NURS 6630 Week 7 Discussion – Case 1: Volume 2, Case #16: The woman who liked a late-night TV

The woman who liked a late-night TV

The patient is a 70-year-old woman who exhibits symptoms of depression due to loneliness. Her son and aide assist in her care. She is hard of hearing and has other cardiological problems. She also has a family history of depression. Her ailment worsened because she was unable to sleep and consequently has s restless leg syndrome.

The three questions I will ask the patient in my office are as follows;

1. Do you feel sleepy or do you have sleep attacks during the day and describe your usual night sleep (Hours of sleep, quality of sleep, etc.)? Lack of sleep results in more health problems and worsens depression. NURS 6630 Week 7 Discussion.

2. Have any members in your family been depressed? Genetic loading in depression, anxiety or schizophrenia. Get medication effectiveness of family similar to patient’s disorder.

3. Have you ever suffered from depression, anxiety or similar problems? Pt exhibited symptoms of depression-crying, sadness etc. Patient’s mother has history of depression.

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Patient’s son and the home health aide are the persons assisting with his care. So, I will direct my questions to his mother as well as her home health aide about depression history, sleeping pattern, the activity of daily living and patient’s compliance with the medication regimen.

physical exams and diagnostic tests

Actigraphy is a device that measures and records movement. It is worn on the wrist and can be used as a rough measure of the sleep-wake cycle. It is useful for assessing insomnia, circadian rhythm disorders, movement disorders and an assortment of rare events (Sadock, 2015). NURS 6630 Week 7 Discussion.

Polysomnography is the continuous attended, comprehensive recording of the biophysiological changes that occur during sleep. It is recorded at night and lasts between 6 and 8 hours. NURS 6630 Week 7 Discussion Brainwave activity, eye movements, submental electromyography activity, nasal-oral airway flow, respiratory effort, oxyhemoglobin saturation, heart rhythm, and leg movement during sleep are measured (Sadock, 2015).

Three differential diagnoses

1. Major Depressive Disorder (MDD)

A major depressive disorder is a depressed mood that persists for least two weeks duration or longer. Signs and symptoms of major depression include poor appetite, insomnia or hypersomnia, low energy or fatigue, low self-esteem, lack of concentration or difficulty making decisions, and feelings of hopelessness, significant weight loss or weight gain and recurring thought of death or suicide (Sadock, 2015). The predisposing factors to this illness include responses to a significant loss such as grief, a financial ruin from natural disaster, or severe medical illness or disability and other factors such as environmental (stressful life events), genetic and physiological or other psychosocial factors. All currently available antidepressants may take 3 to 4 weeks to exert significant therapeutic effects, although they may begin to show their effects earlier. Examples of antidepressant medications include SSRIs, TCAs, and MAOIs.

2. Insomnia

Sleep is regulated by basic mechanisms, and when these systems go awry, sleep disorders occur. Sleep disorders are both dangerous and difficult to treat. Obstruction Sleep Apnea (OSA) Insomnia is defined as difficulty initiating sleep. DSM-5 defines insomnia disorder as dissatisfaction with sleep quantity or quality with one or more of the following symptoms: difficulty in maintaining sleep with frequent awakenings and early morning inability to return to sleep. NURS 6630 Week 7 Discussion Primary insomnia is a condition resulting from too much arousal both at night and day time and may progress to a first major depressive episode (Stahl, 2013). Pharmacologic treatment includes Benzodiazepines, zolpidem, eszopiclone, zaleplon, and Trazodone.

3. Restless Leg Syndrome (RLS)

RLS also known as Ekbom syndrome is an uncomfortable, subjective sensation of the limbs. Usually, the legs, sometimes described as a “creepy crawly” feeling, and the irresistible urge to move the legs when at rest or while trying to fall asleep. Patients often rep