Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample
Insomnia
Insomnia is often defined as the presence of a person’s report of sleeping difficulties or the presence of polysomnographic evidence of disturbed sleep. Insomnia is characterized by long sleep latency, regular nocturnal awakening, long periods of wakefulness during sleep period, and frequent transient arousals (Krystal et al., 2019). Insomnia qualifies as a disorder because it leads to negative consequences, which are not normal and stem from some form of pathological response.(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
Questions to ask the Patient
According to the current medication, the patient is already under treatment for diabetes mellitus or type 2 diabetes, high blood pressure, and depression. The primary problem the patient presents with is insomnia, and it would be appropriate to ask questions to determine the patient’s sleep patterns. The following questions would help determine whether the patient is having sleep problems:(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
- How long does it take you to fall asleep?
- How often do you wake up during the night, and how long does it take to fall back asleep?
- How refreshed do you feel when you wake up?
- Do you feel tired during the day?(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
- Do you have any family members with sleep problems?
- What do you consume before going to sleep?
- Do you have distractions like a computer or television in your bedroom?
The questions are fundamental in helping the assessing practitioner understand the patient’s sleeping patterns, determine any problems with the sleeping patterns, and ascertain whether there are other factors like distractions or family history of sleep problems likely to contribute to the patient’s current sleep condition.(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
Questions to ask a Family Member
The patient’s spouse is dead, and the only people close enough to observe any sleep changes in the patient would be her children. Questions to ask the patient’s children include:
- Do you see any changes in the patient’s regular sleeping partners?
- What time does the patient sleep, and what time does she wake up?
- Are you aware of any patient’s movement during the night?(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
- Does the patient complain of feeling tired after waking up?
- How often does the patient have trouble sleeping?
These questions would help get more information about the patient sleeping patterns, lifestyle changes, and possible reasons causing insomnia.
Physical Exam and Lab Tests
Physical exam to assess the patient for a possible sleep disorder would include checking for a deviated nasal septum, enlarged tonsils, or a narrow throat, which often causes obstructive sleep apnea, contributing to insomnia (Goyal & Johnson, 2017). These exams can provide information about signs of medical problems contributing to insomnia. Appropriate laboratory tests can include blood tests to identify possible thyroid problems or other conditions associated with poor sleep (Green et al., 2021). A significant relationship exists between thyroid dysfunctions and sleep disorders. The results would determine whether other conditions, apart from depression and grief, are causing insomnia.(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
Differential Diagnosis
Other sleep disorders that might be present when a patient complains of insomnia include:
Circadian rhythm sleep-wake disorder
The following symptoms must be present for circadian rhythm sleep-wake disorder:
- A persistent or recurrent sleep pattern disruption, mainly stemming from an alteration of the circadian system or to a misalignment between the endogenous circadian rhythm and the sleep-wake schedule needed by a person’s physical environment or social or professional schedule.(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
- The sleep disruption causes excessive sleepiness or insomnia, or both.
- The sleep disturbance leads to clinically significant distress or impairment in social, occupational, and other crucial functioning areas.
