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

Alzheimer disease (AD) is a slow developing nonreversible brain disorder that results in a permanent loss of neurons and neuronal synapses, causing neurocognitive disorder (Walter et al, 2014.) The loss of neurons is frequently in the areas of the brain responsible for function, memory, and cognition (Walter et al., 2014). In this assignment we will discuss the patient’s symptoms, diagnosis, and treatment in the provided case study/decision tree related to Alzheimer disease. Assessment To successfully assess patients for Alzheimer disease, we can use objective information from informants, such as family members, and caregivers. There are also a few tools such as the mini-mental state exam mentioned in the case study which is a widely used test of cognitive function among the elderly that tests orientation, attention, memory, language, and visual-spatial skills (Willacy, 2017). The mini cog is another test consisting of a recall test for memory and a scored clock drawing test (Alzheimer’s Association, n.d.). Case Study Decision Tree In this case study our patient is a 76-year-old Iranian male who has been exhibiting “worsening strange thoughts and behaviors” at home. His son has noted personality changes, decreased interest in religious activities, and finding amusement in once serious topics (Laureate, n.d.). Our patient’s son also notes that he has become “critical” of everyone, has been forgetting things, and cannot find the right words, often switching to a different conversation entirely. The patient’s lab work and CT scan are normal. During our assessment, the patient had poor eye contact, tangential speech, a restricted affect, and poor insight, poor judgement, and poor impulse control (Laureate, n.d.). The patient also scored 18 out of 30 on the mini-mental state exam. Upon first assessment I made the decision to begin Aricept 5mg PO at bedtime. I made this decision because Aricept/Donepezil is indicated for any stage of AD, including severe AD symptoms (Rosenthal & Burchum, 2021). At the four-week checkup after starting Aricept, the son reports no improvement with his father. After making the first decision I did not expect to see a notable change in our patient’s behaviors or symptoms as he was on a low dose and was only just started on it for a few weeks. It is important to maintain the patient on the initial dosage of Aricept for 1-3 months to minimize side effects, so I felt comfortable increasing Aricept to 10mg at bedtime (Rosenthal & Burchum, 2021). After a month of being on the increased dose of Aricept, our patient’s son reports that he is tolerating the medication well, attended religious services, but there is still no improvement. At this point in the care, I would educate both the patient and son regarding the expectations of our treatment plan. I would reiterate that Aricept, a cholinesterase inhibitor, decreases the destruction of acetylcholine and may help with memory and learning, it will not stop the disease trajectory but may help slow the progression (Walter et al., 2014). I would continue the 10mg of Aricept at bedtime and reiterate to family that with this medication it can take months before stabilization of deterioration is observable (Knowles, 2006). Based on our patient’s behaviors and age, I would not be comfortable increasing this dose due to the possibility of developing adverse side effects, I would consider adding NMDA receptor antagonist therapy (Namenda), with the Aricept because studies have shown less decline in cognitive and day to day function than those taking Aricept alone (Rosenthal & Burchum, 2021). Physical Patient Factors Cholinesterase inhibitors can cause nausea, vomiting, dyspepsia, diarrhea, dizziness, and headaches (Rosenthal & Burchum, 2021). CEI’s can also cause bronchoconstriction due to the