NURS 6521 Discussion week 8

For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.

To Prepare

• Review this week’s interactive media pieces and select one to focus on for this Discussion.
• Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.

By Day 3 of Week 8

Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.

 This week you finish the assignment you started in week 8.  It will be due by the end of Day 7.  We also have a discussion this week that uses interactive media pieces in the resources area.

http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.ht

Decision Tree

This paper focuses on Mr. Akkad, a 76-year-old Iranian male patient diagnosed with major neurodegenerative disorder due to Alzheimer’s disease (presumptive). The clinical manifestations related to major neurocognitive disorder due to Alzheimer’s disease incorporate decline in cognitive ability manifested by complex attention where the individual is inattentive and take a longer duration to process information; impaired execution function displayed by the inability to plan, impaired decision-making, and inability to store information; memory and learning issues; language difficulties displayed by a loss of ability to speak or aphasia; impaired perceptual-motor; social cognition manifested by the inability to identify emotions of other persons; social withdrawal; and emotional distress (Wang et al., 2017). In the case study patient, the patient exhibited “strange behavior” manifested by the changed personality and behavior. Additionally, Mr. Akkad has lost interest in religious activities and was excessively critical with everyone.  Other symptoms included forgetfulness, language problems, among other impaired cognitive functions. In this paper, the aim is for the PMHN to come up with three decisions concerning the medication of Mr. Akkad.

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Decision Point One

The first decision the PMHN can make is to have the client start Exelon (rivastigmine) 1.5 mg orally BID. Exelon is preferred as the first option because it effectively treats Alzheimer’s disease manifested by the client. Besides, rivastigmine works by enhancing cholinergic function and stops acetylcholine breakdown, and thereby accelerating the availability of acetylcholine in the brain, enhancing synaptic transmissions, thus improving memory and other cognitive functions in this patient. Notably, Aricept (donepezil) 5 mg orally at BEDTIME was not choose since donepezil is linked to various side effects like vomiting, loss of appetite, dizziness, diarrhea, shakiness, sleep disturbances, and muscle cramps (Birks & Harvey, 2018). This decision was aimed at improving the patient’s symptoms expected to be manifested by enhanced cognitive function. However, the actual outcome and the expected outcome were different because the son reported that his dad’s symptoms did not improve. His MMSE score was still at 18 out of 30, accompanied by orientation, attention, and memory deficits.

Decision Point Two

In decision point two, the PMHN will rivastigmine dose to 4.5 mg orally BID. The dose is increased because evidence shows that when rivastigmine is administered at a higher dose, its efficacy increases (Zhang et al., 2020). As a result, the higher dose of rivastigmine is anticipated to be more effective in improving Mr. Akkad’s cognitive functions and other behavioral symptoms. Notably, increasing the rivastigmine dose increases the concentration of acetylcholine within the brain, thus increasing its efficacy (Zhang et al., 2020).  In this case, Exelon 6 mg is not selected because increasing the dose of Exelon from 1.5 mg to 6 mg abruptly would lead to a sudden acceleration of the drug levels in the bloodstream, which may increase the chances of adverse and side effects. The decision to increase the rivastigmine dose to 4.5 mg was aimed at stabilizing and enhancing the patient’s symptoms of presumptive Alzheimer’s disease, which is expected to be manifested by improved cognitive function and the capacity to engage in activities of daily living with minimal side effects. However, there was no difference between the expected outcome and the observed outcome of the chosen decision. The patient’s symptoms started to improve, as displayed by the client beginning to participate in religious services with his family. There were also no side effects as expected.

Decision Point Three

In decision point three, the PMHN will increase the Exelon dose to 6 mg. this decision is selected because the efficacy of Exelon is dose-dependent. Increasing its dosage increases the level of acetylcholine in the brain and hence increasing its efficacy. As a result, it is expected that increasing the Exelon dose will lead to an improvement in cognitive function and other behavioral symptoms. A decision to maintain the current Exelon dose was not chosen because the efficacy of Exelon is dose-dependent and is more effective with a higher dosage to enhance the patient’s symptoms. The decision to augment Exelon with Namenda 5 mg was not chosen since it is advisable to optimize the dose of Exelon as a cholinesterase inhibitor before augmenting the Exelon medication (Santos et al., 2018). The decision to raise Exelon to 6 mg was anticipated to continue improving symptoms, which would be manifested by improved cognitive functioning and the ability to perform daily living activities.

Overall, the first decision is for the PMHN to start the patient on Exelon 1.5 mg because Exelon effectively treats cognitive function for individuals with Alzheimer’s disease. However, the results of the decision point one decision showed no improvement, which could be attributed to the fact the medication takes time to improve symptoms. Decision point two was to increase the dose to 4.5 mg, while decision point three increased the dose to 6mg orally. Exelon's dose was increased because the medication is dose-dependent, and higher doses are more effective in treating the client’s symptoms. 

 References

Birks, J. S., & Harvey, R. J. (2018). Donepezil for dementia due to Alzheimer's disease. Cochrane Database of systematic reviews, (6).

Santos, B., González-Fraile, E., Zabala, A., Guillén, V., Rueda, J. R., & Ballesteros, J. (2018). Cognitive improvement of acetylcholinesterase inhibitors in schizophrenia. Journal of Psychopharmacology, 32(11), 1155-1166.

Wang, J., Gu, B. J., Masters, C. L., & Wang, Y. J. (2017). A systemic view of Alzheimer disease—insights from amyloid-β metabolism beyond the brain. Nature reviews neurology, 13(10), 612.

Zhang, X., Yu, R., Wang, H., & Zheng, R. (2020). Effects of rivastigmine hydrogen tartrate and donepezil hydrochloride on the cognitive function and mental behavior of patients with Alzheimer's disease. Experimental and Therapeutic Medicine, 20(2), 1789-1795.