Week 7 discussion
Discussion: Sleep/Wake Disorders
It is not uncommon to experience a night or two of disrupted sleep when there is something major going on in your life. However, sleep/wake disorders are much more than an occasional night of disrupted sleep. A recent report from the Centers for Disease Control and Prevention estimated that between 50 and 70 million American have problems with sleep/wake disorders (CDC, 2015). Although the vast majority of Americans will visit their primary care provider for treatment of these disorders, many providers will refer patients for further evaluation. For this Discussion, you consider how you might assess and treat the individuals based on the provided client factors.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 11, “Disorders of Sleep and Wakefulness and Their Treatment”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
- For insomnia
- alprazolam
- amitriptyline
- amoxapine
- clomipramine
Case 1: Volume 2, Case #16: The woman who liked late-night TV
Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady
Case 3: Volume 1, Case #5: The sleepy woman with anxiety
Review this week’s Learning Resources and reflect on the insights they provide.
Go to the Stahl Online website and examine the case study you were assigned.
Take the pretest for the case study.
Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
Review the posttest for the case study.
Week 7 assignment
Assignment: Assessing and Treating Clients With Pain
Pain can greatly influence an individual’s quality of life, as uncontrolled pain negatively impacts mood, concentration, and the overall physical and mental well-being of clients. Although pain can often be controlled with medications, the process of assessing and treating clients can be challenging because pain is such a subjective experience. Only the person experiencing the pain truly knows the intensity of the pain and whether there is a need for medication therapies. Sometimes, beliefs about pain and treatments for pain can have an adverse effect on the provider-client relationship. For this Assignment, as you examine the interactive case study consider how you might assess and treat clients presenting with pain.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 10, “Chronic Pain and Its Treatment”
Stahl, S. M., & Ball, S. (2009a). Stahl’s illustrated chronic pain and fibromyalgia. New York, NY: Cambridge University Press.
To access the following chapter, click on the Illustrated Guides tab and then the Chronic Pain and Fibromyalgia tab.
Chapter 5, “Pain Drugs”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
- For insomnia
- amitriptyline
- amoxapine
- carbamazepine
- clomipramine
- clonidine (adjunct)
- desipramine
- dothiepin
- doxepin
- duloxetine
- gabapentin
- imipramine
- lamotrigine
- levetiracetam
- lofepramine
- maprotiline
- memantine
- milnacipran
- nortriptyline
- pregabalin
- tiagabine
- topiramate
- trimipramine
- valproate (divalproex)
- zonisamide
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases.
National Institute of Neurological Disorders and Stroke. (2016). Pain: Hope through research. Retrieved from http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#3084_2
Required Media
Laureate Education (2016a). Case study: A Caucasian man with hip pain [Interactive media file]. Baltimore, MD: Author
Note: This case study will serve as the foundation for this week’s Assignment.
To prepare for this Assignment:
Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for pain and sleep/wake disorders.
The Assignment
Examine Case Study: A Caucasian Man With Hip Pain. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
Walden NURS 6630 Week 7 Sample Paper
(Assessing and Treating Clients With Pain)
Assessing and Treating Clients with Pain
Student’s Name:
Institutional Affiliation:
Assessing and Treating Clients with Pain
Mental disorders relating to pain can be quite challenging to treat as the PMHNP walks the tight rope to alleviate the patient’s pain and administer medications with the least severe side effects. Evaluating the pharmacodynamics and pharmacokinetics of a group of preferred drugs and their effects on patients can help make decisions of the most appropriate prescription. This paper explores the decisions that will be made in treating a White male with complex regional pain disorder.
Decision #1
I choose to administer Amitriptyline 25 mg PO QHS to the white male patient with hip pain for the first decision. I selected the decision to administer Amitriptyline 25 mg PO to the patient as he seemed to be experiencing pain due to depression. When administered in low doses such as 25 mg, Amitriptyline effectively alleviates depression and the disorders that it causes, such as complex regional pain disorders among patients. According to Lawson (2017), the daily recommend dose of Amitriptyline among outpatients is a maximum of 150 mg/day. Starting with a low dose and increasing the dosage as the treatment progresses is recommended to reduce the incidences of adverse effects caused by the drug. These negative side effects include agitation, anxiety, constipation, diarrhea, lethargy, sexual dysfunction, and weight gain, among others (Brueckle, Thomas, Seide, et al., 2020).
