Assignment: NURS 6512 Decision Tree for Neurological and Musculoskeletal Disorders

Assignment: NURS 6512 Decision Tree for Neurological and Musculoskeletal Disorders

Assignment: NURS 6512 Decision Tree for Neurological and Musculoskeletal Disorders

Week 6 Assignment: Decision Tree for Neurological and

Alzheimer’s is a common progressive neurological disorder caused by dementia among older adults. The disorder is characterized by mild to moderate cognitive symptoms at first which lead to severe memory loss as the individual ages. Several treatment options have however been provided to help promote the quality of life and reduce suffering among patients diagnosed with this disorder (Tsolaki, 2018). The purpose of this paper is to demonstrate the choice of medication based on pharmacokinetic and pharmacodynamic factors for an elderly patient with Alzheimer’s disease.

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Patient Case Study Summary

The patient in the provided case study is a 76-year-old Iranian male who presented to the clinic with strange behaviors. The patient reports symptoms of Alzheimer’s such as confusion, loss of interest in religious activities, and forgetfulness for the past 2 years. Some of the pharmacodynamic and pharmacokinetic factors that might affect the choice of medication for the patient include his male gender, advanced age, and Iranian race, in addition to the mini-mental examination results which reveal moderate dementia (Tan et al., 2018). The patient’s diagnosis of major neurocognitive disorder resulting from Alzheimer’s disease will also be considered.

Treatment Decisions

Based on the above-mentioned pharmacokinetic and pharmacodynamic factors, the best treatment choice for the patient out of the available options was to initiate 1.5 mg Exelon (rivastigmine) twice daily. Studies have reported great effectiveness with the use of rivastigmine as the first-line medication for the management of Alzheimer’s disease, with great tolerance and safety profile (dos Santos et al., 2018). The second intervention was to titrate the dose upwards from 1.5mg to 4.5 mg twice daily as recommended by clinical guidelines, given that the patient displayed limited reemission of symptoms with the use of 1.5 mg rivastigmine for the past 4 weeks. Despite the patient exhibiting great tolerance to the medication, its effectiveness was still limited which led to the final decision to increase the dose to 6mg orally twice daily.

Expected Outcome

Studies show that rivastigmine may take up to 8 to 12 weeks to completely manage the symptoms of dementia. The dose must however be titrated at intervals of 1.5mg after every 2 weeks, after an initial dose of 1.5mg twice daily, to attain the optimum dose for an effective outcome. The patient should however not exceed 6mg twice daily (Nguyen et al., 2021). As such, the patient was expected to display remission of symptoms, within 8 weeks, with minimal mental examination results of less than 10.

Difference Between Expected Outcome and Actual Outcome

The patient responded adequately to the medication as expected. Within the first four weeks, minimal remission of symptoms was experienced with no side effects as expected. The dose was increased which led to better results until the optimum dose was attained with no side effects (Khoury et al., 2018). As such the patient exhibited great tolerance and adherence to the medication with great effectiveness just as expected.

Conclusion

Alzheimer’s disorder is a disabling condition that requires timely treatment to promote the patient’s quality of life. Several treatment options are however available which require keen consideration of the patient’s pharmacokinetic and pharmacodynamic factors when selecting which drug to use for which patient. The 76-year-old Iranian male patient described above displayed great tolerance and adherence to the use of rivastigmine.

References

dos Santos, P., Leide, C., Ozela, P. F., de Fatima de Brito, M., Pinheiro, A. A., Padilha, E. C., … & Izabel, L. (2018). Alzheimer’s disease: a review from the pathophysiology to diagnosis, new perspectives for pharmacological treatment. Current medicinal chemistry, 25(26), 3141-3159.

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.

Nguyen, K., Hoffman, H., Chakkamparambil, B., & Grossberg, G. T. (2021). Evaluation of rivastigmine in Alzheimer’s disease. Neurodegenerative Disease Management, 11(1), 35-48.

