Case Study: Diagnose Shelby Grace, a 46-year-old woman from a transcript

You are seeing a new patient, Case Study: Diagnose Shelby Grace, a 46-year-old woman from a transcript
Shelby’s Transcript:
Hello. What’s my problem? Hmm, well, I think it’s sleeping, or well, not sleeping as the case may be but I’m thinking that’s not the real problem because then I’d go see my doctor or get a sleep study done. So I’m seeing you instead.

For about the last 8 months or so, when I go to bed, it seems like I’m not at all sleepy, but when I need to be awake, I am sleepy. It weren’t so bad at first. I only had difficulty staying asleep maybe two to three times per week. However, over the past five months, sleep and daytime fatigue, it increased in severity and frequency.

Sometimes I’m so tired I briefly nod off while at my workstation. Btu despite being profoundly tired while at work, I still can’t get to sleep at home! Given what I do at the pharmaceutical company, it’s making things even more stressful.

I’ve been at the factory for about a year. I work rotating shifts. It’s a 12-hour shift, and my schedule varies weekly. I work nights 9 p.m. to 9 a.m. four days one week, then I do days 9 a.m. 9 p.m. four days the next. Sometimes a bonus shift’ll be available for overtime and of course I’ll always take that. Although that means I’m back at work six hours after I get home maybe, uh, three times a month.

Most a the time I have extreme difficulty falling asleep, at least 40 to 60 minutes. And then I wake up three or more times at least five nights per week.

I’ve tried to maintain an active life. But I’m being so much more irritable, I have trouble concentrating, got low energy, and a lack of motivation to go out. What can I do? Or better yet, what can you do to help me?

From your perspective as Shelby’s psychiatric nurse practitioner, answer the following questions in a paper that is in APA format. Include at least three peer-reviewed, evidence-based references.

1. What are two DSM-5 diagnoses you would consider for Shelby? Explain your rationale.
2. What are the likely neurobiological causes of her problems? Explain your rationale.
3. What medication options are available to address her chief complaints? What medication(s) would you prescribe to Shelby? Give the starting dose, route, frequency, timing, and rationale for why you would prescribe the medication(s) you choose.
4. What education would you provide Shelby if you were to prescribe her a sedative hypnotic medication? What FDA warning must you include in your patient education when prescribing this medication or others like it?
5. What is an herbal or “all natural” treatment you could recommend to Shelby?
6. What sleep hygiene education will you give Shelby?

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