Are you taking your medication?

Respond to at least two of your colleagues on two different days in one of the following ways:

If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.Read a selection of your colleagues

Cecilia Isioma
Initial posting on patient depression
COLLAPSE
Question to ask the patient
1. What brings you in today? Rationale: This will help the provider know why the patient came to the clinic again asking open-ended questions will allow the patient to share more information with the provider. (Ball, et al., 2019).
2. Are you taking your medication? Rationale This will help the provider rule out non-compliance as a cause of the patient\’s problem (Stern &Fava, 2016).
3. How many hours do you sleep at night? Rationale Knowing how many hours a patient sleeps will help determine the extent or level of insomnia, whether insomnia primary or secondary, acute or chronic, because some older adults might be sleeping but do not feel rested after sleeping. (Patel, S 2020).
Identify people to speak to about the patient.
Patient\’s children, people that live with patients and caregivers.
Appropriate Question to Ask: Any change in mood, appetite, loss of interest in things patients likes to do, is she fatigued, any change in the environment.
Rationale: These questions will help the provider assess the extent of patients\’ insomnia, gather more information, and answer questions the patient may not remember to tell the provider. Furthermore, it will help rule out external factors. (Ball, et al. l,2021).
Assessment/ Diagnostic Test.
Comprehensive assessment (History taking &assessment).
Blood test: Thyroid panel blood test (T3, T4, Thyroid-stimulating hormone (TSH).
T3 &T4 measure the level of thyroid in the blood, while TSH measures how well the thyroid is a function because it controls the body\’s activities, as in hypothyroidism and hyperthyroidism (McCance &Huether, 2021).
Cortisol level, 24hour plasma, to check cortisol in the body.
Polysomnography (PSG), called sleep study, is used to assess the quality and extent of sleep. It uses electroencephalogram (EEG), electrooculogram, electromyogram, pulse oximetry, airflow, and respiratory effort to evaluate the underlying causes of sleep disturbances. It is an important test in diagnosing sleep disorders. (Rundo&Downey, 2020).
Hamilton Anxiety Scale (HAM-A) to rule out anxiety as a cause of a patient\’s illness or insomnia (Rosenthal & Bruchum, 2021).

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Differential Diagnosis
General anxiety disorder (GAD)
Major depressive disorder.
Post-traumatic stress disorder (PTSD)
I believe a patient has General Anxiety disorder (GAD) as a result of her husband\’s death because of her inability to cope with loss and possibly changes in her life routine, for example, being alone, sleeping alone, and financial burdens all these will sum together to given her worries and insomnia.
GAD is a chronic condition characterized by extreme worries. Patients with GAD usually have another psychiatric disorder, mainly depression (Rosenthal& Bruchum, 2021). GAD\’s signs and symptoms are intention nervousness, vigilance, poor concentration, difficulty falling or staying asleep, agitation, restlessness, hyperactivity, palpitation, and gastrointestinal symptoms(Anxiety and Depression Association of America )(ADAA,n.d).
Trazadone 50mg PO at bedtime and increasing seraline100mg PO daily (Zoloft from 100mg to 200mg.
Trazadone (Oleptrol) is approved by the Food and Drug Administration (FDA) in treating depression and is used as an off–label medication to treat GAD and insomnia because of its strong sedative effect. (Puzantian & Carlat, 2020). It can decrease latency and prolonged sleep duration.
Trazadone does not cause tolerance and dependency. It belongs to the serotonin receptor antagonist and reuptake inhibitor (Rosenthal& Burchum, 2021). Trazadone is metabolized primarily through TYP3A4 to active metabolite mCPP, which is metabolized by 2D6, inducing p-Glycoprotein (Puzantian & Carlat, 2020).
Sertraline (Zoloft) is an FDA SSRI used to treat depression. The dose will be increased from 100 mg to 150 mg. There are no indications that the patient has had any side effects from the initial dose of 100 mg. The mechanism of action for Zoloft (an SSRI includes the blockage of 5-HT (serotonin receptors) reuptake, thereby increasing serotonin activity, which aids the relief of the symptoms of major depression (Rosenthal and Burchum, 2018).

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Drug Interaction/Ethical Consideration.
There is a minimal risk of serotonin syndrome when combining antidepressants with other drugs. However, the side effects are not enough to prevent providers from combining them in treating patients. Trazadone and sertraline are allowed, but with caution (Myoclonic, nd). Therefore in combining sertraline and trazodone, there is a need to change either the dose or the frequency of the Trazadone, and the patient will be closely monitored Myoclinic, n.d).
It is ethical to for the provider to always prescribe drugs when the benefit outweighs its risk and when a particular medication is for the best interest of the individual. Providers should aim to understand the scientific, legal, and ethical principles involved in providing clinical care in complex cases (Piel,et al 2016).

SAMPLE SOLUTION

Hello Cecilia Isioma,
I beg to disagree with the first question about what brought the patient to the hospital. From the case study, it was clearly stated that the patient went to the hospital because of a lack of sleep since she lost her husband. Therefore asking the patient about her reason to seek medical attention would cause | PLACE YOUR ORDER NOW AT writtask.com | with the other two questions about the patient’s duration of sleep and whether she’s taking her medications. Knowing the duration of sleep would help in determining…