Homework: Psychopharmacological Treatment Plan.

Rationale

In my third decision, I opted to begin a low dose of Clonazepam 0.25mg orally at bedtime in the treatment of REM disorders in Mr. Wingate\’s condition. Clonazepam is a benzodiazepine with a long life and is highly recommended in the treatment of REM disorder. Stahl (2014), asserts that the drug should initially be administered in low doses and gradually increased based on patient’s response. On the other hand, it did not recommend beginning Seroquel at bedtime. Despite the effectiveness of Seroquel, the medication which falls under antipsychotic drugs is linked with increased risk of severe side effects on MNDLB geriatric patients including malignant neuroleptic syndrome, somnolence, extrapyramidal symptom and increased mortality (Behrman, Burgess & Topiwala, 2018). As well, it would not be prudent to educate the patient and the family that Rivastigmine takes time to take time to stop the nightmares as the drug seems to worsen Mr. Wingate condition. More importantly, there is no evidence established of Rivastigmine in treating REM disorders.

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Expected Outcomes

Upon administration of Clonazepam 0.25mg orally at bedtime for four weeks, the client is expected to tolerate the drug with minimal or no side effects. In addition, the client is expected to report reduced REM symptoms and overall diminished symptoms of his MNDLB condition characterized by improved attention, memory and cognitive functions

Ethical Implications

It is crucial to note that communication between health professionals, the patient, and their families can impact significantly on the health wellbeing of the patient in addition to the outcome and quality of care. As such, a competent PHMNP should put themselves in patient’s position to be able to render quality of care and ensure their views or opinions should not interfere with their capacity to launch a positive communication with the client and their families (Loghmani, Borhani & Abbaszadeh, 2014). However, PMHNPs can offer their professional view in a therapeutic manner including explaining the side effects of drug prescribed. More importantly, the treatment plan followed the ethical standards and guidelines in communicating, diagnosing and treating the patient and engaging the son. The whole treatment observed the bioethical principles of beneficence and nonmaleficence. As such, all decisions recommended were in the best interest and benefit the patient anchored on the bioethical principle of beneficence (do good). More so, all decisions achieved, and drugs prescribed were evidence-based and the medications were openly communicated to the patient and the family member.

Conclusion

In conclusion, neurocognitive disorders are primarily acquired cognitive disorders or developmental disorders interfering with independence characterized by cognitive decline not due to delirium or other psychiatric condition. Mr. Wingate was diagnosed with the major neurocognitive disorder with Lewy bodies characterized by poor memory, fluctuating alertness, poor coordination, disrupted sleep patterns and nightmares as well as short concentration span. As such, I recommended to Begin Rivastigmine 1.5 mg BID orally and after four weeks, I administered Mr. Wingate with Clonazepam 0.5mg orally at bedtime to address his MNDLB condition. All decisions recommended were meant to benefit the patient and as well communicated to the patient and the family member.

References

American Psychiatric Association. (APA) (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Behrman, S., Burgess, J., & Topiwala, A. (2018). Prescribing antipsychotics in older people: A mini-review. Maturitas, 116, 8-10.

Boot, B. P. (2015). Comprehensive treatment of dementia with Lewy bodies. Alzheimer\’s research & therapy, 7(1), 45.

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

Loghmani, L., Borhani, F., & Abbaszadeh, A. (2014). Factors affecting the nurse-patient\’ family communication in the intensive care unit of kerman: a qualitative study. Journal of caring sciences, 3(1), 67.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essentia