19 Jul Review the interactive media piece assigned by your Instructor.?Reflect on the patients symptoms and aspects of the disorder presented in the interactive media piece. Consider how you m
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.
This study source was downloaded by 100000782822176 from CourseHero.com on 07-18-2023 19:12:22 GMT -05:00
https://www.coursehero.com/file/112656339/Alzheimers-Disease76-year-old-Iranian-MaleBACKGROUNDMr-Adocx/
Alzheimer’s Disease
76-year-old Iranian Male
BACKGROUND
Mr. Akkad is a 76 year old Iranian male who is brought to
your office by his eldest son for “strange behavior.” Mr.
Akkad was seen by his family physician who ruled out any
organic basis for Mr. Akkad’s behavior. All laboratory and
diagnostic imaging tests (including CT-scan of the head) were
normal.
According to his son, he has been demonstrating some
strange thoughts and behaviors for the past two years, but
things seem to be getting worse. Per the client’s son, the
family noticed that Mr. Akkad’s personality began to change
a few years ago. He began to lose interest in religious
activities with the family and became more “critical” of
everyone. They also noticed that things he used to take
seriously had become a source of “amusement” and
“ridicule.”
Over the course of the past two years, the family has noticed
that Mr. Akkad has been forgetting things. His son also
reports that sometimes he has difficult “finding the right
words” in a conversation and then will shift to an entirely
different line of conversation.
SUBJECTIVE
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https://www.coursehero.com/file/112656339/Alzheimers-Disease76-year-old-Iranian-MaleBACKGROUNDMr-Adocx/
During the clinical interview, Mr. Akkad is pleasant,
cooperative and seems to enjoy speaking with you. You
notice some confabulation during various aspects of memory
testing, so you perform a Mini-Mental State Exam. Mr.
Akkad scores 18 out of 30 with primary deficits in
orientation, registration, attention & calculation, and recall.
The score suggests moderate dementia.
MENTAL STATUS EXAM
Mr. Akkad is 76 year old Iranian male who is cooperative
with today’s clinical interview. His eye contact is poor.
Speech is clear, coherent, but tangential at times. He makes
no unusual motor movements and demonstrates no tic. Self-
reported mood is euthymic. Affect however is restricted. He
denies visual or auditory hallucinations. No delusional or
paranoid thought processes noted. He is alert and oriented to
person, partially oriented to place, but is disoriented to time
and event [he reports that he thought he was coming to lunch
but “wound up here”- referring to your office, at which point
he begins to laugh]. Insight and judgment are impaired.
Impulse control is also impaired as evidenced by Mr. Akkad’s
standing up during the clinical interview and walking towards
the door. When you asked where he was going, he stated that
he did not know. Mr. Akkad denies suicidal or homicidal
ideation.
Diagnosis: Major neurocognitive disorder due to Alzheimer’s
disease (presumptive)
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https://www.coursehero.com/file/112656339/Alzheimers-Disease76-year-old-Iranian-MaleBACKGROUNDMr-Adocx/
RESOURCES
§ Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002).
Mini-Mental State Examination (MMSE). Lutz, FL:
Psychological Assessment Resources.
Decision Point OneSelect what you should do:
Begin Exelon (rivastigmine) 1.5 mg orally BID with an
increase to 3 mg orally BID in 2 weeks
: Begin Aricept (donepezil) 5 mg orally at BEDTIME
Begin Razadyne (galantamine) 4 mg orally BID
Decision Point One
Begin Exelon (rivastigmine) 1.5 mg orally BID with an
increase to 3 mg orally BID in 2 weeks
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
The client is accompanied by his son who reports that his
father is “no better” from this medication. He reports that his
father is still disinterested in attending religious
services/activities, and continues to exhibit disinhibited
behaviors
You continue to note confabulation and decide to administer
the MMSE again. Mr. Akkad again scores 18 out of 30 with
primary deficits in orientation, registration, attention &
calculation, and recall
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https://www.coursehero.com/file/112656339/Alzheimers-Disease76-year-old-Iranian-MaleBACKGROUNDMr-Adocx/
Decision Point Two
Increase Exelon to 4.5 mg orally BID
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client’s son reports that the client is tolerating the
medication well, but is still concerned that his father is no
better
He states that his father is attending religious services with
the family, which the son and the rest of the family is happy
about. He reports that his father is still easily amused by
things he once found serious
Decision Point Three
Maintain current dose of Exelon
Guidance to Student
At this point, the client is reporting no side effects and is
participating in an important part of family life (religious
services). This could speak to the fact that the medication
may have improved some symptoms. you need to counsel the
client’s son on the trajectory of presumptive Alzheimer’s
disease in that it is irreversible, and while cholinesterase
inhibitors can stabilize symptoms, this process can take
months. Also, these medications are incapable of reversing
the degenerative process. Some improvements in problematic
behaviors (such as disinhibition) may be seen, but not in all
clients.
