NURS 6630 Assessing and Treating Patients With Anxiety Disorders

Walden University NURS 6630 Assessing and Treating Patients With Anxiety Disorders– Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6630 Assessing and Treating Patients With Anxiety Disorders assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6630 Assessing and Treating Patients With Anxiety Disorders

Whether one passes or fails an academic assignment such as the Walden University NURS 6630 Assessing and Treating Patients With Anxiety Disorders depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6630 Assessing and Treating Patients With Anxiety Disorders

The introduction for the Walden University NURS 6630 Assessing and Treating Patients With Anxiety Disorders is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6630 Assessing and Treating Patients With Anxiety Disorders

After the introduction, move into the main part of the NURS 6630 Assessing and Treating Patients With Anxiety Disorders assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6630 Assessing and Treating Patients With Anxiety Disorders

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6630 Assessing and Treating Patients With Anxiety Disorders

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6630 Assessing and Treating Patients With Anxiety Disorders

In the definition of the NURS 6630 Assessing and Treating Patients With Anxiety Disorders condition, adult anxiety disorders are common psychological conditions characterized by persistent apprehension and worry, which significantly impact the individual’s overall mental and physical health. Research conducted by the Centers for Disease Control and Prevention revealed that over 15% of adults in the United States had symptoms of anxiety to varying extents (Garakani et al., 2020). As this mental illness becomes more common, a variety of treatment approaches, such as medication and psychotherapy, have been created to support the mental health of those who have been diagnosed with it.

In the case study related to NURS 6630 Assessing and Treating Patients With Anxiety Disorders, a 46-year-old Caucasian male presented to the emergency room with symptoms that resembled a heart attack. The person had symptoms such as difficulty breathing, a sensation of constriction in the chest, and a strong sense of impending danger. In addition, the person had a tonsillectomy at the age of eight. In addition, they possess a medical record marked by moderate hypertension. The client admits to using alcohol. His score on the Hamilton Anxiety Rating Scale (HAM-A) was 26. A psychological assessment may help determine the presence of a generalized anxiety disorder.

The patient’s therapy largely involves pharmacotherapy, supplemented by other psychological interventions as necessary. Many pharmacodynamic and pharmacokinetic factors will influence the selection of this drug for the patient. The patient presented with a medical background of moderate hypertension, advanced age, Caucasian ethnicity, obesity, alcohol use, and a HAM-A score of 26, all of which are suggestive of a generalized anxiety disorder (GAD). The NURS 6630 Assessing and Treating Patients With Anxiety Disorders paper seeks to demonstrate the process of making sound judgments by considering the patient’s characteristics, the outcomes of their therapy, and any necessary modifications to their treatment regimen.

NURS 6630 Assessing and Treating Patients With Anxiety Disorders Decision #1

Selected Decision and Rationale

It is recommended to start treatment with Paxil by taking a daily oral dosage of 10 mg. The FDA has granted authorization for the use of Paxil in adults to treat anxiety-related diseases because of its favorable safety profile, supported by evidence-based practice and demonstrated effectiveness (Tafet & Nemeroff, 2020). Paxil is categorized as an SSRI medicine, which stands for selective serotonin reuptake inhibitor. Previous studies have shown the efficacy of paroxetine in treating anxiety-related issues, even at lower doses (McGowan, 2020). Furthermore, it has a good tolerance profile, devoid of dependence potential, and remains generally safe even when used excessively. Enhanced systemic circulation and lower drug metabolism in the liver are characteristics of the CYP2D6*4 variant allele (Melaragno, 2021). Polymorphism, which allows for the use of lesser doses of medicine, is particularly relevant for persons of Caucasian ancestry.

Particularly in the elderly, imipramine is contraindicated for the treatment of anxiety due to its inefficacy and accompanying risks. Moreover, the medication has been associated with increased body weight, potentially posing challenges for individuals in maintaining weight (Creswell et al., 2020). Conversely, buspirone has limited safety in middle-aged and elderly adults, indicating that it should only be used when no safer options are available. The patient’s alcohol use heightens the likelihood of developing a dependency on this medication (Szuhany & Simon, 2022).

