Assignment: Decision Tree for Neurological and Musculoskeletal Disorders Essay

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders Essay

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders Essay

            Alzheimer’s disorder is the main cause of dementia among the elderly. Alzheimer’s is a progressive neurological disorder characterized by mild cognitive symptoms initially, which progress to severe memory loss with time (Atri, 2019). However, with early diagnosis, patients can significantly benefit from the available treatment options to promote their quality of life. This discussion illustrates the choices made in selecting the best treatment for an elderly patient diagnosed with Alzheimer’s disorder.

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Summarize the Patient Case Study

The 76-year-old male patient in the assigned case study was brought to the clinic by his son because of strange behaviors. He has been displaying Alzheimer’s symptoms for the past two years such as forgetfulness, confusion, and loss of interest in religious activities to which he was committed before. Other than the patient’s age, gender, and symptoms, an additional patient-specific characteristic that will affect the decision on which medication to prescribe include Iranian race and min mental exam results revealing moderate dementia. The patient was diagnosed with major neurocognitive disorder due to Alzheimer’s disease (presumptive).

Treatment Decisions

From the available option, the first intervention for this patient was to administer 1.5 mg Exelon (rivastigmine) twice daily orally. Rivastigmine is approved and recommended by the FDA as the first line for the management of Alzheimer’s disorder among the geriatric population as a result of its effectiveness and tolerance displayed through evidence-based practice (Morant et al., 2020). The second intervention was to increase the dose to 4.5mg rivastigmine twice daily based on the limited remission of symptoms displayed by the patient within the 4 weeks of the initial intervention. The patient, however, displayed limited effect, despite great tolerance and adherence (Shah, & Bennett, 2020). As such it was necessary to increase the dose further to 6mg twice daily as the last intervention, for complete remission of symptoms.

Expected Outcome

            When 1.5 mg Exelon was administered, the patient was expected to display at least 50% management of symptoms of Alzheimer’s. Only mild and self-limiting side effects such as nausea and vomiting were expected. Increasing the dose in the second intervention by 1.5mg was expected to promote further remission of symptoms, with no side effects, based on patient tolerance and adherence displayed in the first 4 weeks (Hampel et al., 2018). At a dose of 6 mg twice daily as the last intervention, the patient was expected to display completely managed symptoms with mini-mental examination results of less than 10.

Difference Between Expected and Actual Outcome

After 4 weeks of using 1.5mg Exelon, the patient came back to the clinic with limited management of Alzheimer’s symptoms, and no side effects just as expected (Grossberg et al., 2019). However, the level of remission of symptoms was quite low as the patient still had diminished interest in going to church. The same case happened in the second intervention. When the dose was increased in the last intervention to 6mg twice daily, the patient displayed complete management of symptoms, with no side effects, consistent with what was expected.

Conclusion

Alzheimer’s is a common neurological disorder affecting a majority of the elderly population as a result of brain atrophy. The elderly patient in the provided case study presented with symptoms of Alzheimer’s with mini-mental examination results revealing moderate dementia. Initially, 1.5 mg of Exelon was administered twice daily, which was increased to 4.5 mg and then 6mg to help manage the patient’s symptoms within the 12 weeks of therapy. The patient displayed a positive outcome just as expected.

References

Atri, A. (2019). The Alzheimer’s disease clinical spectrum: Diagnosis and management. Medical Clinics, 103(2), 263-293. https://doi.org/10.1016/j.mcna.2018.10.009.

Grossberg, G. T., Tong, G., Burke, A. D., & Tariot, P. N. (2019). Present algorithms and future treatments for Alzheimer’s disease. Journal of Alzheimer’s Disease, 67(4), 1157-1171. https://doi.org/10.3233/JAD-180903

Hampel, H., Mesulam, M. M., Cuello, A. C., Farlow, M. R., Giacobini, E., Grossberg, G. T., … & Khachaturian, Z. S. (2018). The cholinergic system in the pathophysiology and treatment of Alzheimer’s disease. Brain, 141(7), 1917-1933. https://doi.org/10.1093/brain/awy132

Morant, A. V., Vestergaard, H. T., Lassen, A. B., & Navikas, V. (2020). US, EU, and Japanese regulatory guidelines for development of drugs for treatment of Alzheimer’s disease: Implications for global drug development. Clinical and Translational Science, 13(4), 652-664. https://doi.org/10.1111/cts.12755

Shah, R. C., & Bennett, D. A. (2020). Physicians and Alzheimer dementia: past, present, and future. Annals of internal medicine, 172(10), 695-696. https://doi.org/10.7326/M20-1500

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Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
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.

Photo Credit: KATERYNA KON/SCIENCE PHOTO LIBRARY / Science Photo Library / Getty Images

To Prepare
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.
By Day 7 of Week 8
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.
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