Respond  of your colleagues who were assigned to a   different case than you. Explain how you might apply knowledge gained   from your colleagues’ case studies to you own practice in clinical   settings as a Psychiatric Nurse Practitioner. NOTE: Positive comment                                             Main Post The three questions this writer would as the patient are:  Did your depressive symptoms worsen after the death of your husband?  How many hours per night do you sleep on average?  Do you sleep throughout those hours of sleep or do you wake constantly?  Do you ingest any stimulants like coffee or chocolate before bed?  Do you sleep during the daytime?  The rationale behind question one is to gauge the timeline of the  patient’s depression. She appears to have been suffering with untreated  depression for a long time, however the additional symptoms of insomnia  and tearfulness seemed to worsen after his death. With this information  the nurse practitioner will know if her depression is in an acute state  and the severity of her illness.The patient is reporting sleeplessness;  however the nurse practitioner needs to gauge if the patient is  participating in restful sleep. Sleep of two hours or less may only  consist of REM sleep (Boland et al., 2020). If the patient is not  getting restful sleep, she is not benefiting from the bodily repair that  takes place during sleep (Fitzgerald et al., 2017).  This can place her  at an increased risk for other illnesses and heighten depressive  symptoms (Uchmanowicz et al., 2019).Knowing if the patient sleeps  consistently throughout those hours of sleep will provide information to  the nurse about the kind and amount of sleep the patient is getting.  Ingesting certain stimulants like caffeinated drinks, coffee or  chocolate can affects the client’s sleep by providing wakefulness (Ulke  et al., 2017).  If the patient is sleeping during the daytime, her  circadian rhythm could have been reversed where she will need less sleep  during the night time hours (Fitzgerald et al., 2017). The people this writer would interview are: The patient’s aide  The patient’s son  The patient aide may be able to provide more information about  observed sleepiness during the daytime. In addition, she will be able to  provide information on the patient’s dietary patterns and physical  activity. The questions to the aide would be:     Does she easily nod off during the daytime?  Does she easily become fatigued?  Does she consume a well-balanced diet?  Question one would illicit answers about her getting sleep.  It appears that she in fact getting sleep but because of a revered  circadian rhythm she is not able to get the sleep at the night which is  the desired time.  Question two will help the nurse practitioner gauge  the extent of the effects that non sleep has taken on the patient’s  life. The patient, if constantly fatigued throughout the day has a life  that has been highly impacted by the .

1. Respond
of your colleagues who were assigned to a different case than
you. Explain how you might apply knowledge gained from
your colleagues’ case studies to you own practice in clinical
settings as a Psychiatric Nurse Practitioner.
NOTE: Positive comment
Main Post
The three questions this writer would as the patient are:
Did your depressive symptoms worsen after the death of your
husband?
How many hours per night do you sleep on average?
Do you sleep throughout those hours of sleep or do you wake
constantly?
Do you ingest any stimulants like coffee or chocolate before
bed?
Do you sleep during the daytime?
The rationale behind question one is to gauge the timeline of the
patient’s depression. She appears to have been suffering with
untreated depression for a long time, however the additional
symptoms of insomnia and tearfulness seemed to worsen after
his death. With this information the nurse practitioner will

2. know if her depression is in an acute state and the severity of
her illness.The patient is reporting sleeplessness; however the
nurse practitioner needs to gauge if the patient is participating
in restful sleep. Sleep of two hours or less may only consist of
REM sleep (Boland et al., 2020). If the patient is not getting
restful sleep, she is not benefiting from the bodily repair that
takes place during sleep (Fitzgerald et al., 2017). This can
place her at an increased risk for other illnesses and heighten
depressive symptoms (Uchmanowicz et al., 2019).Knowing if
the patient sleeps consistently throughout those hours of sleep
will provide information to the nurse about the kind and
amount of sleep the patient is getting. Ingesting certain
stimulants like caffeinated drinks, coffee or chocolate can
affects the client’s sleep by providing wakefulness (Ulke et al.,
2017). If the patient is sleeping during the daytime, her
circadian rhythm could have been reversed where she will need
less sleep during the night time hours (Fitzgerald et al., 2017).
The people this writer would interview are:
The patient’s aide
The patient’s son
The patient aide may be able to provide more information about
observed sleepiness during the daytime. In addition, she will be
able to provide information on the patient’s dietary patterns
and physical activity. The questions to the aide would be:
Does she easily nod off during the daytime?
Does she easily become fatigued?
Does she consume a well-balanced diet?
Question one would illicit answers about her getting sleep.

