Assignment: Case Study An Elderly Iranian Man With Alzheimers Disease Decision Tree
Case Study SAMPLE INTRO
In the United States and throughout the world, Alzheimer’s disease affects the majority of senior individuals. Numerous investigations have suggested that Alzheimer’s is a neurological disease that develops gradually over time. According to epidemiological data on the condition, this illness affects more than 70% of senior adults with dementia worldwide.
The presence of memory lapses regarding recent events in a patient’s life is the condition’s most telling symptomatology. Additional symptoms like mood swings, behavioral problems, language challenges, confusion, and a lack of self-care management start to appear as the condition worsens.
The body will gradually stop performing all of its essential tasks, which will ultimately result in death. While Houmani and his colleagues (2018) claim that each patient’s condition has a different life expectancy, the average is nine years after diagnosis. Fundamentally, there is no treatment for Alzheimer’s disease; the only option is to manage the condition to ensure that a patient has a higher quality of life before passing away.
In the present case study, an Iranian man whose son charges that he displays strange behaviors will be examined and pharmacologically treated by the present nurse practitioner. According to the patient interview, Mr. Akadi displayed a loss of interest in things that were initially dear to him. Moreover, the patient has become forgetful in the recent past and confabulation was noticeable from his mental health testing procedure.
Additional symptoms evident from the diagnostic process include impaired judgment and impulse as well as restricted affect. According to a mini-mental status examination that was conducted, the patient also suffers from a major neurocognitive disorder. The nurse suspected that the condition may have been caused by presumptive Alzheimer.
Therefore, the present paper will seek to elucidate the assessment outcomes and create a pharmacological treatment therapy based on informed standard procedures. According to studies, while the condition is essentially untreatable, it can be managed pharmacologically. The pharmacological management is, however, influenced by factors such as dosage, proper selection of drugs, and time of use and administration route. Importantly, it is important for the nurse practitioner to monitor the responsiveness of a patient to drugs and their dosages and make fundamental adjustments after periodic assessment.
Decision Point One
Selected Decision
Decision point one presented the nurse practitioner with three important options. The first option was to start the patient on Razadyne (galantamine) 4 mg daily. The second option would see the nurse prescribe Aricept (donepezil) 5 mg orally during bedtime. Lastly, the nurse can also think of beginning Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks. Out of the three options, the nurse chose to begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks for various pharmacokinetic and pharmacodynamics reasons…..CONTD
Assignment Instructions
Case Study: An Elderly Iranian Man With Alzheimer’s Disease
BACKGROUND
Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.
According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”
Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficulty “finding the right words” in a conversation and then will shift to an entirely different line of conversation.
SUBJECTIVE
During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.
MENTAL STATUS EXAM
Mr. Akkad is a 76 year old Iranian male who is cooperating with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh].
Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When the PMHNP asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.
Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)
RESOURCES
- Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.
Decision Point One
Select What The PMHNP Should Do:
- Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks
- Begin Aricept (donepezil) 5 mg orally at BEDTIME
- Begin Razadyne (galantamine) 4 mg orally BID
Decision Point One
- Begin Razadyne (galantamine) 4 mg orally BID
RESULTS OF DECISION POINT ONE
- 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
Increase Razadyne to 24 mg extended release daily
RESULTS OF DECISION POINT TWO
- Client returns to clinic in four weeks
- The client’s son accompanies the client to his appointment today. The client is in a wheelchair and is somewhat agitated
- You are informed by the son that his father has not taken his medication since he got out of the hospital. Apparently, about 7 days after starting the
Galantamine extended release, the client began having seizures which resulted in a fall and fractured hip. The son reports that his father is agitated with everyone and is asking for help in treating his agitation
Decision Point Three
- Restart Razadyne extended release 24 mg
