The patient is a 71-year-old widowed man who is seen regularly in the clinic for health maintenance and follow-up of his chronic insomnia and anxiety. He has regular prescriptions for triazolam (Halcion) and clonazepam (Klonopin) for these problems. Recently he has been reporting frequent episodes of losing his balance and falling, and eight weeks ago was hospitalized for a hip fracture sustained during one of these falls resulting in hip surgery. On this visit, he also complains of becoming increasingly confused.
What information would be most critical for you to collect in the first visit?
What is the primary goal for the treatment of this patient?
- Identify potential obstacles for change. Which educational approach would the PMHNP provide to overcome these obstacles?
- How would you teach the patient about the Beers list and Halcion?
- Discuss a medication in detail that could be safely substituted to treat insomnia in geriatric patients.
- Submission Instructions:
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Introduction:
As a medical professor responsible for creating assignments and evaluating student performance, I will provide comprehensive answers to the content mentioned. The provided information describes a case of a 71-year-old widowed man presenting with chronic insomnia and anxiety, along with complaints of losing balance, falls, confusion, and a recent hip fracture. In this case, we need to gather critical information, establish the primary treatment goal, identify potential obstacles, educate the patient about the Beers list and Halcion, and discuss an alternative medication for insomnia in geriatric patients.
Answer to Question 1 – What information would be most critical for you to collect in the first visit?
During the initial visit, it is crucial to collect comprehensive information about the patient’s medical history, including the duration and severity of insomnia and anxiety symptoms, previous treatments, and responses. Evaluating the patient’s prior medication use, including triazolam (Halcion) and clonazepam (Klonopin), is essential. The history of falls, including frequency, circumstances, and any associated injuries, particularly the recent hip fracture, requires thorough exploration. Inquiring about any recent changes in the patient’s cognitive function or the presence of confusion is also necessary. Additionally, gathering social history, such as the patient’s living environment and support system, can provide important contextual information.
Answer to Question 2 – What is the primary goal for the treatment of this patient?
The primary treatment goal for this patient is to improve sleep quality, manage anxiety symptoms, prevent falls, and reduce confusion. A comprehensive approach should involve addressing the underlying causes of insomnia and anxiety, optimizing medication management, and implementing non-pharmacological interventions to improve sleep hygiene. Minimizing the risk of falls through appropriate interventions, such as physical therapy and environmental modifications, is crucial. If the confusion is related to medication side effects, it should be addressed by adjusting the medication regimen.
Answer to Question 3 – Identify potential obstacles for change. Which educational approach would the PMHNP provide to overcome these obstacles?
Potential obstacles for change in this patient may include medication adherence, resistance to modifying current medication regimen, and difficulties implementing non-pharmacological interventions. The PMHNP should provide patient-centered education, involving active listening and empathy, to establish a therapeutic alliance. The PMHNP should assess the patient’s beliefs, concerns, and expectations, providing tailored education to address any misconceptions or fears regarding changing medication or incorporating non-pharmacological approaches. The educational approach should be patient-centered, emphasizing the potential benefits of change while addressing individual barriers.
Answer to Question 4 – How would you teach the patient about the Beers list and Halcion?
To educate the patient about the Beers list and Halcion, the PMHNP should provide clear and concise information regarding medication safety in older adults. The PMHNP should explain that the Beers list is a tool that identifies medications with a higher potential to cause harm or adverse effects in the elderly population. Specifically, Halcion, which is a benzodiazepine medication commonly prescribed for insomnia, is included in the Beers list due to its effects on cognitive function and fall risk. The PMHNP should highlight the importance of medication review and the need for potential alternative options to reduce harm and improve overall safety.
Answer to Question 5 – Discuss a medication in detail that could be safely substituted to treat insomnia in geriatric patients.
A medication that could be safely substituted to treat insomnia in geriatric patients is trazodone. Trazodone is an antidepressant that is widely used off-label to manage insomnia in this population. It has sedating properties and a favorable side effect profile in comparison to benzodiazepines. Trazodone’s mechanism of action involves selective serotonin reuptake inhibition and antagonism of histamine receptors. It is generally well-tolerated, with a lower risk of cognitive impairment, falls, addiction, and withdrawal symptoms compared to benzodiazepines. However, it is important to consider individual patient characteristics and potential contraindications or drug interactions before initiating trazodone therapy.
In conclusion, this assignment provides an opportunity for medical college students to critically analyze a case involving a geriatric patient with chronic insomnia, anxiety, falls, and confusion. By collecting critical information, establishing treatment goals, identifying potential obstacles, educating about the Beers list and Halcion, and discussing alternative medications, students can develop a comprehensive understanding of managing insomnia in this population.
