NU 665 WEEK 9 DISCUSSION

Scenario 1

Patient Education Script for Mrs. Jones’ Medication Regimen

Hello, Mrs. Jones. I appreciate you sharing your concerns. Reviewing all your medications is necessary to verify your familiarity with the combined treatment and possible side effects. You are taking Mirtazapine at 7.5 mg before bedtime and Doxepin at 10 mg for bedtime use. These medications activate stronger brain signals of serotonin and histamine through their mechanism of operation. You are also taking Zolpidem (5 mg QHS) for urgent sleep relief and Xanax (0.5 mg BID) for anxiety treatment. You will experience sleepiness during long-term usage of these prescribed medicines, which increases your risk for medication dependency. The neuropathy treatment medication gabapentin at a dosage of 100 mg three times daily helps manage symptoms but can produce high levels of drowsiness as a side effect. Finally, you are taking 225 mg of Venlafaxine daily, an antidepressant that also helps with anxiety and nerve pain but may sometimes cause sleep disturbances.

You must observe these medications as prescribed and promptly report any side effects, such as daytime sleepiness, dizziness, or memory-related issues. The increase in nighttime fall risks due to certain medications prompts us to choose the safest and most effective treatment for you. For instance, good sleep habits can enhance your sleep quality, including maintaining stable nightly schedules and decreasing your afternoon caffeine consumption (Chapoutot et al., 2021). We must collaborate to identify possible changes to enhance your sleep patterns without compromising your safety.

Further Evaluations or Testing Recommendations

You should receive additional testing for sleep-related issues since your ongoing sleep problems continue through various medications. A professional sleep assessment should screen for obstructive sleep apnea (OSA), restless leg syndrome (RLS), and circadian rhythm disorders. A polysomnography (overnight sleep study) or home sleep apnea test should be conducted if you present risk factors like daytime fatigue and snoring. Additionally, because long-term benzodiazepine and sedative use can impact cognition, I recommend a cognitive screening assessment such as the Montreal Cognitive Assessment (MoCA) to monitor for any subtle changes (Chapoutot et al., 2021).

I strongly recommend laboratory tests to measure thyroid function (TFTs) and assess vitamin B12 and iron levels to rule out metabolic factors causing insomnia. Close monitoring is essential to evaluate your Venlafaxine dosage because higher amounts may cause sleep problems. A fall risk assessment becomes necessary because home safety depends on using multiple sedative medications (Van Durme et al., 2020).

Recommended Medication Adjustments

Given current sleep issues and multiple sedative medication usage, I advise a step-by-step process to reduce sedation-dependent drugs along with fall risk factors. Provider-guided Zolpidem tapering along with Xanax reduction is crucial because continuous use of these drugs produces cognitive decline coupled with fall risks and withdrawal symptoms. We could employ Cognitive Behavioral Therapy for Insomnia (CBT-I) because research has proven its success in enduring insomnia management (Chapoutot et al., 2021).

Two safer pharmacologic alternatives for older adults with insomnia include Trazodone, administered at doses of 25-50 mg QHS, and Melatonin, given at doses of 1-3 mg QHS. As high doses of Venlafaxine can cause sleep problems, we should possibly manage the dose down to 150 mg when appropriate for your clinical condition. Regular close observation should support the transition process and preserve symptom management. Follow-up visits will evaluate your reaction to dosage modifications and verify treatment safety and effectiveness, according to Lew et al., 2021.

References

Chapoutot, M., Peter-Derex, L., Bastuji, H., Leslie, W., Schoendorff, B., Heinzer, R., … & Putois, B. (2021). Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders. International journal of environmental research and public health, 18(19), 10222. https://doi.org/10.3390/ijerph181910222

Lew, S. T., DeMartini, J. M., Zamora, E. A., & Ramezani, A. (2021). Psychopharmacology and Integrative Health: combined treatment of psychiatric and neurocognitive conditions. In Springer eBooks. https://doi.org/10.1891/9780826195470.0032

