Decision Tree For Neurological And Musculoskeletal Disorders NURS 6521

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Decision Tree For Neurological And Musculoskeletal Disorders NURS 6521

Decision Tree For Neurological And Musculoskeletal Disorders NURS 6521

The case study depicts a 43-year-old white male who presents with a complaint of pain. He uses a set of clutches when ambulating. The patient reports that he has been referred for psychiatric assessment by his family doctor since the doctor perceived that he had psychological pain (Laureate Education, 2016). The pain began seven years ago after sustaining a fall and landed on the right hip. Four years ago, it was revealed that the cartilage around the right hip joint had a 75% tear.  However, no surgeon was willing to perform a total hip replacement since they believed that there would be tissue repair over time (Laureate Education, 2016). He reports having severe cramping of the right extremity. A neurologist diagnosed  him with complex regional pain syndrome (CRPS). He states that he gets low moods at times but denies being depressed.  He had been prescribed with Hydrocone but used it in low doses due to drowsiness and constipation, and the drug does not manage pain effectively (Laureate Education, 2016). The mental status exam is unremarkable.

Decision Point One: Savella 12.5 mg orally once daily on Day 1, followed by 12.5 mg BD on Day 2 and 3, then 25 mg BD on days 4-7 and then 50 mg BD after that.

Reason: Savella is a serotonin-norepinephrine reuptake inhibitor that has NMDA antagonist activity, which brings analgesia at the nerve endings (Cording et al., 2015). It is indicated for fibromyalgia and thus effective for this client (Cording et al., 2015). I prescribed Savella to help in pain management and improve the overall mood.

Expected Result: I anticipated that Savella would lower the degree of pain. However, it was expected that the client would experience adverse effects such as nausea, constipation, headache, hot flushes, and insomnia.

Expected Vs. Actual Results: The client returned to the clinic after for weeks without using crutches but with a bit of limping. He states that the pain has been more manageable. The pain is severe in the morning but improves throughout the day (Laureate Education, 2016). On a scale of 1-10, the client rates the pain at four and states that he gets to a point on most days where he does not need crutches. Nevertheless, he reported having increased sweating, sleeping difficulties, nausea, and palpitations (Laureate Education, 2016). His BP was 147/92, and the pulse at 110. He denied having suicidal ideations and was still future-oriented.

Decision Point 2: Continue with Savella but lower dose to 25 mg twice a day.

Reason: I selected this decision to lower the severity of the adverse effects of Savella, which include nausea, constipation, headache, hot flushes, and insomnia (Cording et al., 2015).

Expected Result: Reduction in the dose of Savella would help control the side effects but lower the degree of pain control.

Expected Vs. Actual Results: The client returned to the clinic in four weeks using crutches and rates his current pain at 7/10. He reports that his condition has declined since the previous month (Laureate Education, 2016). He states that he sleeps at night but frequently wakes up due to pain in the right leg and foot. The BP is at 124/87 and pulse at 87. He denies having palpitations and suicidal ideations but is discouraged by the slip in pain management and seems sad.

Decision Point 3: Change Savella to 25 mg in the morning and 50 mg at Bedtime.

I reduced the dosage in the morning since the pain is mostly under control and increased the dose at Bedtime when there is less control (Resmini et al., 2015).

Expected Result: By lowering the morning dose and increasing the bedtime dose, I expected that the client’s pain symptom would improve while at the same time controlling the side effects of Savella (Resmini et al., 2015).

Expected Vs. Actual Results: The client reported an improvement in the pain with a rate of 3/10 denied having any side effects from the drug.

References

Cording, M., Derry, S., Phillips, T., Moore, R. A., & Wiffen, P. J. (2015). Milnacipran for pain in fibromyalgia in adults. Cochrane Database of Systematic Reviews, (10).

Laureate Education. (2016). Case Study: A Caucasian man with hip pain. Baltimore, MD: Author.

Resmini, G., Ratti, C., Canton, G., Murena, L., Moretti, A., & Iolascon, G. (2015). Treatment of complex regional pain syndrome. Clinical cases in mineral and bone metabolism: the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases, 12(Suppl 1), 26–30. /orders/doi.org/10.11138/ccmbm/2015.12.3s.026

INSTRUCTIONS

For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

Photo Credit: KATERYNA KON/SCIENCE PHOTO LIBRARY / Science Photo Library / Getty Images

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.
By Day 7 of Week 8

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.

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

The case study is about a 76-year-old Iranian male accompanied to the office by his son after exhibiting odd behavior. The patient scored 18 out of 30 in the Mini-Mental State Exam. He is diagnosed with Major neurocognitive disorder secondary to Alzheimer’s disease. This paper provides a summary of the treatment decisions taken, what I was hoping to achieve, and compare the difference between the expected and actual results.

