NURS 6630 Assessing and Treating Clients With Dementia Patients

NURS 6630 Assessing and Treating Clients With Dementia Patients
Decision Point Two
Selected Decision
After a review of the performance of Exelon four weeks after its administration, the nurse practitioner was presented with certain three options. These were: Increase Exelon to 4.5 mg orally BID, increase Exelon to 6 mg orally BID, Maintain current dose of Exelon, and Add Namenda (memantine) 5 mg orally per day. From the three options, the nurse practitioner chose to increase Exelon to 4.5 mg orally BID.
Reason for Selection
When the client was given the previous dose of Exelon, he demonstrated improvement in his Alzheimer’s symptomatology. Specifically, while he has not wholly accepted to attend church activities, he has begun to show a slight interest. The manifestation of the improvement is evident that the drug has some level of effectiveness at this level. Thus, in addition to the fact that the clients has shown remarkable tolerability to the dosage, the logical thing would be to increase it to 4.5 mg. Pharmacologically, the 4.5 mg would be the maintenance dose of the drug, in order to sustain its effectiveness (Stahl, 2013). Whereas the dosage could be increased to 6 mg, it is vital for the increments to be conducted cautiously as tolerability is monitored. Moreover, prescribing Namenda (In Nageshwaran, In Ledingham, In Wilson, & In Dickenson, 2017) at the present point is not logical since the Exelon has not yet reached its maximum therapeutic level. Thus, Yoon et al. (2017) advises that it is paramount for the maximum potential option to be followed before augmentation can be considered. Also, it would be imprudent to maintain the dosage at its initial level since the drug will not produce maximum benefits. These reasons therefore support the decision to increase Exelon’s dosage to 4.5 mg.
Expected Results
Upon increasing the drug’s dosage, the symptoms are expected to improve even further. Specifically, the restricted confabulation is expected to reduce even further due to the drug’s dosage. In addition to confabulation, the patient’s resistance towards church activities is expected to wane during the intervening period after dosage increase and the next assessment.
Differences between Expected Results and Actual Results
When the client came back to the clinic after four weeks had elapsed since the decision to increase Exelon’s dosage was made, he shows remarkable improvement in certain symptoms of Alzheimer’s. For instance, his son states that Mr. Akid had started to attend church activities more frequently. As expected, some of the symptoms such as amusement towards his erstwhile favorite activities still existed. Chen et al. (2017) argues that the symptomatology of Alzheimer’s ca only be improved and not eliminated. In fact, the drug Exelon can only improve other functions but cognition hence the reason for the persistence of the amusement symptom. Thus, there was no difference between expected results and actual results after the assessment.
Not only do children and adults have different presentations for ADHD, but males and females may also have vastly different clinical presentations. They may also respond to medication therapies differently. For example, some ADHD medications may cause children to experience stomach pain, while others can be highly addictive for adults. In your role, as a psychiatric mental health nurse practitioner, you must perform careful assessments and weigh the risks and benefits of medication therapies for clients across the lifespan. For this Assignment, you consider how you might assess and treat clients presenting with ADHD.
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: Review all materials from the Discussion.
Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). Revision and restandardization of the Conners’ Teacher Rating Scale (CTRS-R): Factors, structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 279-291.
Note: Retrieved from Library databases.
Required Media
Laureate Education (2016d). Case study: A young Caucasian girl with ADHD [Interactive media file]. Baltimore, MD: Author
Note: This case study will serve as the foundation for this week’s Assignment.
To prepare for this Assignment:
This case study will serve as the foundation for this week’s Assignment.
The Assignment
Examine Case Study: A Young Caucasian Girl With ADHD You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
NURS 6630 Assessing and Treating Clients With Dementia Patients
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.
Week 10 assignment
Assignment: Assessing and Treating Clients With Dementia
The Alzheimer’s Association defines dementia as “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2016). This term encompasses dozens of cognitive disorders of impaired memory formation, recall, and communication. The care and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family support, and even the care setting. In your role, as the psychiatric mental health nurse practitioner, you must be prepared to not only treat clients with these various cognitive disorders, but also the multiple behavioral issues that often accompany them. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with dementia.
Reference: Alzheimer’s Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp
Required Readings
Note: All Stahl resources can be accessed through the Library using this link. This link will take you to a log-in page for the Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapter, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 13, “Dementia and Its Treatment”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
For insomnia
donepezil
galantamine
memantine
rivastigmine
Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html
Note: Retrieved from from the Library databases.
Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson’s disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp2009176a.pdf
Required Media
Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.
Note: This case study will serve as the foundation for this week’s Assignment.
To prepare for this Assignment:
Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for dementia.
The Assignment
Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
At each decision point stop to complete the following:
Decision #1
Which decision did you select?
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
Decision #2
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
Decision #3
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients.