Health Medical Homework Help

Please respond to at least 2 of your peer’s posts with substantive comments using the following steps:

• Substantive comments add to the discussion and provide your fellow students with information that will enhance the learning environment.
• References and citations should conform to APA standards.
• Remember: Please respect the opinions of others, even if their views differ. In other words, disagree professionally and respectfully.
  1. Anna

  
  Plan:

  1. Insomnia
     1. Diagnostics: The diagnosis of insomnia is made after evaluating the person’s sleep patterns, medications, psychiatric and medical conditions, and reviewing the patient’s sleep diary (Bollu & Kaur, 2019) . More information is needed to further evaluate this diagnosis in this particular patient.
     2. Therapeutics: Cognitive Behavioral Therapy is the mainstay of insomnia treatment (Bollu & Kaur, 2019).
     3. Educational: Sleep hygiene including limiting daytime naps, avoid evening electronic use, avoid late night dinners, limit evening intake of alcohol and caffeine, avoid smoking (Bollu & Kaur, 2019).
     4. Consultation/Collaboration – Refer for cognitive behavioral therapy (Bollu & Kaur, 2019).
  2. Alcohol Use
     1. Diagnostics: Diagnosed by using the CAGE questionnaire. A score of 2 or greater is sufficient for the diagnosis of alcohol use disorder. The CAGE questionnaire includes asking the following questions: Have you ever felt that you should cut down on your drinking? Have you ever been annoyed by people criticizing your drinking? Have you ever felt guilty about your alcohol use? Have you ever needed an eye-opener to steady your nerves or get rid of a hangover? (Newhrin & Freeman, 2021).
     2. Therapeutics- Recommend alcoholics anonymous (AA) meetings for the client and his family (Nehring & Freeman, 2021)
     3. Educational – Educate on the side effects and negative outcomes of chronic alcohol use including relational difficulties and liver damage (Nehring & Freeman, 2021).
     4. Consultation/Collaboration – Refer to GI for evaluation of his liver (Nehring & Freeman, 2021)

  3. AnxietyDiagnostics: The diagnosis of anxiety disorder is made when an individual meets the following criteria: at least six months of excessive anxiety and worry, difficulty controlling the worry, the anxiety causes distress and/or impairments socially and occupationally, the anxiety is not attributable to any physical cause, and the anxiety is associated with at least three of the following symptoms for a minimum of six months: restlessness, fatigue, poor concentration/mind going blank, irritability, muscle tension, sleep disturbances (Munir & Takov, 2021). Therapeutics – Cognitive Behavioral Therapy (Munir & Takov, 2021). Educational- Counsel to avoid triggers of anxiety such as caffeine, alcohol and nicotine. Educate on the importance of medication compliance, regular sleep patterns and ways to decrease stress. Start lexapro 10 mg once daily (Munir & Takov, 2021). Consultation/Collaboration – Refer for cognitive behavioral therapy. Refer to his primary care physician in order to rule out medical causes of the anxiety symptoms (Munir & Takov, 2021). Information from each of the references above is from a peer-reviewed journal. This means that the research submitted and data gained are evaluation by specialists to ensure that the information is evidence-based and is in line with current guidelines. References: Bollu, P. C., & Kaur, H. (2019). Sleep Medicine: Insomnia and Sleep. Missouri medicine, 116(1), 68–75.Munir, S., & Takov, V. (2021). Generalized Anxiety Disorder. In StatPearls. StatPearls Publishing.Nehring, S. M., & Freeman, A. M. (2021). Alcohol Use Disorder. In StatPearls. StatPearls Publishing.

  EXAMPLE response:
  Hi Anna -Good post! I agree, as you mentioned, the patient should be educated to minimize/avoid daytime napping, and “More information is needed to further evaluate this diagnosis in this particular patient.” Nevertheless, Johns Hopkins University (2021) suggests, insomnia is a contributing factor to the increased morbidity of patients with anxiety disorders. It should be considered a co-existing illness. The treatment of comorbid insomnia, should be treated separately from the treatment of anxiety disorders.Sleep deprivation is a common cause of chronic insomnia. It can be treated through medications and lifestyle changes. However, it can also last for years. Moreover, sleep deprivation can sap your energy level and disposition as well as your health, work performance, and personal satisfaction (MFMER, 1998-2021). ReferencesThe Johns Hopkins University (2021). Insomnia. Johns Hopkins Medicine.https://www.hopkinsmedicine.org/health/conditions-…Mayo Foundation for Medical Education and Research (1998-2021). Insomnia. Mayo Clinic.https://www.mayoclinic.org/diseases-conditions/ins…

