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. 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/sle…

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. https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/… 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 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.

The Decision Tree Assignments are based on interactive case studies that allow you to explore pharmaceutical options and make decisions centered on the client’s needs.   You will be asked to make three decisions concerning the medication to prescribe to a client in the assigned scenarios.  At each decision point, you must evaluate all options before selecting your decision and moving through the rest of the exercise. The rationale for your decisions must be supported with a minimum of five academic resources from the primary and secondary literature. While you may use the course text to support your rationale, it will not count toward the resource requirement.

Your 5-paper will be written on the interactive case study entitled, Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult.  This case can be found in the week 8 folder under the Resources tab. https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/…Click on Required Media to expand the case. If your first draft is more than 5 pages, you should consolidate your writing.  In my experience, papers greater than 5 pages in length are repetitive and/or contain extraneous information that is not part of the required content.  Part of this exercise is to learn how to sift through the literature and extract the pertinent information.  Failure to do so may result in point deductions for issues with clarity.  The final draft that you submit must follow the format endorsed by the nursing program, and this paper must address the required content outlined in the grading rubric and instructions.  The required format is illustrated in the writing template.  The writing template and grading rubric can all be found under the Assignment tab in the week 8 folder.  The formal instructions, my notes on grading, and the late policy are shown below:

• Assignment #2:  Decision Tree
• Introduction to the case (1 page)
• You must briefly summarize the case. You must also highlight the specific patient factors that will impact your decision making when prescribing medication for this patient.  Please note that background information on the diagnosis, diagnostic criteria, or diagnostic testing is NOT required.  It is assumed that you know this; therefore, you should devote yourself to summarizing the case and highlighting specific patient factors that will impact your decisions rather than discussing the aforementioned items.  After all, you only have one page (or less) to cover the required information.  
• Be aware that the writing template and grading rubric require your introduction to end with ONE sentence that is your thesis statement.  See the writing template for format and the grading rubric for details on how you are graded on this statement.

Body of your document

The body of your document should contain three sections that are labeled as follows:  decision #1, decision #2, and decision #3.  Each section should address the topics below.  In your writing, you should be concise, clear, and thorough.  Pharmacokinetics, pharmacodynamics, and specific patient factors must be considered in your writing in order to get full credit. 

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. *In order to receive full credit here, your ethical considerations must be clearly identified as such.  You can identify them in one of two ways:  (1)  You can identify them within each section.  For example, “My ethical considerations are….”  (2)  Or you can identify them separately in a new section labeled “Ethical Considerations.”  This new section should be inserted after the section entitled Decision #3 and before the Conclusion section.  Either one of these options is acceptable.

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.  *See Decision #1 for more information.

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.  *See Decision #1 for more information.

Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. As stated in the writing template, “The conclusion section should recap the major points of your paper. Do not introduce new information in this paragraph.”

Required Readings (click to expand/reduce)American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8
Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC43881…
Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEP, 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-s…
Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP, 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-s…
Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470
Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of Medicine, 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740Medication Resources (click to expand/reduce)U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/in…
Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

alprazolam

amitriptyline

• amoxapine
• amphetamine

desipramine

diazepam

doxepin

• eszopiclone

flunitrazepam

flurazepam

hydroxyzine

• imipramine
• lemborexant
• lorazepam
• melatonin
• methylphenedate

modafinil

armodafinil

carnitine

• clomipramine
• clonazepam
• nortriptyline
• pitolisant

ramelteon

sodium oxybate

solriamfetol

• SSRI’s
• temazepam
• trazodone
• triazolam

trimipramine

wellbutrin

zaleplon

• zolpidem