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\u2019s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.<\/p>\n
Photo Credit: KATERYNA KON\/SCIENCE PHOTO LIBRARY \/ Science Photo Library \/ Getty Images<\/p>\n
To Prepare<\/strong><\/h2>\n\n- Review the interactive media piece assigned by your Instructor.<\/li>\n
- Reflect on the patient\u2019s symptoms and aspects of the disorder presented in the interactive media piece.<\/li>\n
- Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.<\/li>\n
- 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\u2019s diagnosis and treatment.<\/li>\n<\/ul>\n
By Day 7 of Week 8<\/strong><\/h2>\nWrite a 1- to 2-page summary paper that addresses the following:<\/p>\n
\n- Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.<\/li>\n
- 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.<\/li>\n
- 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.<\/li>\n
- 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.<\/li>\n<\/ul>\n
You will submit this Assignment in Week 8.<\/strong><\/p>\nSubmission and Grading Information<\/strong><\/p>\nTo submit your completed Assignment for review and grading, do the following:<\/strong><\/p>\n\n- Please save your Assignment using the naming convention \u201cWK8Assgn+last name+first initial.(extension)\u201d as the name.<\/li>\n
- Click the\u00a0Week 8 Assignment Rubric\u00a0<\/strong>to review the Grading Criteria for the Assignment.<\/li>\n
- Click the\u00a0Week 8 Assignment\u00a0<\/strong>link. You will also be able to \u201cView Rubric\u201d for grading criteria from this area.<\/li>\n
- Next, from the Attach File area, click on the\u00a0Browse My Computer<\/strong>\u00a0button. Find the document you saved as \u201cWK8Assgn+last name+first initial.(extension)\u201d and click\u00a0Open<\/strong>.<\/li>\n
- If applicable: From the Plagiarism Tools area, click the checkbox for\u00a0I agree to submit my paper(s) to the Global Reference Database<\/strong>.<\/li>\n
- Click on the\u00a0Submit<\/strong>\u00a0button to complete your submission.<\/li>\n<\/ul>\n
A Sample Answer For the Assignment: DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/h2>\nTitle: <\/strong> DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/h2>\nThe case study depicts a 43-year-old white male who presents with a complaint of pain. He uses a set of clutches when ambulating. The patient reports that he has been referred for psychiatric assessment<\/a> by his family doctor since the doctor perceived that he had psychological pain (Laureate Education, 2016). The pain began seven years ago after sustaining a fall and landed on the right hip. Four years ago, it was revealed that the cartilage around the right hip joint had a 75% tear.\u00a0 However, no surgeon was willing to perform a total hip replacement since they believed that there would be tissue repair over time (Laureate Education, 2016). He reports having severe cramping of the right extremity. A neurologist diagnosed him with complex regional pain syndrome (CRPS). He states that he gets low moods at times but denies being depressed.\u00a0 He had been prescribed with Hydrocone but used it in low doses due to drowsiness and constipation, and the drug does not manage pain effectively (Laureate Education, 2016). The mental status exam is unremarkable.<\/p>\nDecision Point One: <\/strong>Savella 12.5 mg orally once daily on Day 1, followed by 12.5 mg BD on Day 2 and 3, then 25 mg BD on days 4-7 and then 50 mg BD after that.<\/p>\nReason: <\/strong>Savella is a serotonin-norepinephrine reuptake inhibitor that has NMDA antagonist activity, which brings analgesia at the nerve endings (Cording et al<\/em>., 2015). It is indicated for fibromyalgia and thus effective for this client (Cording et al<\/em>., 2015). I prescribed Savella to help in pain management and improve the overall mood.<\/p>\nExpected Result: <\/strong>I anticipated that Savella would lower the degree of pain. However, it was expected that the client would experience adverse effects such as nausea, constipation, headache, hot flushes, and insomnia<\/a>.<\/p>\nExpected Vs. Actual Results: <\/strong>The client returned to the clinic after for weeks without using crutches but with a bit of limping. He states that the pain has been more manageable. The pain is severe in the morning but improves throughout the day (Laureate Education, 2016). On a scale of 1-10, the client rates the pain at four and states that he gets to a point on most days where he does not need crutches. Nevertheless, he reported having increased sweating, sleeping difficulties, nausea, and palpitations (Laureate Education, 2016). His BP was 147\/92, and the pulse at 110. He denied having suicidal ideations and was still future-oriented.