NURS 6630 Week 7 Discussion
Case 1: Volume 2, Case #16: 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.
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.
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).
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https://www.coursehero.com/file/33466518/NURS-6630-Week-7-Discussiondocx/
, 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.
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
This study source was downloaded by 100000849840424 from CourseHero.com on 07-25-2022 05:37:27 GMT -05:00
https://www.coursehero.com/file/33466518/NURS-6630-Week-7-Discussiondocx/
Case 1: Volume 2, Case #16: 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.
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.
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).
This study source was downloaded by 100000849840424 from CourseHero.com on 07-25-2022 05:37:27 GMT -05:00
https://www.coursehero.com/file/33466518/NURS-6630-Week-7-Discussiondocx/
, 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.
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
This study source was downloaded by 100000849840424 from CourseHero.com on 07-25-2022 05:37:27 GMT -05:00
https://www.coursehero.com/file/33466518/NURS-6630-Week-7-Discussiondocx/
