NURS 6521 Decision Tree for Neurological and Musculoskeletal Disorders
Sample Answer for NURS 6521 Decision Tree for Neurological and Musculoskeletal Disorders Included After Question
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.
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.
By Day 7 of Week 8
Write a 1- to 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.
You will submit this Assignment in Week 8.
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A Sample Answer For the Assignment: NURS 6521 Decision Tree for Neurological and Musculoskeletal Disorders
Title: NURS 6521 Decision Tree for Neurological and Musculoskeletal Disorders
It is no coincidence that the neurological system and the musculoskeletal system share both anatomical, physiological, and functional connectivity. This structure-function relationship between the neuronal and muscular topology is responsible for influencing the disease process, the pathogenesis, presentation, diagnostic formulation, and treatment of both systems. Therefore, an understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment and helps in educating the affected patients. This paper provides an account of the interplay between the neurological and the musculoskeletal system, how the racial and ethnic variables impact the physiological functioning, and how these processes interact to affect the patient.
Pathophysiologic Processes That Would Account for The Patient Presenting These Symptoms
Conspicuously, the patient has a history of hypertension and smoking that form the basis of his clinical symptoms including left-sided weakness of both the upper and lower limbs and a mild left facial droop. These features suggest a stroke. Hypertension is a well-established cause of stroke through various mechanisms that include acceleration of the arteriosclerotic process in the cerebral arteries thus increasing the risk of stenosis, embolism, and consequently infarction. Furthermore, high intravascular pressure within the cerebral arteries leads to considerable damage to the endothelial lining and alteration of the smooth muscle function (Wajngarten & Silva, 2019). This endothelial damage and altered blood cell-endothelium interaction lead to the formation of local thrombi, ischemia, and cerebral infarction whereas smooth muscle cell degeneration leads to intracerebral hemorrhages.
Smoking on the other hand is associated with an increased risk of developing a stroke. According to Pan et al. (2019) smokers have an increased risk of overall stroke compared with nonsmokers, with a pooled odds ratio of 1.61 (95% CI: 1.34–1.93). Tobacco smoke contains a lot of chemicals that include nicotine, carbon monoxide, and cyanide among many others. These chemicals increase the risk of developing atherosclerosis, platelet aggregation, hypertension, low levels of high-density cholesterol, and high levels of low-density cholesterol. A complex and multifactorial interaction of the abovementioned factors leads to impaired vascular function resulting in both cardiovascular compromise and cerebral embolism and infarction.
Racial/Ethnic Variables That May Impact Physiological Functioning
Generally, evidence shows that a racial disparity exists in the presentation of this physiological process, affecting more blacks as compared to whites. According to a study by Howard et al. (2019), the black individuals aged between 45 and 64 years had a 3-fold increase of developing stroke as compared with the whites. Black individuals have a higher preponderance of stroke because of their high risk to develop metabolic conditions such as diabetes mellitus, hypertension, obesity, hypercholesterolemia, and smoking (Tong et al., 2021).
How These Processes Interact to Affect the Patient
Neurological and musculoskeletal processes work hand in hand. Every movement the body makes requires communication between the brain and the muscles. Consequently, a pathologic process affecting the neurological process can lead to musculoskeletal manifestations such as hemiplegia, muscle spasms, muscle atrophy, and muscle pain among others. For instance, chronic musculoskeletal pain is principally considered a nervous system disorder as a result of nervous system plasticity (George & Bishop, 2018). Similarly, several factors such as smoking, hypertension, aging, and racial variables impact these physiologic systems resulting in an inherent complexity of interactions that affect patient functioning.
Conclusion
Musculoskeletal and neurological systems are correlated. Nurses must assess both systems at a given point for effective diagnosis and treatment. It is also elemental to educate the patient concerning modifiable risk factors such as smoking and hypertension that result in occurrences that limit the functioning of the musculoskeletal and neurological systems.
