mechanism of action and receptors/neurotransmitters that the drug acts on? If the answer is YES, you should consider doing additional research to address the above two questions

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Also include how ethical considerations might impact your treatment plan and communication with clients.

The rubric, as I interpret it, suggests 5 references cited with every assignment for full credit on this portion (20 points). References used for your introductory paragraph, ethical considerations or conclusion do not count towards the 5 references required. As a general rule of thumb, I would encourage you to reference AT LEAST two sources (not including the textbook) for each decision point â€“ this will result in 6 references total for your clinical decision making.

Introduction

A person’s physical and mental health improves when they get enough sleep. Chronic sleep deprivation reduces a person’s quality of life, IQ, productivity at work, and ability to avoid accidents (Zhang et al., 2019). It is more common among the elderly, women, shift workers, and individuals with physical or mental health concerns (Au et al.,2019). As a result of insomnia, many find it difficult to fall and stay asleep, as well as to function at their best in both their personal and professional lives (Zhang et al., 2019). Moreover, suicide is more likely to be considered or attempted by insomniacs (Zhang et al., 2019)Case Study For Insomnia Essay Paper. Essentially, insomnia reduces a person’s quality of life.

This week’s case study involves a 31-year-old patient suffering from insomnia. Prior to the death of his fiancée six months earlier, the man had never had insomnia. He is nervous about operating the forklift at work because he never gets enough sleep. The patient admitted to using diphenhydramine, yet he reported feeling better the following day. After being administered Lortab for a fractured ankle, his medical history suggests that he began abusing opioids. It has been four years since he got an opiate prescription. The client indicates that he only gets a restful sleep after having four drinks at night. He was alert, focused, and made an excellent first impression by making eye contact and smiling. The patient did not report hallucinations related to sound or vision; he made sound judgments and had a positive perspective of life. Moreover, nothing suggests that the patient is considering suicide or homicide. Thus, a healthcare provider should decide on the most proper insomnia medication based on evidence and research. This study explores three potential pharmaceutical options available for this patient.

Decision One

As a first step, I had my patient take 50 mg of Hydroxyzine before going to sleep each night.

Why I Selected this Decision

Hydroxyzine, a first-generation antihistamine, is easily absorbed via the blood-brain barrier (Lavigne et al., 2019). Insomnia is treated with this sedative and anticholinergic medication, which aids sleep. PNP’s advised dosage is appropriate for this treatment. The patient took 50mg of Hydroxyzine before bedtime. Notably, a lower dose should be tried before increasing the medication for an insomniac patient. Drowsiness and relaxation are caused by Hydroxyzine’s inhibition of H1 receptors (Lavigne et al., 2019). Hydroxyzine is available over the counter and effectively manages insomnia. However, the patient should take this sedative in higher doses based on their tolerance levels (Lavigne et al., 2019)Case Study For Insomnia Essay Paper. Diarrhea, dry mouth, and eyes are possible side effects of the antihistamine hydroxyzine.

Why I did not choose the other options

The other option included the patient taking 10mg of Zolpidem before going to sleep. However, several contraindications could adversely affect the patient’s recovery process (Edinoff et al., 2021). Diphenhydramine could also be administered to help the patient rest; however, the medication had unwanted side effects. Zolpidem should be the last resort due to its unpleasant side effects. Trazodone 50-100 mg was also ruled out due to the symptoms of blurred vision, dizziness, lethargy, nausea, and vomiting (Jaffer et al., 2017). Male Trazodone side effects include a loss of libido and difficulty ejaculating. As a result, it was a less appealing choice at the outset.

Ethical Considerations

Healthcare providers should inform patients of Hydroxyzine’s potential adverse effects. This entails assisting them in identifying the contraindications when they occur and telling the patient what to do if this happens. As a result, many people may receive the medical care they require (Barber, 2021)Case Study For Insomnia Essay Paper. Patients should be aware of any potential adverse effects, common or uncommon, to make an educated decision. The doctor may recommend an alternative if a patient is concerned about possible side effects.

Decision Two

This decision involved reducing the Hydroxyzine dosage to 25mg.

Why I Selected this Choice

This decision was made after four weeks following the first decision; it was crucial to assess the patient’s response before proceeding to another treatment plan. Based on the patient’s experience, the new dosage had a similar next-day effect to the first; he still experienced dry eyes and mouth each morning. Studies indicate that taking Hydroxyzine effectively controls insomnia (Olson et al., 2021). I recommended hydroxyzine 25mg every night before bed because of the rapid response time. Notably, taking the sleep aid for more than two weeks is not recommended.

Why I did not select the other choice

Hydroxyzine’s side effects are substantially more severe. According to Lavigne et al. (2019), adults should take it in the range of 50 to 100 mg. It is possible to develop drug resistance when a doctor lowers the dosage of a patient’s medication (Kim et al., 2020)Case Study For Insomnia Essay Paper. Thus, considering its side effects before altering the dosage is essential for better clinical outcomes and patient satisfaction. In this case study, diphenhydramine contributed to the patient’s discomfort. It is challenging to stick to a treatment plan if side effects worsen.

