Practicum-Decision Tree-WK8DU-WK10 Essay.

Posted: December 3rd, 2022

Practicum-Decision Tree-WK8DU-WK10 Essay.

Assignment 1- Practicum-Decision Tree-WK8DU-WK10

For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.
The Assignment:Practicum-Decision Tree-WK8DU-WK10 Essay.

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Learning Objectives
Students will:
• Evaluate clients for treatment of mental health disorders
• Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
Examine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
• Decision #1: Differential Diagnosis== Major Neurocognitive Disorder with Lewy Bodies- FYI use that diagnosis.
o Which Decision did you select?
o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
• Decision #2: Treatment Plan for Psychotherapy
o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.Practicum-Decision Tree-WK8DU-WK10 Essay.
o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
• Decision #3: Treatment Plan for Psychopharmacology
o Why did you select this Decision? Support your response with evidence and references to the Learning Resources.Practicum-Decision Tree-WK8DU-WK10 Essay.
o What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
o 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 and their family.
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.

NOTE THE FOLLOWING IMPORTANT
• Decision #1: Differential Diagnosis= Major Neurocognitive Disorder with Lewy Bodies
• Decision #2: Treatment Plan for Psychotherapy- PLEASE WRITE ON PSYCHOTHERAPY TREATMENT PLAN FOR THE DIAGNOSIS AND NOT MEDICATION AND ANSWER THE BULLET QUESTIONS AS ASKED ABOVE.
• Decision #3: Treatment Plan for Psychopharmacology- PLEASE WRITE ON THE MEDICATIONS YOU CHOSE ( Decision1- Begin Rivastigmine 1.5 mg orally twice a day . followed by Begin Clonazepam 0.5 mg orally at bedtime when the client return in 4 weeks. THEN AND ANSWER THE BULLET QUESTIONS AS ASKED ABOVE
• ALL REFERENCES 5 YEARS OR LESS.
• SEE THE SAMPLE FORMAT.
• DO NOT COPY FROM PREVIOUS WORK AS PLAGIARISM CHECK WILL SEE IT.
• SEE THE ATTACHED MAIN CASE SCENARIO FOR YOUR INFORMATION AND THE BEST DECISION TO SELECT TO WORK ON.
Brief introduction and conclusion

Practicum-Decision Tree-WK8DU-WK10
Introduction
The focus of this assignment is on Mr. Wingate, a 76-year-old male who presented with symptoms of Alzheimer’s disease. The client reported memory problems that impaired his functioning. He also reported fluctuating energy levels, concentration problems, sleep problems, nightmares while sleeping, coordination problems, and abnormal movements. Resting tremors, impaired insight, impaired attention and concentration, and constricted affect were revealed. The client’s MMSE was 17, with calculation, memory and orientation deficits indicating serious cognitive impairment. In this paper, three decisions will be made regarding the client’s diagnosis and treatment. Ethical consideration that may affect the treatment of the client will be discussed.Practicum-Decision Tree-WK8DU-WK10 Essay.
Decision Point 1: Differential Diagnosis
Major Neurocognitive disorder with Lewy bodies
Rationale for Selecting the Decision
Diagnosis of is major neurocognitive disorder with Lewy bodies was chosen because the client exhibits clinical features associated with the neurological disorder. According to American Psychiatric Association (2014) major neurocognitive disorder with Lewy bodies is characterized by clinical features such as concentration and attention problems, visual hallucinations, rapid eye movement (REM) sleep behavior disorder, and parkinsonian motor signs. The client manifests symptoms such as (REM) sleep behavior disorder, rest tremor and slowing movement indicating parkinsonian motor signs, impaired concentration, and attention problems; these symptoms are consistent with clinical features of major neurocognitive disorder with Lewy bodies (American Psychiatric Association, 2014).

Expected Outcomes
The expected outcome is that the diagnosis of major neurocognitive disorder with Lewy bodies will be confirmed for the client. Diagnostic tests that can be used to confirm the diagnosis include SPECT or PET imaging (DAT uptake) and Iodine-MIBG myocardial scintigraphy to determinesynucleinopathy (Gomperts, 2016).Practicum-Decision Tree-WK8DU-WK10 Essay.
Difference between Expected outcome and Outcome of Decision #1
There is no difference between the expected outcome and the actual outcome of the decision because the client manifests symptoms suggestive of Major Neurocognitive Disorder with Lewy bodies.
Decision Point Two: Psychotherapy
Electroconvulsive therapy
Rationale for Selecting the Decision
The decision to have the client undergo bilateral electroconvulsive therapy is because evidence shows that electroconvulsive therapy reduces depressive symptoms and improves neuropsychiatric symptoms in individuals with major neurocognitive disorder with Lewy bodies (Connors et al, 2018). Evidence also shows that patients undergoing electroconvulsive therapy have less recurrent hallucinations, reduced psychotic symptoms and also reduced motor symptoms (Connors et al, 2018).Practicum-Decision Tree-WK8DU-WK10 Essay.
Expected Outcomes
By selecting this decision, it is expected that the client will manifest significant improvement when it comes to neuropsychiatric symptoms, psychotic symptoms and also motor symptoms. This is because electroconvulsive therapy has been shown to be effective in improving these symptoms in individuals with major neurocognitive disorder with Lewy bodies (Connors et al, 2018).
Difference between Expected outcome and Outcome of Decision
However, the client did not showany improvement in both neuropsychiatric symptoms and motor symptoms. Moreover, the (REM Sleep Behavior Disorder) RBD worsened as indicated by more nightmares and acting when dreaming.
Decision Point Three: Psychopharmacology
Decision1- Begin Rivastigmine 1.5 mg orally twice a day
Rationale for Selecting the Decision
The decision for the client to start Rivastigmine 1.5 mg was selected because the evidence shows the efficacy of Rivastigmine in treating cognitive such as memory, attention and neuropsychiatric symptoms in individuals with major neurocognitive disorder with Lewy bodies (Gabbard, 2014).
Expected Outcomes
By selecting this decision, the expectation was that the client would manifest improvement in cognitive and neuropsychiatric symptoms such as the ability to concentrate, attention, sleep problems, concentration problems, and memory. This is because Rivastigmine has been demonstrated to be effective in improving cognitive and neuropsychiatric symptoms in individuals with major neurocognitive disorder with Lewy bodies (Boot, 2015). It was also expected that the client would tolerate the medication.Practicum-Decision Tree-WK8DU-WK10 Essay.
Difference between Expected outcome and Outcome of Decision
The outcome of the decision was different from the expected outcome. The client did not manifest any symptom improvement and actually, the RBD worsened as indicated by more nightmares and acting when dreaming. The lack of notable symptom improvement can be attributed to the fact that Rivastigmine just slows the disease progression but does not reverse the already existing cognitive and neuropsychiatric deficits (Sadock et al, 2014).
Decision Point Three: Psychopharmacology
Begin Clonazepam 0.5 mg orally at bedtime
Rationale for Selecting the Decision
This decision was selected because the medication can reduce RBD and hence the nightmares and acting out at night will reduce. Evidence has demonstrated the efficacy of clonazepam in the treatment of rapid eye movement (REM) sleep behavior disorder (Escribá&Hoyo, 2016). This is because RBD is worsening for the client and therefore treatment of RBD is a priority.Practicum-Decision Tree-WK8DU-WK10 Essay.
Expected Outcome
Selection of this decision expected that the RBD symptoms would reduce and this will be manifested fewer nightmares and reduced acting out while dreaming. This is because evidence shows that clonazepam is effective in the treatment of rapid eye movement (REM) sleep behavior disorder (Escribá&Hoyo, 2016).
Ethical Considerations
Ethical considerations that may affect the treatment include informed consent and decision-making ability. It would be important for the PMHNP to inform the client and his son about the side effects of all treatment options to ensure they make an informed decision (Hedge &Ellajosyula, 2016). For example, since Clonazepam is a benzodiazepine, it can increase the risk of falls for the client. Moreover, cognition impairment may hinder the client’s decision to make treatment decisions (Hedge &Ellajosyula, 2016).Practicum-Decision Tree-WK8DU-WK10 Essay.
Conclusion
The client’s diagnosis is major neurocognitive disorder with Lewy bodies as indicated by symptoms such as rapid eye movement sleep behavior disorder and other cognitive and neuropsychiatric symptoms. The second decision is for the client to undergo electroconvulsive therapy to reduce depressive symptoms, neuropsychiatric symptoms, and motor symptoms. The third decision is for the client to start Rivastigmine, followed by Clonazepam. Ethical aspects that may affect the treatment plan are decision-making ability and informed consent.
Practicum-Decision Tree-WK8DU-WK10
Introduction
The focus of this assignment is on Mr. Wingate, a 76-year-old male who presented with symptoms of Alzheimer’s disease. The client reported memory problems that impaired his functioning. He also reported fluctuating energy levels, concentration problems, sleep problems, nightmares while sleeping, coordination problems, and abnormal movements. Resting tremors, impaired insight, impaired attention and concentration, and constricted affect were revealed. The client’s MMSE was 17, with calculation, memory and orientation deficits indicating serious cognitive impairment. In this paper, three decisions will be made regarding the client’s diagnosis and treatment. Ethical consideration that may affect the treatment of the client will be discussed.Practicum-Decision Tree-WK8DU-WK10 Essay.
Decision Point 1: Differential Diagnosis
Major Neurocognitive disorder with Lewy bodies
Rationale for Selecting the Decision
Diagnosis of is major neurocognitive disorder with Lewy bodies was chosen because the client exhibits clinical features associated with the neurological disorder. According to American Psychiatric Association (2014) major neurocognitive disorder with Lewy bodies is characterized by clinical features such as concentration and attention problems, visual hallucinations, rapid eye movement (REM) sleep behavior disorder, and parkinsonian motor signs. The client manifests symptoms such as (REM) sleep behavior disorder, rest tremor and slowing movement indicating parkinsonian motor signs, impaired concentration, and attention problems; these symptoms are consistent with clinical features of major neurocognitive disorder with Lewy bodies (American Psychiatric Association, 2014).Practicum-Decision Tree-WK8DU-WK10 Essay.