<\/p>\nDecision Point 2: <\/strong>Continue with Savella but lower dose to 25 mg twice a day.<\/p>\nReason: <\/strong>I selected this decision to lower the severity of the adverse effects of Savella, which include nausea, constipation, headache, hot flushes, and insomnia (Cording et al<\/em>., 2015).<\/p>\nExpected Result: <\/strong>Reduction in the dose of Savella would help control the side effects but lower the degree of pain control.<\/p>\nExpected Vs. Actual Results: <\/strong>The client returned to the clinic in four weeks using crutches and rates his current pain at 7\/10. He reports that his condition has declined since the previous month (Laureate Education, 2016). He states that he sleeps at night but frequently wakes up due to pain in the right leg and foot. The BP is at 124\/87 and pulse at 87. He denies having palpitations and suicidal ideations but is discouraged by the slip in pain management<\/a> and seems sad.<\/p>\nClick here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/a><\/span><\/em><\/h3>\n![\"DECISION](\"http:\/\/nursingassignmentcrackers.com\/wp-content\/uploads\/2023\/02\/DECISION-TREE-FOR-NEUROLOGICAL-AND-MUSCULOSKELETAL-NURS-6521-300x135.png\")
DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/figcaption><\/figure>\nDecision Point 3: <\/strong>Change Savella to 25 mg in the morning and 50 mg at Bedtime.<\/p>\nI reduced the dosage in the morning since the pain is mostly under control and increased the dose at Bedtime when there is less control (Resmini et al<\/em>., 2015).<\/p>\nExpected Result: <\/strong>By lowering the morning dose and increasing the bedtime dose, I expected that the client\u2019s pain symptom would improve while at the same time controlling the side effects of Savella (Resmini et al<\/em>., 2015).<\/p>\nExpected Vs. Actual Results: <\/strong>The client reported an improvement in the pain with a rate of 3\/10 denied having any side effects from the drug.<\/p>\nReferences<\/h2>\n
Cording, M., Derry, S., Phillips, T., Moore, R. A., & Wiffen, P. J. (2015). Milnacipran for pain in fibromyalgia in adults.\u00a0Cochrane Database of Systematic Reviews<\/em>, (10).<\/p>\nLaureate Education. (2016). Case Study: A Caucasian man with hip pain<\/em>. Baltimore, MD: Author.<\/p>\nResmini, G., Ratti, C., Canton, G., Murena, L., Moretti, A., & Iolascon, G. (2015). Treatment of complex regional pain syndrome.\u00a0Clinical cases in mineral and bone metabolism: the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases<\/em>,\u00a012<\/em>(Suppl 1), 26\u201330. https:\/\/doi.org\/10.11138\/ccmbm\/2015.12.3s.026<\/a><\/p>\nA Sample Answer 2 For the Assignment: DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/h2>\nTitle: <\/strong> DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/h2>\nAlzheimer\u2019s 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\u2019s 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\u2019s disease.<\/p>\n
Patient Case Study Summary<\/strong><\/h2>\nThe assigned case study demonstrates a 76-year-old Iranian male with symptoms of Alzheimer\u2019s 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\u2019s diagnosis of Alzheimer\u2019s disorder will also be considered.<\/p>\n
Treatment Decisions<\/strong><\/h2>\nBased 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\u2019s disease (Fish et al., 2019). Previous studies support great effectiveness, and safety profile for use of the drug among the elderly diagnosed with Alzheimer\u2019s (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.<\/p>\n
Expected Outcome<\/strong><\/h2>\nStudies show that Exelon when administered appropriately takes between 8 to 12 weeks to completely manage symptoms of Alzheimer\u2019s 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.<\/p>\n
Difference Between Expected Outcome and Actual Outcome<\/strong><\/h2>\nJust like expected, the patient displayed a minimal reduction of symptoms of Alzheimer\u2019s 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\u2019s symptoms just as expected (Huang et al., 2020).<\/p>\n
Conclusion<\/strong><\/h2>\nAlzheimer\u2019s 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\u2019s symptoms, with no side effects reported.<\/p>\n
<\/p>\n
