What Should Pmhnp Teach the Families of Dementia Patients

Description

Week 10: Therapy for Clients with Dementia

In then many countries, to exist onetime is shameful; to be mentally ill equally well every bit sometime is doubly shameful. In so many countries, people with elderly relatives who are too mentally sick are ashamed and attempt to hibernate what they see as a disgrace on the family.
—Dr. Nori Graham, psychiatrist and honorary vice president of Alzheimer's Disease International

In this quote, Dr. Graham is expressing her observations and experiences in her work with numerous international organizations. Many patients and their families experience feelings of anxiety and shame upon receiving a diagnosis of dementia. Lynda Hogg, an Alzheimer's patient, shares her feelings that "some people don't want to be associated with someone with an disease affecting the brain" (Alzheimer's Disease International, 2012). Every bit a psychiatric mental health nurse practitioner providing care to clients presenting with dementia, it is critically important to consider the impact of these disorders on clients, caregivers, and their families. A thorough agreement of the health implications of these disorders, besides every bit each customer's personal concerns, will aid you in making constructive treatment and direction decisions.

This calendar week, you explore strategies to go a social change agent for psychiatric mental health. Then, as you examine the cess and handling of clients with dementia, you lot also consider related ethical and legal implications.

Photograph Credit: [Maskot]/[Maskot]/Getty Images

Assignment: Assessing and Treating Clients With Dementia

The Alzheimer's Association defines dementia as "a general term for a decline in mental ability severe enough to interfere with daily life" (Alzheimer's Association, 2016). This term encompasses dozens of cognitive disorders of impaired retentiveness formation, call back, and communication. The intendance and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family unit back up, and even the care setting. In your role, every bit the psychiatric mental health nurse practitioner, y'all must exist prepared to non only treat clients with these various cognitive disorders, but also the multiple behavioral bug that frequently accompany them. For this Assignment, as you examine the client case study in this week'southward Learning Resource, consider how you might assess and treat clients presenting with dementia.

Reference: Alzheimer's Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.asp

Learning Objectives

Students will:

Assess client factors and history to develop personalized therapy plans for clients with dementia
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for dementia
Evaluate efficacy of treatment plans
Clarify ethical and legal implications related to prescribing therapy for clients with dementia

Learning Resources

Annotation: To access this week'south required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Notation: All Stahl resources can exist accessed through the Walden Library using this link. This link will take y'all to a log-in page for the Walden Library. Once you log into the library, the Stahl website will announced.

Stahl, S. Chiliad. (2013). Stahl's essential psychopharmacology: Neuroscientific footing and practical applications (4th ed.). New York, NY: Cambridge University Printing.
To access the following chapter, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 13, "Dementia and Its Treatment"

Stahl, S. Thou. (2014b). The prescriber'southward guide (fifth ed.). New York, NY: Cambridge University Press.
To admission information on the following medications, click on The Prescriber's Guide, fifth ed tab on the Stahl Online website and select the advisable medication.
Review the post-obit medications:
For insomnia

donepezil

galantamine

memantine

rivastigmine

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Doc, 85(1), twenty–22. Retrieved from http://www.aafp.org/journals/afp.html
Notation: Retrieved from from the Walden Library databases.

Meltzer, H. Y., Mills, R., Revell, South., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson'southward disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp20...

Required Media

Laureate Educational activity. (2016h). Case report: An elderly Iranian man with Alzheimer's disease [Interactive media file]. Baltimore, Doctor: Author.
Note: This instance study will serve as the foundation for this week's Assignment.

To prepare for this Assignment:

Review this week's Learning Resource. Consider how to assess and care for clients requiring therapy for dementia.

The Assignment

Examine Case Study: An Elderly Iranian Homo With Alzheimer's Disease. You lot volition be asked to make three decisions concerning the medication to prescribe to this client. Exist sure to consider factors that might impact the client's pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:
- Conclusion #ane
  - Which decision did you select?
  - Why did you select this determination? Support your response with testify and references to the Learning Resources.
  - What were y'all hoping to attain by making this decision? Support your response with evidence and references to the Learning Resources.
  - Explain whatever deviation between what you expected to achieve with Decision #1 and the results of the decision. Why were they unlike?
- Decision #2
  - Why did yous select this decision? Support your response with evidence and references to the Learning Resources.
  - What were you hoping to accomplish past making this decision? Support your response with show and references to the Learning Resource.
  - Explain whatever difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
- Conclusion #3
  - Why did you select this decision? Support your response with evidence and references to the Learning Resources.
  - What were you hoping to achieve by making this determination? Support your response with evidence and references to the Learning Resources.
  - Explain whatsoever difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might touch on your treatment program and communication with clients.