The other two decisions, which included administering Savella 12.5 mg to the patients or Neurontin (gabapentin) 300 mg, were less advantageous. The administration of Savella 12.5 mg was therefore ruled out because though the drug would effectively reduce the patient’s pain, it could cause adverse side effects that would be a huge health challenge to the patient. According to Derry, Phillips, Moore, & Wiffen (2015), the most adverse side effects of Savella include elevated blood pressure, nausea, insomnia, nausea, and sweating. The benefits of the drug to patients should be weighed against the side effects. In the case of the white male patient with hip pains, Savella’s adverse effects would exceed the benefits of the drug in reducing pain. The drug would thus be less beneficial. The administration of Neurontin (gabapentin) 300 mg would also be less beneficial to the patient. According to Peckham, Evoy et al. (2018), Neurontin (gabapentin) is mainly preferred as a form of antiepileptic drug and anticonvulsant. The patient did not seem to have any significant convulsing episodes that could warrant the use of Neurontin (gabapentin). The drug would also be less preferred due to its low effect on reducing pain and the adverse effect of drowsiness and feeling foggy, which could affect the patients’ quality of life.
In deciding to administer Amitriptyline 25 mg to the patient, I was hoping to reduce the patient’s pain levels to a level of about five out of teen on his scale and avoid any adverse effects. According to Brueckle et al. (2020), a low dosage of Amitriptyline is effective in alleviating pain among patients with complex regional pain disorder while not causing major side effects.
What I expected to achieve and what I achieved in deciding to administer Amitriptyline 25 mg to the patient was similar. After a month, the client reported that his pain level was six out of ten. Simultaneously, he also had no major adverse effects, with the only side effect being groggy in the morning.
Decision #2
For the second decision, I selected the option of increasing the administration of Amitriptyline from the current 25mg to 125mg before bed time. According to Lawson (2017), a maximum dosage of 150mg of Amitriptyline per day will be safe for outpatients. By increasing the dosage of Amitriptyline from 25mg per day to 125 mg taken before bedtime, I was hoping to reduce the patient’s pain levels to lower than 4 out of 10. I was also hoping to reduce the side effects of grogginess in the morning by asking the client to take the full dose before going to bed. My expectations in increasing the dosage of Amitriptyline from 25 mg to 125 mg on the client and the result of my decision were similar in that’s the patient reported having a pain level of four out of ten and not being groggy in the morning. His only complaint was a little weight gain.
Decision #3
I choose to continue administering Amitriptyline 125 mg daily dose to the patients during bed time for the third decision. I also chose to refer the patient to a life coach who would help him control his weight gain through healthy diets and effective exercise habits. According to Plodkowski, McGarvey, Reisinger-Kindle, et al. (2016), Qysmia should only be prescribed to morbidly obese patients with a BMI of more than 30kg/m2. Patients with a BMI of less than 30 should explore other options to manage their weight. By making this decision, I was hoping to achieve the client’s pain goals of three out of ten and help him control his weight gain. According to Lawson (2017), the appropriate dosage of Amitriptyline can play a significant role in treating patients with complex regional pain disorders.
My expectations for taking the third decision to continue administering Amitriptyline 12mg to the patient were similar to the results. The patient’s pain goal of three was achieved with non-adverse side effects being witnessed.
Ethical Considerations
The three ethical considerations that would need to be considered in the patient’s treatment would include confidentiality and beneficence. All the decisions made to treat the patients would thus need to be made to benefit the patient. All the information relating to the patient’s identification and treatment details would also need to be kept in confidence (Stein & van Niekerk, 2015).
References
Brueckle, M., Thomas, E.T., Seide, S.E., et al. (2020). Adverse drug reactions associated with
Amitriptyline — protocol for a systematic multiple-indication review and meta-analysis. Syst Rev 9, 59 https://doi.org/10.1186/s13643-020-01296-8.
Derry, S., Phillips, T., Moore, R. A., & Wiffen, P. J. (2015). Milnacipran (Savella) for
neuropathic pain in adults. The Cochrane database of systematic reviews, 2015(7), CD011789. https://doi.org/10.1002/14651858.CD011789.
Lawson K. (2017). A Brief Review of the Pharmacology of Amitriptyline and Clinical Outcomes
in Treating Fibromyalgia. Biomedicines, 5(2), 24. https://doi.org/10.3390/biomedicines5020024.
Peckham, A. M., Evoy, K. E., Ochs, L., & Covvey, J. R. (2018). Gabapentin for Off-Label Use:
Evidence-Based or Cause for Concern?. Substance abuse : research and treatment, 12, 1178221818801311. https://doi.org/10.1177/1178221818801311.
Plodkowski, R. A., McGarvey, M. E., Reisinger-Kindle, K., Kramer, B., Nelson, E., Lee, J., &
Nguyen, Q. T. (2016). Obesity Management: Clinical Review and Update of the Pharmacologic Treatment Options. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 33(1), 6–16.
Stein, D. J., & van Niekerk, A. A. (2015). Ethics of psychopharmacology. International
perspectives in philosophy and psychiatry. The Oxford handbook of psychiatric ethics (p. 1175–1190). Oxford University Press.
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