Examine Case Study An Elderly Iranian Man With Alzheimers Essay

Examine Case Study An Elderly Iranian Man With Alzheimers

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, there will be three decisions. I will choose one out of the three and give the outcome. At each decision point, these are the thoughts to ponder:

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 Examine Case Study: An Elderly Iranian Man With Alzheimer’s

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.***

Finally: 1. Complete the decision tree (keep track of what you selected. Come up with a rational reason why you chose it. Come up with a patient-specific rational reason behind not choosing the other two options not chosen).

2. Write a paper addressing all sections listed based on the decision tree.

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Case Study: Alzheimer’s Disease

(76-Year-old Iranian Male)

BACKGROUND

Mr. Akkad is a 76-year-old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including a CT scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficulty “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, and cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is a 76-year-old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear and coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic.

The self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes were noted.

He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh].

Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When the PMHNP asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

RESOURCES

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.

Decisions Made and Outcomes (Needed to formulate the paper) (Must use and formulate paper based off of the chosen decision. Then tell why the other two decisions were not a good choice with in-text citations noted for each.)

Choices for Decision 1: Select what the PMHNP should do:

• Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks
• Begin Aricept (donepezil) 5 mg orally at BEDTIME
• Begin Razadyne (galantamine) 4 mg orally BID

Decision Choice Chosen: Begin Exelon (rivastigmine) 1.5 mg orally BID with an examine Case Study:

• An Elderly Iranian Man With Alzheimer’s
• Increase to 3 mg orally BID in 2 weeks

***Explain why the other two choices were rejected (not adequate choices)***

RESULTS OF DECISION POINT ONE

The client returns to the clinic in four weeks

The client is accompanied by his son who reports that his father is “no better” from this medication. He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors

You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

Choices for Decision 2: Select what the PMHNP should do:

• Increase Exelon to 4.5 mg orally BID
• Increase Exelon to 6 mg orally BID
• Discontinue Exelon and begin Namenda (memantine) 10 mg orally BID

Decision Choice Chosen: Increase Exelon to 4.5 mg orally BID

***Explain why the other two choices were rejected (not adequate choices)***

RESULTS OF DECISION POINT TWO

The client returns to the clinic in four weeks

The client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better

He states that his father is attending religious services with the family, which the son and the rest of the family are happy about. He reports that his father is still easily amused by things he once found serious

Choices for Decision 3: Select what the PMHNP should do:

• Increase Exelon to 6 mg orally BID
• Maintain current dose of Exelon
• Add Namenda (memantine) 5 mg orally per day

Decision Choice Chosen: Increase Exelon to 6 mg orally BID

***Explain why the other two choices were rejected (not adequate choices)***

Outcome: Guidance to Student at this point, the client is reporting no side effects and is participating in an important part of family life (religious services). This could speak to the fact that the medication may have improved some symptoms.

The PMHNP needs to counsel the client’s son on the trajectory of presumptive Alzheimer’s disease in that it is irreversible, and while cholinesterase inhibitors can stabilize symptoms, this process can take months. Also, these medications are incapable of reversing the degenerative process. Some improvements in problematic behaviors (such as disinhibition) may be seen, but not in all clients.

At this point, the PMHNP could maintain the current dose until the next visit in 4 weeks, or the PMHNP could increase it to 6 mg orally BID and see how the client is doing in 4 more weeks.

Augmentation with Namenda is another possibility, but the PMHNP should maximize the dose of the cholinesterase inhibitor before adding augmenting agents. However, some experts argue that combination therapy should be used from the onset of treatment.

Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern.

***Write on each decision. Make sure that in each decision choice, you explain why the other two decisions were not good choices. Use cited sources to validate points. Make sure that this paper has at least 7 References. Please use in-text citations for each section of each decision. Don’t forget the ethical considerations for this assignment. Make it a section by itself.***

***Also please make sure when looking at the ethical consideration for this assignment that you look at how the Caucasian (male) ethnicity and pain medications interact.***

Please use the following format when formulating the paragraphs for each section. Don’t forget the in-text citations. Remember to use at least 7 references.

Introduction to Examine Case Study An Elderly Iranian Man With Alzheimers

Decision #1

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)

Anticipated Results (of Chosen Decision)

The difference in Results (Anticipated VS Actual)

Decision #2

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)

Anticipated Results (of Chosen Decision)

The difference in Results (Anticipated VS Actual)

Decision #3

Reasons for Choosing the Decision (Why is it the best choice out of the 3 choices)

Anticipated Results (of Chosen Decision)

The difference in Results (Anticipated VS Actual)

Ethical Considerations

Conclusion

References

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An Elderly Iranian Man with Alzheimers’s Disease Paper Sample

Alzheimer’s disease is a lifelong neurodegenerative disorder that builds up slowly, but eventually, becomes worse. People with this disorder find it difficult to remember current events. In the course of the disorder progression, other symptoms manifest in the patient where some of them are mood swings, language, behavioral concerns, disorientation, along with motivation loss. It would also be possible to tell that a person is vulnerable to the disorder if he or she is unable to manage self-care (Kales et al., 2019).

Looking at the case study involving an 86-year- old Iranian man, his symptoms suggest that he suffers from the disorder. Even his family reported that he was fond of forgetting things and this can be confirmed by looking at the background information. Again, the subjective information, principally, the mini-mental state exam (MMSE) revealed that he had moderate dementia and this relates his mental status exam that showed that his judgment and insights were impaired. This paper presents various decisions that are aimed at promoting his cognitive functioning.

