Shelby Grace is a 46-year-old Caucasian woman referred to you by her primary care physician for insomnia. Shelby complains of sleeplessness and sleepiness for approximately eight months. Initially, she only had difficulty staying asleep two to three nights per week. However, over the past five months, sleep and daytime fatigue have increased in severity and frequency. She now wakes up three or more times per night at least five nights per week, and on most nights has difficulty falling asleep (taking about 40 to 60 minutes). She has tried to maintain an active social and professional life. She notes increased irritability and a lack of motivation.
During the visit, you note that she has always been a poor sleeper during times of stress, but nearly always improved after a few days. For this reason, she never thought that she had insomnia and had, on occasion, taken over-the-counter medications. She also notes an increase in her caffeine intake to four cups of coffee and one to three diet colas per day.
Shelby states that while her primary care provider gave her a prescription for Ambien for sleep, she has heard “bad things about Ambien” and thus hasn’t filled the prescription.
From your perspective as Shelby’s psychiatric nurse practitioner, answer the following questions in a paper no longer than two double-spaced pages (not including the reference page) and in APA format. Include at least three peer-reviewed, evidence-based references.
Why is Ambien an effective medication for insomnia?
What group/class of drugs does Ambien belong to? What are the main pharmacokinetic differences between the other medications in this class of drugs? Identify what differences (if any) there are between the medications in this class of drug and when or why you would use one medication versus another within this class.
What dose of Ambien would you start Shelby on? Why?
What sleep hygiene education should you give Shelby?
What complementary medication (either prescription or herbal) could you recommend for Shelby?
What interactions such as food-drug, substance-drug, herbal-drug, and/or drug-drug should you educate Shelby about while taking Ambien?
What education would you provide Shelby about Ambien? What FDA warning must you include in your patient education when prescribing this medication or others like it?
Hamlet and Revenge Hamlet and retribution of vengeance have made numerous individuals breakdown. The idea of its utilization drives individuals to act deceitfully through annoyance as opposed to reason. Vengeance is simple sensible feeling; one turn merits another round. In any case, this is a risky hypothesis. Vengeance is the primary topic in Hamlet. Fortinbras, Laertes, and Hamlet are looking for vengeance for their dad's demise. In any case, thusly, every one of the three individuals rely upon feeling as opposed to suspecting and make an extremely large wager. Hamlet and retribution are hopeless organizations attempting vengeance and those looking for retribution (Hamlet) inevitably face demise after the wrongdoing. History of misfortune of retribution Prosser's view on Hamlet's vengeance "Saints are asked to fight back, as most misfortunes of retaliation, casualties or wrongdoings are legitimately identified with the hero" (Prosser) of retribution The impacts of misfortune incorporate Julius Caesar, Macbeth and Andronis. In Shakespeare 's paper by Shakespeare, Shakespeare centers around vengeance and builds up the idea of death in the play. What is the awfulness of the retribution of the Elizabethan time? This is a misfortune, its thought process is vengeance, and its fundamental plot incorporates the procedure of counter. The awfulness of retribution in the long run prompted the passing of the killer and the Avengers himself. In misfortune of vengeance, we need three letters. Shakespeare's "Hamlet" shows the overall components found in the awfulness of the vengeance of the renaissance ("misfortune of retribution"). Be that as it may, despite the fact that Hamlet is a misfortune of retribution, Shakespeare convolutes the fundamental vengeance plot by making three retribution plots. By including significant developments, Shakespeare makes 'Ship of the Concentric Revenge Miwa' (Frye 90) which is certainly not a physical legend yet an apparition, not a phantom, yet a scholarly saint who is an issue. did. viewpoint In Shakespeare's 'Hamlet' retribution, Shakespeare vindicated as the subject of the considerable number of works. Retribution assumes a significant job in the improvement of Fortinbras, Prince of Norway, Hamlet, the Prince of Denmark, and the child of Polonius Laertes. Each of the three requested vengeance for their dad's homicide. In Hamlet, vengeance can be deciphered as another character. Everybody looking for vengeance will defeat it. To begin with, after each murder every child has a reasonable activity plan.>GET ANSWER