References
George, S. Z., & Bishop, M. D. (2018). Chronic musculoskeletal pain is a nervous system disorder… now what? Physical Therapy, 98(4), 209–213. https://doi.org/10.1093/ptj/pzy002
Howard, V. J., Madsen, T. E., Kleindorfer, D. O., Judd, S. E., Rhodes, J. D., Soliman, E. Z., Kissela, B. M., Safford, M. M., Moy, C. S., McClure, L. A., Howard, G., & Cushman, M. (2019). Sex and race differences in the association of incident ischemic stroke with risk factors. JAMA Neurology, 76(2), 179–186. https://doi.org/10.1001/jamaneurol.2018.3862
Pan, B., Jin, X., Jun, L., Qiu, S., Zheng, Q., & Pan, M. (2019). The relationship between smoking and stroke: A meta-analysis: A meta-analysis. Medicine, 98(12), e14872. https://doi.org/10.1097/MD.0000000000014872
Tong, X., Schieb, L., George, M. G., Gillespie, C., Merritt, R. K., & Yang, Q. (2021). Racial/ethnic and geographic variations in long-term survival among Medicare beneficiaries after acute ischemic stroke. Preventing Chronic Disease, 18(200242), E15. https://doi.org/10.5888/pcd18.200242
Wajngarten, M., & Silva, G. S. (2019). Hypertension and stroke: Update on treatment. European Cardiology, 14(2), 111–115. https://doi.org/10.15420/ecr.2019.11.1
A Sample Answer 2 For the Assignment: NURS 6521 Decision Tree for Neurological and Musculoskeletal Disorders
Title: NURS 6521 Decision Tree for Neurological and Musculoskeletal Disorders
Alzheimer’s is one of the most common types of dementia among the elderly. It is a progressive disorder that starts presenting with mild memory loss (Shah, & Bennett, 2020). This disorder affects parts of the brain which control an individual’s thoughts, memory, and language. It can seriously impair the patient’s ability to conduct routine daily activities.
Summarize the Patient Case Study
The patient in the case study provided is 76 years old who was presented to the clinic by his eldest son as a result of strange behaviors. He started displaying symptoms of Alzheimer’s about two years ago. He lost interest in religious activities and started getting confused and forgetful. When Mini-Mental State Exam was administered, his score suggested moderate dementia.
Treatment Decisions
The first decision was to start Exelon (rivastigmine) 1.5 mg orally twice a day, which was to be increased to 3mg twice a day in two weeks. Based on the treatment outcome, the dose of Exelon was increased to 4.5 mg orally twice a day after 4 weeks. The last decision was to increase the dose further to 6 mg twice a day and observe the clinical outcome for the next four weeks. Rivastigmine is a cholinesterase inhibitor approved by the FDA as the first-line medication for managing symptoms of Alzheimer’s disease (Morant, Vestergaard, Lassen, & Navikas, 2020). Studies show that the recommended starting dose of Exelon is 1.5mg, to assess the patient’s tolerance, after which the dose can be increased to 3mg in two weeks. The dosage can however be increased to 4.5 mg then 6 mg depending on the patient’s tolerance and treatment outcome.
NURS 6521 Decision Tree for Neurological and Musculoskeletal Disorders
Expected Outcome
With the first decision, the patient was expected to display more than 50% remission of Alzheimer’s symptoms (Grossberg, Tong, Burke, & Tariot, 2019). Increasing the dosage in the second intervention was even expected to display further management of symptoms, as the last decision was expected for the patient’s symptoms to be completely managed.
Difference Between Expected and Actual Outcome
The first treatment outcome was quite different from what was expected as the patient’s symptoms did not improve. The second and last outcomes were exactly as expected as the patient displayed no side effects with well-controlled symptoms (Atri, 2019).
