The case study is about a 76-year-old male Iranian patient suspected of having Alzheimer’s disease. The conclusion is reports based on his eldest son, and during the test, there were no organic disease processes found. The behavioral changes began two years earlier, which involved changes in personality and apathy, accompanied by memory loss, which challenges in recognizing the appropriate words. During the speech, self-reported euthymic mood and clinical interview confabulation are often noticed. The patient often has an impairment and a lack of impulse control in his insight and judgment. There is no reported ideation of suicide, and because of Alzheimer’s disease, the patient is diagnosed with neurocognitive disorder.
Donepezil 5 mg at bedtime will be used as the first approach. The donepezil use has been studied for decades by patients who have Alzheimer’s disease. The medication is an inhibitor of acetylcholinesterase, which raises the brain’s acetylcholine levels also makes up for the reduced cholinergic neurons function (Čolović, Krstić, Lazarević-Pašti, Bondžić, & Vasić, 2013). An evaluation of randomized clinical trials analyzes the effect that donepezil has on Alzheimer’s patients utilizing randomized control trials. The results revealed that there is evidence that donepezil is effective in managing this condition in three main fields, including behavior, functional capacity, and cognition (Knowles, 2006, pp. 195–219). These are the key areas in which the patient affected as well as the aim was to reduce his quality of life effect. As demonstrated in the case, he had major personality changes that had a negative impact on his involvement in activities of interest.
The effects of Donepezil vary as complications may occur along with minimal clinical benefits. The patient-reported side effects documented in patients taking this medication, like appetite, loss of weight, nausea, vomiting, and diarrhea. (Kumar & Sharma., 2019).
The second decision was cognitive behavioral therapy use, that has been shown to have a beneficial effect in early-stage patients of Alzheimer’s disease. In isolated cases, evidence suggesting psychosocial treatments for dementia patients identified (Forstmeier, Maercker, Savaskan, & Roth, 2015). There is also limited empirical information on such approaches, though. Among patients who have neuropsychiatric symptoms, certain researchers have described behavioral treatments as necessary. This may also be used by the patient to promote behavior, especially directed at reducing apathy & enhancing the patient’s self-control. Mood improvement might have a positive effect on the quality of life as well as the patient’s ability to engage in activities that increase his cognitive status.
In this case, the third decision will involve family members in the therapeutic process, which will continue to improve behaviors that help the patient. The aim is to improve the patient’s support system and also daily interactions, though it has been shown to have a significant effect on the emotional and cognitive well-being of dementia patients.
References
Čolović, M. B., Krstić, D. Z., Lazarević-Pašti, T. D., Bondžić, A. M., & Vasić, a. V. (2013). Acetylcholinesterase inhibitors: pharmacology and toxicology. Curr Neuropharmacol, 11(3), 315–335. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648782/
Forstmeier, S., Maercker, A., Savaskan, E., & Roth, a. T. (2015). Cognitive-behavioral treatment for mild Alzheimer’s patients and their caregivers (CBTAC): study protocol for a randomized controlled trial. Trials., 16. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650298/
Knowles, J. (2006). Donepezil in Alzheimer’s disease: an evidence-based review of its impact on clinical and economic outcomes. Core Evid., 1(3), 195–219. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321665/
Kumar, A., & Sharma., S. (2019). Donepezil. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513257/
A Sample Answer 3 For the Assignment: NURS 6521 Decision Tree for Neurological and Musculoskeletal
Title: NURS 6521 Decision Tree for Neurological and Musculoskeletal
Alzheimer’s is one of the most common progressive neurological disorders among the elderly caused by dementia. Patients will present with mild to moderate cognitive signs and symptoms at the onset of the disorder, which will progress to severe memory loss with time, as they grow much older (Li et al., 2019). However, several treatment options have been proven to be effective in the management of Alzheimer’s disorder among the elderly. The purpose of this discussion is to illustrate the decision process in selecting the most effective drug, based on pharmacokinetic and pharmacodynamic factors, for treating an elderly patient diagnosed with Alzheimer’s disease.
Patient Case Study Summary
The assigned case study demonstrates a 76-year-old Iranian male with symptoms of Alzheimer’s disorder. The patient displays strange behavior upon arrival at the clinic reporting symptoms of memory loss, forgetfulness, confusion, and diminished interest in religious activities for the last 2 years. Pharmacokinetic and pharmacodynamic patient factors which contributed to the selection of drugs for this patient include his advanced age, male gender, Iranian race, and presenting symptoms in addition to the mini-mental exam results of moderate dementia. the patient’s diagnosis of Alzheimer’s disorder will also be considered.
