NURS 6630 WK8 ASSIGNMENT 2 ASSESSING AND TREATING PATIENTS WITH SLEEP / DISORDERS

Insomnia Sleep is a vital component for an individual's ability to function as it is also vital for mental and physical health. Chronic insomnia is related to many impairments that can affect an individual's quality of life, cognition, work-related problems, and accidents (Smith et al., 2016). Risk factors for insomnia include advanced age, female gender, different hours of shifts one has to work along with, comorbid medical or psychiatric conditions (Smith et al., 2016). Insomnia can be defined as difficulties in falling asleep and staying asleep, repeated awakenings or not being able to go back to sleep along with personal and daytime difficulties (Smith et al., 2016). Case Study The client is a 31-year-old male who presents to the office today with a chief complaint of Insomnia. The patient reports that he has never really slept well and since the sudden loss of his fiancé six months ago sleeping has become more difficult as he is not able to fall or stay asleep at night. He feels his ability to work the forklift at his site of employment is being affected and he has fallen asleep on the job from not getting rest the night before. Patient reports using diphenhydramine in the past but does like the way he feels the next morning. The patient's medical record reveals a history of opiate abuse which started after he was prescribed Lortab for acute pain in the past for a broken ankle due to asking accident. The patient reports not having prescription opiate medications in the last four years. The patient reports he recently started drinking 4 beers a night to help with sleep. Mental status exam The patient is alert and oriented times 4. Eye contact and is appearance is appropriate. Denies any auditory or visual hallucinations. Judgment, insight, and reality contact are all intact. The patient denies suicidal/homicidal ideation and is future-oriented. The purpose of this assignment is use research, evidence and knowledge to select the best medication for the patient with insomnia. Three medication choices will be provided and discussed why or why not the treatment selection would be the most appropriate. Decision one The first medication selected for this client is going to be Trazodone 50-100 mg daily at bedtime.Trazodone is a serotonin 2 antagonist/reuptake inhibitor; antidepressant, and hypnotic (Stahl, 2008). Trazodone is used as an antidepressant for the major depressive disorder but is also is used to treat insomnia (Shin & Saadabadi, 2020). Trazodone inhibits the reuptake of serotonin and blocks histamine and alpha-1-adrenergic receptors as well as blocking serotonin 5-HT receptors (Shin & Saadabadi, 2020). Trazodone helps to decrease the level of neurotransmitters that are associated with stimulating effects (Shin & Saadabadi, 2020). The dose of Trazodone for insomnia should be anywhere from 25 to 150 mg at bedtime (Camprodon & Roffman, 2016). Trazodone's half-life is 3-6 hours and in low doses generate and maintain sleep without the negative side effects such as daytime drowsiness or becoming tolerant (Jaffer, 2017). With trazodone blocking these receptors helps to increase and balance levels of serotonin in the brain (Shin & Saadabadi, 2020). Melatonin, a hormone that is a precursor to serotonin that is secreted by the pineal gland contributes in maintain circadian rhythms (Camprodon & Roffman, 2016). Trazodone was not approved by the federal drug administration for insomnia, but it is still the most common off-label choice in the treatment for insomnia and its benefits are that it has a low risk of being a habit- forming or addictive (Jaffer, 2017). The client has a history of substance abuse as noted above and this medication has a low risk of being abused which makes Trazodone an appropriate choice for him. Trazodone side effects include sedation, dry mouth, nausea, and dizziness, hypotension (Camprodon & Roffman, 2016). Priapism is an adverse effect that can occur in male patients in the first month of treatment, this is considered to be a medical emergency that should be treated quickly (Camprodon & Roffman, 2016). Common side effects with most classes of antidepressants include reduced libido, delayed orgasm or anorgasmia, arousal complications, and erectile dysfunction (Camprodon & Roffman, 2016). A very rare and adverse effect of trazodone is priapism (Camprodon & Roffman, 2016). Trazodone is known to be associated with approximately 80% of drug-induced priapism episodes (Roy, 2015). Patient education on the risk of priapism should be reviewed with the patient. Priapism is a penile erection that consists of pain and lasts more than 4 hours (Roy, 2015). Higher doses of trazodone such as 200 mg have revealed the interval from the REM sleep phase to penile detumescence was prolonged (Roy,2015). The goal of selecting this medication is to induce sleep and to decrease waking episodes that will improve functioning throughout the day. Expected outcomes for the patient are to achieve greater amounts of sleep, to enhance the feeling of being rested, and to have improved sleep patterns. Zolpidem: 10 mg daily at bedtime was not selected for this client. Zolpidem is a nonbenzodiazepine, benzodiazepine receptor agonist (non-BZD, or BzRA) hy