Insomnia Case Study Paper

/in /by

Insomnia Case Study Paper

Insomnia Case Study

Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient, he has never been a “great sleeper” but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancé. The patient states this is affecting his ability to perform his job, which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patient’s medical record from his previous physician states that he has a history of opiate abuse, which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep, approximately four beers prior to bed. Insomnia Case Study Paper

 

Decision Point One-Trazodone 50mg po at bedtime.

Trazodone po at bedtime

RESULTS OF DECISION POINT ONE

  • Patient returns to clinic in 2 weeks
  • Patient states medication works well but gives him an unpleasant side effect of an erection lasting approximately 15 minutes after waking
  • Patient states this makes it difficult to get ready for work or go downstairs and have coffee with his girlfriend and daughter in the morning
  • Patient denies auditory/visual hallucinations and is future oriented

Decision Point Two

Decrease trazodone to 25 mg daily at bedtime

RESULTS OF DECISION POINT TWO

  • Patient returns to clinic in 2 weeks
  • Patient states trazodone is very effective for sleep
  • Patient states sometimes the 25 mg dosage isn’t quite enough to help him sleep through the night
  • Patient denies auditory/visual hallucinations and is future oriented

ORDER  A PLAGIARISM FREE PAPER  NOW

Decision Point Three

Continue dose. Encourage sleep hygiene. Follow up in 4 weeks

Feedback to Student

Since the patient is already showing a partial response from trazodone, it may not be prudent to switch therapy. A thorough sleep hygiene analysis should always be performed prior to initiation of pharmacotherapy as well as at reassessments. If you find the patient isn’t practicing proper sleep hygiene, you may continue the dose and encourage sleep hygiene. If the patient is practicing good sleep hygiene, you may consider discontinuing trazodone and initiating hydroxyzine. Although there are some negative side effects associated with hydroxyzine such as Xerostomia and Xerophthalmia, it is still a safer medication to prescribe than ramelteon. Insomnia Case Study Paper

 

ASSIGNMENT QUESTIONS. 5 pages please see below;

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 (Zolpidem: 10 mg daily at bedtime, Hydroxyzine 50mg daily at bedtime), 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 (Explain that an erection lasting 15 minutes is not considered a priapism and should diminish over time, continue with current dose, Discontinue trazodone. Initiate therapy with suvorexant 10 mg daily at bedtime) 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 (Discontinue trazodone. Initiate therapy with ramelteon 8 mg nightly at bedtime. Follow up in 4 weeks, Discontinue trazodone. Initiate therapy with hydroxyzine 50 mg nightly at bedtime. Follow up in 4 weeks), 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. Insomnia Case Study Paper