Seraphina Alvarez, age 55, is an elementary school teacher who has planned on retiring at the end of this academic year. She is the married mother of seven adult children, six of whom live within a 15-mile radius and see her often. Her husband, Joe, has been retired for 3 years. He receives Social Security and a small pension from his former employment as a construction worker. Seraphina and Joe’s oldest daughter’s two children and two dogs came to live with them approximately 10 months ago because their daughter is unable to provide a home for them. The children, Joseph, age 15, and Mariah, age 12, are “good kids.” They are good students who are active in school and church activities. They resent having to move from their long-time home and school and are acting-out some. Seraphina also resents having to raise her grandchildren. It interferes with plans that she and her husband had made to travel after she retired. In fact, she may not be able to retire as planned because they need the extra income to meet the children’s needs. She loves the children and tries very hard not to let her resentment show. She also has guilt feelings that she did not do all she could or should have done to raise her daughter to be a responsible parent. As a result, she is unable to sleep well and reports having anxiety. Seraphina first turned to herbal remedies common in her culture and to prayer. Neither of these interventions has helped, but she is reluctant to discuss her problems with anyone else. She sees her parish priest on a regular basis. He is very supportive of her and understanding of her feelings of resentment but does not realize that she is experiencing anxiety and insomnia. Seraphina, whose health has always been good, has begun having some health issues, including hypertension, diarrhoea, and weight loss. She finds herself becoming more anxious, and her family has noticed that she is decreasing time spent with family and friends and does not leave her home other than to go to work and to go to church. She has lost 16kg (35 lb) in 2 months and appears to have lost her “zest” for living. Her diet consists of black coffee and fresh fruit. Joe frequently finds her sitting in a rocking chair on their front porch during the night, rather than being in bed. She also has begun missing work, saying “I just don’t feel up to facing the kids today.”
1. What current factors in Seraphina’s life are interfering with her ability to get a good night’s sleep? 2. What medications may Seraphina’s health care provider order on a short-term or longer-term basis? 3. What part do herbal remedies play in anxiety control and sleep induction in the Latino culture? What specific herbs is Seraphina probably using?