Assignment: Alzheimer\’s Disease 76 year old Iranian Male

Assignment: Alzheimer\’s Disease 76 year old Iranian Male

Assignment  Alzheimer ‘s Disease 76 year old Iranian Male

This is the same one believe you said you already had the information from the Stal web site. Week 10 Assignment Alzheimer\’s Disease 76 year old Iranian Male. Please let me know?

An Elderly Iranian Man with Alzheimer’s

Most elderly people in the United States and across the world suffer from Alzheimer’s condition. According to several studies, Alzheimer’s as a neurodegenerative condition, which starts slowly and then degenerates over a sustained period. Epidemiological data regarding the condition reveals that this disease affects over 70 per cent of elderly people with dementia in the world. The most revealing symptomology of the condition involves the presence of memory lapse concerning latest events in a patient’s life. As the condition advances, additional symptoms including mood swings, behavioral issues, language difficulties, disorientation, and the absence of self-care management begin to manifest. Gradually, the body will lose all of its vital functions, a phenomenon that will eventually culminate into death. Houmani and his colleagues (2018) assert that the lifespan of the disease varies from one patient to another yet the expectancy does not exceed nine years post-diagnosis.  More fundamentally, Alzheimer’s condition lacks a cure and the only available respite is to manage it so as to make certain that a patient enjoys an improved quality of life before their eventual demise.

In the present case study, an Iranian man whose son charges that he displays strange behaviors will be examined and pharmacologically treated by the present nurse practitioner. According to the patient interview, Mr. Akan displayed a loss of interest in things that were initially dear to him. Moreover, the patient has become forgetful in the recent past and confabulation was noticeable from his mental health testing procedure. Additional symptoms evident from the diagnostic process include impaired judgment and impulse as well as restricted affect. According to a mini-mental status examination that was conducted, the patient also suffers from a major neurocognitive disorder. The nurse suspected that the condition may have been caused by presumptive Alzheimer. Therefore, the present paper will seek to elucidate the assessment outcomes and create a pharmacological treatment therapy based on informed standard procedures. According to studies, while the condition is essentially untreatable, it can be managed pharmacologically. The pharmacological management is however influenced by factors such as dosage, proper selection of drugs, and time of use and administration route. Importantly, it is important for the nurse practitioner to monitor the responsiveness of a patient to drugs and their dosages and make fundamental adjustments after periodic assessment.

Decision Point One

Selected Decision

Decision point one presented the nurse practitioner with three important options. The first option was to start the patient on Razadyne (galantamien) 4 mg daily. The second option would see the nurse prescribe Aricept (donepezil) 5 mg orally during bedtime. Lastly, the nurse can also think of beginning begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks. Out of the three options, the nurse chose to begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks for various pharmacokinetic and pharmacodynamics reasons.

Reasons for Selection

The drug Exelon, which is the trade name of the chemical compound rivastigmine, has proven to be comparatively effective in the management of Alzheimer’s. The mechanism of action of the compound rivastigmine involves inhibition of acetylcholinesterase in the brain (Stahl, 2013). Specifically, its pharmacodynamics advantage over the other listed medications is found in the fact that it inhibits butyrylcholinesterase that is implicated in the progression of the symptoms of Alzheimer’s. Moreover, the oral route of administration ensures that the drug is well-absorbed, with a bioavailability of around 40%. The drug achieves peak plasma concentration within an hour of administration, with its peak cerebrospinal fluid concentrations occurring between 1.4-3.6 hours (Rhoads & Murphy, 2015).  Also, the drug crosses the blood-brain barrier with plasm binding protein of about 40% while it undergoes quick urinal elimination at over 97%.

On the other hand, Razadyne acts selectively by inhibiting the enzyme acetylcholinesterase. In addition, it has a plasma protein binding rate of about 18%, which is comparatively low. The drug also has a bioavailability of between 80%-100% and a terminal elimination half-life of seven hours (Cohen, L., Jann, M., & Penzak, 2016). Similar to Exelon, the drug also achieves its peak inhibition effect one hour after administration; however, this occurs at 8 mg of the drug while for Exelon, the effect was achieved at 3 mg. Donepezil is also a selective inhibitor of acetylcholinesterase, which enhances the concentrations of acetylcholine at the cholinergic synapses (Stahl, 2013). Nevertheless, its pharmacodynamics and pharmacokinetics are less superior to the above discussed drugs. Therefore, from the analysis, it was prudent for the nurse to choose Exelon based on its mechanism of action and its superior elimination and quick rate of achieving its inhibitory effect.

Expected Results

Studies concerning the effectiveness of Exelon by Yoon et al. (2017) observed that the symptomatic reversal began at around 2 weeks after administration. However, the observed improvement in the patient’s behavior after the two week period is only supposed to be slight. Additionally, the confabulatory restrictions are expected to start reducing within two weeks. This is in line with the targeted mechanism of action of Exelon’s chemical molecule.

Differences between Expected Results and Actual Results

            Upon returning to the clinic after four weeks, the patient still showed disinterest in church activities according to his son. His disinhibited behaviors still continued and his confabulation was still present. When the MMSE score was taken, he scored 18 out of 30. Thus, the only noticeable difference between the expected result and the actual result was the absence of improvement in Mr. Akid’s interest in religious activities. The difference between the expected results and the actual results could be attributable to the administered dosage since the drug is partially effective at this dose in most cases.

