Assignment: Assessing and Treating Clients With Dementia Essay

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Assignment: Assessing and Treating Clients With Dementia Essay

Assignment: Assessing and Treating Clients With Dementia Essay

 

Dementia is a medical condition that is mainly associated with advanced age. It is characterized by a severe decline in mental ability affecting individual’s daily life. The symptoms of dementia include amnesia, aphasia, apraxia, agnosia, and impairment of executive functions such as problem-solving. Alzheimer’s disease which is a progressive neurodegenerative mental condition is the most common form of dementia (Korytkowska & Obler, 2016). It leads to problems affecting the patient’s memory, ability to reason, learn, communicate, carry out daily activities and make a judgment. Cure for Alzheimer’s disease has not yet been discovered. However, several medications can be used to manage the symptoms.

The case study provided is of an Iranian male 76 years of age who was brought in to the hospital by his eldest son, complaining of “strange behavior.”  His son reported that the strange behavior and thoughts started about two years ago, and have been getting worse ever since. His family also reported some changes in his personality such as loss of interest in religious activities, becoming forgetful, lack of seriousness in things that matter, the inability of communicating effectively and inability to stick to one topic during a conversation. As per the mini-mental examination that was conducted, the patient had a score of 18/30 with a deficit in orientation, attention, calculation, registration, and recall, which are all indicators of moderate dementia. The main purpose of this paper is to assess and come up with a treatment plan for the patient with dementia with keen considerations of the pharmacokinetic and pharmacodynamic properties of the available psychotropic agents for necessary intervention, in addition to legal and ethical considerations.

 

Decision Point One

Selected Decision

Start 5mg Aricept (donepezil) PO at bedtime

Reason for Selection

Aricept (donepezil) is a cholinesterase inhibitor approved by the FDA for the treatment of cognitive symptoms such as confusion, memory loss, and inability to think and reason appropriately as associated with Alzheimer’s disease. The mode of action of Aricept is through preventing the breakdown of acetylcholine which as an important second messenger in learning and memory. The levels of acetylcholine in the brain are thus elevated hence relieving the cognitive symptoms associated with dementia. Donepezil is metabolized by CYP450 2D6 and CYP450 3A4, which are positive for Iranians such as the patient, with an elimination half-life of approximately 70 hours (Behrens et al., 2018). The side effects of Aricept are quite mild and self-limiting such as nausea and vomiting, increased bowel movement frequency and anorexia. Based on its long duration of action and the first onset of action among other pharmacokinetic properties, Aricept is administered at a dose of 5 to 10 mg at bedtime, with a starting dose of 5mg daily which may be increased to 10 mg daily after 4 to 6 weeks, based on the patient’s compliance. Given that the patient experience memory loss, a less frequently administered drug was the best choice for managing his condition.

Other available options such as 1.5mg Exelon (rivastigmine) PO, BD with an increasing dose to 3mg PO, BD in two weeks and

Assignment Assessing and Treating Clients With Dementia Essay

Assignment Assessing and Treating Clients With Dementia Essay

4mg Razadyne (galantamine) PO, BD were not the best choices, particularly for this patient. In as much as they belong to the same group, they have more severe side effects such as diarrhea, seizures, trouble urinating, severe abdominal pain, fainting, and tremors. They also have a short duration of action and hence administered twice a day, thus not appropriate for a patient experiencing memory loss.

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Expected Results

The patient is expected to show an improved baseline in memory or behavior within a period of 4 to 6 weeks (Behrens et al., 2018). He is also expected to improve cognitive symptoms and start experiencing an increased interest in daily activities, improved communication, and maintaining a conversation, improved reasoning, reduced instances of forgetfulness and improved reasoning. His MMSE score is also expected to increase.

Differences between Expected Results and Actual Results

            Upon visiting the hospital after four weeks, the patient was accompanied by his son, who complained that the symptoms of his father were not improving. His son claimed that the drug was not working, and his father still had no interest in taking part in religious services and activities and continued exhibiting strange behavior with the MMSE score still at 18/30. This was entirely unexpected, but it might have been as a result of the 5mg dose which might be below the therapeutic index of the patient.

