Assessing and Treating Clients With Dementia Essay

Posted: November 18th, 2022

Assessing and Treating Clients With Dementia Essay

Assessing and Treating Clients With Dementia The Alzheimer’s Association defines dementia as “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2016). This term encompasses dozens of cognitive disorders of impaired memory formation, recall, and communication. The care and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family support, and even the care setting. In your role, as the psychiatric mental health nurse practitioner, you must be prepared to not only treat clients with these various cognitive disorders, but also the multiple behavioral issues that often accompany them. Assessing and Treating Clients With Dementia Essay. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with dementia. Reference: Alzheimer’s Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp Learning Objectives Students will: • Assess client factors and history to develop personalized therapy plans for clients with dementia • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for dementia • Evaluate efficacy of treatment plans • Analyze ethical and legal implications related to prescribing therapy for clients with dementia To prepare for this Assignment: Review the reading resources (see attachment doc) 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. (Decisions have already been made. See decision results in the attached case study) 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. Assessing and Treating Clients With Dementia Essay. I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree (see results of decision tree in the attachment doc). I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest. I do not need you to tell me the treatment options available to you – I am very familiar with the cases. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) AND why you did not choose the other options (with clinically relevant and patient specific data). At each decision point, stop to complete the following: * Decision #1 Select what the PMHNP should do next: • You decided to begin the client with Aricept (Donepezil) 5 mg by mouth at the hour of sleep. (see attachment for result of decision#1) • 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. • Why did you not choose the option to begin Galantamine 4 mg orally BID or Exelon (rivastigmine) 1.5 mg orally BID with the increase to 3 mg by mouth BID in two weeks? • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different? Decision #2 Select what the PMHNP should do next: • You decide to increase the Donepezil to 10 mg at bedtime. (see attachment for result of 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. • Why did you not choose the options to discontinue Aricept and start Galantamine extended-release 24 mg orally daily or discontinue Aricept to start Namenda extended release 28 mg orally daily? • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? Decision #3 Select what the PMHNP should do next: • You decide to continue Aricept 10 mg orally at bedtime. (see attachment for result of 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. • Why did you not choose the options to either increase Aricept to 15 mg orally at bedtime for six weeks, then increase to 20 mg orally at night or stop Aricept to begin Namenda 5 mg orally daily? • 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.Assessing and Treating Clients With Dementia Essay

Assessing and Treating Clients with Dementia

Introduction

This assignment focuses on Mr. Akkad, a 76-year-old Iranian man. The client’s MMSE score was 18/30, with deficits in orientation, registration, attention & calculation, as well as recall, indicating moderate dementia. The provided information also shows that the client’s behavior has changed and he has become very forgetful. The MSE indicates that the client’s affect is restricted and he is disoriented to events and time. In addition, his insight, impulse control,and judgment are impaired. The diagnosis of the client is major neurocognitive disorder due to Alzheimer’s disease (presumptive). The purpose of this assignment is to make three decisions regarding the medications for the client. In addition, any ethical consideration that may influence the treatment plan will be outlined.Assessing and Treating Clients With Dementia Essay

Decision Point One

The chosen decision is to start Aricept (donepezil) 5 mg orally at bedtime. This decision was selected because donepezil is an acetylcholinesterase inhibitor that works through obstructing the effects of cholinesterase inhibitors by breaking down acetylcholine; this prolongs the action of acetylcholine which is normally reduced in individuals with Alzheimer’s disease such as the client (Sabbagh et al, 2016). In addition, Aricept (donepezil) has been shown to improve global clinical status, the performance of activities of daily living, cognitive function, as well as in improving memory, functionality,and awareness (Cummings et al, 2015).

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Selection of this decision aimed to improve the client’s cognitive performance such as improving his memory. The decision also aimed to improve his behavior, functionality as well as his ability to perform some activities of daily living. This is because evidence shows that Aricept(donepezil) improves symptoms of Alzheimer’s disease such as forgetfulness, behavioral changes, and cognitive function (Cummings et al, 2015).

The reason for not choosing the option to start Galantamine 4 mg orally BID or Exelon (rivastigmine) 1.5 mg orally BID is because these two options are indicated for mild-to-moderate Alzheimer’s disease while donepezil) 5 mg orally is indicated for mild-to-moderate-to-severe Alzheimer’s disease (Sadowsky et al, 2014).

However, the actual results were not as expected. This is because as per the son’s report, the client did not show any improvement and also his MMSE score was still 18/330 with deficits in memory, orientation and attention. The difference between the actual results and what was expected with the decision is attributable to the low dose of Aricept (donepezil) for the client. This is because evidence shows that higher doses of donepezil are more effective because the efficacyof acetylcholinesterase inhibitors such as donepezildepends on the dose (Shimizu et al, 2015).Assessing and Treating Clients With Dementia Essay

Decision Point Two

The chosen decision point two is to increase Aricept to 10 mg orally at BEDTIME. The reason for selecting this decision is because evidence shows that the efficacy of acetylcholinesterase inhibitors such as donepezil depends on the dose(Shimizu et al, 2015). This is because evidence shows that higher doses of donepezil are more effective because the efficacy of acetylcholinesterase inhibitors such as donepezil depends on the dose (Shimizu et al, 2015). Therefore, an increase of donepezil dose from 5 mg to 10 mg is likely to be more effective and hence it is expected that the client will show improvement with the increased dose.