Tan, E. C., Hilmer, S. N., Garcia-Ptacek, S., & Bell, J. (2018). Current approaches to the pharmacological treatment of Alzheimer’s disease. Australian Journal of general practice, 47(9), 586-592. https://search.informit.org/doi/10.3316/informit.849432651288623

Tsolaki, M. (2018). An old and new challenge for the treatment of Alzheimer’s disease. Journal of Neurology and Neuroscience, 09.

NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal 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)

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Content

Name: NURS_6521_Week8_Assignment_Rubric

		Excellent	Good	Fair	Poor
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific.		Points Range: 18 (18%) – 20 (20%) The response accurately and thoroughly summarizes in detail the patient case study assigned, including specific and complete details on each of the three decisions made for the patient presented.	Points Range: 16 (16%) – 17 (17%) The response accurately summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.	Points Range: 14 (14%) – 15 (15%) The response inaccurately or vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.	Points Range: 0 (0%) – 13 (13%) The response inaccurately and vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented, or is missing.
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.		Points Range: 23 (23%) – 25 (25%) The response accurately and thoroughly explains in detail how the decisions recommended for the patient case study are supported by the evidence-based literature. The response includes specific and relevant outside reference examples that fully support the explanation provided.	Points Range: 20 (20%) – 22 (22%) The response accurately explains how the decisions recommended for the patient case study are supported by the evidence-based literature. The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.	Points Range: 18 (18%) – 19 (19%) The response inaccurately or vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature. The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.	Points Range: 0 (0%) – 17 (17%) The response inaccurately and vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature, or is missing. The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.
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.		Points Range: 18 (18%) – 20 (20%) The response accurately and thorough explains in detail what they were hoping to achieve with the decisions recommend for the patient case study assigned. The response includes specific and relevant outside reference examples that fully support the explanation provided.	Points Range: 16 (16%) – 17 (17%) The response accurately explains what they were hoping to achieve with the decisions recommended for the patient case study assigned. The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.	Points Range: 14 (14%) – 15 (15%) The response inaccurately or vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned. The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.	Points Range: 0 (0%) – 13 (13%) The response inaccurately and vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned, or is missing. The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decisions in the exercise. Describe whether they were different. Be specific and provide examples.		Points Range: 18 (18%) – 20 (20%) The response accurately and clearly explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise. The response provides specific, accurate, and relevant examples that fully support whether there were differences between the decisions made and the decisions available in the exercise.	Points Range: 16 (16%) – 17 (17%) The response accurately explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise. The response provides accurate examples that support whether there were differences between the decisions made and the decisions available in the exercise.	Points Range: 14 (14%) – 15 (15%) The response inaccurately or vaguely explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise. The response provides inaccurate or vague examples that may or may not support whether there were differences between the decisions made and the decisions available in the exercise.	Points Range: 0 (0%) – 13 (13%) vaguely explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise, or is missing. The response provides inaccurate and vague examples that do not support whether there were differences between the decisions made and the decisions available in the exercise, or is missing.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.		Points Range: 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity.	Points Range: 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.	Points Range: 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.	Points Range: 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation		Points Range: 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors	Points Range: 4 (4%) – 4 (4%) Contains a few (1–2) grammar, spelling, and punctuation errors	Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains several (3–4) grammar, spelling, and punctuation errors	Points Range: 0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.		Points Range: 5 (5%) – 5 (5%) Uses correct APA format with no errors	Points Range: 4 (4%) – 4 (4%) Contains a few (1–2) APA format errors	Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains several (3–4) APA format errors	Points Range: 0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors
Total Points: 100

Name: NURS_6521_Week8_Assignment_Rubric

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
Multiple sclerosis (MS) is a nervous system disorder affecting the spinal cord and the brain. The myelin sheath is normally destroyed in people diagnosed with MS, slowing down or blocking messages between the body and the brain leading to the associated symptoms. Most people normally start displaying symptoms between the ages of 20 and 40 years (Ferraro et al., 2018). Such symptoms include muscle weakness, visual disturbances, coordination, and balance problems, numbness, and memory problems among others. However, with appropriate treatment patients’ quality of life and well-being can be improved. The purpose of this paper is to demonstrate appropriate decision-making in selecting the most effective medication for the treatment of a 26-year-old with multiple sclerosis.
Summarize the Patient Case Study
The patient in the provided case study is a 26-year-old female with a diagnosis of multiple sclerosis. She was scheduled for a follow-up appointment with her physician but is still concerned about more knowledge about her MS diagnosis. She also needs to be informed concerning the impact of the disorder on her neurologic and musculoskeletal system in addition to the specific drug therapy plans on which she can decide.
Treatment Decisions
From the available option, the best medication to consider for initial therapy for the patient is 25mg Amitriptyline orally at bedtime. Based on the patient outcome, the drug can be titrated upwards at intervals of 25mg per week, not exceeding 200mg per day. Amitriptyline is a tricyclic antidepressant that has proven to be effective in the management of painful parenthesis in the legs and arms among MS patients (Rae-Grant et al., 2018). The second intervention was to continue with the same medication and increase the dose to 125mg at bedtime given that the patient displayed a minimal reduction of symptoms but great tolerance to the medication. The last intervention was to continue the same drug and dose, 125mg amitryptiline at bedtime, and advise the patient to see a life coach for counseling on good dietary habits and exercise (Mésidor et al., 2021). This decision was based on the great effectiveness displayed by the drug in the management of the patient’s symptoms, with weight gain as the only side effect.
Expected Outcome
With the use of Amitriptyline 25mg once daily, the patient was expected to display at least 50% remission of symptoms, with common side effects such as nausea, vomiting, headache, and dry mouth (Stankiewicz & Weiner, 2020). These side effects were however expected to diminish with time as the patient continues taking the drug. The dose was expected to be titrated upwards at the rate of 25 mg per week to an optimal dose with complete remission of the patient’s symptoms within 8 to 12 weeks.
Difference Between Expected and Actual Outcome
The patient displayed great effectiveness with the medication just as expected. Her pain level reduced gradually with an increased dose with the optimum dose attained at 125mg orally at bedtime (Stamoula et al., 2021). However, she displayed significant weight gain which was not expected. As such, it was necessary to introduce a life coach to help with lifestyle modification that will help the patient maintain healthy body weight.
Conclusion
Multiple sclerosis is a disabling neurological and musculoskeletal disorder that can be managed by the use of several medications. For the 26-year-old patient in the provided case study, the use of 125mg amitriptyline once daily displayed great effectiveness in the management of the MS symptoms.

References
Ferraro, D., Plantone, D., Morselli, F., Dallari, G., Simone, A. M., Vitetta, F., … & Vollono, C. (2018). Systematic assessment and characterization of chronic pain in multiple sclerosis patients. Neurological Sciences, 39(3), 445-453. https://doi.org/10.1007/s10072-017-3217-x
Mésidor, M., Rousseau, M. C., Duquette, P., & Sylvestre, M. P. (2021). Classification and visualization of longitudinal patterns of medication dose: An application to interferon‐beta‐1a and amitriptyline in patients with multiple sclerosis. Pharmacoepidemiology and drug safety, 30(9), 1214-1223. https://doi.org/10.1002/pds.5297
Rae-Grant, A., Day, G. S., Marrie, R. A., Rabinstein, A., Cree, B. A., Gronseth, G. S., … & Pringsheim, T. (2018). Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology, 90(17), 777-788. https://doi.org/10.1212/WNL.0000000000005347
Stamoula, E., Siafis, S., Dardalas, I., Ainatzoglou, A., Matsas, A., Athanasiadis, T., … & Papazisis, G. (2021). Antidepressants on multiple sclerosis: a review of in vitro and in vivo models. Frontiers in Immunology, 12. DOI: 10.3389/fimmu.2021.677879
Stankiewicz, J. M., & Weiner, H. L. (2020). An argument for broad use of high efficacy treatments in early multiple sclerosis. Neurology-Neuroimmunology Neuroinflammation, 7(1). https://doi.org/10.1212/NXI.0000000000000636