Expected Outcome

The patient’s symptoms are anticipated to decrease by a minimum of 50% during the next four weeks. Negative responses, such as dizziness and headache, are expected to disappear independently (Bandelow, 2020). The patient’s Hamilton Anxiety Rating Scale score must be less than 10.

Ethical Consideration

The PMHNP has a legal duty to safeguard the well-being of patients and prevent any harm to them (Tafet & Nemeroff, 2020). When choosing the most suitable treatment plan, it is crucial to consider the patient’s ability to make independent decisions and ethical principles, such as promoting well-being and avoiding harm (Lee & Stein, 2022).

NURS 6630 Assessing and Treating Patients With Anxiety Disorders Decision #2

Selected Decision and Rationale

Currently, the recommended approach is to raise the daily oral dose of paroxetine to 20 mg, taking into account the individual’s reaction. According to professional guidelines, patients should receive increasing dosages of paroxetine (10 mg increments) based on their response, with a maximum daily dose not exceeding 50 mg (Bandelow, 2020). During the past four to five days, the first intervention effectively alleviated the individual’s feelings of anxiousness. The present score on the HAM-A is 18. The drug’s efficacy and tolerability have been proven via clinical studies (Szuhany & Simon, 2022). No adverse effects were detected, indicating a satisfactory level of safety. A significant proportion of patients need 8-12 weeks to establish the optimal dose for successfully managing symptoms of GAD (Tafet & Nemeroff, 2020). To optimize efficacy, it was crucial to establish consistent adherence to medicine and progressively increase the dose (Lee & Stein, 2022).

It is not recommended to escalate the dose to 40 mg since there are inconsistencies in clinical standards. A significant escalation in dose might hurt the patient’s pharmaceutical tolerance (Creswell et al., 2020). It is also unsuitable to persist in giving the same medication at an identical dosage, regardless of the patient’s dissatisfaction with the outcomes (McGowan, 2020). Due to the expected lack of further effectiveness in treating anxiety symptoms, patients may become less likely to follow the prescribed medicine (Melaragno, 2021).

Expected Outcome

Given that the individual’s chest discomfort and difficulty breathing have already been resolved, it is anticipated that raising the dosage would have a more pronounced impact on the remaining symptoms of concern (Garakani et al., 2020). Based on the provided information, the HAM-A score is expected to be less than ten.  

Ethical Consideration

 The PMHNP is responsible for conveying the patient’s findings and involving them in choices about their health (Tafet & Nemeroff, 2020). Before implementing the treatment plan, the nurse must get the patient’s agreement, even if it is in the patient’s best interests. This is done to uphold the patient’s autonomy and enhance the results.

NURS 6630 Assessing and Treating Patients With Anxiety Disorders Decision #3

Selected Decision and Rationale

The ultimate decision was to continue administering the patient’s existing paroxetine dose while closely monitoring them for signs that could suggest the need for supplementary anxiety medication. The patient demonstrated a noteworthy alleviation of anxiety symptoms by 61 percent, which indicates an acceptable degree of adherence and tolerance to the prescribed drug. Empirical data indicates that paroxetine is a very effective intervention for alleviating symptoms of anxiety (Bandelow, 2020). Patients often experience significant relief of symptoms after more than 50% of them have been resolved (Lee & Stein, 2022). To maximize the therapeutic advantages and minimize the likelihood of enduring unpleasant effects, strict adherence to the medication’s recommended dose and treatment regimen is ideal (Szuhany & Simon, 2022).

Since the person had already seen over fifty percent reduction in symptoms, increasing the dose to thirty milligrams was unnecessary. A link has been shown between surpassing the authorized amount of intake and higher levels of toxicity, as well as negative consequences (Creswell et al., 2020). The patient’s absence of any discernible improvement after receiving the whole prescribed amount ruled out any possibility of considering an alternate therapy. Administering Buspirone to this person is contraindicated due to the high likelihood of developing drug resistance (Melaragno, 2021).  

Expected Outcome

The patient is expected to have improved control of anxiety symptoms by continuing to take Paxil at the same dosage (Garakani et al., 2020). The individual is expected to have a HAM-A score of around 7, indicating mild or insignificant anxiety.

Ethical Consideration

The patient conveyed contentment with the efficacy of the drug in mitigating her anxiety symptoms (Bandelow, 2020). Carers must prioritize patient autonomy while stressing the need to adhere to the pharmaceutical regimen to enhance care outcomes (McGowan, 2020).

Also Read:

Treatment for a Patient With a Common Condition

Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

WEEK 8 Short Answer Assessment

Assessing and Treating Patients With Sleep Wake Disorders

Assessing and Treating Patients With ADHD

Psychopharmacologic Approaches to Treatment of Psychopathology

Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Conclusion

Anxiety disorders are prevalent psychiatric conditions that mostly impact individuals in the middle-aged and elderly population. Several indicators of this psychiatric disorder jeopardize the client’s bodily and emotional well-being. Previous research has shown that anxiety disorders are prevalent psychological conditions that mostly affect adults in their forties and fifties (Garakani et al., 2020). The physical and mental well-being of the patient in the NURS 6630 Assessing and Treating Patients With Anxiety Disorders are at risk due to many indicators of this mental disorder. Previous studies have shown the greater effectiveness of various therapy methods in treating this psychological condition (Bandelow, 2020). Multiple factors must be considered when choosing a drug for a certain patient. For this particular example, the patient’s first therapy consisted of a daily prescription of 10 mg of paroxetine. The two choices were eliminated because of their unfavorable safety profiles and increased worries about dependency. By using this strategy, the patient successfully controlled their anxiety, as shown by the absence of respiratory distress or sensations of chest tightness (Creswell et al., 2020). By professional practice norms, the dose was increased to 20 mg once daily.

After undergoing a four-week treatment plan where the patient took a daily dose of 20 mg of paroxetine, they saw a decrease in symptoms that was more than 61%. Research indicates that a patient’s pharmaceutical dosage is considered adequate when their feelings of anxiety have diminished by more than 50% (Tafet & Nemeroff, 2020). The medicine has a favorable safety profile since it has not been associated with any known negative effects. The patient was advised to adhere to the present pharmaceutical dose in order to sustain the ongoing reduction of anxiety symptoms (Melaragno, 2021). The PMHNP provided the patient with detailed information on each option, including potential advantages and disadvantages (Szuhany & Simon, 2022). Their participation in the process of selecting medication upheld the patient’s autonomy.

References

Bandelow, B. (2020). Current and novel psychopharmacological drugs for anxiety disorders. In Advances in Experimental Medicine and Biology (pp. 347–365). https://doi.org/10.1007/978-981-32-9705-0_19

Creswell, C., Waite, P., & Hudson, J. L. (2020). Practitioner Review: Anxiety disorders in children and young people – assessment and treatment. Journal of Child Psychology and Psychiatry, 61(6), 628–643. https://doi.org/10.1111/jcpp.13186

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of Anxiety Disorders: Current and emerging treatment options. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.595584

Lee, H. J., & Stein, M. B. (2022). Update on treatments for anxiety-related disorders. Current Opinion in Psychiatry, 36(2), 140–145. https://doi.org/10.1097/yco.0000000000000841

McGowan, O. O. (2020). Pharmacogenetics of anxiety disorders. Neuroscience Letters, 726, 134443. https://doi.org/10.1016/j.neulet.2019.134443

Melaragno, A. (2021). Pharmacotherapy for anxiety disorders: From First-Line options to Treatment Resistance. Focus, 19(2), 145–160. https://doi.org/10.1176/appi.focus.20200048

Szuhany, K. L., & Simon, N. M. (2022). Anxiety disorders. JAMA, 328(24), 2431. https://doi.org/10.1001/jama.2022.22744

