Assignment: Assessing and Treating Clients With Dementia NURS 6630N

Assignment: Assessing and Treating Clients With Dementia NURS 6630N

Decision Point Three

Selected Decision

On the twelfth week of the pharmacotherapy, the client visits the clinic again. After analysis of the progress, the nurse is expected to choose between increasing Exelon’s dosage to 6 mg and maintaining it at 4 mg. Given the prevailing circumstances, the nurse practitioner will choose to increase the dosage to 6 mg.

Reason (s) for Selection

Analysis of literary materials on the dosage and administration of Exelon reveal that the maximum dosage for the drug is 6 mg. However, the decision to prescribe a maximum dose for the drug is contingent upon the tolerability exhibited by the patient as well as safety of the medication (Cohen, L., Jann, M., & Penzak, 2016). The nurse has incrementally improved the dosage of the drug to 4.5 mg yet the client has not reacted negatively to the drug. Up until now, Mr. Akid has not complained of any side-effects or contraindications caused by the drug. Thus, it will only be logical for the nurse to increase the dosage to 6 mg pursuant to the standard procedure followed in the management of Alzheimer’s and other similar conditions. The above explanation automatically excludes maintaining the dosage at 4.5 mg. Moreover, augmenting Exelon with Namenda will not receive recommendation as Exelon is already proving effective. Also, augmenting Exelon with Namenda is a gamble that is too risky to countenance for the nurse.

Expected Results

            At 6mg, Exelon is already at its maximum dosage. Given that the drug has already improved certain symptoms, the expectation is that it will continue to improve them even further and even prevent a relapse of the affected symptoms.

Differences between Expected Results and Actual Results

            The latest assessment revealed that certain Alzheimer’s symptoms persisted when the client came back to the clinic. Nevertheless, other symptoms had improved remarkable, which was a justification to the decision to increase the dosage (Tasman et al., 2015). The two outcomes were expected as studies reveal that the degenerative feature of Alzheimer’s is not under the purview of cholinesterase inhibitors. Therefore, the nurse practitioner expected the presence of some of the symptoms of Alzheimer’s.

Ethical Considerations

            Normally, when patients seek treatment and prescriptions from mental healthcare practitioners, they expect the evident symptoms to undergo remission. However, Alzheimer’s, as already mentioned in the discussion, is a diseases of various pathophysiology and most of the formulated therapies fail to improve cognition. As such, Leuzy and Gauthier (2012) assert that during the creation of the present therapy, the nurse practitioner was supposed to remind the client and his family of the painstaking process that the treatment normally Thus, ethically, the nurse is expected to advise the patient and his family of this fact in a compassionate manner. However, during such conversations, the nurse is similarly expected to stress to the family of the need to continue with the management of the disease.

Conclusion

The management of Alzheimer’s is a complicated and painful affair. Whereas treatment options are available, the condition cannot be completely eliminated. As such, even when a patient seeks treatment with support from their family, they normally do this with the knowledge that they are simply prolonging the inevitable. Having said that, the treatment options that are available improve the quality of life of a patient by improving some of the symptomatology of the disease. To effectively do this, a nurse is required to monitor a patient for tolerability, effectiveness, and safety of administered drugs and make appropriate adjustments. Thus, the management of Alzheimer’s is a dynamic process that requires a nurse’s full attention to details including the ethics of the same.

Assignment: Assessing and Treating Clients With Dementia NURS 6630N

The Assignment
Examine Case Study: An Elderly Iranian Man With Alzheimer’s Disease. 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 stop to complete the following:
o 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?
o Decision #2
 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 #2 and the results
of the decision. Why were they different?
o 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.
Note: Support your rationale with a minimum of three academic resources. While you
may use the course text to support your rationale, it will not count toward the resource
requirement.
By Day 7
Submit your assignment
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
 Please save your Assignment using the naming convention “WK10Assgn+last name+first
initial.(extension)” as the name.
 Click the Week 10 Assignment Rubric to review the Grading Criteria for the Assignment.
 Click the Week 10 Assignment link. You will also be able to “View Rubric” for grading criteria
from this area.
 Next, from the Attach File area, click on the Browse My Computer button. Find the document
you saved as “WK10Assgn+last name+first initial.(extension)” and click Open.

 If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my
paper(s) to the Global Reference Database.
 Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Week 10 Assignment Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 10 Assignment draft and review the originality report.
Submit Your Assignment by Day 7
To submit your Assignment:
Week 10 Assignment

Making Connections

Now that you have:
 Assessed clients presenting with dementia
 Developed personalized plans of therapy for clients with dementia
 Examined factors that influence pharmacokinetic and pharmacodynamic processes in clients
requiring therapy for dementia
 Explored ethical and legal implications of prescribing therapy to clients with dementia
Next week, you will build on your assessment and treatment skills as you examine
clients presenting for therapy for comorbid conditions.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the
Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through this link provided.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and
practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapter, click on the Essential Psychopharmacology, 4th ed
tab on the Stahl Online website and select the appropriate chapter. Be sure to read all
sections on the left navigation bar for each chapter.

 Chapter 13, “Dementia and Its Treatment”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge
University Press.

To access information on the following medications, click on The Prescriber’s Guide,
5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:
For insomnia
 donepezil
 galantamine
 memantine
 rivastigmine

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia.
American Family Physician, 85(1), 20–22. Retrieved from
http://www.aafp.org/journals/afp.html
Note: Retrieved from from the Walden Library databases.
Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J.
H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of
Parkinson's disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved
from http://www.nature.com/npp/journal/v35/n4/pdf/npp2009176a.pdf
Required Media
Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s
disease [Interactive media file]. Baltimore, MD: Author.
Note: This case study will serve as the foundation for this week’s Assignment.
To prepare for this Assignment:
 Review this week’s Learning Resources. Consider how to assess and treat clients requiring
therapy for dementia.