References<\/strong><\/h2>\nFish, P. V., Steadman, D., Bayle, E. D., & Whiting, P. (2019). New approaches for the treatment of Alzheimer\u2019s disease.\u00a0Bioorganic & medicinal chemistry letters<\/em>,\u00a029<\/em>(2), 125-133. https:\/\/doi.org\/10.1016\/j.bmcl.2018.11.034<\/a><\/p>\nHuang, L. K., Chao, S. P., & Hu, C. J. (2020). Clinical trials of new drugs for Alzheimer\u2019s disease.\u00a0Journal of biomedical science<\/em>,\u00a027<\/em>(1), 1-13. https:\/\/doi.org\/10.1186\/s12929-019-0609-7<\/a><\/p>\nKhoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current therapies for Alzheimer\u2019s disease: focus on rivastigmine.\u00a0Therapeutic Advances in Drug Safety<\/em>,\u00a09<\/em>(3), 171-178. https:\/\/doi.org\/10.1177\/2042098617750555<\/a><\/p>\nLi, 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\u2019s disease.\u00a0Frontiers in neuroscience<\/em>,\u00a013<\/em>, 472. https:\/\/doi.org\/10.3389\/fnins.2019.00472<\/a><\/p>\n
By Day 7 of Week 8<\/strong><\/h2>\nWrite a 1- to 2-page summary paper that addresses the following:<\/p>\n
\n- Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.<\/li>\n
- 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.<\/li>\n
- 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.<\/li>\n
- 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.<\/li>\n<\/ul>\n
You will submit this Assignment in Week 8.<\/strong><\/p>\nSubmission and Grading Information<\/strong><\/p>\nTo submit your completed Assignment for review and grading, do the following:<\/strong><\/p>\n\n- Please save your Assignment using the naming convention \u201cWK8Assgn+last name+first initial.(extension)\u201d as the name.<\/li>\n
- Click the\u00a0Week 8 Assignment Rubric\u00a0<\/strong>to review the Grading Criteria for the Assignment.<\/li>\n
- Click the\u00a0Week 8 Assignment\u00a0<\/strong>link. You will also be able to \u201cView Rubric\u201d for grading criteria from this area.<\/li>\n
- Next, from the Attach File area, click on the\u00a0Browse My Computer<\/strong>\u00a0button. Find the document you saved as \u201cWK8Assgn+last name+first initial.(extension)\u201d and click\u00a0Open<\/strong>.<\/li>\n
- If applicable: From the Plagiarism Tools area, click the checkbox for\u00a0I agree to submit my paper(s) to the Global Reference Database<\/strong>.<\/li>\n
- Click on the\u00a0Submit<\/strong>\u00a0button to complete your submission.<\/li>\n<\/ul>\n
A Sample Answer For the Assignment: DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/h2>\nTitle: <\/strong> DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/h2>\nThe case study depicts a 43-year-old white male who presents with a complaint of pain. He uses a set of clutches when ambulating. The patient reports that he has been referred for psychiatric assessment<\/a> by his family doctor since the doctor perceived that he had psychological pain (Laureate Education, 2016). The pain began seven years ago after sustaining a fall and landed on the right hip. Four years ago, it was revealed that the cartilage around the right hip joint had a 75% tear.\u00a0 However, no surgeon was willing to perform a total hip replacement since they believed that there would be tissue repair over time (Laureate Education, 2016). He reports having severe cramping of the right extremity. A neurologist diagnosed him with complex regional pain syndrome (CRPS). He states that he gets low moods at times but denies being depressed.\u00a0 He had been prescribed with Hydrocone but used it in low doses due to drowsiness and constipation, and the drug does not manage pain effectively (Laureate Education, 2016). The mental status exam is unremarkable.<\/p>\nDecision Point One: <\/strong>Savella 12.5 mg orally once daily on Day 1, followed by 12.5 mg BD on Day 2 and 3, then 25 mg BD on days 4-7 and then 50 mg BD after that.<\/p>\nReason: <\/strong>Savella is a serotonin-norepinephrine reuptake inhibitor that has NMDA antagonist activity, which brings analgesia at the nerve endings (Cording et al<\/em>., 2015). It is indicated for fibromyalgia and thus effective for this client (Cording et al<\/em>., 2015). I prescribed Savella to help in pain management and improve the overall mood.<\/p>\nExpected Result: <\/strong>I anticipated that Savella would lower the degree of pain. However, it was expected that the client would experience adverse effects such as nausea, constipation, headache, hot flushes, and insomnia<\/a>.