Tafet, G. E., & Nemeroff, C. B. (2020). Pharmacological treatment of anxiety disorders: The role of the HPA axis. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00443

Sample Answer 2 for NURS 6630 Assessing and Treating Patients With Anxiety Disorders

Anxiety disorders make the patients constantly worry and persistently anxious. The patients with the condition present with various symptoms which complicate their daily lives. Some of the symptoms include nervousness, muscle trembling, chest tightness, and shortness of breath. Therefore, there is a need for patients with anxiety disorders to seek medical attention from psychiatric mental health specialists. Various approaches have been used to treat and manage the condition, including pharmacological and psychotherapy approaches (Horenstein & Heimberg, 2020). The implication is that the prescriber should use medications that can be monitored for dose adjustments and potential stoppage or change in case there are adverse reactions. Therefore, the purpose of this assignment is to summarize a case study of a patient with anxiety disorder and explore various decision points upon the administration of appropriate medication.

The Case Summary

The case is of a forty-six-year-old white male patient who presented to the facility after a referral because he felt he was having a heart attack. The patient experiences a feeling of impending doom, breath shortness, and chest tightness. The patient also has mild hypertension and is overweight. The ER ruled out myocardial infarction, and he also had a normal EKG. While in the office, the patient indicated that he consumes alcohol occasionally to help him deal with his worries at work. The patient is single but currently takes care of his aging parent. He indicates that he fears for his job since the management at his workplace is harsh. The patient scored 26 upon administration of HAM-A, hence diagnosed with anxiety disorder.     

Decision 1

The Selected Decision

The first decision made was to begin Paxil 10 mg PO daily

Why the Decision Was Selected

The decision was made since Paxil has been approved and widely used as a first-line drug to treat anxiety disorder (Kowalska et al., 2021). While it has similar efficacy as tricyclic antidepressants, Paxil has fewer side effects hence a good choice. In addition, it has a better safety record and a higher response rate compared to other classes of drugs.

Why the Other Options Were Not Selected

The other two options included beginning Buspirone 10 mg Po BID or Begin Imipramine 25 mg Po BID. Buspirone was not chosen since it is recommended for use among patients with anxiety disorder only if the first line of treatment is not effective or presents safety concerns (Wilson & Trip, 2021). Therefore, it should be used as a second line of treatment (Garakani et al., 2020). This medication also has more side effects in comparison to Paxil, and patients also tend to abuse it after use. Imipramine, also an antidepressant, is only considered a second line of treatment for anxiety disorder. In addition, it has various undesirable side effects, such as urinary hesitancy, sedation, and weight gain (Chang et al., 2021). Therefore, it is not a good option since the patient also already has mild hypertension.

What I was Hoping to Achieve by Making the Decision

One of the goals I was hoping to achieve by making the decision was to help the patient have reduced anxiety symptoms and lead a normal life. The medication is expected to act within four weeks. Hence the patient should have fewer worries and experience reduced heart attack-like symptoms (Kowalska et al., 2021). I also expected the HAM-A scores to substantially reduce.

How Ethical Consideration May Impact the Treatment Pan and Communication

One of the ethical considerations at this stage is to offer the patient education regarding the potential side effects of Paxil in addition to informing the patient regarding other available treatment options, such as psychotherapy (Haddad & Geiger, 2020). The patient’s autonomy has to be upheld and be allowed to choose the best option without influence. The patient also needs to be informed of risks connected to not treating the conditions.

Decision 2

The Selected Decision

The second decision made is to increase the dose to 20 mg PO daily

Why the Decision Was Selected

After the first medication dose, the patient came back to the facility, indicating that his symptoms had improved. For example, he no longer experiences breath shortness, chest tightness, and decreased worries. Besides, the HAM-A scores substantially reduced to 18, indicating a partial response implying that the medication is effective; hence an appropriate titration should be done for optimum results. Therefore, a gradual increase from 10 mg to 20 mg should be the choice (Melaragno, 2021). It is also important to note that the patient has not experienced any adverse side effects, indicating that he is tolerating the medication well.