  1. Kaur
  1. Insomnia (ICD-10 F51.01).
  • Diagnostics: based upon chief complaint “I’m having trouble sleeping, I need something to help me sleep” and patient’s subjective assessment. Objective assessment, BMI=41.3, the patient is morbidly obese along with other presenting symptoms, highly suspicious for obstructive sleep apnea. A comprehensive approach to therapy involves assessing both OSA and insomnia in order to provide comprehensive care. Insomnia symptoms can predict OSA and also have an adverse impact on treatment (Ong & Crawford, 2013).
  • Therapeutics – Cognitive behavioral therapy is the leading nonpharmacologic treatment for insomnia (Ong & Crawford, 2013). Trial of Melatonin, and educate the patient that Melatonin is a naturally occurring hormone that is involved in circadian rhythms which chemically signals the brain to become sleepy. Also, it is available as an over-the-counter supplement and with a lack of major side effects (Heldt, 2017).
  • Education – Educate the patient that even though alcohol makes you feel sleepy, it actually causes a loss of sleep due to disrupted sleep cycles, fragmented sleep, and nonrestorative sleep (Suni, 2020). Educate the importance of behavioral therapy. It is important to teach patients sleep hygiene. Also, educate the patient that maintaining a regular sleep schedule may be beneficial, refraining from drinking alcohol, avoiding naps during the day, avoiding caffeine near bedtime, and getting plenty of exercises may also be beneficial.
  • Consultation/Collaboration – referrals to cognitive behavioral therapy and sleep study

  2 Alcohol use ( ICD-10 – F10.99).

  • Diagnostics – CAGE Questionnaire Assessment and based upon the subjective assessment.
  • Therapeutics – Start Gabapentin. The initial dose of Gabapentin is 300 mg a day in the evening for 5 days then 300 mg twice a day and then increases to 300 mg three times a day in a few weeks. Gabapentin is a safe, readily available, and effective drug for alcohol-use disorder. Moreover, in addition to its use in treating alcohol dependence, gabapentin also has specific benefits for alcohol-induced insomnia (Mason et al., 2018). Also, there is some evidence that gabapentin is a moderately effective anti-anxiety medication without the risk of tolerance and abuse that can occur with benzodiazepines (Heldt, 2017).
  • Education – Explain how alcohol can contribute to insomnia and encourage patients to refrain from drinking. Provide information about the symptoms of alcohol dependence and withdrawal. Educate on the side effects of Gabapentin.
  • Consultation/Collaboration – referral for cognitive behavioral therapy.
  1. Anxiety ( ICD- 10-F41.9)
  • Diagnostics – Subjective assessment “ frequent feelings of anxiety”. Further assessment with PHQ-2 to assess depression.
  • Therapeutics – Start Lexapro 5 mg a day for 2 weeks then increase to Lexapro 10 mg a day. Side effects discussed in detail. Also, the patient was counsel to refrain from alcohol.

  Labs to check for CBC, CMP, TSH

  • Education – Non-pharmacological techniques such as regular aerobic exercise and yoga discussed. The patient will be educated that he can benefit from regular yoga practice by staying relaxed in daily life and also by maintaining the strength to face events without getting frustrated (Shah, 2020).
  • Consultation/Collaboration – referral for talk therapy, Cognitive behavioral therapy.

  The articles ‘Insomnia and obstructive sleep apnea’ and ‘Gabapening for alcohol use disorder’ are peer-reviewed articles and provide evidence-based guidelines. I believe in this scenario patient is having secondary insomnia due to experiencing sleep apnea symptoms. Gabapentin is generally well-tolerated, and it does not have the risk of abuse or dependency as compared to benzodiazepines. In the third article, ‘The Top 10 Tips to Deal With Stress and Panic’ yoga has been shown to improve anxiety and depression along with medical management. ReferencesHeldt, J. (2017). Memorable Psychopharmacology. CreateSpace Independent Publishing Platform. Mason, B. J., Quello, s., & Shadan, F. (2018). Gabapentin for the treatment of alcohol use disorder. US National Library of Medicine, 27(1), 113-124. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC59575…Ong, J. C., & Crawford, M. R. (2013). Insomnia and Obstructive Sleep Apnea. Sleep Medicine Clinic, 8(3), 389-398. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC37639…Shah, S. (2020). Yoga for Anxiety: The Top 10 Tips to Deal With Stress and Panic. Yoga. https://www.artofliving.org/us-en/yoga-for-anxiety…Suni, E. (2020). What Causes Insomnia? Sleep Foundation. https://www.sleepfoundation.org/insomnia/what-caus…