<\/p>\nExpected Vs. Actual Results: <\/strong>The client returned to the clinic after for weeks without using crutches but with a bit of limping. He states that the pain has been more manageable. The pain is severe in the morning but improves throughout the day (Laureate Education, 2016). On a scale of 1-10, the client rates the pain at four and states that he gets to a point on most days where he does not need crutches. Nevertheless, he reported having increased sweating, sleeping difficulties, nausea, and palpitations (Laureate Education, 2016). His BP was 147\/92, and the pulse at 110. He denied having suicidal ideations and was still future-oriented.<\/p>\nDecision Point 2: <\/strong>Continue with Savella but lower dose to 25 mg twice a day.<\/p>\nReason: <\/strong>I selected this decision to lower the severity of the adverse effects of Savella, which include nausea, constipation, headache, hot flushes, and insomnia (Cording et al<\/em>., 2015).<\/p>\nExpected Result: <\/strong>Reduction in the dose of Savella would help control the side effects but lower the degree of pain control.<\/p>\nExpected Vs. Actual Results: <\/strong>The client returned to the clinic in four weeks using crutches and rates his current pain at 7\/10. He reports that his condition has declined since the previous month (Laureate Education, 2016). He states that he sleeps at night but frequently wakes up due to pain in the right leg and foot. The BP is at 124\/87 and pulse at 87. He denies having palpitations and suicidal ideations but is discouraged by the slip in pain management<\/a> and seems sad.<\/p>\nClick here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/a><\/span><\/em><\/h3>\nDECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/figcaption><\/figure>\nDecision Point 3: <\/strong>Change Savella to 25 mg in the morning and 50 mg at Bedtime.<\/p>\nI reduced the dosage in the morning since the pain is mostly under control and increased the dose at Bedtime when there is less control (Resmini et al<\/em>., 2015).<\/p>\nExpected Result: <\/strong>By lowering the morning dose and increasing the bedtime dose, I expected that the client\u2019s pain symptom would improve while at the same time controlling the side effects of Savella (Resmini et al<\/em>., 2015).<\/p>\nExpected Vs. Actual Results: <\/strong>The client reported an improvement in the pain with a rate of 3\/10 denied having any side effects from the drug.<\/p>\nReferences<\/h2>\n
Cording, M., Derry, S., Phillips, T., Moore, R. A., & Wiffen, P. J. (2015). Milnacipran for pain in fibromyalgia in adults.\u00a0Cochrane Database of Systematic Reviews<\/em>, (10).<\/p>\nLaureate Education. (2016). Case Study: A Caucasian man with hip pain<\/em>. Baltimore, MD: Author.<\/p>\nResmini, G., Ratti, C., Canton, G., Murena, L., Moretti, A., & Iolascon, G. (2015). Treatment of complex regional pain syndrome.\u00a0Clinical cases in mineral and bone metabolism: the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases<\/em>,\u00a012<\/em>(Suppl 1), 26\u201330. https:\/\/doi.org\/10.11138\/ccmbm\/2015.12.3s.026<\/a><\/p>\nA Sample Answer 2 For the Assignment: DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/h2>\nTitle: <\/strong> DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/h2>\nAlzheimer\u2019s 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\u2019s 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\u2019s disease.<\/p>\n
Patient Case Study Summary<\/strong><\/h2>\nThe assigned case study demonstrates a 76-year-old Iranian male with symptoms of Alzheimer\u2019s 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\u2019s diagnosis of Alzheimer\u2019s disorder will also be considered.<\/p>\n
Treatment Decisions<\/strong><\/h2>\nBased 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\u2019s disease (Fish et al., 2019). Previous studies support great effectiveness, and safety profile for use of the drug among the elderly diagnosed with Alzheimer\u2019s (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.<\/p>\n
Expected Outcome<\/strong><\/h2>\nStudies show that Exelon when administered appropriately takes between 8 to 12 weeks to completely manage symptoms of Alzheimer\u2019s 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.<\/p>\n
Difference Between Expected Outcome and Actual Outcome<\/strong><\/h2>\nJust like expected, the patient displayed a minimal reduction of symptoms of Alzheimer\u2019s 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\u2019s symptoms just as expected (Huang et al., 2020).<\/p>\n