At this point, you could maintain the current dose until the
This study source was downloaded by 100000782822176 from CourseHero.com on 07-18-2023 19:12:22 GMT -05:00
https://www.coursehero.com/file/112656339/Alzheimers-Disease76-year-old-Iranian-MaleBACKGROUNDMr-Adocx/
next visit in 4 weeks, or you could increase it to 6 mg orally
BID and see how the client is doing in 4 more weeks.
Augmentation with Namenda is another possibility, but you
should maximize the dose of the cholinesterase inhibitor
before adding augmenting agents. However, some experts
argue that combination therapy should be used from the onset
of treatment.
Finally, it is important to note that changes in the MMSE
should be evaluated over the course of months, not weeks.
The absence of change in the MMSE after 4 weeks of
treatment should not be a source of concern.
This study source was downloaded by 100000782822176 from CourseHero.com on 07-18-2023 19:12:22 GMT -05:00
https://www.coursehero.com/file/112656339/Alzheimers-Disease76-year-old-Iranian-MaleBACKGROUNDMr-Adocx/ Powered by TCPDF (www.tcpdf.org)
,
7/18/23, 6:52 PM Week 6: Learning Resources : Advanced Pharmacology-Summer 2023
https://waldenu.instructure.com/courses/65879/pages/week-6-learning-resources?module_item_id=1752199 1/3
LEARNING RESOURCES
Required Readings
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 14, “Muscarinic Antagonists” (pp. 90-98)
Chapter 15, “Adrenergic Agonists” (pp. 99–107)
Chapter 16, “Adrenergic Antagonists” (pp. 108–119)
Chapter 17, “Indirect-Acting Antiadrenergic Agents” (pp. 120–124)
Chapter 18, “Introduction to Central Nervous System Pharmacology” (pp. 125–126)
Chapter 19, “Drugs for Parkinson Disease” (pp. 127–142)
Chapter 20, “Drugs for Alzheimer Disease” (pp. 159–166)
Chapter 21, “Drugs for Seizure Disorders” (pp. 150–170)
Chapter 22, “Drugs for Muscle Spasm and Spasticity” (pp. 171–178)
Chapter 24, “Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics” (pp. 183–194)
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 (https://www.aafp.org/pubs/afp/topics/by-topic.dementia.html) . Retrieved from https://www.aafp.org/pubs/afp/topics/by-topic.dementia.html
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 (https://search.ebscohost.com/login.aspx?
7/18/23, 6:52 PM Week 6: Learning Resources : Advanced Pharmacology-Summer 2023
https://waldenu.instructure.com/courses/65879/pages/week-6-learning-resources?module_item_id=1752199 2/3
direct=true&db=edsgea&AN=edsgcl.632776407&site=eds- live&scope=site&authtype=shib&custid=s6527200) . Journal of Family Practice, 69(6), 280–292.
Document: Mid-Term Summary & Study Guide (PDF) (https://waldenu.instructure.com/courses/65879/files/4007735?wrap=1) (https://waldenu.instructure.com/courses/65879/files/4007735/download?download_frd=1)
Required Media
Walden University, LLC. (Producer). (2019b). Alzheimer’s disease (http://cdn- media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html) [Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease.