Decision One

In the first decision, I initiated the patient on Rivastigmine 1.5 mg PO BID with an increase to 3 mg orally BID in two weeks. The decision is supported by evidence-based literature since Rivastigmine is an irreversible inhibitor of acetylcholinesterase and its therapeutic effect includes improving cholinergic function. It improves cognitive symptoms by modifying acetylcholine transmitters (Khoury et al., 2018). Rivastigmine is indicated in treating mild to moderate AD dementia, as in the case of this patient. I hoped that initiating Rivastigmine would delay cognitive decline in the patient and enhance his performance of ADLs. I also hoped that Rivastigmine would improve the patient’s social behavior. The expected and actual outcomes were different since the patient still displayed odd social behaviors after four weeks of treatment. The MMSE score remained at 18, and the patient had deficits in registration, orientation, attention, recall, and calculation.

Decision Two

In decision two, I increased Rivastigmine to 4.5 mg orally BD. The dose was increased since the initial dose did not have a positive impact.  Khoury et al. (2018) explain that Rivastigmine should be gradually increased to allow the clinician to monitor adverse effects. The study further explains that Rivastigmine can take months to show improvement in neurocognitive symptoms, thus increasing the dose is important to show improvement over time. Therefore, the decision is based on evidence-based literature. I hoped that increasing the dose might result in a positive outcome in alleviating the patient’s cognitive and behavioral symptoms. The actual and expected outcomes were similar to some degree since the son reported that the father had started attending religious services with the family. However, the son reported that the father had not improved and was amused by serious things.

Decision Three

In decision three, I increased Rivastigmine to 6 mg orally BD to improve the patient’s cognitive symptoms. Besides, the patient did not report any side effects with the drug, and thus increasing the dose was appropriate. Folch et al. (2018) assert that Rivastigmine should be increased to the maximum dose before changing or augmenting the treatment. I hoped that increasing the dose would improve the client’s social behavior to a greater degree, and the son would report an improvement in the father’s condition. Besides, I hoped that increasing the dose would improve the patient’s cognitive symptoms and the MMSE score. The expected and actual results were similar to some extent since the patient exhibited improved social interactions and engaged in family activities. Besides, the odd behaviors had decreased as the patient rarely got amused by serious things.

Conclusion

The patient was initiated with Rivastigmine 1.5 mg BD to improve the cognitive and behavioral symptoms. However, the initial dose did not achieve the desired effect, which resulted in increasing the dose to 4.5 BD. Increasing the dose led to some improvement in social interactions, but no cognitive improvement was noted. Rivastigmine was then increased to 6 mg BD to improve the cognitive and behavioral symptoms.

References

Folch, J., Busquets, O., Ettcheto, M., Sánchez-López, E., Castro-Torres, R. D., Verdaguer, E., Garcia, M. L., Olloquequi, J., Casadesús, G., Beas-Zarate, C., Pelegri, C., Vilaplana, J., Auladell, C., & Camins, A. (2018). Memantine for the Treatment of Dementia: A Review on its Current and Future Applications. Journal of Alzheimer’s disease: JAD, 62(3), 1223–1240. /orders/doi.org/10.3233/JAD-170672

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. /orders/doi.org/10.1177/2042098617750555

You will submit this Assignment in Week 8.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.

Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.

Click the Week 8 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 “WK8Assgn+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 8 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 8 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 8

To participate in this Assignment:

Week 8 Assignment

What’s Coming Up in Week 7?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will continue working on your Assignment started in Week 6, and you will complete your Midterm Exam.

Next Week

To go to the next week:

Week 6: Neurologic and Musculoskeletal Disorders

Sabrina is a 26 year old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems. Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.

As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?

This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study. Assignment: Decision Tree for Neurological and Musculoskeletal Disorders NURS 6521

Learning Objectives

Students will:

Learning Resources
Required Readings (click to expand/reduce)

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)

American Academy of Family Physicians. (2019). Dementia. Retrieved from http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=5

This website provides information relating to the diagnosis, treatment, and patient education of dementia. It also presents information on complications and special cases of dementia. Assignment: Decision Tree for Neurological and Musculoskeletal Disorders NURS 6521

Document: Mid-Term Summary & Study Guide (PDF)

Required Media (click to expand/reduce)

Laureate Education (Producer). (2019b). Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease.

Laureate Education (Producer). (2019e). Complex regional pain disorder [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat complex regional pain disorders.

Disorders of The Nervous System

Reflect on the comprehensive review of disorders of the nervous system and think about how you might recommend or prescribe pharmacotherapeutics to treat these disorders. (15m)

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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  • Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

  • Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. Decision Tree For Neurological And Musculoskeletal Disorders NURS 6521

  • APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

  • Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. Decision Tree For Neurological And Musculoskeletal Disorders NURS 6521

  • LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

  • Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Decision Tree For Neurological And Musculoskeletal Disorders NURS 6521

  • Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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SCORE A+ WITH HELP FROM OUR PROFESSIONAL WRITERS

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