NURS 6521 Decision Tree for Neurological and Musculoskeletal Disorders
NURS 6521 Decision Tree for Neurological and Musculoskeletal Disorders
NURS 6521 Decision Tree for Neurological and Musculoskeletal Disorders
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.
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.
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
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.
To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.
Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 8 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Week 6: Neurologic and Musculoskeletal Disorders and Opioids
Sabrina is a 26 year old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems. Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.
As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?
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 and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.
Learning Objectives
Students will:
Evaluate patients for treatment of neurologic and musculoskeletal disorders
Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders
Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders
Learning Resources
Required Readings (click to expand/reduce)
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 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.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat complex regional pain disorders.
Disorders of The Nervous System
Reflect on the comprehensive review of disorders of the nervous system and think about how you might recommend or prescribe pharmacotherapeutics to treat these disorders. (15m)
Speed Pharmacology. (2019). Drugs for Parkinson’s Disease (Made Easy) [Video]. https://www.youtube.com/watch?v=Z84iypHdftQ&t=13s
Note: This media program is approximately 9 minutes.
Speed Pharmacology. (2019). Pharmacology- Drugs for Alzheimer’s Disease (Made Easy) [Video]. https://www.youtube.com/watch?v=euzRPrvrwj0&t=31s
Note: This media program is approximately 7 minutes.
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NURS_6521_Week8_Assignment_Rubric
Grid View
List View
Excellent Good Fair Poor
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific.
18 (18%) – 20 (20%)
The response accurately and thoroughly summarizes in detail the patient case study assigned, including specific and complete details on each of the three decisions made for the patient presented.
16 (16%) – 17 (17%)
The response accurately summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.
14 (14%) – 15 (15%)
The response inaccurately or vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.
0 (0%) – 13 (13%)
The response inaccurately and vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented, or is missing.
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.
23 (23%) – 25 (25%)
The response accurately and thoroughly explains in detail how the decisions recommended for the patient case study are supported by the evidence-based literature.
The response includes specific and relevant outside reference examples that fully support the explanation provided.
20 (20%) – 22 (22%)
The response accurately explains how the decisions recommended for the patient case study are supported by the evidence-based literature.
The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.
18 (18%) – 19 (19%)
The response inaccurately or vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature.
The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.
0 (0%) – 17 (17%)
The response inaccurately and vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature, or is missing.
The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.
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.
18 (18%) – 20 (20%)
The response accurately and thorough explains in detail what they were hoping to achieve with the decisions recommend for the patient case study assigned.
The response includes specific and relevant outside reference examples that fully support the explanation provided.
16 (16%) – 17 (17%)
The response accurately explains what they were hoping to achieve with the decisions recommended for the patient case study assigned.
The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned.
The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned, or is missing.
The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decisions in the exercise. Describe whether they were different. Be specific and provide examples.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.
The response provides specific, accurate, and relevant examples that fully support whether there were differences between the decisions made and the decisions available in the exercise.
16 (16%) – 17 (17%)
The response accurately explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.
The response provides accurate examples that support whether there were differences between the decisions made and the decisions available in the exercise.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.
The response provides inaccurate or vague examples that may or may not support whether there were differences between the decisions made and the decisions available in the exercise.
0 (0%) – 13 (13%)
vaguely explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise, or is missing.
The response provides inaccurate and vague examples that do not support whether there were differences between the decisions made and the decisions available in the exercise, or is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
4 (4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%)
Uses correct APA format with no errors
4 (4%) – 4 (4%)
Contains a few (1–2) APA format errors
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors
Total Points: 100
Name: NURS_6521_Week8_Assignment_Rubric
Grading Rubric Guidelines
Performance Category
10
9
8
4
0
Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic decisions.
Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions
Evaluates literature resources to develop a comprehensive analysis or synthesis.
Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion
Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions.
Evaluates information from source(s) to develop a coherent analysis or synthesis.
Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.
Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.
Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis.
Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion.
Demonstrates little or no understanding of the topic.
Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.
Information is taken from source(s) without any interpretation/evaluation.
The posting uses information that is not valid, relevant, or reliable
No evidence of the use of scholarly inquiry to inform or change professional or academic decisions.
Information is not valid, relevant, or reliable
Performance Category
10
9
8
4
0
Application of Course Knowledge –
Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations
Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources;
Applies concepts to personal experience in the professional setting and or relevant application to real life.
Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources.
Applies concepts to personal experience in their professional setting and or relevant application to real life
Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content
Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson.
Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life
Does not demonstrate a solid understanding of the principles and concepts presented in the lesson
Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post.
Posts are superficial and do not reflect an understanding of the lesson content
Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life
Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored
No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category
5
4
3
2
0
Interactive Dialogue
Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days.
(5 points possible per graded thread)
Exceeds minimum post requirements
Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days.
Replies to a post posed by faculty and to a peer
Summarizes what was learned from the lesson, readings, and other student posts for the week.
Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days
Replies to a question posed by a peer
Summarizes what was learned from the lesson, readings, and other student posts for the week.
Meets expectations of 2 posts on 2 different days.
The main post is not made by the Wednesday deadline
Does not reply to a question posed by a peer or faculty
Has only one post for the week
Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments
Does not post to the thread
No connections are made to the topic
Minus 1 Point
Minus 2 Point
Minus 3 Point
Minus 4 Point
Minus 5 Point
Grammar, Syntax, APA
Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted.
Points deducted for improper grammar, syntax and APA style of writing.
The source of information is the APA Manual 6th Edition
2-3 errors in APA format.
Written responses have 2-3 grammatical, spelling, and punctuation errors.
Writing style is generally clear, focused, and facilitates communication.
4-5 errors in APA format.
Writing responses have 4-5 grammatical, spelling and punctuation errors.
Writing style is somewhat focused.
6-7 errors in APA format.
Writing responses have 6-7 grammatical, spelling and punctuation errors.
Writing style is slightly focused making discussion difficult to understand.
8-10 errors in APA format.
Writing responses have 8-10 grammatical, spelling and punctuation errors.
Writing style is not focused, making discussion difficult to understand.
Post contains greater than 10 errors in APA format.
Written responses have more than 10 grammatical, spelling and punctuation errors.
Writing style does not facilitate communication.
The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
0 points lost
-5 points lost
Total Participation Requirements
per discussion thread
The student answers the threaded discussion question or topic on one day and posts a second response on another day.
The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement
per discussion thread
The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.
The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.
