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[ANSWERED OCTOBER 2022] Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

To Prepare

  • Review the interactive media piece assigned by your instructor.
  • Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
  • Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
  • You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

Write a 1- to 2-page summary paper that addresses the following:

  • Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
  • Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
  • What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
  • Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

References

Hussien, R. M., & Shoukry, A. A. (2020). Rivastigmine patch (Exelon patch) compared to melatonin patch in prevention of postoperative delirium in the elderly. Ain-Shams Journal of Anesthesiology12(1), 1-7. https://asja.springeropen.com/articles/10.1186/s42077-020-00087-6

Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current therapies for Alzheimer’s disease: focus on rivastigmine. Therapeutic advances in drug safety9(3), 171-178. https://doi.org/10.1177%2F2042098617750555

Yoon, S. J., Choi, S. H., Na, H. R., Park, K. W., Kim, E. J., Han, H. J., … & Na, D. L. (2017). Effects on agitation with rivastigmine patch monotherapy and combination therapy with memantine in mild to moderate Alzheimer\’s disease: a multicenter 24?week prospective randomized open?label study (the Korean EXelon Patch and combination with mEmantine Comparative Trial study). Geriatrics & Gerontology International17(3), 494-499. https://doi.org/10.1111/ggi.12754

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

  • Chapter 11, “Basic Principles of Neuropharmacology” (pp. 67–71)
  • Chapter 12, “Physiology of the Peripheral Nervous System” (pp. 72–81)
  • Chapter 12, “Muscarinic Agonists and Cholinesterase Inhibitors” (pp. 82–89)
  • Chapter 14, “Muscarinic Antagonists” (pp. 90-98)
  • Chapter 15, “Adrenergic Agonists” (pp. 99–107)
  • Chapter 16, “Adrenergic Antagonists” (pp. 108–119)
  • Chapter 17, “Indirect-Acting Antiadrenergic Agents” (pp. 120–124)
  • Chapter 18, “Introduction to Central Nervous System Pharmacology” (pp. 125–126)
  • Chapter 19, “Drugs for Parkinson Disease” (pp. 127–142)
  • Chapter 20, “Drugs for Alzheimer Disease” (pp. 159–166)
  • Chapter 21, “Drugs for Seizure Disorders” (pp. 150–170)
  • Chapter 22, “Drugs for Muscle Spasm and Spasticity” (pp. 171–178)
  • Chapter 59, “Drug Therapy of Rheumatoid Arthritis” (pp. 513–527)
  • Chapter 60, “Drug Therapy of Gout” (pp. 528–536)
  • Chapter 61, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 537–556)

Expert Answer and Explanation

Decision Tree for Neurological and Musculoskeletal Disorders

Summary of the Case and Decision Made

The case study assigned was about Mr. Akkad is a 76-year-old Iranian male who brought a nurse’s office by his son because he exhibits strange behavior, which started two years ago. The patient’s family doctor ruled any organic basis for this behavior. Lab results, including CT-scan, show that the patient is healthy. The patient’s son mentions that the patient has lost interest in things he viewed as significant in his life. The patient is also forgetful. Diagnosis tests presumed that the patient has major neurocognitive disorder due to Alzheimer’s disease. Therefore, it was recommended that he start taking 1.5mg rivastigmine orally BID and increase the dose to 3mg orally BID in two weeks. When he did show any positive result, the dose was increased to 4.5 mg orally BID for one month. After four weeks, the current dose was maintained because it showed positive results.

Justification of the Decisions Made 

Rivastigmine was prescribed to the patient because it is one of the drugs used to treat the effects of moderate and mild Parkinson’s disease and Alzheimer’s condition. According to Regenold et al. (2018), rivastigmine has been used for the treatment of dementia diseases because it has proved to be effective in improving thinking and memory of people who experience deterioration of mental health. Also, the drugs have been used because it can increase the patient’s functional activities. The patient has had behavioral problems. Thus, it was used to improve the patient his strange behaviors. Khoury et al. (2018) report that the drug should be prescribed from 1.5 mg, and if the patient does not show positive improvement, it should be increased gradually. The drug has shown significant symptomatic effects when used by dementia patients (Kadohara et al., 2017). Thus, it was used so that it can improve the independence of the patient.

The Possible Results for the Decisions

When making the decisions for this case, I was hoping to achieve the following results. First, I was hoping that the medication would improve the thinking of the patient, and thus make him embark on the activities he previously deemed important, such as going for religious functions. It was hoped that the drug could improve the reasoning of the patient, and this would make it less amused when he encounteres elements, he deemed serious (Khoury et al., 2018). Also, it was hoped the patient’s behavior would change after he takes the prescribed medication.

Comparison Between the Results Expected and the Ones Achieved 

Exelon to 4.5 mg orally BID dose was prescribed because it was hoped that the medication could improve the mental condition of the patient. However, the actual results were different. The patient’s son returned to the hospital, complaining that the medication did not work after four weeks. As a result, the dosage was increased to 3 mg. The dosage was increased with the hope that the patient’s condition could improve. However, the patient still scored 18 out of 30 with key deficits in the recall, registration, calculation and attention, and orientation. Also, his son complained that his father was still not interested in significant activities, such as religious functions. Therefore, the dose was increased to 4.5, and it was aimed that this drug would work this time. Weeks later, the patient’s son came back to the hospital complaining that the health of this father I still not better. However, he reports that the patient can now attend religious functions. Thus, I decided that the current medication should be maintained for four more weeks because it has proven to be somehow effective.

References

Kadohara, K., Sato, I., Doi, Y., Arai, M., Fujii, Y., Matsunaga, T., & Kawakami, K. (2017). Prescription patterns of medications for Alzheimer’s disease in Japan from 2010 to 2015: a descriptive pharmacy claims database study. Neurology and therapy, 6(1), 25-37. https://link.springer.com/article/10.1007/s40120-016-0057-1

Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current therapies for Alzheimer’s disease: focus on rivastigmine. Therapeutic advances in drug safety, 9(3), 171-178. https://journals.sagepub.com/doi/full/10.1177/2042098617750555

Regenold, W. T., Loreck, D. J., & Brandt, N. (2018). Prescribing Cholinesterase Inhibitors for Alzheimer Disease: Timing Matters. American family physician, 97(11), 700-700. Retrieved from https://www.semanticscholar.org/paper/Prescribing-Cholinesterase-Inhibitors-for-Alzheimer-Regenold-Loreck/d42dcbd248bf0595610e9963718617ddb3bee3c3

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