According to Dr. Lee, Mrs. Gomez had been suffering from hypertension and diabetes. This condition could be the reason that Mrs. Gomez has trouble getting adequate sleep. Medical research shows that there is a connection between diabetes and sleep apnea. For patients with breathing apnea, they might frequently have moments where they have halted breathe while they are breathing. When a patient suffers such a condition, they find themselves waking up repeatedly throughout the night and therefore they will not have a favorable sleep pattern. In the morning the patient will be having fatigue and will not have rested.
Moreover, the fact that Mrs. Gomez has diabetes could be the reason she is having difficulty sleeping. It has been proven that diabetes leads to disorders that make it hard to sleep. Patients with type 2 diabetes have an increased risk for restless leg syndrome, periodic limb movements and they suffer pain associated disruption (Taylor, 2014). Consequently, the patients experience strange feelings around the legs in the evening and this makes them find it hard falling asleep.
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Studies have shown that there is a link between hypertension and insomnia among elderly patients. According to Sforza, et al. (2014) insomnia is closely associated with increased blood pressure and increased risk of hypertension. Women are more vulnerable to suffering negative impacts of insomnia. If a patient continues to suffer from insomnia for a long time, they will risk having issues with morbidity or worse their risk of mortality might increase. For elderly patients who sleep less than five hours, a day they will have a high risk of hypertension.
It is apparent that Mrs. Gomez does not have pain or breathing difficulties that could lead her to a lack of good sleeping time. Additionally, the patient does not experience apneic spells. The fact that the patient lost her husband makes her sad and it is possible she is suffering from depression. This is also the reason she can concentrate on doing essential chores, reading, and Going to church. She has the inability to focus, and she doesn’t have much energy, sometimes she gets in slow motion, and she has stopped the activities she previously enjoyed. The diseases she is suffering from Hypertension and diabetes could also be the cause of the depressive symptoms.
Physical Exam and Diagnostic Tools
From her history, the problem of difficulty in sleeping is more as a result of depression rather than hypertension and diabetes. Considering the patient has lost her husband, she is sad, and that is the reason she has problems with concentration and has lost interest in the things she used to enjoy. However, examining the patient proves she doesn’t have suicidal, and she is a religious woman. The fact that Mrs. Gomez depressive symptoms are seven out of ten in the major depressive diagnostic criteria points out she is suffering from depression (Blackburn, Wilkins-Ho, & Wiese, 2017). She has also lost interest in going to church, and she cannot concentrate on daily chores.
According to medical studies, the elderly are more vulnerable to depression, but only 10 percent of the patients get treatment. The reason behind this failure is that the elderly display different symptoms of depression. The disease is also confused with the effects of multiple illnesses that the elderly suffer from. It is also reported that depression among older adults last longer and such patients have a minimal capability of benefiting from rehabilitation.
One of the steps that can be used in treating insomnia for Mrs. Gomez would involve minimizing her exposure to Benzodiazepine medicines. Example of this drugs includes Ativan, Klonopin, and Xanax and Hypnotic drugs such as Ambien and Lunesta. According to medical research, these drugs increase the risk of impaired alertness, respiratory depression, and fall (Nagai et al, 2013). Alternatively, Mrs. Gomez might need to be administered with hormone melatonin and low dosages of antidepressants to help treat insomnia.
According to Blackburn, et al. (2017), some of the predisposing factors of depression include previous clinical depression, physical and chronic disabling illnesses, drug use, and persistent sleep difficulties. When a medical nurse identifies these factors they should examine the patient Using the DSM-5 criteria. However is essential to avoid confusing the symptoms of loss of interest and pleasure to that of dementia. The tools that can be utilized for depression in the elderly patient include the Geriatric depression scale (GDS) this is a questionnaire for self-rated assessment and the last device is the Cornell scale for depression in dementia (CSDD); involves interviewing family members or caregiver and the patient.
Differential Diagnosis
Diagnose for bipolar disorder; with this type of diagnosis the physician will need to ask the patient if they had any manic or hypomanic episodes. These episodes causes disturbances and would make it difficult for the patient to find sleep. This diagnoses also measures the possibility of the patient suffering from dementia that causes confusion and apathy.
Diagnosis for adjustment disorder associated with depressed mood; this diagnoses evaluates the environment of the patient and assess the effects of the mid features of depression and considers depressing conditions such as grief and loss of a loved one.
Diagnosing for drug induced mood disorder; patients might need to be examined to determine if they have been using drugs such as alcohol or cannabis. Having alcohol induced mood disorder is a common occurrence and it’s a major reason why the elderly suffer insomnia.
I choose these diagnosis techniques for Mrs. Gomez because they would be used to establish the kind of medications and care that she requires. For the final diagnosis I would choose the diagnosis for adjustment disorder integrated with the GDS questionnaires. These would be significant in measuring how the loss of her husband have worsened her depression. Additionally, it would measure the care she is receiving from her close relatives or caregivers and determine if there is any kind of deficiency in the care.
Treatment
Depression in order adults might be treated using various practices. One option is the use of psychotherapy, the magnitude of the effect varies what the types of control group used. The approach is described as being moderately effective. Other treatment options include medicine, counseling’s, electroconvulsive therapy and brain stimulation. The type of medication depends on the severity of depression symptoms. Antidepressants are perceived to be a right approach to treating depression and insomnia, but the risk of side effects should be considered in older patients. A physician might consider avoiding Amitriptyline and Imipramine because they have a sedating effect.
In the case of Mrs. Gomez, I recommend the use of cognitive therapy to treat her depression. This therapy is known to be effective in defusing thoughts and can be use dot eliminate negative and suicidal thoughts (Blackburn, Wilkins-Ho, & Wiese, 2017). The approach is preferable because it reduces symptoms of fatigue, poor esteem and improves concentration. The patient would use it to effectively recognize and correct negative thoughts.
References
Blackburn, P., Wilkins-Ho, M., & Wiese, B. S. (2017). Depression in older adults: Diagnosis and management. British Columbia Medical Journal, 59(3).
Nagai, M., Hoshide, S., Nishikawa, M., Shimada, K., & Kario, K. (2013). Sleep duration and insomnia in the elderly: associations with blood pressure variability and carotid artery remodeling. American journal of hypertension, 26(8), 981-989.
Sforza, E., Saint Martin, M., Barthelemy, J. C., & Roche, F. (2014). Association of self-reported sleep and hypertension in non-insomniac elderly subjects. Journal of Clinical Sleep Medicine, 10(09), 965-971.
Taylor, W. D. (2014). Depression in the elderly. New England journal of medicine, 371(13), 1228-1236.
