Neurological And Musculoskeletal Disorders Assignment
Neurological And Musculoskeletal Disorders Assignment
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.
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.
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.
You will submit this Assignment in Week 8.
Submission and Grading Information- Neurological And Musculoskeletal Disorders Assignment
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- Click the Week 8 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
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Grading Criteria- Neurological And Musculoskeletal Disorders Assignment
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Week 8 Assignment Rubric
Check Your Assignment Draft for Authenticity
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Submit your Week 8 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 8
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Week 8 Assignment
Alzheimer’s Disease
76-year-old Iranian Male
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. Neurological And Musculoskeletal Disorders Assignment
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. Neurological And Musculoskeletal Disorders Assignment
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 you should do:
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
- 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 One
: Begin Aricept (donepezil) 5 mg orally at BEDTIME
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 Neurological And Musculoskeletal Disorders Assignment
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. Neurological And Musculoskeletal Disorders Assignment
Decision Point Two
Select what you should do next:
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. Neurological And Musculoskeletal Disorders Assignment
Decision Point Two
Discontinue Razadyne and begin Aricept (donepezil) 10 mg orally daily
RESULTS OF DECISION POINT TWO
- Client returns to clinic in four weeks
- The client is accompanied by his son for today’s appointment who informs you that he stopped giving his father the mew medication because after just a few doses, his father began experiencing appetite loss, followed by nausea, diarrhea, and vomiting. Neurological And Musculoskeletal Disorders Assignment
Decision Point Two
Discontinue Razadyne and begin Exelon (rivastigmine) 1.5 mg orally BID
RESULTS OF DECISION POINT TWO
- 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 still not interested in attending religious services with the family, and he is still concerned that his father is still easily amused by things he once found serious. Neurological And Musculoskeletal Disorders Assignment
Decision Point Three
Select what you should do next:
Decision Point Three
Increase Exelon to 3 mg orally BID
Guidance to Student
Cholinesterase inhibitors can take months to demonstrate any stabilization in the degenerative course of Alzheimer’s disease. Since the client has had no side effects, it would be prudent to consider increasing the Exelon dose to 3 mg orally BID. Recall that the target dose of Exelon is 12 mg orally daily in divided doses, or a transdermal patch delivering 9.5 mg daily could be used. Slow titration of the drug toward a therapeutic dose will decrease the risk of side effects. These should be teaching points directed toward the client and his son. Neurological And Musculoskeletal Disorders Assignment
Learning Resources- Neurological And Musculoskeletal Disorders Assignment
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 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)
Document: Mid-Term Summary & Study Guide (PDF)
Required Media (click to expand/reduce)
Disorders of The Nervous System
Reflect on the comprehensive review of disorders of the nervous system and think about how you might recommend or prescribe pharmacotherapeutics to treat these disorders. (15m). Neurological And Musculoskeletal Disorders Assignment