week 6 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders/NURS 6521

week 6 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders/NURS 6521

week 6 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders/NURS 6521

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.

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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.

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Decision Tree: 76 Year-Old Iranian Male

            Persons in the age group of 70 years and above are at risk of developing neurocognitive disorders (NCDs). These are characterized by cognitive impairment and the collective of symptoms is usually referred to as dementia. The characteristic features are spatial disorientation, language problems such as dysarthria (slurring of words), amnesia or forgetfulness, and lack of motor coordination (APA, 2013; Sadock et al., 2015). The patient in this case study is a 76 year-old male of Iranian descent who is presented by the son to the clinic. The chief complaint is that he has become disinterested in activities that were hitherto important to him such as religious activities. He is also bemused by serious matters that previously were taken seriously by him. He is diagnosed with Alzheimer’s disease. This exercise calls for three clinical decisions to be made concerning his pharmacotherapeutic management.

First Decision Point

            The decision is made here to commence the patient on donepezil (Aricept) 5 mg by mouth every bedtime. This decision is informed by the fact that this drug is FDA-approved for the treatment of Alzheimer’s disease and hence scholarly evidence exists for its efficacy and tolerability (Stahl, 2017). By making this decision what was hoped to be achieved was a reduction in the symptoms of cognitive decline within a span of several weeks. However, what was expected and he result of the above decision in a span of four weeks were not the same. After four weeks on the donepezil, the patient is brought back by the same son who states that there has been no change in his condition and that his strange behaviors continue. This was to be however to be expected since the therapeutic effect of most psychiatric medications take weeks to start showing.

Second Decision Point

            The second decision point coincides with the return visit which indicates that the patient has not improved in the last four weeks. Three options are presented: increasing the donepezil to 10 mg by mouth every bedtime; stopping donepezil and starting memantine (Namenda); or stopping donepezil and starting galantamine (Razadyne). The choice was made to increase the dose of donepezil to 10 mg orally at bedtime and observe for another four weeks. The reason for this was that the donepezil needed to be given time to start showing its therapeutic effects. Even if the drug was changed at this stage, the other one would also take tie before showing any therapeutic effect.   

Third Decision Point

            After another four weeks the patient is brought back again by the son. Some improvement is reported in that the patient is now attending religious events again. However, he is still confused and bemused by what should be serious things to him. This outcome s in line with what was expected – some improvement. At this decision point therefore, the decision is made to continue with the donepezil 10 mg orally at bedtime to give the drug time to exert its full therapeutic effect. As things stand, what was expected and what the outcome is are not far apart. This means that the treatment plan is on course and the patient will get the full therapeutic effect in due course.

Conclusion

            Clinical decision making is something that requires critical thinking and that one be guided by evidence-based practice. This is exactly what was done in this case of the 76 Iranian male with Alzheimer’s disease. Being FDA-approved, donepezil proved to e the best choice for him. However, there would be need for patience as the therapeutic effect is usually slow in coming.

  References

American Psychological Association [APA] (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5^th ed. Author.

Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11^th ed. Wolters Kluwer.

Stahl, S.M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide, 6^th ed. Cambridge University Press