References
Morant, A. V., Vestergaard, H. T., Lassen, A. B., & Navikas, V. (2020). US, EU, and Japanese regulatory guidelines for development of drugs for treatment of Alzheimer’s disease: Implications for global drug development. Clinical and Translational Science, 13(4), 652-664. https://doi.org/10.1111/cts.12755
Grossberg, G. T., Tong, G., Burke, A. D., & Tariot, P. N. (2019). Present algorithms and future treatments for Alzheimer’s disease. Journal of Alzheimer’s Disease, 67(4), 1157-1171. DOI:10.3233/JAD-180903
Atri, A. (2019). The Alzheimer’s disease clinical spectrum: Diagnosis and management. Medical Clinics, 103(2), 263-293. DOI: 10.1016/j.mcna.2018.10.009.
Shah, R. C., & Bennett, D. A. (2020). Physicians and Alzheimer dementia: past, present, and future. Annals of internal medicine, 172(10), 695-696. https://doi.org/10.7326/M20-1500
A Sample Answer 3 For the Assignment: NURS 6521 Decision Tree for Neurological and Musculoskeletal Disorders
Title: NURS 6521 Decision Tree for Neurological and Musculoskeletal Disorders
The assigned case study demonstrates an adult Caucasian male, at the age of 43 years with pain as the main chief complaint. He reports using crutches as support to promote movement. The patient’s family doctor however claims that the patient’s pain is mental rather than physical. The physician reports that most of the patient’s symptoms are made up, as he is only trying to get narcotics. The patient reports that he started experiencing the pain about 7 years ago when he fell at his work and landed on his right hip. Mental evaluation outcome, in combination with the above presentation, led to a primary diagnosis of complex regional pain disorder (reflex sympathetic dystrophy). Several factors including the patient’s diagnosis, presenting symptoms, age, Caucasian race, and male gender will be utilized in the development of the patient’s care plan.
Decision Point One
The initial intervention was to administer 25mg of amitriptyline per oral every night and gradually increase the dose at intervals of 25 mg every week, not exceeding a maximum dose of 200mg/day. Previous evidence reveals the great effectiveness of amitriptyline in the treatment of complex regional pain disorder, with a rating of 6.6/10 (Javed & Abdi, 2021). Neurontin and Savella were inappropriate with this patient given that the former is unable to manage other symptoms of CRPD other than pain, as the latter would result in insomnia (Eldufani et al., 2020). The patient is expected to display complete remission of symptoms and ambulation without support within four weeks, with great compliance and adherence to the prescribed medication (Handa, 2021).
Decision Point Two
The second intervention was to encourage the patient to continue taking amitriptyline at a dose of 125 mg every night. According to Suer and Sehgal (2021), attaining the optimum therapeutic dose of amitriptyline can take between 4 to 8 weeks, with the patient being able to completely manage their symptoms within 8 to 12 weeks. The patient displayed great tolerance and adherence to the medication, with the only side effect being a groggy feeling in the morning that can be managed by taking the drug at least one hour before going to bed (Handa, 2021). Lowering the dose of amitriptyline, and introducing Bio freeze roll-on therapy was not necessary as the patient needs long-term therapy, rather than a temporary intervention. Adding Neurontin was also inappropriate given that amitriptyline is considered safer (Taylor et al., 2021). The patient’s symptoms are expected to reduce even further with no groggy feeling the following morning for the next four weeks.
Decision Point Three
The final decision was to advise the patient to continue taking 125mg of amitriptyline every night and refer him to a life coach for appropriate dietary interventions and physical activity/exercise. The patient reported improved pain symptoms, with no groggy feeling the following morning with the previous intervention. This shows the great effectiveness of the drug (Javed & Abdi, 2021). He, however, complained of gaining weight which is a common side effect of the medication that is usually managed with non-pharmacological intervention to promote a positive outcome for the patient (Handa, 2021). Reducing the dose of amitriptyline or introducing a new drug to the patient current regimen would only complicate the adherence and tolerance level of the patient and lead to new side effects with a negative outcome (Suer & Sehgal, 2021). However, with this intervention, the patient’s body weight is expected to normalize with complete remission of symptoms within the following four weeks (Eldufani et al., 2020).
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/
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