Why the Other Options Were Not Selected

The other two options include increasing the dose to 40 mg PO daily or no change to the drug or dose. It is worth noting that the patient’s improvement was partial; hence maintaining the dosage at 10 mg would give no further improvements or positive changes. In addition, increasing the dosage to 40 mg per day without gradually titrating the medication can lead to various side effects, such as delayed ejaculation, vomiting, nausea, and headaches (Garakani et al., 2020). A normal titration recommendation is usually 10 mg; hence increasing it to 40 mg would present a 30 mg increase which is way too high.

What I was Hoping to Achieve by Making the Decision

I was hoping to achieve increased positive results by increasing the dosage to 20 mg. I was also hoping that the patient gets treated and not only relieves symptoms (Garakani et al., 2020). In addition, I was also hoping that the patient’s score on the HAM-A scale would reduce by at least half.

How Ethical Consideration May Impact the Treatment Pan and Communication

The improvements observed by the patients may lead to excitement, and the patient may even request that he stops taking the medication. However, it is important to advise the patient on the need to continue with the treatment at the end to prevent a potential recurrence of anxiety symptoms. The patient’s autonomy should also be respected, and his input should be considered in further plans.

Decision 3

The Selected Decision

The third decision selected was to maintain the current dose

Why the Decision Was Selected

 Upon increasing the dosage to 20 mg, the patient returned to the clinic and indicated that the symptoms had reduced even further. In addition, the patient also had a reduction of the HAM-A scores to 10 (Rabinowitz et al., 2023). There has been a sixty-one percent reduction in the symptoms. Therefore, it will be prudent to maintain the current medication dose as part of the maintenance therapy.

Why the Other Options Were Not Selected

The other two options included increasing the Paxil dosage to 30 mg PO daily or adding an augmentation agent like BuSpar. Increasing the dosage to 30 mg PO daily would further reduce anxiety symptoms. However, there is a high risk of increased side effects (Garakani et al., 2020). The patient data is also not showing any need for augmenting agents like BuSpar. Hence, this choice was also ignored.

What I was Hoping to Achieve by Making the Decision

The decision made was to maintain the dosage. Therefore, I was hoping for all the anxiety symptoms experienced by the patient clear out. I am also hoping that the patient will not suffer any consequences due to ignoring the other two options. I was also hoping that the patient should have improved feelings and not experience any heart attack-like symptoms.

How Ethical Consideration May Impact the Treatment Pan and Communication

There are also ethical considerations that may impact the treatment and communication. One of them is that the patient needs to be educated on the potential risks and threats of increasing the dosage to more than 20 mg in case the patient requests it. The decision should also be made to ensure that the patient does not face any harm but ensure that the patient continues to experience improved symptoms.

Conclusion

The patient in this case study was diagnosed with anxiety disorder; hence medication treatment decision points were taken. The patient presented with various symptoms, such as chest tightness, the feeling of impending doom, and shortness of breath. Therefore, there was a need for the patient with anxiety disorders to seek medical attention from a psychiatric mental health specialist. Various approaches have been used to treat and manage the condition, including pharmacological and psychotherapy approaches. In the case of this patient, the treatment used was 10 mg of Paxil initially. This decision was made while two other decisions were left out, such as beginning Buspirone 10 mg Po BID or Begin Imipramine 25 mg Po BID. The two choices were majorly ignored since both are considered a second line of treatment (Garakani et al., 2020). Therefore, they are only used when the first line of treatment, in this case, Paxil, is not effective or is presenting safety concerns for the patient. The dosage was increased to 20 mg after the patient initially showed improvement. Besides, two other choices were ignored to ensure that the patient goes on in his path to recovery. This dosage was to be maintained to help balance the risk factors and the expected benefits.