Walden University, LLC. (Producer). (2019e). Complex regional pain disorder (http://cdn- media.waldenu.edu/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_07/index.html) [Interactive media file]. Baltimore, MD: Author.
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)
7/18/23, 6:52 PM Week 6: Learning Resources : Advanced Pharmacology-Summer 2023
https://waldenu.instructure.com/courses/65879/pages/week-6-learning-resources?module_item_id=1752199 3/3
Speed Pharmacology. (2019). Drugs for Parkinson’s Disease (Made Easy) (https://www.youtube.com/watch?v=Z84iypHdftQ&t=13s) [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) (https://www.youtube.com/watch?v=euzRPrvrwj0&t=31s) [Video].
Note: This media program is approximately 7 minutes.
,
7/18/23, 6:51 PM Week 6: Assignment
https://waldenu.instructure.com/courses/65879/assignments/559048?module_item_id=1752193 1/2
This assignment does not count toward the final grade.
Due No Due Date Points 0
Back to Week at a Glance (https://waldenu.instructure.com/courses/65879/modules/items/1752187)
(https://cdn-
media.waldenu.edu/2dett4d/Walden/Canvas/Getty/1920×938/GettyLicense_932736896.jpg) 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.
To Prepare:
DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS
RESOURCES
Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.
WEEKLY RESOURCES (https://waldenu.instructure.com/courses/65879/modules/items/1752199)
7/18/23, 6:51 PM Week 6: Assignment
https://waldenu.instructure.com/courses/65879/assignments/559048?module_item_id=1752193 2/2
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.
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.
BY DAY 7 OF WEEK 8
,
7/18/23, 6:49 PM Week 8: Assignment
https://waldenu.instructure.com/courses/65879/assignments/559052 1/6
Due Sunday by 10:59pm Points 100 Submitting a text entry box or a file upload Attempts 0 Allowed Attempts 2
Start Assignment
Back to Week at a Glance (https://waldenu.instructure.com/courses/65879/modules/items/1752243)
(https://cdn-
media.waldenu.edu/2dett4d/Walden/Canvas/Getty/1920×938/GettyLicense_932736896.jpg) Submit your Assignment, started in Week 6.
DECISION TREE FOR NEUROLOGICAL AND MUSCULOSKELETAL
RESOURCES
Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.
WEEKLY RESOURCES (https://waldenu.instructure.com/courses/65879/modules/items/1752257)
BY DAY 7 OF WEEK 8
7/18/23, 6:49 PM Week 8: Assignment
https://waldenu.instructure.com/courses/65879/assignments/559052 2/6
NURS_6521_Week8_Assignment_Rubric
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm (http://writingcenter.waldenu.edu/57.htm) ). All papers submitted must use this formatting.
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
1. To submit your completed assignment, save your Assignment as WK8Assgn_LastName_Firstinitial
2. Then, click on Start Assignment near the top of the page. 3. Next, click on Upload File and select Submit Assignment for review.
SUBMISSION INFORMATION
7/18/23, 6:49 PM Week 8: Assignment
https://waldenu.instructure.com/courses/65879/assignments/559052 3/6
Criteria Ratings Pts
20 pts
25 pts
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific.
20 to >17.8 pts Excellent
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.
17.8 to >15.8 pts Good
The response accurately summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.
15.8 to >13.8 pts Fair
The response inaccurately or vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.
13.8 to >0 pts Poor
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.
25 to >22.25 pts Excellent
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.
22.25 to >19.75 pts Good
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.
19.75 to >17.25 pts Fair
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.
17.25 to >0 pts Poor
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.
7/18/23, 6:49 PM Week 8: Assignment
https://waldenu.instructure.com/courses/65879/assignments/559052 4/6
Criteria Ratings Pts
20 pts
20 pts
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.
20 to >17.8 pts Excellent
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.
17.8 to >15.8 pts Good
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.
15.8 to >13.8 pts Fair
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.
13.8 to >0 pts Poor
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.
20 to >17.8 pts Excellent
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
17.8 to >15.8 pts Good
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
15.8 to >13.8 pts Fair
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
13.8 to >0 pts Poor
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
7/18/23, 6:49 PM Week 8: Assignment
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