Van Durme, C., Spaetgens, B., Driessen, J., Nielen, J., Sastry, M., Boonen, A., & De Vries, F. (2020). Obstructive sleep apnea and the risk of gout: a population-based case-control study. Arthritis Research & Therapy, 22(1). https://doi.org/10.1186/s13075-020-02176-1

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NU 665 WEEK 9 DISCUSSION

Value: 100 points
Due: Create your initial post Day 3 and
reply to at least one of your peers by Day
7.
Grading Category: Discussions
Note: In this type of discussion, you will
not see the responses of your classmates
until after you have posted your own
response to the following prompts.
Initial Post
Please choose one of the patient
scenarios below and answer the
associated prompts.
Scenario 1
Mrs. Jones is an 85-year-old female,
widowed patient who lives alone in her
own one-story home. She has strong
family support in her children, and a strong
tie to her Christian faith. She tries to keep
busy but recognizes how difficult getting
older is, with the loss of many family
members and friends she once had. Other
than this loneliness and grief, she feels
well. She denies depressive symptoms,
states anxiety and panic symptoms are
well managed with her current medication
regimen. Her chief complaint today is
insomnia. She states despite her current
medication regimen, she still cannot
initiate or maintain sleep. Mrs. Jones
states, “I’ve just never been a good
sleeper!” Her current medications include:
Week 9 Discussion 1: Sleep Disorders
Dashboard My courses NU-665C-02-25PCSP Week 9: Sleep Disorders
Week 9 Discussion 1: Sleep Disorders

To do: Make forum posts: 1

Mirtazapine 7.5 mg PO QHS –
insomnia
Doxepin 10 mg PO QHS – insomnia
Gabapentin 100 mg PO TID – mild
idiopathic neuropathy
Zolpidem 5 mg PO QHS
Xanax 0.5 mg PO BID
Venlafaxine 225 mg PO daily
Answer the following prompts using 2-3
scholarly references:
1. Write an original patient education
script explaining Mrs. Jones’ current
medication regimen. (1–2
paragraphs)
2. Is there any further evaluation or
testing you would order? (1–2
paragraphs)
3. Are there any changes to her
medication regimen you would
make? If so, what would your
changes be? (1–2 paragraphs)
Scenario 2
James is a 15-year-old patient who
identi
es as male. James presents today
with his mother, who provides collateral
information. James has a diagnosis of
autism spectrum disorder. He is currently
prescribed:
Oxcarbazepine 300 mg PO BID – off
label for mood swings and irritability
Paroxetine 20 mg PO daily in the PM
– social anxiety
James states that he feels sluggish during
the day and has trouble waking up for
school. He states that if he had his way, he
would stay in bed and sleep all day. His
mother laughs and states, “You’d never
know it! He sure sounds like he’s sleeping,
with the way he snores!”
Upon interview, James reports the
following symptoms as positive when the
PMHNP screens for depression:
Depressed mood – some days
Insomnia or poor sleep – nearly
every day
Appetite – Intact
Suicidal ideation – None

Concentration – Impaired nearly
every day
Hobbies/Interests/Pleasure: Video
games (online gaming with friends)
– intact
Guilt/worthlessness/hopelessness:
None
Energy: Low nearly every day
This information was corroborated by the
patient’s mother.
Answer the following prompts using 2-3
scholarly references:
1. Write an original dialogue between
yourself and James and his mother,
including additional questions you
have for them. (1–2 paragraphs)
2. List the three most likely causes of
James’ current symptoms with brief
rationale. (1–2 paragraphs)
3. Given your differentials, what is your
next step in this case? How would
you explain the reasoning for this
step to James and his mother? (1–2
paragraphs)
Use the appropriate APA formatting as
listed in the syllabus.
Replies
Reply to at least one of your peers who
wrote about the opposite prompt. In your
reply post, respond with scholarly
discourse and an evidence-based
framework. Does your peers’ post follow
the current evidence? What might you do
differently in practice? Your assertions
should be backed by evidence that
references at least two scholarly sources.
Please refer to the Grading Rubric for
details on how this activity will be graded.
The described expectations meet the
passing level of 80%. You are directed to
review the Discussion Grading Rubric for
criteria which exceed expectations.

NU 665 WEEK 9 DISCUSSION