WHAT I NEED IS 1 REPLY COMMENT PER POST, EACH COMMENT NEEDS TWO HAVE TWO APA REFERENCE ABOVE 2013 WITH CITATION. POST1 The selected case for this discussion is case number five which involves sleepy woman with anxiety . The three questions to ask the patient a. Does anxiety interfere with your ability to concentrate? The choice for this question is based on the fact that anxiety can send one into a true tailspin of disruptive and irrational thinking which interferes with the ability to focus b. Which medication did you use for narcolepsy? The question will help in determining if the drugs used to treat past narcolepsy was effective to avoid possible onset. c. Do you experience headache, dizziness, nausea, vomiting, constipation or dry mouth? The question will help determine if the patient is responding positively to bupropion. These are some of the side effects of bupropion and therefore, persistent of these symptoms would mean the patient is not responding well to bupropion The people in the patient’s life to speak to or get feedback from for further assessment of the patient’s situation a. The husband : How do you describe the sleeping pattern of your wife? The question will help in determining if the patient is having sleeping disorder, that is, excessive sleep. b. Former class teacher : How do you describe the concentration of the patient while in class? Lack of concentration is one of symptoms of sleep apnea and therefore, the question will determine if the patient has recurring sleep apnea. The physical exams and diagnostic tests that would be appropriate for the patient and the use of the results I will perform physical exam to look for signs and symptoms of anxiety such as nervousness, restlessness, panics, rapid heartrate and weakness and lethargy. The result will be used to determine severity of the anxiety disorder and consequently helps in selecting the most effective medication. I will also use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). I will also use polysomnography to monitors heart, lung and brain activity, breathing pattern to help in ruling the presence of absence of sleep apnea (Mokhlesi & Cifu, 2017). The three differential diagnoses for the patient The first differential diagnosis is anxiety disorder. The patient presents symptoms of anxiety such as excessive sleep during the day. The second differential diagnosis could be sleep apnea. This order can make one to feel tired and unrefreshed. During the day, one may feel fatigued and experiencing difficulty concentrating or unintentionally fall asleep. Further, obstructive sleep apnea is the most likely differential diagnosis for this patient. This is because obstructive sleep apnea is associated with excessive daytime sleep just like evidenced in the patient. The third differential diagnosis is narcolepsy. The past medical history of the patients showed that she had been diagnosed with narcolepsy and therefore, it is possible that the patient has another onset of narcolepsy. Hypersomnia is another possible condition of the patient because she is having or excessive sleepiness. The patient has trouble staying awake during the day. Insomnia is another possible condition as the patient has daytime impairment related daytime sleepiness (Ardani et al. 2016). Two pharmacologic agents and their dosing appropriate for the patient’s sleep/wake therapy The first pharmacologic agent that would be appropriate for the patient’s sleep/wake therapy by considering that the patient has narcolepsy is to start initial dosage of amphetamines at 10 mg orally per day in divided doses. The medication will be used induce daytime alertness because the patient is experiencing excessive sleep which is a symptom of obstructive sleep apnea. The second pharmacologic agent that would be appropriate for the patient’s sleep/wake therapy is gabapentin. The medication is useful in patients with restless leg syndrome and i…
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