Decision Point Two

Selected Decision

Increase the 5mg dose of Aricept to 10mg PO at bedtime.

Reason for Selection

            Based on the results after the first intervention, the patient showed no response to the drug, with no side effects reported, showing the dose was below the therapeutic index. The dose should thus be increased to a maximum for its effect to be enjoyed by the patient. Given that the patient did not prove non-compliant to the drug, changing the medication to Raza dyne (galantamine) ER 24 mg PO or Namenda (memantine) ER 28 mg PO would not be appropriate as it will only confuse the patient and lose his trust in the medication in case such a case reoccurs (Behrens et al., 2018). The drugs might also elicit inappropriate side effects that might further worsen than patient condition. Thus, the most appropriate intervention to make is to continue with the same drug but increase the dose to 10 mg for the therapeutic effect to be realized maximumly (Keough, King, & Lemmerman, 2016).

Expected Results

The patient is expected to report improved symptoms of dementia within 4 to 6 weeks after the intervention. He should be able to have regained interest in taking part in daily activities such as going to church, improved memory, improved reasoning, improved ability to maintain a conversation and able to communicate effectively. His MMSE scores are also expected to increase.

Differences between Expected Results and Actual Results

Upon coming back to the hospital after for weeks, the patient accompanied by his son seemed to be in a much better state. His son reported that the patient was tolerant to the medication, with minimal reduction of symptoms and no side effects. He was able to go to church which most of the family members were proud of. However, his son still states that the patient is still amused by certain things that were previously serious to him. The results were better than before but still under the nurse’s expectations.

Decision Point Three

Selected Decision

Continue the same 10mg dose of Aricept PO, at bedtime

Reason for Selection

            The results reported by the patient were an indication that the drug was working. The patient was also tolerant to the medication with no side effects. Consequently, a dose of 23 mg is only recommended only if the patient has taken the 10mg dose for at least three months which is not the case. Hence, the best intervention is for the client to continue with the same dose as it will take time for all the symptoms to be resolved entirely. Increasing the dose of Aricept to 15 mg PO at bedtime for six weeks, then increasing it further to 20 mg, or to discontinue it and start Namenda 5mg PO daily is not appropriate at this time, as a higher dose might elicit side effects that might compromise the patients’ health even further. Previous studies show that Aricept can take up to several months before its effects stabilize in managing the patient’s condition (Schutz et al., 2019). Thus, discontinuing the drug is inappropriate. However, adding Namenda to the current regimen might be appropriate as NMDA receptor antagonists are usually used together with cholinesterase inhibitors in the management of Alzheimer’s disease to improve the therapeutic effects and minimize the undesired effect.

Expected Results

            The patient is expected to improve the cognitive symptoms of Alzheimer’s disease within 4 to 6 weeks. His interest in daily activities is expected to improve maximumly within this period. He is also expected to have improved concentration and memory with minimal side effects. His MMSE score is also expected to improve.

Differences between Expected Results and Actual Results

            After four weeks, the patient came back to the hospital with improved symptoms. He was able to maintain a good conversation and participate actively in religious activities. His memory also improved with maximumly reduced symptoms of “strange activities.” His MMSE scores had also improved as expected (Behrens et al., 2018).

Conclusion with Ethical Considerations

Managing dementia is complex given the wide range of the available therapeutic option besides similar sign and symptoms just like other mental disorders. Ethical considerations require the nurse to involve the patient family members in his care plan for an effective outcome. The patient must also be involved in every intervention with a clear explanation of the options, side effects and the reasons behind certain choices being made (Mauk, 2017). Generally, adherence to medication greatly depends on the pharmacological and pharmacokinetic properties of the drugs for the best choices to be made to boost both the patients physical and mental health.

cite scholarly resources including peer-review journals and current practice guidelines
 Please, all bullets points, bold, red and highlighted area must be attended to.
 A clear purpose statement (The purpose of this paper is to…) is required in the introduction of all writings

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