Alzheimer’s Disease”

o 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.

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.

Interactive media piece case study below:

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 difficult “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 you perform 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 76 year old Iranian male who is cooperative 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 you 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.

Op

Options for Decisions below: Tips. Pick one that be a better option and answer all questions above. Need 3 x references

1. Begin Exalon 1.5 mg po bid with an increase to 3 mg po bid in two weeks( pt not feeling better).

2. Increase Exelon to 4.5mg orally bid( pt not feeling better)

3. Increase Exelon to 6mg po bid. ( Pt improved, dose could be maintained and checked in 4 wks, Namenda could also be added).

OR

1. Begin Aricept 5mg po bedtime ( pt no feeling better)

2. Increase Aricept to 10mg po ( Pt still not feeling Better NB Aricept at 5mg can be effective)

3. Continue Aricept 10 mg ( pt not any better) or ( 5mg with Namenda can be effective). 

OR

1. Begin Razadyne 4 mg ( pt not feeling better)

2. Increase Razadyne to 24 mg extended release( Pt has seizures/SE)

3. Retart Razadyne ( pt has more s/e). Respidal not apprappriate.

Resource for references

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

· Chapter 10, “Basic Principles of Neuropharmacology” (pp. 73–77)

· Chapter 11, “Physiology of the Peripheral Nervous System” (pp. 79–90)

· Chapter 12, “Muscarinic Agonists and Antagonists” (pp. 91–107)

· Chapter 13, “Adrenergic Agonists” (pp. 109–119)

· Chapter 14, “Adrenergic Antagonists” (pp. 121–132)

· Chapter 15, “Indirect-Acting Antiadrenergic Agents” (pp. 133–137)

· Chapter 16, “Introduction to Nervous System Pharmacology” (pp. 139–141)

· Chapter 17, “Drugs for Parkinson Disease” (pp. 143–158)

· Chapter 18, “Drugs for Alzheimer Disease” (pp. 159–166)

· Chapter 19, “Drugs for Epilepsy” (pp. 167–189)

· Chapter 20, “Drugs for Muscle Spasm and Spasticity” (pp. 191–201)

· Chapter 57, “Drug Therapy of Rheumatoid Arthritis” (pp. 629–641)

· Chapter 58, “Drug Therapy of Gout” (pp. 643–651)

· Chapter 59, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 653–672)

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.

Learning Resources

Required Media (click to expand/reduce)

Laureate Education (Producer). (2019b). Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease.

Review literature regarding issues or concerns within your selected nurse practitioner specialty: Lifestyle changes (increasing activity in teenagers)

Select a theory or model which is relevant to your nurse practitioner specialty and would offer a meaningful context for evidence-based practice surrounding the issue or concern which you identified.  

1.  In a PowerPoint Presentation, address the following.  

o  Introduction to the presentation 

o  Identify and describe a theory or model and explain its relevance to your nurse practitioner specialty. 

o  Describe an issue or concern that is related to your nurse practitioner specialty, and explain its impact on health care outcomes 

o  Explain how the theory or model can be used as a framework to guide evidence-based practice to address the issue or concern, and discuss the unique insight or perspective offered through the application of this theory or model.  

o  Conclusion to the presentation 

o  References 

Preparing the presentation 

·  Application: Use Microsoft Word 2013™ to create the PowerPoint presentation.   

·  Length: The PowerPoint presentation must be 7 total slides (excluding title and reference slides).  

·  Speaker notes should be used and include in-text citations when applicable. 

·  A minimum of three (3) scholarly literature sources must be used.  

End-of-Life Issues

With our framework of ethical theories and principles in hand, we begin our look at some of the critical ethical issues in our contemporary world, starting with end-of-life issues. This assessment covers ethical questions related to end-of-life care. Passive euthanasia is the removal or refusal of life-sustaining treatment. Examples of passive euthanasia include removal of a feeding tube or a ventilator, or forgoing a life-prolonging surgery. Passive euthanasia is legal in all 50 states, and the principle of autonomy gives informed patients the right to refuse any and all treatments. Patients who are unable to make such decisions in the moment (because they are unconscious, for example) might have made their intentions clear beforehand with an advance directive or similar document. Things become more complicated, however, when a patient who is unable to make treatment choices has not made his or her wishes clear, either formally in a written document, or informally in conversations with family members or friends. Another problem concerns cases in which there is disagreement about whether the treatment is sustaining the life of a person in the full sense or merely as a body that, because of severe and irreversible brain trauma, is no longer truly a living person.

Active euthanasia, or assisted suicide, introduces further difficult moral questions. A patient who has a terminal illness and who has refused treatments that would merely prolong a potentially very painful and debilitating death might want the process of dying to be hastened and made less painful. The patient might want to take his or her own life before the disease reaches its horrible final stages. Should patients be legally allowed to have help in this endeavor? If suicide itself is not morally wrong, at least in cases like these, is it wrong for another person to directly help bring about the patient’s death? Is it wrong for doctors, a role we naturally associate with healing and the promotion of life, to use their medical expertise to deliberately end a patient’s life if the patient wants this?

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Articulate ethical issues in health care. 
  • Articulate the moral issues associated with limiting life support.
• Competency 2: Apply sound ethical thinking related to a health care issue. 
  • Demonstrate sound ethical thinking and relevant ethical principles when considering limiting life support.
  • Explain important considerations that arise when contemplating limiting life support.
• Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals. 
  • Exhibit proficiency in clear and effective academic writing skills.

Preparation

• Case Study: Mr. Martinez. 

This media piece provides the context for this assessment; make sure you have reviewed the case study thoroughly.

Additionally, it may be useful to think through the following issues as they relate to Mr. Martinez’s case:

• Should Mr. Martinez be transferred to intensive care, where his respiratory failure can be treated by a ventilator, and by CPR if necessary, and his oxygen level can be monitored? 
  • What are the key ethical issues or models at play in this case study?
  • What are the key end-of-life issues at play in this case study?
  • How can an understanding of models and best-practice help to guide health care practitioners to make ethical and legal decisions?

Instructions

In a 2–3 page analysis of the case study, address the following:

• The patient’s directives.
• The patient’s quality of life.
• The family’s stated preferences.
• The moral issues associated with limiting life support.
• The ethical principles most relevant to reaching an ethically sound decision.
• Important considerations such as implications, justifications, and any conflicts of interest that might arise because of the patient’s respiratory failure.

When writing your assessment submission assume that doctors cannot contact Mrs. Martinez and must make this choice on their own. To help you reach an objective, ethically sound decision, draw upon concepts and arguments from the suggested resources or your independent research. Support your response with clear, concise, and correct examples, weaving and citing the readings and media throughout your answer.

Complete Evidence Table as described in the Evidence Table Worksheet. 

No plagiarism. APA format. 

PICOT Question:

Among African Americans at risk for hypertension and attending the Sumpter Free Health Clinic (P) will a nurse-led community outreach and health education program (I) compared to no program (C) reduce health disparities predisposing patients from hypertension development (O) within one year (T)?

 The purpose of this assignment is to provide a concise description and appraisal of the American Association of Colleges of Nursing (AACN) Essentials of master’s Education in Nursing. Following APA guideline, provide a brief explanation on each of the essentials reflecting on each essential affects the clinical practice and the author’s interpretation on each essential. Make sure to include a (Title page, abstract, introduction, body, conclusion, and reference page).  

Title Page: Title of article, journal information and your name and date 1 point Your score Abstract: Brief summary of article (1-2 paragraphs) 1 points The Problem: (2 or 3 paragraphs) Is the problem clearly stated? Is the problem practically important? What is the purpose of the study? What is the hypothesis? Are the key terms defined? 3 points Review of Literature: (1 -2 paragraphs) Are the cited sources pertinent to the study? Is the review too broad or too narrow? Are the references recent? Is there any evidence of bias? 2 points Design and Procedures: (3-4 paragraphs) What research methodology was used? Was it a replica study or an original study? What measurement tools were used? How were the procedures structures? Was a pilot study conducted? What are the variables? How was sampling performed? 3 points Data analysis and Presentation: (1 – 2 paragraphs) 2 points How was data analyzed? Did findings support the hypothesis and purpose? Were weaknesses and problems discussed? Conclusions and Implications: (2-3 paragraphs) 3 points Are the conclusions of the study related to the original purpose? Were the implications discussed? Whom the results and conclusions will affect? What recommendations were made at the conclusion? What is your overall assessment of the study and the article?