3. It appears that she in fact getting sleep but because of a revered
circadian rhythm she is not able to get the sleep at the night
which is the desired time. Question two will help the nurse
practitioner gauge the extent of the effects that non sleep has
taken on the patient’s life. The patient, if constantly fatigued
throughout the day has a life that has been highly impacted by
the lack of sleep. The aide would be able to provide a clear,
picture of the patient’s diet. The aide would be able to reveal if
the patient consumes a vast amount of sugar or caffeine which
could interrupt sleep.
Questions to the son would surround the family’s psychiatric
history. These questions will help the nurse practitioner
construct the family history of the patient and rule out or
consider familial history as a cause for her symptoms.
Can you recall any maternal family members with psychiatric
disorders including depression and insomnia?
Did the symptoms start after the death of the client’s husband?
This would help the nurse practitioner rule out depressive
symptoms as the cause of her insomnia.
Physical Examinations and Tests
Sleep Study:
Polysomnogram
– The sleep study or polysomnogram measures the brain
waves, blood oxygen, leg movements and breathing during
sleep (Meghdadi et al., 2019). The Nurse Practitioner would be
able to rule out physiological reason’s ad the cause for the
patient’s insomnia.

4. Actigraphy
: This is where a small device is worn on the wrist and it
measures the person’s sleep wake cycle for a specified period
(Meghdadi et al., 2019). This is convenient for this client and
the Nurse Practitioner would be able to monitor the client’s
sleep health and gauge the severity of the disruption of her
sleep.The nurse practitioner could also physically examine the
patient’s nares for septal occlusion.
Septal occlusion or deviation
could lead to problems with sleeping even during sleep, this
would be important for the nurse practitioner to evaluate as this
could be interfering with the patient’s sleep.
Epworth sleepiness scale
– assesses the patient’s tendency to nod off in various
situations (Meghdadi et al., 2019). For this client it would be
necessary for the nurse practitioner to assess the severity of her
nodding off during the day time especially at unexpected times
like during eating and other activities that would put her safety
at risk.
Differential Diagnosis
G47.00 Unspecified Insomnia Disorder
- The patient is experiencing insomnia at nighttime that could
be related to several factors. She reports staying up late to
watch T.V., depressive symptoms, restless leg syndrome, sleep
apnea and sleeping during the daytime. Some of these factors
have not been ruled out yet as the cause of her anxiety.
G47.23 Persistent Irregular Sleep Wake type severe
F32.9 Unspecified Depressive Disorder
G25.81 Restless legs syndrome

5. Medications:
Trazodone 50 mg – This medication would be the first choice as
it offers antidepressant properties as well as promotes sleep in
those diagnoses with insomnia. It is generally safe for the
elderly population at low doses (Pagel et al., 2018). The Nurse
Practitioner should monitor the patient and evaluate the needs
to slowly increase or in some cases decrease the dose.
Rozerem 8 mg- Is a nonbenzodiazepine hypnotic that promotes
sleep. The patient would benefit from his, but an added benefit
would be that she would be at a diminished risk of falls as this
is a concern following the use of hypnotics in the elderly. This
drug is reported as one that would prevent less falls from over
sedation (Pagel et al., 2018).
Lessons Learned
This writer has learned that it is important to conduct a
complete evaluation of the patient and not just focus on the
presenting symptoms. There are additional environmental and
physiological symptoms that could be attributed to the patient’s
insomnia. In this case the patient had several factors that could
be contributing her insomnia and they needed to be ruled out.
The cause of her insomnia could have been physiological from
the sleep apnea or from her habits of staying up tool late at
nights and sleeping during the daytime. It is also important to
evaluate medications, social and economic factors before the
resorting to pharmacological interventions.
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