Walden NURS 6521C Wk 6 Assessing a Patient with Dementia Essay

Homework Help & Homework Answers

Walden NURS 6521C Wk 6 Assessing a Patient with Dementia Essay

 

Week 6 decision tree for Neurological and Musculoskeletal Disorders.

Week 6: Neurologic and Musculoskeletal Disorders and Opioids

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.

Learning Objectives

Students will:

  • Evaluate patients for treatment of neurologic and musculoskeletal disorders
  • Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders
  • Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

 

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

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: The case scenario is sent as an attach!!!! I also send a second attach as an example for this assignment so that you can check and get ideas!!!

  • 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.

You will submit this Assignment in Week 8.

 

 

 

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 24, “Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics” (pp. 183–194)
  • 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.

 

Rubric Detail

 

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6521_Week8_Assignment_Rubric

  Excellent 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. 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.

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.

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. 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.

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.

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. 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.

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. 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.

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.
5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors

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. 5 (5%) – 5 (5%)

Uses correct APA format with no errors

Total Points: 100  

Name: NURS_6521_Week8_Assignment_Rubric

The professor wants the students to follow this email below!!!!!!

Evidence-Based Literature

Posted on: Tuesday, July 13, 2021 12:00:00 AM EDT

Good Morning Cohort,

The Week 6 Assignment requires the use of evidence-based literature, MUST utilize primary resources to support decisions.  Also, sources should from within the last 5 years.  Please review the rubric, in order to maximize points the following criteria should be met:

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.

Primary Literature

Original research and/or new scientific discoveries

Immediate results of research activities

Often includes analysis of data collected in the field or laboratory

Examples:

Original research published as articles peer-reviewed journals.

Dissertations

Technical reports

Conference proceedings

 

Secondary Literature

Summarizes and synthesizes primary literature

Usually broader and less current than primary literature

Examples:

Literature review articles

Books

Since most information sources in the secondary literature contain extensive bibliographies, they can be useful for finding more information on a topic

Tertiary Literature

Summaries or condensed versions of materials

Usually with references to primary or secondary sources

A good place to look up facts or get a general overview of a subject

Examples:

Textbooks

Dictionaries

Encyclopedias

Handbooks

 

I have provided information below as well as the citation for your review.  Also, please utilize the Walden University Writing Center.

https://academicguides.waldenu.edu/writingcenter

https://academicguides.waldenu.edu/writingcenter/evidence/

  • 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.

URL: https://library.elmhurst.edu/c.php?g=294916&p=1965974

What is Evidence-based literature?

Evidence-based literature is used to support evidence-based practice (EBP) in nursing; it “involves an ability to access, summarize, and apply information from the literature to day-to-day clinical problems.” Evidence-based literature exists on a continuum from weaker-to-stronger evidence (see pyramid above).

Many databases have some form of check box or limiter that allows you to restrict results to evidence-based literature.

  • Articles from evidence-based practice journals
  • Articles about evidence-based practice
  • Research articles (including systematic reviews, clinical trials, meta-analyses, etc.)
  • Commentaries on research studies (applying the practice to research)

As you can see, the results vary in terms of the type of literature and strength of evidence.

(source Kessenich CR, “Teaching nursing students evidence-based nursing.” Nurse Educator, Nov/Dec 1997, 22(6): 25-29.)

Types of Nursing Literature

Systematic Reviews:(also known as “meta-analysis”) A systematic review identifies an intervention for a specific disease or other problem in health care, and determines whether or not this intervention works. To do this authors locate, appraise and synthesize evidence from as many relevant scientific studies as possible. They summarize conclusions about effectiveness, and provide a unique collation of the known evidence on a given topic, so that others can easily review the primary studies for any intervention.

Empirical research articles: Empirical research is based on observed and measured phenomena and derives knowledge from actual experience rather than from theory or belief. Usually published in peer-reviewed journals.

   Key characteristics to look for:

  • Statement about the methodology being used
  • Research questions to be answered
  • Definition of the group or phenomena being studied
  • Process used to study this group or phenomena, including any
  • controls or instruments such as tests or surveys
  • Ask yourself: Could I recreate this study and test these results?
  • Read the abstract of the article for a description of the methodology

Research articles will include a bibliography of other literature reviewed, and may lead you to similar articles; its primary purpose is to present original findings. Look for the following elements

  • Introduction
  • Research design (participants)
  • Discussion of data & methods
  • Results
  • Numerical data

Evidence-Based Care Sheets and Evidence-Based Articles: both evidence-based care sheets and evidence-based articles are similar to review articles (described below). These types of articles focus on summarizing research relating to specific ailments and the efficacy of their treatments, and serve as general overviews.

Review articles: Summarizes and synthesizes the results of many different original studies. Its purpose is to define the state of the literature on a particular topic, and discuss different methodologies for conducting research. Review articles are excellent sources for locating research articles, and contain helpful bibliographies.

Clinical articles: Written for practitioners. Clinical articles might present a particular case study or define a new technique.

(sources: NRS 410 Research and Evidence-Based Practice: Types of Nursing Literature   https://library.elmhurst.edu/nrs410 , Clemens, Rachel, “Library Research Guide for Nursing,” Dept. of Nursing, Cal State University , http://guides.library.fullerton.edu/nursing/articletypes.htm) and Cahoy, Ellysa, “What is Empirical Research,” Education and Behavioral Sciences Library, Penn State University, http://www.libraries.psu.edu/psul/researchguides/edupsych/empirical.html)

 

You will submit this Assignment in Week 8.  Please remember that this Assignment is due By Day 7 (Sunday) of Week 8 at 1:59 am EST.

 

Please check the course announcements during the week for any important information related to the course. See the Week 6 tab for all the resources and assignments for this week and post any questions you have to the Contact the Instructor area. If you need to contact me, my email is carman.silver@mail.waldenu.edu.

 

Dr. XXXXX

 

Case scenario for this week see attach

Alzheimer’s Disease
76-year-old Iranian Male

 

 

 

 

Decision Point One

 

Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

RESULTS OF DECISION POINT ONE

***Will Begin Exelon(rivastatine)1.5 mg orally twice daily with an increase to 3 mg orally twice in 2 weeks

  • Client returns to clinic in four weeks
  • The client is accompanied by his son who reports that his father is “no better” from this medication. He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors
  • You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

Decision Point Two

 

IInncrease Exelon to 4.5 mg orally BID

 

RESULTS OF DECISION POINT TWO

***Will Increase Exelonto 4.5 mg orally twice a day

  • Client returns to clinic in four weeks
  • Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better
  • He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious

 

 

 

Decision Point Three

 

Increase Exelon to 6 ppppppppmg orally BID

 

***Will increase Exelon to 6 mg orally twice a day

Guidance to Student

 

 

At this point, the client is reporting no side effects and is participating in an important part of family life (religious services). This could speak to the fact that the medication may have improved some symptoms. you needs to counsel the client’s son on the trajectory of presumptive Alzheimer’s disease in that it is irreversible, and while cholinesterase inhibitors can stabilize symptoms, this process can take months. Also, these medications are incapable of reversing the degenerative process. Some improvements in problematic behaviors (such as disinhibition) may be seen, but not in all clients.

At this point, you could maintain the current dose until the next visit in 4 weeks, or you could increase it to 6 mg orally BID and see how the client is doing in 4 more weeks. Augmentation with Namenda is another possibility, but you should maximize the dose of the cholinesterase inhibitor before adding augmenting agents. However, some experts argue that combination therapy should be used from the onset of treatment.

Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern.