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Student Name
Course:
Instructor:
Liberty University
Post with Response:
Week 12: Dementia Care Plan
Assessment:
The patient presents with a history of bipolar disorder and dementia, it is
unknown if the patient has any other chronic conditions. The patient has had
episodes of agitation that recently began the patient's caregiver stating that the
patient has become oppositional, refusing most care, paranoid, resisting sleep and
arguing with participants in her day program. It is important to determine when the
agitation started and if there are things that cause the patient to become more
agitated. The patient is currently taking three medications, it is important to
understand why the patient was placed on these medications in the first place to
determine how to properly change the medications. If the medications are solely for
dementia and bipolar disorder than they will be changed as described below.
Plan:
It is important to properly taper medications, specifically quetiapine, it is important to
know when the medication began to determine how long the medication needs to be
tapered for. It may take up to a month to taper quetiapine appropriately. I would place the
patient on Risperidone 0.25mg and increase to 0.5mg after slight tapering of quetiapine.
Stahl (2013) state that risperidone is not the first-line treatment for patients with only
dementia,“some patients will nevertheless require treatment with an atypical antipsychotic,
in this case, risperidone is often a preferred agent at very low doses”. In this scenario, the
patient also has a history of bipolar disorder that can cause changes in medication.Stahl
(2013) state that“treatment of agitation and aggression in dementia is a very controversial
area, due to the potential for misuse of antipsychotics as ‘chemical straight-jackets’ to over
tranquilize patients, and also safety concerns about cardiovascular events and death from
these drugs”. To prevent over tranquilizing patients it is important that we slowly increase
and the dose and keep low doses in the elderly. APA (2010) states that the recommended
dosage for risperidone in the elderly is “0.25-1.0 mg day of risperidone”. Both Depakote and
bupropion should also be properly discontinued and again depend on how long the patient
has been taking the medications.
I also believe that the patient would benefit from Trazodone to help her sleep
throughout the night, I would start the patient off at the lowest dose and then increase slowly
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