Conclusion<\/strong><\/h2>\nAlzheimer\u2019s 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\u2019s symptoms, with no side effects reported.<\/p>\n
<\/p>\n
References<\/strong><\/h2>\nFish, P. V., Steadman, D., Bayle, E. D., & Whiting, P. (2019). New approaches for the treatment of Alzheimer\u2019s disease.\u00a0Bioorganic & medicinal chemistry letters<\/em>,\u00a029<\/em>(2), 125-133. https:\/\/doi.org\/10.1016\/j.bmcl.2018.11.034<\/a><\/p>\nHuang, L. K., Chao, S. P., & Hu, C. J. (2020). Clinical trials of new drugs for Alzheimer\u2019s disease.\u00a0Journal of biomedical science<\/em>,\u00a027<\/em>(1), 1-13. https:\/\/doi.org\/10.1186\/s12929-019-0609-7<\/a><\/p>\nKhoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current therapies for Alzheimer\u2019s disease: focus on rivastigmine.\u00a0Therapeutic Advances in Drug Safety<\/em>,\u00a09<\/em>(3), 171-178. https:\/\/doi.org\/10.1177\/2042098617750555<\/a><\/p>\nLi, 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\u2019s disease.\u00a0Frontiers in neuroscience<\/em>,\u00a013<\/em>, 472. https:\/\/doi.org\/10.3389\/fnins.2019.00472<\/a><\/p>\n
You will submit this Assignment in Week 8.<\/strong><\/p>\n Submission and Grading Information<\/strong><\/p>\n To submit your completed Assignment for review and grading, do the following:<\/strong><\/p>\n The case study depicts a 43-year-old white male who presents with a complaint of pain. He uses a set of clutches when ambulating. The patient reports that he has been referred for psychiatric assessment<\/a> by his family doctor since the doctor perceived that he had psychological pain (Laureate Education, 2016). The pain began seven years ago after sustaining a fall and landed on the right hip. Four years ago, it was revealed that the cartilage around the right hip joint had a 75% tear.\u00a0 However, no surgeon was willing to perform a total hip replacement since they believed that there would be tissue repair over time (Laureate Education, 2016). He reports having severe cramping of the right extremity. A neurologist diagnosed him with complex regional pain syndrome (CRPS). He states that he gets low moods at times but denies being depressed.\u00a0 He had been prescribed with Hydrocone but used it in low doses due to drowsiness and constipation, and the drug does not manage pain effectively (Laureate Education, 2016). The mental status exam is unremarkable.<\/p>\n Decision Point One: <\/strong>Savella 12.5 mg orally once daily on Day 1, followed by 12.5 mg BD on Day 2 and 3, then 25 mg BD on days 4-7 and then 50 mg BD after that.<\/p>\n Reason: <\/strong>Savella is a serotonin-norepinephrine reuptake inhibitor that has NMDA antagonist activity, which brings analgesia at the nerve endings (Cording et al<\/em>., 2015). It is indicated for fibromyalgia and thus effective for this client (Cording et al<\/em>., 2015). I prescribed Savella to help in pain management and improve the overall mood.<\/p>\n Expected Result: <\/strong>I anticipated that Savella would lower the degree of pain. However, it was expected that the client would experience adverse effects such as nausea, constipation, headache, hot flushes, and insomnia<\/a>.<\/p>\n Expected Vs. Actual Results: <\/strong>The client returned to the clinic after for weeks without using crutches but with a bit of limping. He states that the pain has been more manageable. The pain is severe in the morning but improves throughout the day (Laureate Education, 2016). On a scale of 1-10, the client rates the pain at four and states that he gets to a point on most days where he does not need crutches. Nevertheless, he reported having increased sweating, sleeping difficulties, nausea, and palpitations (Laureate Education, 2016). His BP was 147\/92, and the pulse at 110. He denied having suicidal ideations and was still future-oriented.<\/p>\n Decision Point 2: <\/strong>Continue with Savella but lower dose to 25 mg twice a day.<\/p>\n Reason: <\/strong>I selected this decision to lower the severity of the adverse effects of Savella, which include nausea, constipation, headache, hot flushes, and insomnia (Cording et al<\/em>., 2015).<\/p>\n Expected Result: <\/strong>Reduction in the dose of Savella would help control the side effects but lower the degree of pain control.<\/p>\n Expected Vs. Actual Results: <\/strong>The client returned to the clinic in four weeks using crutches and rates his current pain at 7\/10. He reports that his condition has declined since the previous month (Laureate Education, 2016). He states that he sleeps at night but frequently wakes up due to pain in the right leg and foot. The BP is at 124\/87 and pulse at 87. He denies having palpitations and suicidal ideations but is discouraged by the slip in pain management<\/a> and seems sad.<\/p>\n Decision Point 3: <\/strong>Change Savella to 25 mg in the morning and 50 mg at Bedtime.<\/p>\n I reduced the dosage in the morning since the pain is mostly under control and increased the dose at Bedtime when there is less control (Resmini et al<\/em>., 2015).<\/p>\n Expected Result: <\/strong>By lowering the morning dose and increasing the bedtime dose, I expected that the client\u2019s pain symptom would improve while at the same time controlling the side effects of Savella (Resmini et al<\/em>., 2015).<\/p>\n Expected Vs. Actual Results: <\/strong>The client reported an improvement in the pain with a rate of 3\/10 denied having any side effects from the drug.<\/p>\n Cording, M., Derry, S., Phillips, T., Moore, R. A., & Wiffen, P. J. (2015). Milnacipran for pain in fibromyalgia in adults.\u00a0Cochrane Database of Systematic Reviews<\/em>, (10).<\/p>\n Laureate Education. (2016). Case Study: A Caucasian man with hip pain<\/em>. Baltimore, MD: Author.<\/p>\n Resmini, G., Ratti, C., Canton, G., Murena, L., Moretti, A., & Iolascon, G. (2015). Treatment of complex regional pain syndrome.\u00a0Clinical cases in mineral and bone metabolism: the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases<\/em>,\u00a012<\/em>(Suppl 1), 26\u201330. https:\/\/doi.org\/10.11138\/ccmbm\/2015.12.3s.026<\/a><\/p>\n Alzheimer\u2019s 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\u2019s 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\u2019s disease.<\/p>\n The assigned case study demonstrates a 76-year-old Iranian male with symptoms of Alzheimer\u2019s 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\u2019s diagnosis of Alzheimer\u2019s disorder will also be considered.<\/p>\n 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\u2019s disease (Fish et al., 2019). Previous studies support great effectiveness, and safety profile for use of the drug among the elderly diagnosed with Alzheimer\u2019s (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.<\/p>\n Studies show that Exelon when administered appropriately takes between 8 to 12 weeks to completely manage symptoms of Alzheimer\u2019s 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.<\/p>\n Just like expected, the patient displayed a minimal reduction of symptoms of Alzheimer\u2019s 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\u2019s symptoms just as expected (Huang et al., 2020).<\/p>\n Alzheimer\u2019s 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\u2019s symptoms, with no side effects reported.<\/p>\n <\/p>\n Fish, P. V., Steadman, D., Bayle, E. D., & Whiting, P. (2019). New approaches for the treatment of Alzheimer\u2019s disease.\u00a0Bioorganic & medicinal chemistry letters<\/em>,\u00a029<\/em>(2), 125-133. https:\/\/doi.org\/10.1016\/j.bmcl.2018.11.034<\/a><\/p>\n Huang, L. K., Chao, S. P., & Hu, C. J. (2020). Clinical trials of new drugs for Alzheimer\u2019s disease.\u00a0Journal of biomedical science<\/em>,\u00a027<\/em>(1), 1-13. https:\/\/doi.org\/10.1186\/s12929-019-0609-7<\/a><\/p>\n Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current therapies for Alzheimer\u2019s disease: focus on rivastigmine.\u00a0Therapeutic Advances in Drug Safety<\/em>,\u00a09<\/em>(3), 171-178. https:\/\/doi.org\/10.1177\/2042098617750555<\/a><\/p>\n 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\u2019s disease.\u00a0Frontiers in neuroscience<\/em>,\u00a013<\/em>, 472. https:\/\/doi.org\/10.3389\/fnins.2019.00472<\/a><\/p>\n\n
A Sample Answer For the Assignment: DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/h2>\n
Title: <\/strong> DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/h2>\n
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/a><\/span><\/em><\/h3>\n
References<\/h2>\n
A Sample Answer 2 For the Assignment: DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/h2>\n
Title: <\/strong> DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL NURS 6521<\/strong><\/h2>\n
Patient Case Study Summary<\/strong><\/h2>\n
Treatment Decisions<\/strong><\/h2>\n
Expected Outcome<\/strong><\/h2>\n
Difference Between Expected Outcome and Actual Outcome<\/strong><\/h2>\n
Conclusion<\/strong><\/h2>\n
References<\/strong><\/h2>\n