Treatment Decisions
Based on the patient history and the pharmacokinetic and pharmacodynamic factors mentioned above, the most appropriate intervention is to initiate Exelon 1.5mg twice daily. Exelon (rivastigmine) is an FFDA-approved drug for treating mild to moderate Alzheimer’s disease (Fish et al., 2019). Previous studies support great effectiveness, and safety profile for use of the drug among the elderly diagnosed with Alzheimer’s (Khoury et al., 2018). The second decision was to increase the dose of Exelon to 4.5 mg twice daily as recommended by most clinical practice guidelines for patients who have displayed great tolerance but with minimal effectiveness. The last decision was to increase the dose further to 6mg twice daily, to promote optimal effectiveness as the patient still displayed limited remission of symptoms with the previous intervention.
Expected Outcome
Studies show that Exelon when administered appropriately takes between 8 to 12 weeks to completely manage symptoms of Alzheimer’s among elderly patients. As such, with the initial intervention of 1.5mg Exelon twice daily, the patient was expected to display approximately 50% remission of symptoms (Nguyen et al., 2021). The dose was however to be titrated to obtain the optimum outcome, not exceeding 6mg twice daily. The same results were expected with the second and third interventions with no side effects expected.
Difference Between Expected Outcome and Actual Outcome
Just like expected, the patient displayed a minimal reduction of symptoms of Alzheimer’s with no side effects reported with the first intervention. After the dose was increased in the second intervention, the patient reported further remission of symptoms, but at a slow rate, hence increasing the dose in the last intervention, which led to optimal remission of Alzheimer’s symptoms just as expected (Huang et al., 2020).
Conclusion
Alzheimer’s is a common disorder among the elderly compromising their quality of life and well-being. For the patient in the provided case study, it was necessary to administer Exelon at a starting dose of 1.5 mg which was titrated to 4.5mg then 6.5mg twice daily. The patient displayed great effectiveness with this medication in the management of his Alzheimer’s symptoms, with no side effects reported.
References
Fish, P. V., Steadman, D., Bayle, E. D., & Whiting, P. (2019). New approaches for the treatment of Alzheimer’s disease. Bioorganic & medicinal chemistry letters, 29(2), 125-133. https://doi.org/10.1016/j.bmcl.2018.11.034
Huang, L. K., Chao, S. P., & Hu, C. J. (2020). Clinical trials of new drugs for Alzheimer’s disease. Journal of biomedical science, 27(1), 1-13. https://doi.org/10.1186/s12929-019-0609-7
Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current therapies for Alzheimer’s disease: focus on rivastigmine. Therapeutic Advances in Drug Safety, 9(3), 171-178. https://doi.org/10.1177/2042098617750555
Li, D. D., Zhang, Y. H., Zhang, W., & Zhao, P. (2019). Meta-analysis of randomized controlled trials on the efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer’s disease. Frontiers in neuroscience, 13, 472. https://doi.org/10.3389/fnins.2019.00472
Nguyen, K., Hoffman, H., Chakkamparambil, B., & Grossberg, G. T. (2021). Evaluation of rivastigmine in Alzheimer’s disease. Neurodegenerative Disease Management, 11(1), 35-48. https://doi.org/10.2217/nmt-2020-0052
Name: NURS_6521_Week8_Assignment_Rubric
NURS 6521 Decision Tree for Neurological and Musculoskeletal Grading Rubric
| Performance Category |
100% or highest level of performance
100%
16 points |
Very good or high level of performance
88%
14 points |
Acceptable level of performance
81%
13 points |
Inadequate demonstration of expectations
68%
11 points |
Deficient level of performance
56%
9 points
|
Failing level
of performance
55% or less
0 points |
| Total Points Possible= 50 |
16 Points |
14 Points |
13 Points |
11 Points |
9 Points |
0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
- Provides evidence of scholarly inquiry relevant to required TD topic(s).
- Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
- Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
- Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
|
Presentation of information was good, but was superficial in places and included all of the following elements:
- Provides evidence of scholarly inquiry relevant to required TD topic(s).
- Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
- Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
- Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
|
Presentation of information was minimally demonstrated in all of the following elements:
- Provides evidence of scholarly inquiry relevant to required TD topic(s).
- Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
- Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
- Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
|
Presentation of information is unsatisfactory in one of the following elements:
- Provides evidence of scholarly inquiry relevant to required TD topic(s).
- Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
- Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
- Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
|
Presentation of information is unsatisfactory in two of the following elements:
- Provides evidence of scholarly inquiry relevant to required TD topic(s).
- Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
- Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
- Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
|
Presentation of information is unsatisfactory in three or more of the following elements
- Provides evidence of scholarly inquiry relevant to required TD topic(s).
- Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
- Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
- Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information
|
|
16 Points |
14 Points |
13 Points |
11 Points |
9 Points |
0 Points |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
- Applies principles, knowledge and information from scholarly resources to the required topic.
- Applies facts, principles or concepts learned from scholarly resources to a professional experience.
- Application of information is comprehensive and specific to the required topic.
|
Presentation of information was good, but was superficial in places and included all of the following elements:
- Applies principles, knowledge and information from scholarly resources to the required topic.
- Applies facts, principles or concepts learned from scholarly resources to a professional experience.
- Application of information is comprehensive and specific to the required topic.
|
Presentation of information was minimally demonstrated in the all of the following elements:
- Applies principles, knowledge and information from scholarly resources to the required topic.
- Applies facts, principles or concepts learned from scholarly resources to a professional experience.
- Application of information is comprehensive and specific to the required topic.
|
Presentation of information is unsatisfactory in one of the following elements:
- Applies principles, knowledge and information from scholarly resources to the required topic.
- Applies facts, principles or concepts learned from and scholarly resources to a professional experience.
- Application of information is comprehensive and specific to the required topic.
|
Presentation of information is unsatisfactory in two of the following elements:
- Applies principles, knowledge and information from scholarly resources to the required topic.
- Applies facts, principles or concepts learned from scholarly resources to a professional experience.
- Application of information is comprehensive and specific to the required topic.
|
Presentation of information is unsatisfactory in three of the following elements
- Applies principles, knowledge and information and scholarly resources to the required topic.
- Applies facts, principles or concepts learned scholarly resources to a professional experience.
- Application of information is comprehensive and specific to the required topic.
|
| |
10 Points |
9 Points |
|
|
6 Points |
0 Points |
| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count)
The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count)
Responses are substantive and relate to the topic. |
Demonstrated all of the following:
- Initial post must be a minimum of 300 words.
- The peer and instructor responses must be a minimum of 150 words each.
- Responses are substantive
- Responses are related to the topic of discussion.
|
Demonstrated 3 of the following:
- Initial post must be a minimum of 300 words.
- The peer and instructor responses must be a minimum of 150 words each.
- Responses are substantive
- Responses are related to the topic of discussion.
|
|
|
Demonstrated 2 of the following:
- Initial post must be a minimum of 300 words.
- The peer and instructor responses must be a minimum of 150 words each.
- Responses are substantive
- Responses are related to the topic of discussion.
|
Demonstrated 1 or less of the following:
- Initial post must be a minimum of 300 words.
- The peer and instructor responses must be a minimum of 150 words each.
- Responses are substantive
- Responses are related to the topic of discussion.
|
| |
8 Points |
7 Points |
6 Points |
5 Points |
4 Points |
0 Points |
| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing.
The source of information is the APA Manual 6th Edition
Error is defined to be a unique APA error. Same type of error is only counted as one error. |
The following was present:
AND
- Responses have 0-3 grammatical, spelling or punctuation errors
AND
- Writing style is generally clear, focused on topic,and facilitates communication.
|
The following was present:
- 4-6 errors in APA format.
AND/OR
- Responses have 4-5 grammatical, spelling or punctuation errors
AND/OR
- Writing style is somewhat focused on topic.
|
The following was present:
- 7-9 errors in APA format.
AND/OR
- Responses have 6-7 grammatical, spelling or punctuation errors
AND/OR
- Writing style is slightly focused on topic making discussion difficult to understand.
|
The following was present:
- 10- 12 errors in APA format
AND/OR
- Responses have 8-9 grammatical, spelling and punctuation errors
AND/OR
- Writing style is not focused on topic, making discussion difficult to understand.
|
The following was present:
- 13 – 15 errors in APA format
AND/OR
- Responses have 8-10 grammatical, spelling or punctuation errors
AND/OR
- Writing style is not focused on topic, making discussion difficult to understand.
AND/OR
- The student continues to make repeated mistakes in any of the above areas after written correction by the instructor.
|
The following was present:
- 16 to greater errors in APA format.
AND/OR
- Responses have more than 10 grammatical, spelling or punctuation errors.
AND/OR
- Writing style does not facilitate communication
|
| |
0 Points Deducted |
|
|
|
|
5 Points Lost |
| Participation
Requirements |
Demonstrated the following:
- Initial, peer, and faculty postings were made on 3 separate days
|
|
|
|
|
Failed to demonstrate the following:
- Initial, peer, and faculty postings were made on 3 separate days
|
| |
0 Points Lost |
|
|
|
|
5 Points Lost |
| Due Date Requirements |
Demonstrated all of the following:
- The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
|
|
|
|
Demonstrates one or less of the following.
- The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
