FIU Appreciation for Detailed Presentation on NMs Case Discussion

ASSIGNMENT: Provide a response to discussion prompts that your colleagues provided in their video presentations. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient. To two (2) separate students.

STUDENT 1 TOPIC AND PLEASE PROVIDE TWO SEPARATE RESPONSES WITH AT LEAST 3 PARAGRAPHS TO EACH WITH SCHOLARLY REFERENCE .

Example :
**Student 1 :
-Response 1 , Thank you Mr. Raul for your video presentation, it was very informative. I believe….. (based on student question and presentation) .. .. … Continue for at least 2-3 paragraph . with Reference.

-Response 2, : Mr. Raul , I also believe and would like to add that to this diagnosis or treatment that ….. (based on question and presentation). . . . . . Continue 2-3 parapgraph with reference.

***Student 2 , with two separate responses and References

Respond to
Student 1: MR. RAUL question topic:

—–> Question: 1.Recognize psychopharmacology/psychotherapy options for treatment plan for dementia.

HPI: CC (chief complaint): “I forget everything, I have difficulty finding my keys”

HPI: Patient N.M is a 78-years-old Hispanic male who presents with his wife for a psychiatry evaluation, he was referred by his PCP due to some behaviors changes, forgetful, some decline in cognitions and new learning taskes. Patient has history of hypertension and diabetes which are well compensated with medication. Patient’s wife reported that the patient had changed his behavior for the past few years, having problem remembering where he left things like his house keys, easily irritable and verbally agitated sometimes with no reason, unable to pay bills at home because he gets confused. His wife reported that patient change his mood every late afternoon, he usually is in good mood in the morning but when the night start he change to a different person. Patient’s whife reported the patient started few months ago telling her she is cheating on him, and start confabulating that she hide the man in the house and text him at night. Patient’s wife reported that he is not always aggressive or agitated, and sometimes he looks down, isolated, not sleeping at night, refusing to eat because his wife put poison on the food, and go to bed for days and not taking care of his ADLs.

Diagnostic Impression:Mild Neurocognitive Disorder, due to Alzheimer’s disease:

• Risks and benefits of medication were discussed with patient and his wife, including non-medical treatment.
• Potential side effects explained, possible nauseas, diarrheas, and insomnia are side effects reported with the use of Donepezil.
• Discussed the risk of possible medication interaction if mixed with OTC medications. Explained how alcohol affect mental, physical and sleep health.

Patient will initiate Donepezil 5 mg oral at bedtime, indicated to slow down progression of the disease, dose could be increased within 4 to 6 weeks to 10 mg daily and to 23 mg over 3 months of therapy (Boland, Verdiun, & Ruiz, 2022).

Student 2, Ms. Brittany

Question: 1)What medications should be avoided in the elderly and why? Support your answer.
2) What is an alternative therapy/ non-pharmacologic treatment for GAD?

Case to read : CC (chief complaint): “Doing Well”

HPI: MD is a 73-year-old white female presenting today for a follow up assessment and psychotropic medication management session. Patient reports she is doing well, moods have been stable and she is feeling positive. She is having some short-term memory impairment walking in a room and forgetting what she was going to get. At work she doesn’t have this memory impairment as bad as she does at home. Her sleep has been fair. Still expresses difficulty with sleep initiation but has fair sleep maintenance. Therapy with Sandy at Lake Mary Counseling has been helpful to work through traumas and decrease depression also. She feels therapy and medication combination are helpful. She denies any new medical or medication changes. Her appetite is good, although she admits to poor food choices. She denies any SI/SHI/HI. She endorses satisfaction with current drug regimen, and she is uninterested in medication changes at this time.

Diagnostic Impression : Generalized Anxiety (GAD)

ReflectionsThis patient was placed on Wellbutrin XL 150 mg daily and I had questioned that she was on a medication that she indicated in her chart that was ineffective. Upon further discussion with my preceptor, she stated that the trial was ineffective and therefore she felt it was a good option for this patient. It is important to discuss medications with patients and specific reactions to medications they feel were ineffective.

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