References

Chang, G. R., Hou, P. H., Wang, C. M., Lin, J. W., Lin, W. L., Lin, T. C., … & Wang, Y. C. (2021). Imipramine accelerates nonalcoholic fatty liver disease, renal impairment, diabetic retinopathy, insulin resistance, and urinary chromium loss in obese mice. Veterinary Sciences, 8(9), 189. https://doi.org/10.3390/vetsci8090189

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.595584

Haddad, L. M., & Geiger, R. A. (2020, September 1). Nursing ethical considerations – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK526054/

Horenstein, A., & Heimberg, R. G. (2020). Anxiety disorders and healthcare utilization: A systematic review. Clinical Psychology Review, 81, 101894. https://doi.org/10.1016/j.cpr.2020.101894

Kowalska, M., Nowaczyk, J., Fijałkowski, Ł., & Nowaczyk, A. (2021). Paroxetine—overview of the molecular mechanisms of action. International Journal of Molecular Sciences, 22(4), 1662. https://doi.org/10.3390/ijms22041662

Melaragno, A. J. (2021). Pharmacotherapy for anxiety disorders: from first-line options to treatment resistance. Focus, 19(2), 145-160. https://doi.org/10.1176/appi.focus.20200048

Rabinowitz, J., Williams, J. B., Hefting, N., Anderson, A., Brown, B., Fu, D. J., …& Schooler, N. R. (2023). Consistency checks to improve measurement with the Hamilton Rating Scale for Anxiety (HAM-A). Journal of Affective Disorders, 325, 429–436. https://doi.org/10.1016/j.jad.2023.01.029

Wilson, T. K., & Tripp, J. (2021, August 12). Buspirone – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK531477/

NURS 6630 Treatment for a Patient With a Common Condition Sample

Three Questions I Would Ask the Patient, With a Rationale 

The questions asked include: 

1. What motivated you to come to the hospital today?  

Asking this open-headed question will prompt the patient to provide further information about his ailment and develop a trusting care relationship. 

1. Are you a regular consumer of caffeinated drinks or beverages?  

Evaluating the patient’s possible caffeine addiction and regular use before bedtime is crucial since it can contribute to insomnia. 

1. Have you ever suffered from Gastro Esophageal Reflux Disease (GERD)?  

The open-headed question is vital in establishing a connection with the current symptoms. According to Awadalla and Al-Musa (2021), GERD can contribute to insomnia among elderly patients due to poor sleep quality and discrepancies in circadian preferences. The three questions aim to rule out the possible influence of environmental factors and assess the patient’s worries to better understand her health status. 

People in the Patient’s Life for Providing Feedback to Further Assess the Patient’s Situation 

The ideal people in this patient’s life for providing responses to evaluate her situation include her caregiver and a close family member conversant with her history. Her caregiver will be acquainted with her medications and response to drugs, while an immediate family member will have a better overview of her social life before and after her husband’s death. 

Specific questions for the caregiver include: 

1. For how long has the patient been on the prescribed medications? 

1. Are the doses maintained, or are there occasional adjustments? 

1. Have the remedies effectively managed diabetes, hypertension, and major depressive disorder (MDD)? 

1. Has her state varied or worsened after her husband’s death despite taking the medications? 

Consequently, specific questions for the close family member include: 

1. What has been the nature of the patient’s social life? 

1. From your observations, how was her medical status before her husband’s death? 

1. Did her state worsen after her long-time husband passed on? 

Physical Exams and Diagnostic Tests Appropriate for the Patient 

A self-report is ideal for diagnosing insomnia. A blood test can be ordered to rule out potential thyroid problems. Green et al. (2021) note that hyperthyroidism results in excess thyroid hormone, leading to sleep dysfunction. Besides, the Hamilton Anxiety Rating Scale (HAM-A) can be administered to examine the severity of her anxiety (Slater et al., 2019). The scale will assist in managing insomnia if it is connected to anxiety. Hamilton Depression Rating Scale (HDRS) is also viable in examining the symptoms of depression (Nixon et al., 2020). It will significantly help to appraise the patient’s feelings of suicidal ideation, guilt, and her current stage of insomnia. 

