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Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
Walden University
NURS 6521: Advanced Pharmacology
Date
Introduction
The advanced practitioner can diagnose dementia or Alzheimer's Disease (AD) though it
is a daunting task. To be sufficiently impaired in daily life, at least two cognitive functions are
required for dementia diagnosis. This includes the ability to think, to recall, to speak language, to
solve problems and to understand visuals. There are no final diagnostic tests for dementia, but
physicians need multi-assessments to evaluate their memory, understanding, reasoning,
judgment, vocabulary and attention. The major known risk factor for AD is advancing age. In 90
percent of patients the age of onset is 65 years or older. After 65 years of age, AD's risk increases
exponentially and doubles every 10 years to 80 and then decreases or falls at AD's rates. The
only other known risk factor is a family history of AD (Rosenthal, & Burchum, 2018). Advanced
practitioners also meet patients in their initial visit to medical providers who seek treatment for
cognitive and psychological decrease. If these changes start to have negative effects, testing is a
crucial factor (Schoeder, Martin, & Walling, 2019).
Summary of Mr. Akkad’s Scenario
Mr. Akkad is a 76-year-old Iranian whose behavior worries the family. His eldest son
provided his father with history and is a trustworthy historian. The symptoms started "a few
years ago," according to his reports. The loss of interest symptoms are changes in family,
personality and conversation due to incalculable changes. Both lab tests have returned as normal,
but his son says his dad has had strange thoughts and behavior for two years. He is also losing
interest in religious activity and has trouble finding the right words while referring to his
relatives. In the last 2 years, these symptoms have progressively deteriorated, and changes in
persona are primarily of concern (Laureate Education, 2019b).
Treatment decisions
The first of three choices to initiate Mr Akkad's treatment was that he was about to leave
and the mini-mental condition examination (MMSE) score of 18/30 points, indicating moderate
Dementia (Schoeder et al., 2019). Aricept 5 mg by mouth at bedtime is the recommended
treatment for this process, followed by tolerance tests within 4-6 weeks. My second choice was
to increase the dose to 10 mg at bedtime because the symptoms were still present. Without side
effects Mr. Akkad tolerated Aricept so no reason to switch medicines was available. The third
decision was to hold him at bedtime with Aricept 10 mg because some of his signs changed, no
regression was seen, and no drug side effects were found (Webster, Groskreutz, & Grinbergs-
Saull, 2017). There are no cures for Alzheimer's disease, therefore, to treat disease if the
symptoms progress slowly and keep working.
Evidence Based Decision Making
The research based on evidence supports the treatment of patients like Mr. Akkad using
aricept. Aricept was granted approval for extreme AD in 2006, and a 23 mg tablet was given and
approved for the treatment of Alzheimer's dementia disorder, following its initial approval in
1996 for the treatment of mild to moderate AD (5 and 10 mg dosé tablets), (Ehret, & Chamberlin
2015).
The decision to use Aricept initially was based on the research and investigating evidence
that its benefits were the less side-effect for mild to moderate Alzheimer's symptoms in general.
It can be coupled with other medicines for the therapy of dementia such as Namenda, in addition
to reduced rates of adverse effects. In order that GI symptoms are often associated with GI at
peak plasma levels, it is required to take any cholinesterase inhibitors in the night (Epperly &
Dunay, 2017).
Expected Response from Aricept Treatment
The lack of care for themselves is one of the major difficulties for families whose dear
ones have Alzheimer's. I hope that the son of Mr. Akkad will gain hope by providing this family
with the right education, support and therapy (Rosenthal, & Burchum, 2018). The main problems
faced by carers are the lack of reliable and available knowledge on dementia, family
dissatisfaction, lack of routine, and lack of familiarity with maintaining the wellbeing of the
carer.
Conclusion
Learning the principles involved in the diagnosis of Alzheimer's allows experienced
nurse practice to agree on treatment start-up when properly evaluated by a professional. It also
helps to know the side effects that can occur where patients can be sought treatment and the
importance of ongoing alternative medication therapy.
References
Ehret, M. J., & Chamberlin, K. W. (2015). Current practices in the treatment of Alzheimer
disease: Where is the evidence after the phase III trials?Clinical Therapeutics,37(8),
1604-1616. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1016/j.clinthera.2015.05.510.
Laureate Education. (2019b). Alzheimer’s disease [Video file]. Retrieved from
http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/i
ndex.html
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice
providers. St. Louis, MO: Elsevier.
Webster, D., Groskreutz, A., & Grinbergs-Saull, A. (2017). Development of core outcome set for
disease modification trials in mild to moderate dementia: A systematic review, patient
and public consultation and consensus recommendations. NIHR Journals Library, 21(26).
Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK436205/ doi: 10.3310/hta21260
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