(Solution) NURS 6630 Week 8 Assignment 2: Assessing and Treating Patients with Sleep/Wake Disorders ( a 31-year-old male who presents to the office with a chief complaint of insomnia.)

The case presents a 31-year-old male who presents with complaints of insomnia. The patient reports that his insomnia has worsened over the past six months. Even though the patient states that he has had sleeping problems in the past, he states that his current situation is worse, particularly due to problems falling asleep and maintaining sleep at night. As reported by the patient, his situation has worsened, and this has prompted him to seek medical care. He also adds that his symptoms of insomnia have significantly affected his capacity to perform his job as a forklift operator. Patient-specific factors are important when assessing and treating the patient to ensure proper and informed decision-making concerning the patient's treatment. One of the significant factors is his medication history. Essentially, the patient reports that he previously used diphenhydramine to manage his symptoms of insomnia, but he does not like the way the drug makes him feel in the morning. Additionally, the patient has a history of opiate abuse, which began after breaking his ankle, and was prescribed hydrocodone (acetaminophen) for acute pain management. Another factor is that the patient has been using alcohol to help him sleep, and he takes around four bottles of beer before sleeping. 2 This study source was downloaded by from CourseH on :36:22 GMT -06:00 GRADED A+ Decision #1 Start trazodone 50–100 mg daily at bedtime. The first decision would be to start 50-100 mg daily of Trazodone at bedtime. Trazodone is a selective serotonin reuptake inhibitor (Stahl., 2013). As a sedating antidepressant, the medication is used off-label as a hypnotic for the treatment of insomnia related to depression. As such, the medication is the most appropriate for this patient given that he attributes his insomnia symptoms to his fiancé's death, thus illustrating depression as the possible cause of his insomnia. Besides, compared to nonbenzodiazepine receptor agonists, sedating antidepressants have fewer adverse effects. The drug works by blocking serotonin 2A receptors potently (Stahl., 2013). The drug has a half-life of about 6-8 hours, and it is a highly effective hypnotic when administered at lower doses than that used as an antidepressant (Stahl., 2013). Lower doses of trazodone (25 mg-100mg) administered at bedtime have been shown to induce and maintain sleep devoid of causing daytime sedating effects (Sateia et al., 2017) I choose not to select the alternative choice of starting zolpidem 10 mg orally at bedtime. Essentially, this is because of the associated side effects of the drug, which is a nonbenzodiazepine hypnotic (Riemann et al., 2017). These side effects include dizziness, nightmares, nausea, anterograde amnesia, and agitation. Stahl. (2013) states that in some patients, the use of a 10 mg dose increases the risk of next-day impairment in driving and other activities that require alertness. Additionally, the medication can lead to visual and auditory hallucinations when used with alcohol. Riemann et al. (2017) state that if coadministered with alcohol, this increases the risk of CNS depression. I also choose not to select 25-100 mg of hydroxyzine due to its strong sedative properties similar to diphenhydramine. This makes the drug dangerous given that the patient is a forklift operator (Riemann et al., 2017).