A Differential Diagnosis for the Patient 

The patient’s medical history shows that she was previously diagnosed with depression. As such, the definitive differential diagnosis will be generalized anxiety disorder (GAD), which might have intensified after the death of her husband. According to Landreville et al. (2021), GAD causes anxiety about various situations and hinders relaxation as the affected person continually feels anxious. The conclusion is informed by changes in her social and living dynamics as she has to sleep alone and bear financial burdens. She also has to deal with thoughts about her husband’s death. Unexpected changes in her routine and social life may be attributed to insomnia. 

Pharmacologic Agents Appropriate for the Patient’s Antidepressant Therapy Based on Pharmacokinetics and Pharmacodynamics 

The U.S. Food and Drug Administration (FDA) approved Temazepam for the management of insomnia. According to Stenveld et al. (2019), it is in the category of benzodiazepines and is effective in managing insomnia by modulating gamma-aminobutyric acid (GABA) to elicit sedation, relax skeletal muscles, and hypnosis. The drug is metabolized in the liver into inactive metabolites. Related side effects include clumsiness, dizziness, and a reduction in the patient’s alertness (Stenveld et al., 2019). Consequently, Trazodone would be an ideal remedy for insomnia. It is approved by the FDA to manage major depression. It acts by blocking serotonin reuptake (Wang et al., 2020). The drug is metabolized via CYP3A4 into the active metabolite, meta-chlorophenylpiperazine (mCPP). The active metabolite is subsequently metabolized into 2D6 to induce P-glycoprotein. Wang et al. (2020) caution that Trazodone can cause daytime dizziness. Prescription of this medication to an elderly patient should consider this side effect. 

Contraindications to Use or Alterations in Dosing That May Need to be Considered Based on Ethical Prescribing or Decision-Making 

Temazepam is the ideal and safer medication for this elderly patient because the drug does not have active metabolites. Additionally, it has a brief half-life and no history of interactions with the present medicines taken by the elderly patient (Stenveld et al., 2019). Adding this drug to the current treatment regimen will not induce drug toxicity. The problem with using this drug in individuals in line with ethical decision-making is related to the awareness that sleep regulation has a genetic link. It can be overlooked in the treatment process if it is not considered during the diagnosis phase. 

“Check Points” and Therapeutic Changes Based on Possible Outcomes Given the Treatment Options Chosen 

The commencing dose is low for an elderly patient. For instance, Temazepam 7.5mg tab PO at bedtime would be an ideal starting dose. In the check-up for the four weeks, outcomes expected entail a reduction in anxiety and improvement in the sleep pattern. If the outcomes have not been actualized, ordering 15mg tab PO at bedtime would be beneficial. Nevertheless, the medication has the side effect of dizziness and body weakness (Stenveld et al., 2019). In week 8, the medical outcomes can be reviewed to gauge the progress. The dose should not surpass 30mg PO at bedtime. Caution is necessary when increasing the dose for this elderly patient to minimize the intensity of the side effects. 

References 

Awadalla, N. J., & Al-Musa, H. M. (2021). Insomnia among primary care adult population in Aseer region of Saudi Arabia: Gastroesophageal reflux disease and body mass index correlates. Biological Rhythm Research, 52(10), 1523-1533. https://doi.org/10.1080/09291016.2019.1656933 

Green, M. E., Bernet, V., & Cheung, J. (2021). Thyroid dysfunction and sleep disorders. Frontiers in Endocrinology, 12, 1-4. https://doi.org/10.3389/fendo.2021.725829 

Landreville, P., Gosselin, P., Grenier, S., & Carmichael, P. H. (2021). Self-help guided by trained lay providers for generalized anxiety disorder in older adults: Study protocol for a randomized controlled trial. BMC Geriatrics, 21(1), 324. https://doi.org/10.1186/s12877-021-02221-x 

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