Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
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Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.
Photo Credit: KATERYNA KON/SCIENCE PHOTO LIBRARY / Science Photo Library / Getty Images
To Prepare
Review the interactive media piece assigned by your Instructor.
Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.
BELOW IS THE QUESTION
Write a 2-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.
BELOW IS THE REQUIRED READING————————-
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Chapter 11, “Basic Principles of Neuropharmacology” (pp. 67–71)
Chapter 12, “Physiology of the Peripheral Nervous System” (pp. 72–81)
Chapter 12, “Muscarinic Agonists and Cholinesterase Inhibitors” (pp. 82–89)
Chapter 14, “Muscarinic Antagonists” (pp. 90-98)
Chapter 15, “Adrenergic Agonists” (pp. 99–107)
Chapter 16, “Adrenergic Antagonists” (pp. 108–119)
Chapter 17, “Indirect-Acting Antiadrenergic Agents” (pp. 120–124)
Chapter 18, “Introduction to Central Nervous System Pharmacology” (pp. 125–126)
Chapter 19, “Drugs for Parkinson Disease” (pp. 127–142)
Chapter 20, “Drugs for Alzheimer Disease” (pp. 159–166)
Chapter 21, “Drugs for Seizure Disorders” (pp. 150–170)
Chapter 22, “Drugs for Muscle Spasm and Spasticity” (pp. 171–178)
Chapter 24, “Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics” (pp. 183–194)
Chapter 59, “Drug Therapy of Rheumatoid Arthritis” (pp. 513–527)
Chapter 60, “Drug Therapy of Gout” (pp. 528–536)
Chapter 61, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 537–556)
American Academy of Family Physicians. (2019). Dementia. Retrieved from http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=5
This website provides information relating to the diagnosis, treatment, and patient education of dementia. It also presents information on complications and special cases of dementia.
Linn, B. S., Mahvan, T., Smith, B. E. Y., Oung, A. B., Aschenbrenner, H., & Berg, J. M. (2020). Tips and tools for safe opioid prescribing: This review–with tables summarizing opioid options, dosing considerations, and recommendations for tapering–will help you provide rigorous Tx for noncancer pain while ensuring patient safety. Journal of Family Practice, 69(6), 280–292..
This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise (Please utilize the Alzheimer’s Disease: Interactive Media File) and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.
Alzheimer’s Disease
76-year-old Iranian Male
76-year-old Iranian Male
BACKGROUND
Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis 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 behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose 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.”
Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.
SUBJECTIVE
During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.
MENTAL STATUS EXAM
Mr. 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 no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, 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. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or 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.
Decision Point One
Select what you should do:
Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks.
Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks.
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
The client is accompanied by his son who reports that his father is “no better” from this medication. He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors
You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall
: Begin Aricept (donepezil) 5 mg orally at BEDTIME.
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better
He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious
Begin Razadyne (galantamine) 4 mg orally BID.
Decision Point Three
Discontinue Aricept and restart Razadyne at 4 mg orally BID
Guidance to Student
The client is experiencing usual side effects associated with Aricept. The issue may be that the medication was started at too high of a dose. Many times, especially in older adults, side effects are dose dependent. Aricept is generally started at 5 mg orally daily at bedtime for the first 4–6 weeks, at which point it can be increased to 10 mg orally at bedtime. The fact that the client had such a significant group of side effects at 10 mg indicates that the drug should not be restarted at 10 mg orally at bedtime, as the client would most likely experience these side effects again. Restarting the drug at the appropriate starting dose, while also educating the client and his son about the potential side effects of Aricept, would be appropriate.
The side effect profile that the client is experiencing is most likely dose dependent. Discontinuation of Aricept and initiation of Razadyne can certainly be done, especially with a therapeutic dose of Razadyne such as the one suggested here. However, you should educate the client and his son as to the fact that the side effects experienced may have been dose dependent and transient.
Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change
in the MMSE after 4 weeks of treatment should not be a source of concern.
Please make sure to use 7th edition APA format ,add 5 references not more than 5 years old and make sure you go through the grading rubric.
this paper must include title page, introduction,summary with appropriate citation. Please make sure to use headings to indicate part of the question you are answering and also provide examples as indicated in the question.
http://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html
Please copy the above link and open it and then you can see everything like I already placed for you.
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