Decision Point Two

Selected Decision

After a review of the performance of Exelon four weeks after its administration, the nurse practitioner was presented with certain three options. These were: Increase Exelon to 4.5 mg orally BID, increase Exelon to 6 mg orally BID, Maintain current dose of Exelon, and Add Namenda (memantine) 5 mg orally per day. From the three options, the nurse practitioner chose to increase Exelon to 4.5 mg orally BID.

Reason for Selection

            When the client was given the previous dose of Exelon, he demonstrated improvement in his Alzheimer’s symptomatology. Specifically, while he has not wholly accepted to attend church activities, he has begun to show a slight interest. The manifestation of the improvement is evident that the drug has some level of effectiveness at this level. Thus, in addition to the fact that the clients has shown remarkable tolerability to the dosage, the logical thing would be to increase it to 4.5 mg. Pharmacologically, the 4.5 mg would be the maintenance dose of the drug, in order to sustain its effectiveness (Stahl, 2013). Whereas the dosage could be increased to 6 mg, it is vital for the increments to be conducted cautiously as tolerability is monitored. Moreover, prescribing Namenda (In Nageshwaran, In Ledingham, In Wilson, & In Dickenson, 2017) at the present point is not logical since the Exelon has not yet reached its maximum therapeutic level. Thus, Yoon et al. (2017) advises that it is paramount for the maximum potential option to be followed before augmentation can be considered. Also, it would be imprudent to maintain the dosage at its initial level since the drug will not produce maximum benefits. These reasons therefore support the decision to increase Exelon’s dosage to 4.5 mg.

Expected Results

            Upon increasing the drug’s dosage, the symptoms are expected to improve even further. Specifically, the restricted confabulation is expected to reduce even further due to the drug’s dosage. In addition to confabulation, the patient’s resistance towards church activities is expected to wane during the intervening period after dosage increase and the next assessment.

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            When the client came back to the clinic after four weeks had elapsed since the decision to increase Exelon’s dosage was made,

he shows remarkable improvement in certain symptoms of Alzheimer’s. For instance, his son states that Mr. Akid had started to attend church activities more frequently. As expected, some of the symptoms such as amusement towards his erstwhile favorite activities still existed. Chen et al. (2017) argues that the symptomatology of Alzheimer’s ca only be improved and not eliminated. In fact, the drug Exelon can only improve other functions but cognition hence the reason for the persistence of the amusement symptom. Thus, there was no difference between expected results and actual results after the assessment.

Decision Point Three

Selected Decision

On the twelfth week of the pharmacotherapy, the client visits the clinic again. After analysis of the progress, the nurse is expected to choose between increasing Exelon’s dosage to 6 mg and maintaining it at 4 mg. Given the prevailing circumstances, the nurse practitioner will choose to increase the dosage to 6 mg.

Reason (s) for Selection

Analysis of literary materials on the dosage and administration of Exelon reveal that the maximum dosage for the drug is 6 mg. However, the decision to prescribe a maximum dose for the drug is contingent upon the tolerability exhibited by the patient as well as safety of the medication (Cohen, L., Jann, M., & Penzak, 2016). The nurse has incrementally improved the dosage of the drug to 4.5 mg yet the client has not reacted negatively to the drug. Up until now, Mr. Akid has not complained of any side-effects or contraindications caused by the drug. Thus, it will only be logical for the nurse to increase the dosage to 6 mg pursuant to the standard procedure followed in the management of Alzheimer’s and other similar conditions. The above explanation automatically excludes maintaining the dosage at 4.5 mg. Moreover, augmenting Exelon with Namenda will not receive recommendation as Exelon is already proving effective. Also, augmenting Exelon with Namenda is a gamble that is too risky to countenance for the nurse.

Expected Results

            At 6mg, Exelon is already at its maximum dosage. Given that the drug has already improved certain symptoms, the expectation is that it will continue to improve them even further and even prevent a relapse of the affected symptoms.

Differences between Expected Results and Actual Results

            The latest assessment revealed that certain Alzheimer’s symptoms persisted when the client came back to the clinic. Nevertheless, other symptoms had improved remarkable, which was a justification to the decision to increase the dosage (Tasman et al., 2015). The two outcomes were expected as studies reveal that the degenerative feature of Alzheimer’s is not under the purview of cholinesterase inhibitors. Therefore, the nurse practitioner expected the presence of some of the symptoms of Alzheimer’s.

Ethical Considerations

            Normally, when patients seek treatment and prescriptions from mental healthcare practitioners, they expect the evident symptoms to undergo remission. However, Alzheimer’s, as already mentioned in the discussion, is a diseases of various pathophysiology and most of the formulated therapies fail to improve cognition. As such, Leuzy and Gauthier (2012) assert that during the creation of the present therapy, the nurse practitioner was supposed to remind the client and his family of the painstaking process that the treatment normally Thus, ethically, the nurse is expected to advise the patient and his family of this fact in a compassionate manner. However, during such conversations, the nurse is similarly expected to stress to the family of the need to continue with the management of the disease.

Assignment: Alzheimer\’s Disease 76 year old Iranian Male Conclusion

The management of Alzheimer’s is a complicated and painful affair. Whereas treatment options are available, the condition cannot be completely eliminated. As such, even when a patient seeks treatment with support from their family, they normally do this with the knowledge that they are simply prolonging the inevitable. Having said that, the treatment options that are available improve the quality of life of a patient by improving some of the symptomatology of the disease. To effectively do this, a nurse is required to monitor a patient for tolerability, effectiveness, and safety of administered drugs and make appropriate adjustments. Thus, the management of Alzheimer’s is a dynamic process that requires a nurse’s full attention to details including the ethics of the same.

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Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource