Patient’s Symptoms and Aspects Discussion

To Prepare Review the interactive media piece assigned by your Instructor. CLICK HERE http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html • • 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.

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Alzheimer’s Disease in a 76 Year-Old Iranian Male Patient

Alzheimer’s disease is a debilitating cognitive degenerative disease that affects the elderly, even though it is not characterised by any overt organic abnormalities. This paper is about a 76 year-old male patient suffering from the condition. Mr. Akkad who is Iranian is brought to the office by his son with a history of changes in behavior in the near past. After examination by their family doctor, he had been found to have no obvious physical illness after numerous tests that included laboratory investigations and radiologic examination. The most striking observation according to the son is that the patient had been undergoing a change in behavior and personality for the last few years. Initially, he placed a lot of emphasis on religious activities but lately he had been avoiding the same. He was also avoiding and belittling the significance of other family activities that hitherto had carried great importance to him. Notably, he has been developing forgetfulness in the past twenty four months and it has been difficult to hold a coherent conversation with him lately.Patient’s Symptoms and Aspects Discussion

Subjective and Objective Examination

During the examination, the patient is co-operative and is good natured. A mental status examination he is given yields a score of eighteen out of thirty. The patient is noted to be disoriented, forgetful, and lacks concentration. He is clearly demented. He can recognize people he knows but has difficulty telling where he is. He cannot also discern the time.

Decision Point One    

The patient is started on donepezil or Aricept to be taken 5 mg before going to sleep. This is medical therapy that has been shown to be effective in symptom relief in patients with dementia of Alzheimer’s disease (Stahl, 2017; Katzung, 2018). In starting this medication, what was hoped was slow but steady remission of the symptoms (Hammer & McPhee, 2018; Huether & McCance, 2017). Aricept has a slow but effective impact on the symptoms of Alzheimer’s disease in the elderly. However, since the patient and their family expect an immediate response, it is imperative that tbey are counselled on what to expect. In this case, the patient’s son is told not to exoect6an immediate response, at least in the first one month. This is important psychological preparation and also helps in fostering compliance to treatment.

Decision Point Two

After four weeks of treatment the patient has not shown any improvement in the symptoms. This outcome was however anticipated since Aricept takes time to produce clinical therapeutic effect. There the dose is adjusted to 10mg at night. The patient and his son are reassured and encouraged to continue with the treatment in the expectation of a positive response.

Decision Point Three

After the last visit, the patient now comes back with news of some improvement. The progress is slow but the patient and his son are reassured accordingly. The Aricept is continued at the same dose of 10mg when going to sleep. It is hoped that the patient will continue to improve on the medication at that optimum therapeutic dose. According to available evidence, increasing the dose of Aricept above 10mg would not be beneficial in its efficacy. Therefore, the dose is left at 10mg as the optimum dose. Additionally, the patient and his son are psychologically prepared for long-term therapy if the patient continues to respond favorably to treatment.Patient’s Symptoms and Aspects Discussion

References

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. New York, NY: McGraw-Hill Education.

Huether, S.E. & McCance, K.L. (2017). Understanding pathophysiology, 6^th ed. St. Louis, MO: Elsevier, Inc.

Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14^th ed. New York, NY: McGraw-Hill Education.

Stahl, S.M. (2017). Stahl’s essential psychopharmacology: Prescriber’s guide, 6th ed. New York, NY: Cambridge University Press.

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Patient’s Symptoms and Aspects Discussion