NURS 6630 Week 10 Assignment: Assessing and Treating Clients With Dementia

NURS 6630 Week 10 Assignment: 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. 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

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapter, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 13, “Dementia and Its Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

• For insomnia
• donepezil
• galantamine
• memantine
• rivastigmine

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html

Note: Retrieved from from the Walden Library databases.

Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson’s disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp2009176a.pdf

Required Media

Laureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for dementia.

Walden NURS 6630 Week 10 Sample Paper (Assessing and Treating Clients with Dementia)

Assessing and Treating Clients with Dementia

Student’s Name:

Institutional Affiliation:

Assessing and Treating Clients with Dementia

The treatment of brain degeneration illnesses such as Alzheimer’s will require the PMHNP to consider the benefits and side effects of such treatments. The PMHNP will recognize that though the brain degeneration caused by conditions such as Alzheimer’s is not reversible, it can be controlled when the right medication and dosage are administered to patients. This paper explores the pharmacokinetics and pharmacodynamics of the medications administered to control Alzheimer’s in a 76-year-old Iranian male.

Decision #1

For the first decision, I decided to administer Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID after two weeks. I made the decision to administer Exelon (rivastigmine) 1.5 mg to the patient and increase the dosage to 3 mg after two weeks as the drug is known to be effective in limiting the symptoms of degenerative brain disease as a cholinesterase inhibitor (Khoury, Rajamanickam, & Grossberg, 2018). I also made the decision, to begin with, a 1.5 mg dosage and increase to 3mg after two weeks as this would help to avoid severe side effects on the patients a such as the loss of appetite, nausea, and upset stomach (Khoury et al., 2018). The medication would benefit the patients and cause less harm.

The other two decisions, which would be to administer Aricept (donepezil) 5 mg orally or Razadyne (galantamine) 4 mg orally BID, would be less advantageous and would not be considered.  The central reason for not administering Aricept (donepezil) 5 mg to the 76-year-old Iranian male would be because of the severe side effects associated with the drug. According to Agboton, Mahdavian, Singh, et al. (2014), Aricept has been shown to cause a slow and irregular heartbeat in some patients, which can result in fainting. On the other hand, the decision to administer Razadyne would be less advantageous as it can cause severe side effects such as fast, slow, and irregular breathing, which would be detrimental to the elderly patient’s health. Razadyne would also have a higher probability of contributing to severe side effects such as slow or irregular heartbeats in a patient and would not be considered (Nakagawa, Ohnishi, Kobayashi, et al., 2017).

By making the decision to administer Exelon (rivastigmine) 1.5 mg orally and increase to 3 mg orally BID in 2 weeks, I was hoping to help limit the symptoms of Alzheimer’s on the patient, including loss of interest in important activities, and increasing the patients Mini-Mental State Exam (MMSE) score. According to Kandiah, Pai, Senanarong, et al. (2017), Exelon will be effective in treating most symptoms of Alzheimer’s and will boost the brain’s activity of patients.

What I was hoping to achieve after administering Exelon 1.5 mg orally and increasing the dose to 3 mg orally after two weeks and the results of the decision were different because no improvements were noted in the patient’s MMSE score. The patient was also quite disinterested in important activities in their life, such as religious activities. From the results, it was evident that the medication had not yet been effective on the patient. According to Khoury et al. (2018), cholinesterase inhibitors will not be effective from the onset, with effects likely to be observed in the second month of administration.

Decision #2

For the second decision, I choose to increase the dosage of Exelon to 4.5 mg orally. I selected this decision because the patient had not displayed any severe side effects with the administration of 3mg of Exelon in the past month. Increasing the dosage of Exelon to 4.5 mg was also needed to bring about the preferred results of limiting the symptom of Alzheimer’s on the patient. According to Kandiah et al. (2017), increasing the dosage of Exelon is recommended among patients who do not experience severe side effects so as to limit the symptoms of Alzheimer’s.

By making the decision to increase the dosage of Exelon to 4.5 mg, I was hoping to improve the patient’s brain functionality and interest in activities which they liked. What I expected to achieve in increasing the dosage of Exelon to 4.5 mg was similar to what I achieved in that after a month, the patients showed increased functionality by attending religious activities and showing interest. This showed the dosage was effective in limiting the symptoms of Alzheimer’s on the patient.

Decision #3

For the third decision, I choose to increase Exelon dosage to 6mg orally. According to Khoury et al. (2018), increasing the dosage of Exelon is recommended in cases where the patient does not show any severe side effects. The increased dosage will be more effective in limiting Alzheimer’s symptoms.

By making the decision to increase the Exelon dosage of the 76-year-old Iranian patient to 6mg, I was hoping to sustain the patient’s interests in activities which they liked and improve the brain functionality. Cholinesterase inhibitors help to stabilize the symptoms of Alzheimer’s and help patients to regain interest in activities they consider important while functioning better (Kandiah et al., 2017). What I was hoping to accomplish by increasing the dosage was similar to what I achieved in that the patient showed an increased interest in religious activities and general improvement in brain function. This showed that the increased dosage was effective in limiting Alzheimer’s symptoms in the patients.

Ethical Considerations

In treating the 76-year-old Iranian male, the ethical principles of confidentiality and beneficence would be followed. Only the medication that provides the benefits to the patients would be considered, with all the information related to the treatment being held in confidence by all involved parties.

References

Agboton, C Mahdavian, S., Singh, A.,  Ghazvini, P.,  Hill, A.,  & Sweet, R. (2014). Impact of

nighttime donepezil administration on sleep in the older adult population: A retrospective study. Mental Health Clinician 1; 4 (5): 257–259. doi: /orders/doi.org/10.9740/mhc.n222761.

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.

Kandiah N, Pai MC, Senanarong V, Looi I, Ampil E, Park KW, Karanam AK,  & Christopher S.

(, 2017). Rivastigmine: the advantages of dual inhibition of acetylcholinesterase and butyrylcholinesterase and its role in subcortical vascular dementia and Parkinson’s disease dementia. Clin Interv Aging. 12:697-707 /orders/doi.org/10.2147/CIA.S129145.

Nakagawa, R., Ohnishi, T., Kobayashi, H., Yamaoka, T., Yajima, T., Tanimura, A., Kato, T., &

Yoshizawa, K. (2017). Long-term effect of galantamine on cognitive function in patients with Alzheimer’s disease versus a simulated disease trajectory: an observational study in the clinical setting. Neuropsychiatric disease and treatment, 13, 1115–1124. /orders/doi.org/10.2147/NDT.S133145.

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