By selecting this decision, the expectation was that the client will manifest improvement when it comes to symptoms of Alzheimer’s disease. It is thus expected that the client will show improvement in memory, functionality and behavior change which will be manifested by him starting to participate in religious activities once again. It is also expected that the client will tolerate the dose. This is because as evidence shows, higher doses of acetylcholinesterase inhibitors like donepezil are associated with better efficacy (Shimizu et al, 2015).

The reason for not choosing options to discontinue Aricept and start Galantamine extended-release 24 mg orally daily or the option todiscontinue Aricept to start Namenda extended release 28 mg orally daily is because the client has not manifested any clinical presentations or drug intolerability that would warrant discontinuation of Aricept.

There was a similarity between the selected decision and the actual decision. The actual results showed some improvement as the client started attending religious services. This shows an increased efficacy of the medication with an increased dose (Shimizu et al, 2015). The client seems to be tolerating the dose increase since he does not manifest any side effect.Assessing and Treating Clients With Dementia Essay

Decision Point Three

The selected decision is for the client to continue Aricept 10 mg orally at BEDTIME. This decision was selected because the client is manifesting some improvement with the current dose and thus it is expected that improvements will continue manifesting. Another reason for selecting this decision is because the client is tolerating the current dose so maintaining this dose will ensure tolerability and prevent adverse events (Pasqualetti et al, 2015).

Choosing this decision hoped to improve the client’s cognitive performance as well as his ability to perform activities of daily living. Another expectation was that the client will tolerate the medication and will not have any adverse event and minimal side effects. This is because efficacy and tolerability acetylcholinesterase inhibitors such as donepezildepend on dose and so maintaining the current dose was expected to ensure efficacy and tolerability as well (Pasqualetti et al, 2015).

The reason for not selecting the option to Aricept to 15 mg orally at bedtime is because even though the efficacy of acetylcholinesterase inhibitors like donepezil depends on dose, its tolerability is also dose-dependent and thus the medication is also dose limiting (Shimizu et al, 2015). The reason for not choosing the decision to stop Aricept to begin Namenda 5 mg orally daily is because the client is manifesting improvement with Aricept and tolerating the medication and hence no clinical reason to stop the medication.Assessing and Treating Clients With Dementia Essay

Ethical Considerations

Ethical issues that may affect the client’s treatment include autonomy and ability to make decisions. For example, the disease may make the client may lose his capacity to determine and communicate what he wants or make decisions regarding his treatment (Molinuevoet al, 2016). This is because Alzheimer’s disease impairs an individual’s cognitive ability and hence can impair the client’s capacity to understand the treatment options (Molinuevo et al, 2016).Assessing and Treating Clients With Dementia Essay

References

Cummings J, Richard S, Schmitt F & Drew V. (2015). A practical algorithm for managing Alzheimer’s disease: what, when, and why? Ann Clin Transl Neurol. 2(3), 307–323.

Molinuevo J, Cami J, Carne X, Jean G, Isaac M, Kim S, Morris J, Craig R, Reisa S & Jason K. (2016). Ethical challenges in preclinical Alzheimer’s disease observational studies and trials: results of the Barcelona summit. Alzheimers Dement. 12(5), 614–622.

Pasqualetti G, Tognini S, Calsolaro V, Polini A & Fabio M. (2015).Potential drug–drug interactions in Alzheimer patients with behavioral symptoms.Clin Interv Aging. 1(10), 1457–1466.

Sadowsky C, Micca J, Grssberg G & Drew V. (2014).RivastigmineFrom Capsules to Patch: Therapeutic Advances in the Management of Alzheimer’s Disease and Parkinson’s Disease Dementia. Prim Care Companion CNS Disord. 16(5).

Sabbagh M, Han S, Kim S, Na H, Lee J, Sowani A, Ampil E, Dash A et al. (2016). Clinical Recommendations for the Use of Donepezil 23 mg in Moderate-to-Severe Alzheimer’s Disease in the Asia-Pacific Region. Dement Geriatr Cogn Dis Extra. 6(3): 382–395.

Shimizu S, Kannetaka H, Hirose D, Sakurai H &Hanvu H. (2015). Differential Effects of Acetylcholinesterase Inhibitors on Clinical Responses and Cerebral Blood Flow Changes in Patients with Alzheimer’s Disease: A 12-Month, Randomized, and Open-Label Trial. Dement Geriatr Cogn Dis Extra. 5(1), 135–146. Assessing and Treating Clients With Dementia Essay