Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
Write a 3-page summary paper that addresses the following:
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.
Requirements: 3 pages
10/2/23, 10:44 AMPsychopharmacologic Approaches to Treatment of Psychopathologyhttps://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html1/3Alzheimer’s Disease76-year-old Iranian Male BACKGROUNDMr. Akkad is a 76 year old Iranian male who is brought to your oce by his eldest son for“strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organicbasis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.According to his son, he has been demonstrating some strange thoughts and behaviorsfor the past two years, but things seem to be getting worse. Per the client’s son, thefamily noticed that Mr. Akkad’s personality began to change a few years ago. He began tolose interest in religious activities with the family and became more “critical” of everyone.They also noticed that things he used to take seriously had become a source of“amusement” and “ridicule.”
10/2/23, 10:44 AMPsychopharmacologic Approaches to Treatment of Psychopathologyhttps://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html2/3Over the course of the past two years, the family has noticed that Mr. Akkad has beenforgetting things. His son also reports that sometimes he has dicult “nding the rightwords” in a conversation and then will shift to an entirely dierent line of conversation.SUBJECTIVEDuring the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoyspeaking with you. You notice some confabulation during various aspects of memorytesting, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 withprimary decits in orientation, registration, attention & calculation, and recall. The scoresuggests moderate dementia.MENTAL STATUS EXAMMr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview.His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes nounusual motor movements and demonstrates no tic. Self-reported mood is euthymic.Aect however is restricted. He denies visual or auditory hallucinations. No delusional orparanoid thought processes noted. He is alert and oriented to person, partially orientedto place, but is disoriented to time and event [he reports that he thought he was comingto lunch but “wound up here”- referring to your oce, at which point he begins to laugh].Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr.Akkad’s standing up during the clinical interview and walking towards the door. Whenyou asked where he was going, he stated that he did not know. Mr. Akkad denies suicidalor homicidal ideation.Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)RESOURCES§ Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination(MMSE). Lutz, FL: Psychological Assessment Resources.
10/2/23, 10:44 AMPsychopharmacologic Approaches to Treatment of Psychopathologyhttps://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html3/3Decision Point OneSelect what you should do:Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3mg orally BID in 2 weeks(1.html): Begin Aricept (donepezil) 5 mg orally at BEDTIME(2.html)Begin Razadyne (galantamine) 4 mg orally BID(3.html)
10/2/23, 10:43 AMPsychopharmacologic Approaches to Treatment of Psychopathologyhttps://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/1.html1/3Alzheimer’s Disease76-year-old Iranian Male Decision Point OneBegin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3mg orally BID in 2 weeksRESULTS OF DECISION POINT ONE Client returns to clinic in four weeks The client is accompanied by his son who reports that his fatheris “no better” from this medication. He reports that his father
10/2/23, 10:43 AMPsychopharmacologic Approaches to Treatment of Psychopathologyhttps://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/1.html2/3is still disinterested in attending religious services/activities,and continues to exhibit disinhibited behaviors You continue to note confabulation and decide to administerthe MMSE again. Mr. Akkad again scores 18 out of 30 withprimary decits in orientation, registration, attention &calculation, and recallDecision Point TwoIncrease Exelon to 4.5 mg orally BIDRESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Client’s son reports that the client is tolerating themedication well, but is still concerned that his father is nobetter He states that his father is attending religious services withthe family, which the son and the rest of the family ishappy about. He reports that his father is still easilyamused by things he once found seriousDecision Point ThreeIncrease Exelon to 6 mg orally BID
10/2/23, 10:43 AMPsychopharmacologic Approaches to Treatment of Psychopathologyhttps://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/1.html3/3Guidance to StudentAt this point, the client is reporting no side eects and isparticipating in an important part of family life (religious services).This could speak to the fact that the medication may haveimproved some symptoms. you needs to counsel the client’s sonon the trajectory of presumptive Alzheimer’s disease in that it isirreversible, and while cholinesterase inhibitors can stabilizesymptoms, this process can take months. Also, these medicationsare incapable of reversing the degenerative process. Someimprovements in problematic behaviors (such as disinhibition) maybe seen, but not in all clients.At this point, you could maintain the current dose until the nextvisit in 4 weeks, or you could increase it to 6 mg orally BID and seehow the client is doing in 4 more weeks. Augmentation withNamenda is another possibility, but you should maximize the doseof the cholinesterase inhibitor before adding augmenting agents.However, some experts argue that combination therapy should beused from the onset of treatment.Finally, it is important to note that changes in the MMSE should beevaluated over the course of months, not weeks. The absence ofchange in the MMSE after 4 weeks of treatment should not be asource of concern.Start Over (index.html)
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