Expected Outcomes
The expected outcome is that the diagnosis of major neurocognitive disorder with Lewy bodies will be confirmed for the client. Diagnostic tests that can be used to confirm the diagnosis include SPECT or PET imaging (DAT uptake) and Iodine-MIBG myocardial scintigraphy to determinesynucleinopathy (Gomperts, 2016).
Difference between Expected outcome and Outcome of Decision #1
There is no difference between the expected outcome and the actual outcome of the decision because the client manifests symptoms suggestive of Major Neurocognitive Disorder with Lewy bodies.
Decision Point Two: Psychotherapy
Electroconvulsive therapy
Rationale for Selecting the Decision
The decision to have the client undergo bilateral electroconvulsive therapy is because evidence shows that electroconvulsive therapy reduces depressive symptoms and improves neuropsychiatric symptoms in individuals with major neurocognitive disorder with Lewy bodies(Connors et al, 2018). Evidence also shows that patients undergoing electroconvulsive therapy have less recurrent hallucinations, reduced psychotic symptoms and also reduced motor symptoms (Connors et al, 2018).Practicum-Decision Tree-WK8DU-WK10 Essay.
Expected Outcomes
By selecting this decision, it is expected that the client will manifest significant improvement when it comes to neuropsychiatric symptoms, psychotic symptoms and also motor symptoms. This is because electroconvulsive therapy has been shown to be effective in improving these symptoms in individuals with major neurocognitive disorder with Lewy bodies(Connors et al, 2018).
Difference between Expected outcome and Outcome of Decision
Just like expected, the client showed some improvement in both neuropsychiatric symptoms and motor symptoms. The client reported improved concentration and improvedcoordination. The client also reported fewer tremors and reduced abnormal movements.Practicum-Decision Tree-WK8DU-WK10 Essay.
Decision Point Three: Psychopharmacology
Decision1- Begin Rivastigmine 1.5 mg orally twice a day
Rationale for Selecting the Decision
The decision for the client to start Rivastigmine 1.5 mg was selected because the evidence shows the efficacy of Rivastigmine in treating cognitive such as memory, attention and neuropsychiatric symptoms in individuals with major neurocognitive disorder with Lewy bodies (Gabbard, 2014).
Expected Outcomes
By selecting this decision, the expectation was that the client would manifest improvement in cognitive and neuropsychiatric symptoms such as the ability to concentrate, attention, sleep problems, concentration problems, and memory. This is because Rivastigminehas been demonstrated to be effective in improvingcognitive and neuropsychiatric symptoms in individuals with major neurocognitive disorder with Lewy bodies (Boot, 2015). It was also expected that the client would tolerate the medication.
Difference between Expected outcome and Outcome of Decision
The outcome of the decision was different from the expected outcome. The client did not manifest any symptom improvement and actually, the RBD worsened as indicated by more nightmares and acting when dreaming. The lack of notable symptom improvement can be attributed to the fact that Rivastigmine just slows the disease progression but does not reverse the already existing cognitive and neuropsychiatric deficits (Sadock et al, 2014).
Decision Point Three: Psychopharmacology
Begin Clonazepam 0.5 mg orally at bedtime
Rationale for Selecting the Decision
This decision was selected because the medication can reduce RBD and hence the nightmares and acting out at night will reduce. Evidence has demonstrated the efficacy of clonazepam in the treatment of rapid eye movement (REM) sleep behavior disorder (Escribá&Hoyo, 2016). This is because RBD is worsening for the client and therefore treatment of RBD is a priority.Practicum-Decision Tree-WK8DU-WK10 Essay.
Expected Outcome
Selection of this decision expected that the RBD symptoms would reduce and this will be manifested fewer nightmares and reduced acting out while dreaming. This is because evidence shows that clonazepam is effective in the treatment of rapid eye movement (REM) sleep behavior disorder(Escribá&Hoyo, 2016).
Ethical Considerations
Ethical considerations that may affect the treatment include informed consent and decision-making ability. It would be important for the PMHNP to inform the client and his son about the side effects of all treatment options to ensure they make an informed decision(Hedge &Ellajosyula, 2016). For example, since Clonazepam is a benzodiazepine, it can increase the risk of falls for the client. Moreover, cognition impairment may hinder the client’s decision to make treatment decisions (Hedge &Ellajosyula, 2016).
Conclusion
The client’s diagnosis is major neurocognitive disorder with Lewy bodies as indicated by symptoms such as rapid eye movement sleep behavior disorder and other cognitive and neuropsychiatric symptoms. The second decision is for the client to undergo electroconvulsive therapy to reduce depressive symptoms, neuropsychiatric symptoms, and motor symptoms. The third decision is for the client to start Rivastigmine, followed by Clonazepam. Ethical aspects that may affect the treatment plan are decision-making ability and informed consent.Practicum-Decision Tree-WK8DU-WK10 Essay.