Central sleep apnea
Central sleep apnea is defined as a disorder in which an individual’s breathing recurrently stops and starts during sleep period (Pavlova, 2017). The following symptoms must be present for central sleep apnea:
- Airflow cessation of 10 or more seconds without any inspiratory effort(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
- Repeating apneas during sleep period in the absence of respiratory effect
Restless legs syndrome
The following symptoms must be present for restless legs syndrome:
- An urge to move the legs and the patient is partially relieved by moving them (Krystal et al., 2019)
- An abnormal leg sensation during rest time at the end of the day(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
- Trouble falling asleep
Obstructive sleep apnea
The following symptoms must be present for obstructive sleep apnea:
- Snoring
- Frequent awakening
- Unintentional sleep episodes during wakefulness
- Daytime sleepiness
- Unrefreshing sleep
- Fatigue(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
- Insomnia
- Waking up breath holding, gasping, or chocking
- Breathing interruptions (Krystal et al., 2019)
Periodic limb movement disorders
The following symptoms must be present for periodic limb movement disorder:
- The presence of PLMS of over 15 periodic limb movements every hour in adults and over five periodic limb movements every hour in children (Joseph & Nagalli, 2021)
- Sleep problems(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
- Altered daytime functioning
Insomnia is the confirmed diagnosis since the patient presents with trouble falling or staying asleep, altered sleep/wake schedule, altered bedtime routine, nocturnal behavior, and daytime dysfunction (Krystal et al., 2019). The others were refuted since despite the patient presenting with disturbed sleep, which includes difficulty initiating or maintaining sleep, early morning awakening, unrefreshing sleep, and resultant daytime dysfunction, she does not present with any breathing difficulties or an urge to move limbs.(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
Pharmacological Agents
Drugs can help the patient fall asleep, although it is not recommended for the patient to rely on the sleeping pills for more than a few weeks. Approved medications that can be prescribed to the patient include:(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
- Eszopiclone 1 mg PO HS (Rösner et al., 2018)
- Ramelteon 8 mg PO qHS (Kuriyama et al., 2014)
- Zaleplon 10 mg PO qHS initially (Bhandari & Sapra, 2019)
- Zoldipem 6.25 mg PO qHS (Bouchette et al., 2021)
Ramelton is a hypnotic agent and has a novel mechanism of action. It would be more appropriate than the other agents because it is the only melatonin agonist currently indicated for insomnia treatment (Kuriyama et al., 2014). It acts at the MT1 and MT2 receptors to promote sleep and cause an effect on circadian rhythms. The other agents work by increasing GABA effects in the CNS by binding to GABA receptors. Contraindications for Ramelton include calcium, magnesium, potassium, sodium oxybates, and fluvoxamine (Medscape, n.d.). Using Ramelton together with these agents can be harmful to the patient.
The patient should follow up with the practitioner to assess her response to drug therapy and any need for therapeutic changes. Drugs prescribed are expected to help the patient regain normal sleep patterns within a few weeks, and the patient should not rely on them. Possible therapeutic changes would include discarding drug therapy and adopting interventions like relaxation techniques, sleep restrictions, stimulus control therapy, and light therapy, which are less likely to cause dependence.(Treatment for a Patient with a Common Condition-Insomnia Case Study Comprehensive Nursing Paper Sample)
References
Bhandari, P., & Sapra, A. (2019). Zaleplon. StatPearls [Internet].
Bouchette, D., Akhondi, H., & Quick, J. (2021). Zolpidem. In StatPearls [Internet]. StatPearls Publishing.
Goyal, M., & Johnson, J. (2017). Obstructive Sleep Apnea Diagnosis and Management. Missouri medicine, 114(2), 120–124.
Green, M. E., Bernet, V., & Cheung, J. (2021). Thyroid Dysfunction and Sleep Disorders. Frontiers in endocrinology, 12, 725829. https://doi.org/10.3389/fendo.2021.725829
Joseph, V., & Nagalli, S. (2021). Periodic limb movement disorder. In StatPearls [Internet]. StatPearls Publishing.
Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World psychiatry : official journal of the World Psychiatric Association (WPA), 18(3), 337–352. https://doi.org/10.1002/wps.20674
Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World psychiatry : official journal of the World Psychiatric Association (WPA), 18(3), 337–352. https://doi.org/10.1002/wps.20674
Kuriyama, A., Honda, M., & Hayashino, Y. (2014). Ramelteon for the treatment of insomnia in adults: a systematic review and meta-analysis. Sleep medicine, 15(4), 385–392. https://doi.org/10.1016/j.sleep.2013.11.788
Medscape. (n.d.). Ramelteon. https://reference.medscape.com/drug/rozerem-ramelteon-342928
Pavlova M. (2017). Circadian Rhythm Sleep-Wake Disorders. Continuum (Minneapolis, Minn.), 23(4, Sleep Neurology), 1051–1063. https://doi.org/10.1212/CON.0000000000000499
Rösner, S., Englbrecht, C., Wehrle, R., Hajak, G., & Soyka, M. (2018). Eszopiclone for insomnia. The Cochrane database of systematic reviews, 10(10), CD010703. https://doi.org/10.1002/14651858.CD010703.pub2
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