Background Information

The client in the case is a 76-year-old Iranian male identified as Mr. Akkad aged who came to the clinic being accompanied by his son following his strange behavior. The family physician ruled out potential organic basis, and the imaging along with the laboratory tests were normal. His son reported that his father acted strangely that has become intense over the two years.

He added that his father started being disengaged from the religious activities with the family and becomes critical of every member of the family. Unfortunately, what he perceives as being serious becomes his source of ridicule and amusement. His son added that it has been difficult for the client to remember current things to an extent, he finds it difficult to identify the right words in a conversation and would sometimes even change the conversation, promptly.

Decision #1

After analyzing the background, subjective, in conjunction with the objective data of the patient, the PMHNP decided to present the patient with Aricept 5mg orally BID that was to be taken prior to getting to bed. The physician opted for this medication because it is normally used as a startup medication for patients with Alzheimer’s disease and so it is considered as a startup medication alongside being used as a progressive medication.

After subjecting the patient to this decision, the PMHNP hoped to see a slight improvement in the health of the patient in the sense the medication has been designed to reduce the disorder symptoms (Kales et al., 2019). In contrary to the anticipated results, four weeks after adhering the decision, the patient was accompanied by his son back to the clinic who reported that he had not noticed any improvement in his father. His son stated that his father was still disengaged from religious activities.

Furthermore, the confabulation of the patient read 18 out of 30 in the MMSE the same results he scored before being engaged in the decision. Certainly, the patient did not respond to the medication which suggests nonalignment between the anticipated results with the real outcome.

Decision #2

Following the results of the previous decision, it would be necessary for the physician to introduce the patient to a new decision which, specifically, entailed increasing the Aricept dosage to Aricept 10mg orally BID. So, in this decision, the physician augmented the drug dosage for the patient to Aricept 10mg orally BID that was to be taken prior going to bed. By increasing the drug dosage, I hoped the health condition of the patient would improve gradually as the patient may even stay for some months for him to recover from the illness (Nowrangi, Lyketsos, & Rosenberg, 2015).

This nearly matched the real results because the outcome showed that the patient is tolerating the medication only that his son is still not comfortable with the condition of his father. Nevertheless, his son reports that the patient has started attending religious services, an act that makes his family happy. This suggests that the patient has started responding to the medication.

Decision #3

After learning about the potentiality of the previous decision, I felt that it is necessary to maintain the same approach and this will entail maintaining Aricept 10mg orally BID for the patient. When using Aricept pharmacological agent to treat a patient, the physicians are recommended to present a maximum of Aricept 10mg orally BID as no piece of evidence has confirmed about the potentiality of Aricept on a patient when its dosage exceeds Aricept 10mg orally BID. Increasing the dosage beyond the recommended drug dosage may see the patient suffer some side effects associated with the drug (Berry & Amp, 2017). After adhering this decision, I hoped to see further improvement in the health condition of the patient. This would be by hearing from his son about his increased engagement in religious activities. Certainly, this nearly matched the real results where the response of the patient to the medication was positive, though, it gradual.

Ethical Considerations

The physicians, especially, those who deal with their patients vulnerable to various cognitive health complications usually face a hard time in the course of dealing with their patients. As a way of managing such constraints, ethical considerations have been developed and then, the physicians are challenged to engage these considerations when dealing with their patients. Proper administration is the first ethical consideration where the physicians are advised to adhere to the directives that have been set for them when prescribing medications to their patients.

Proper prescription is another ethical consideration where the physician is advised to prescribe the right drug dosage to the patient (Heneka et al., 2015). Based on this consideration, a physician is encouraged to modify the drug dosage based on how the patient responds to the medication. To be specific, it may be necessary for the physician to augment the drug dosage if the patient is responding positively and reduce the drug dosage or even change the medication if the patient suffers side effects associated with the medication.

Conclusion

Alzheimer’s is a neurodegenerative disorder that advances slowly but, becomes potential over time. People with the disorder find it difficult to recall current events. Some symptoms evident in such people are mood swings, motivation loss, and being disoriented among other disorder symptoms. While various medications have been designed to treat the disorder, the physicians are encouraged to stick to Aricept following its potentiality in relieving the disorder symptoms (Heneka et al., 2015).

However, they should not introduce a higher drug dosage to the patient as it may predispose the patient to serious side effects that may affect the health of the patient, potentially. That said, the physician should subject their patients to a low drug dosage when introducing them to such drugs to find out how their bodies respond to the medication.

References

Heneka, M. T., Carson, M. J., El Khoury, J., Landreth, G. E., Brosseron, F., Feinstein, D. L., … & Herrup, K. (2015). Neuroinflammation in Alzheimer’s disease. The Lancet

Neurology, 14(4), 388-405. behavioral control in Alzheimer’s. Social Science & Medicine, 188, 51-59. https://doi.org/10.1016/S1474-4422(15)70016-5

Berry, B., & Apesoa-Varano, E. C. (2017). Berry, B., & Apesoa-Varano, E. C. (2017).

Medication takeovers: Covert druggings and behavioral control in Alzheimer’s. Social Science & Medicine, 188, 51-59. https://doi.org/10.1016/j.socscimed.2017.07.003

Kales, H. C., Lyketsos, C. G., Miller, E. M., & Ballard, C. (2019). Management of behavioral and psychological symptoms in people with Alzheimer’s disease: an international Delphi consensus. International Psychogeriatrics, 31(1), 83-90. https://doi.org/10.1017/S1041610218000534

Nowrangi, M. A., Lyketsos, C. G., & Rosenberg, P. B. (2015). Principles and management of neuropsychiatric symptoms in Alzheimer’s dementia. Alzheimer’s research & therapy, 7(1), 12. https://doi.org/10.1186/s13195-015-0096-3