Ethical Considerations

The physician must ensure that the patient’s therapy does not cause harm to the patient. The patient would not have been harmed if he had been informed about Hydroxyzine’s side effects and their changes after altering the dosage. Lower dosages reduce the impact of the medication’s side effects.

Decision Three

The final decision was to ensure the patient improved his recovery with a low likelihood of recurrence.

Why I selected this choice

The patient stated that he felt between whenever he drank alcohol while taking temazepam. However, alcohol can interfere with the effectiveness of certain medications (Geoffroy et al., 2020). The combination of alcohol and benzodiazepines can lead to respiratory depression and demise. Thus, a medicine that helps people drink less alcohol is critical in the current situation.

Why I did not select the other choices

There must be an understanding by the PNP that prolonged use of medication and alcohol can jeopardize treatment. The patient should stop using temazepam and switch to Sonata instead. When used at the correct dosage, Sonata is an effective sleep aid. Patients will not crave alcohol because this medicine replicates the effects of alcohol.

Ethical Considerations

Identifying and administering an effective drug depends on the patient’s medical history and lifestyle factors to reduce potential harm. The choice taken in this case study was appropriate considering the risks associated with the other medications. Zolpidem and Trozadone could have affected the patient’s job effectiveness; he drives to work and operates a forklift. Notably, administering the drug with the best safety profile meets the patient’s recovery goals and best interests Case Study For Insomnia Essay Paper.

Conclusion

A healthcare provider should determine the root cause of insomnia before addressing it. Because some people with insomnia have a history of drinking, any medication prescribed for them should take this into consideration. The patient’s work performance is hampered by fatigue in this week’s case study. The death of his wife may have contributed to his insomnia; how a patient behaves is critical in selecting the best course of action. Thus, a physician should determine whether the patient’s drinking is linked to their mental health issues. The patient has taken a variety of pain and sleep medications as a result of addiction. In this case, I recommend taking 50mg of hydroxyzine daily. Despite four weeks of treatment, the patient is still experiencing symptoms. A dose of temazepam 15 mg is prescribed for the patient before bed. Four weeks later, the patient is back with fewer symptoms. Due to medication and alcohol, his heart rate has decreased. I replaced Temazepam with Sonata to assist the patient in handling the smoking and drinking addictions.

Ethical considerations include the patient’s history of opiate and alcohol use; several anti-insomnia medications are adversely affected by alcohol. A physician should be upfront with the patient about how alcohol consumption affects their insomnia and how their treatment will go before starting medication. Trazodone off-label prescribing is also unethical; patients may be hesitant to begin treatment because of the off-label use of this medication. The patient must be involved in the decision-making process and informed of the risks and benefits of the administered drugs. The patient’s issues such as the death of a loved one, intoxication, and lack of sleep necessitate regular hospital visits. Detecting warning signs of suicidal ideation in patients as early as possible is critical Case Study For Insomnia Essay Paper.

References

Barber, B. (2021). The ethics of experimentation with human subjects. In Constructing the Social System (pp. 417-436). Routledge.

Edinoff, A. N., Wu, N., Ghaffar, Y. T., Prejean, R., Gremillion, R., Cogburn, M., … & Kaye, A. D. (2021). Zolpidem: efficacy and side effects for insomnia. Health psychology research, 9(1).

Geoffroy, P. A., Lejoyeux, M., & Rolland, B. (2020). Management of insomnia in alcohol use disorder. Expert opinion on pharmacotherapy, 21(3), 297-306.

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.

Kim, G., Lee, J., Kim, H., & Nam, S. (2020). The Effectiveness and Side Effects of Conscious Sedation using Chloral hydrate, Hydroxyzine, and Nitrous oxide. JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DENTISTRY, 47(2), 109-119.

Lavigne, J. E., Hur, K., Kane, C., Au, A., Bishop, T. M., & Pigeon, W. R. (2019). Prescription medications for the treatment of insomnia and risk of suicide attempt: a comparative safety study. Journal of general internal medicine, 34(8), 1554-1563.

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Olson, C., Jhawar, A., Elfessi, Z., & Doyle, R. (2021). Hydroxyzine-induced priapism. The American Journal of Emergency Medicine, 48, 375-e5.

Zhang, Y., Ren, R., Lei, F., Zhou, J., Zhang, J., Wing, Y. K., … & Tang, X. (2019). Worldwide and regional prevalence rates of co-occurrence of insomnia and insomnia symptoms with obstructive sleep apnea: a systematic review and meta-analysis. Sleep medicine reviews, 45, 1-17 Case Study For Insomnia Essay Paper