Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example
Questions to ask the patient
- Do you drink caffeinated drinks? If yes, how many cups a day and at what time?
Caffeine is a strong stimulant. Often, some people, especially those working long hours into the night, take caffeine to avoid sleeping. However, the case is different because the patient reports sleep disturbances that could be caused by caffeine. Taking caffeine during the day causes reduced levels of the primary metabolite of melatonin; 6-sulfatoxymelatonin affects psychomotor response and cognitive function.(Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example)
- How many hours do your sleep at night?
The patient’s mind is disoriented and has been mentally devastated over the past ten months. This condition causes disturbances in sleep cycles, and one cannot sleep adequately throughout the night. Lack of sleep is always a sign of discomfort or an underlying condition such as depression which subsequently increases anxiety resulting in insomnia.(Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example)
- During the past month, have you had any feelings of depression, hopelessness, or low-esteem?
The loss of a loved one often renders an individual vulnerable to depression. Therefore, appropriate medical intervention is needed to address cases where patients experience insomnia. This question can be used in multiple cases of assessing depression and help ascertain the need for further assessments and treatments. The nature of response provided by patients is also critical to determine the possibility of additional risks to themselves or others. (Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example)
Further Assessments
When assessing patients experiencing depression and other related mental illnesses, further assessments beyond the scope of patient well-being are essential to understand other contributing factors such as stressors. In this scenario, it seems that the deceased was a primary figure in the wife’s life. However, collecting more information from friends, family, and caregivers, if any, would provide insights into past and current situations Ferenchick, Ramanuj, & Pincus, 2019). This can be a challenging task, but you could ask the patient about who brought them to the facility and if it could be possible to talk with them.(Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example)
Caregivers can provide vital information about patients and their general well-being. Since the woman has experienced difficulties over the past ten months, there is a possibility she has forgotten a lot about herself, family, and well-being. Therefore, you could ask caregivers and any other close relative the following questions about the patient:(Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example)
- How has she been eating?
- Have you noticed any behavior change, signs of anxiety, or changes in memory?
- Does she seem hopeless?(Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example)
- Have there been significant changes in her interest in doing things?
- Are you certain whether she takes her medications or has noticed any side effects from prescribed medications?
Appropriate Physical Tests and Diagnostic Exams
Patients often do not know their diagnosis but make judgments based on signs and symptoms experienced. For the patient, in this case, she reports lack of sleep as the main symptom. This requires screening which is an appropriate physical test to determine any other underlying condition. Therefore, at the initial stages, the woman will be screened for depression through available options such as the Geriatric Depression Scale Short Form (SGDS), Mini-Mental State Exam MMSE) and Cornell Scale for Depression in Dementia (CSDD) (Brown et al., 2015). Another possibility that may require screening is dementia. Given that she is an older adult, the patient could also have dementia, and early screening could help improve their condition. The Cornell Scale for Depression in Dementia is appropriate for patients who experience mild to severe cognitive impairment. Similarly, the Geriatric Depression Scale Short Form tests depression using a short and straightforward method that provides similar results.(Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example)
Laboratory testing and baseline lab work provide practitioners with the necessary data and diagnosis of patient conditions. These tests help diagnose insomnia and depression at early stages and also detect them at later stages. Baseline lab work can be thorough but should include Erythrocyte Sedimentation Rate, urea, creatinine, glucose, liver function, complete blood count, electrolytes, B-12, and iron studies.(Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example)
Differential Diagnosis
A differential diagnosis refers to a complete list of possible conditions that may be causing particular symptoms. It can be based on facts from medical history, physical examinations, and laboratory results. The most likely differential diagnosis for the elderly patient could be vascular depression (Darwish et al., 2018). This is a common condition for elderly patients above 60 years and with no known history of mental health issues. It can also be detected in patients with a medical history of vascular diseases or hypertension, conditions characterized by inflammations in vascular systems which result in the release of cytokines. Notably, the current prescribed medications t treat hypertension could be conclusive that the likely differential diagnosis is vascular depression. (Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example)
Appropriate Antidepressant Therapy
The patient is currently under prescribed medication with the following drugs: Metformin 500mg BID, Januvia 100mg, Losartan 100mg, HCTZ 25mg, and Sertraline 100mg. Therefore, there should be significant improvements in depressive symptoms, though gradual. Although the scenario does not provide medication timelines for the drugs, knowing the patient takes Sertraline would be essential. This is because Sertraline has adverse side effects such as causing insomnia and should be complemented with low-dose Tricyclic antidepressants (TCAs) like Trazodone (Jaffer, 2017). The impacts of TCAs are rapid, and effects could be seen as soon as the first dose. As a result, its dosage should be reduced when depression symptoms improve to prevent extreme oversedation cases. Intake of Sertraline causes instability in blood-sugar levels. Therefore, switching from TCAs to Bupropion is recommended as studies from diabetes cases utilizing it show better outcomes. (Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example)
Contraindications
Contraindications describe situations where specific drugs and procedures should be avoided because they may cause harm to patients. Buspirone is contraindicated in patients with kidney and liver diseases because it may elevate or lower excretes to harmful levels. Sertraline should not be taken with serotonergic medications (O’Callaghan et al., 2018). It is contraindicated in patients under pimozide, monoamine oxidase inhibitors, or thioridazine. Lastly, Trazadone is contraindicated in patients taking Monoamine oxidase inhibitors.(Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example)
Check Point
The patient requires attention and close supervision from caregivers and providers. A follow-up should be made after four weeks to determine whether the increased dosage of Trazadone is effective in restoring the patient’s sleep patterns. If there are no significant improvements, changing medication to Buspirone will be necessary.(Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example)
References
Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-insomnia-and-mental-illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20common,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder%20%28ADHD%29
Brown, E. L., Raue, P. J., & Halpert, K. (2015). Evidence-based practice guideline: Depression detection in older adults with dementia. Journal of Gerontological Nursing, 41(11), 15-21. https://doi.org/10.3928/00989134-20151015-03
Darwish, L., Beroncal, E., Sison, M. V., & Swardfager, W. (2018). Depression in people with type 2 diabetes: Current perspectives. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 11, 333-343(Treatment for a Patient with a Common Condition Comprehensive Nursing Essay Example). https://doi.org/10.2147/dmso.s106797
Ferenchick, E. K., Ramanuj, P., & Pincus, H. A. (2019). Depression in primary care: part 1—screening and diagnosis. BMJ, 365.
Jaffer, K. (2017). Trazodone for insomnia: A systematic review. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842888/
O’Callaghan, F., Muurlink, O., & Reid, N. (2018). Effects of caffeine on sleep quality and daytime functioning. Risk Management and Healthcare Policy, 11, 263-271. https://doi.org/10.2147/rmhp.s156404
Write From Scratch