NURS 6521 Week 8 Assignment - Decision Tree for Neurological and Musculoskeletal Disorder

Decision Tree for Neurological and Musculoskeletal Disorder Alzheimer's is a brain disorder caused by progressive memory loss, impaired thinking, and neuropsychological symptoms, including hallucinations or delusions (Rosenthal & Burchum, 2018). Patients with Alzheimer's disease usually cannot perform routine tasks daily. As advanced nurse practitioners, interviewing the patient and the family members along with the tool will help to diagnose a person's possible Alzheimer, dementia, or other issues, such as reviewing the patient's overall health, prescription, diet, past medical problems, ability on activities daily, and any memory or behavior changes. Diagnosis tests may require blood and urine tests to identify other possible causes of the problem. Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to rule out other possible causes for symptoms (National Institute on Aging, n.d.). The risk factors for AD are advancing age in 90% of patients, and the age of onset is 65 or older (Rosenthal & Burchum, 2018). AD increases and doubles every ten years until age 85 to 90, with the risk of reducing or decreasing AD rates (Rosenthal & Burchum, 2018). Another risk factor is a family history of AD (Rosenthal & Burchum, 2018). Case Study In this case study, a 76-year-old Iranian male Mr. Akkad is brought to the doctor's office by his eldest son because of the patient's unusual behavior. Mr. Akkad was seen by his family physician. All laboratory and diagnostic imaging tests ordered by his PCP (including a head CT scan) were normal. Per his son, this patient has been showing strange thoughts and behaviors for the past two years and getting worse. He began to lose interest in religious activities with the family and became more "critical" of everyone. The family has noticed that Mr. Akkad has increasingly forgotten things, and sometimes he has difficulty finding the right words during the conversation. The finding from the assessment: He is alert and oriented to person, partially oriented to place, but is disoriented to time and event, such as the mistake think he was coming to lunch, but he was not. His eye contact is poor. Speech is clear and coherent but tangential at times. He makes no unusual motor movements. The self-reported mood is euthymic and restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes were noted. Insight and judgment are impaired. Impulse control is also impaired, as evidenced by Mr. Akkad's standing up during the clinical interview and walking toward the door. When you asked where he was going, he said he did not know. Mr. Akkad denies suicidal or homicidal ideation. Decision Tree for Treatment My decision tree, including my choices to discuss with this patient, first decision begins with prescribing Aricept (donepezil) 5 mg orally at bedtime. Donepezil is FDA-approved for mild, moderate, and severe Alzheimer's disease (Donepezil - Statpearls - NCBI Bookshelf, 2020). There is no evidence that donepezil alters the progression of Alzheimer's disease (Donepezil - Statpearls - NCBI Bookshelf, 2020). However, some symptoms can be by improving cognition and behavior. Donepezil hydrochloride is a piperidine derivative and a centrally acting, rapid, reversible acetylcholinesterase inhibitor (Donepezil - Statpearls - NCBI Bookshelf, 2020). Acetylcholinesterase is an enzyme that degrades acetylcholine after release from the presynapse (Donepezil - Statpearls - NCBI Bookshelf, 2020). Donepezil binds reversibly to acetylcholinesterase and inhibits acetylcholine hydrolysis, thus increasing acetylcholine's availability at the synapses and enhancing cholinergic transmission (Donepezil - Statpearls - NCBI Bookshelf, 2020). I also discuss the common side effects with his son, such as nausea, diarrhea, vomiting, insomnia, muscle cramps, fatigue, and anorexia (Donepezil - Statpearls - NCBI Bookshelf, 2020). A follow-up appointment with his PCP in four weeks if his symptoms do not improve with his medication. The second decision was to increase the dosage of Aricept to 10mg by mouth at bedtime. The maximum recommended dosage of ARICEPT in patients with mild to moderate Alzheimer's disease is 10 mg daily (Donepezil - Statpearls - NCBI Bookshelf, 2020). A dose of 10 mg should only be administered once patients have been on a daily dose of 5 mg for 4 to 6 weeks (Aricept, 2020). AD progresses slowly in three general stages: early, middle, and late (Aricept, 2020). The third decision is if this patient is starting to show improvement by returning to religious services and tolerating the medications. For mild to moderate dementia, the initial dose is 5 mg/day; it can be increased to 10 mg/day slowly over four weeks (Donepezil - Statpearls - NCBI Bookshelf, 2020). For moderate to severe dementia, the dose can increase gradually up to 23 mg/day after the patient has been on a 10 mg/day dose for at least three months (Donepezil - Statpearls - NCBI Bookshelf, 2020). Continuing education to this patient and his son about disease progression is necessary and reevaluate this patient in one month. Explaining the fact of the evidence-based literature in this case study to support the discussion and recommendations with this patient Evidence-Based Literature the objectives of Birks and Harvey's updated Cochrane systematic review were to determine the clinical efficacy and safety of donepezil in people with mild, moderate, or severe dementia due to Alzheimer's disease (Donepezil - Statpearls - NCBI Bookshelf, 2020). It aimed to compare the efficacy of doses of donepezil and assess its effect on healthcare resource use and costs. The evidence suggests that people with mild, moderate, or severe dementia may experience a small benefit in cognitive function, activities of daily living, and clinician-rated global impression scores when treated for 12–24 weeks with donepezil at a dose of 10 mg/day (Donepezil - Statpearls - NCBI Bookshelf, 2020). In this case study, this patient improved by returning to church. However, if a higher dose is required, the higher dropout rates and adverse effects with higher doses may indicate that the side effects of this medication remain a clinical challenge. This patient tolerated the increase in the medication with no adverse effects. This review highlights that clinicians in this practice should support further research to identify the maximum duration of treatment with donepezil for those with Alzheimer's disease-related dementia weighed against the effectiveness (Donepezil - Statpearls - NCBI Bookshelf, 2020). Research is warranted to establish indicators that may assist in determining when treatment is no longer beneficial (Govind, 2020). As an APN, I want to help this patient and his family by providing resources and treatment options for this patient. I achieved the outcome of giving this patient 10mg of Aricept, as evidenced by his cognitive improvements. As your loved one's cognitive, physical, and functional abilities diminish over the years, it is easy to become overwhelmed and neglect your health and well-being (Donepezil - Statpearls - NCBI Bookshelf, 2020). This is a devastating diagnosis; when a family goes through this, which is frustrating and hopeless at times.