Annotation: Back up your rationale with a minimum of three academic resources. While you may use the grade text to support your rationale, it volition not count toward the resources requirement.

Background

Mr. Akkad is a 76 yr 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 beliefs. All laboratory and diagnostic imaging tests (including CT-scan of the caput) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, simply things seem to be getting worse. Per the customer's son, the family noticed that Mr. Akkad'southward personality began to change a few years agone. He began to lose interest in religious activities with the family and became more than "disquisitional" of everyone. They besides noticed that things he used to take seriously had become a source of "amusement" and "ridicule."

Over the grade of the past two years, the family unit 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 so will shift to an entirely dissimilar line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to relish speaking with you. You lot notice some confabulation during diverse aspects of memory testing, so the PMHNP performs a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with principal deficits in orientation, registration, attention & calculation, and call back. The score suggests moderate dementia.

MENTAL Condition Exam

Mr. Akkad is 76 year quondam Iranian male who is cooperative with today's clinical interview. His eye contact is poor. Oral communication is articulate, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Cocky-reported mood is euthymic. Affect even so is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alarm and oriented to person, partially oriented to identify, simply is disoriented to time and event [he reports that he idea he was coming to lunch just "wound up hither"- referring to your function, at which point he begins to express joy]. Insight and judgment are impaired. Impulse control is likewise impaired as evidenced by Mr. Akkad's standing upward during the clinical interview and walking towards the door. When the PMHNP 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, K. F., Folstein, Due south. E., & McHugh, P. R. (2002). Mini-Mental Country Examination (MMSE). Lutz, FL: Psychological Assessment Resources.

Select what the PMHNP should practice:

Brainstorm Exelon (rivastigmine) 1.five mg orally BID with an increase to three mg orally BID in two weeks

: Begin Aricept (donepezil) five mg orally at BEDTIME

Decision Betoken One

: Begin Aricept (donepezil) 5 mg orally at BEDTIME

RESULTS OF Determination 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 even so disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors

Y'all continue to note confabulation and determine to administrate the MMSE once again. Mr. Akkad over again scores 18 out of xxx with master deficits in orientation, registration, attending & calculation, and retrieve

Decision Bespeak Two

Select

Increment Aricept to ten mg orally at BEDTIME

Discontinue Aricept and brainstorm Razadyne (galantamine) extended release 24 mg orally daily

Discontinue Aricept and begin Namenda (memantine) extended release, 28 mg orally daily

Decision Signal Two

Increase Aricept to 10 mg orally at BEDTIME

RESULTS OF Determination Point TWO

Client returns to clinic in 4 weeks

Customer's son reports that the client is tolerating the medication well, but is still concerned that his father is no ameliorate

He states that his male parent is attending religious services with the family unit, which the son and the rest of the family unit is happy about. He reports that his begetter is still easily amused by things he once constitute serious

Decision Betoken 3

Select what the PMHNP should exercise next:

Go on Aricept 10 mg orally at BEDTIME

Increase Aricept to 15 mg orally at BEDTIME x 6 weeks, then increment to 20 mg orally at BEDTIME

Discontinue Aricept and begin Namenda 5 mg orally daily

Decision Signal 2

Increase Aricept to 10 mg orally at BEDTIME

RESULTS OF DECISION Indicate 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 male parent is attending religious services with the family unit, which the son and the residuum of the family is happy nigh. He reports that his father is still easily amused by things he once constitute serious

Decision Point Three

Continue Aricept x mg orally at BEDTIME

Guidance to Student
At this point, it would be prudent for the PMHNP to go on Aricept at ten mg orally at bedtime. Recall that this medication can take several months before stabilization of deterioration is noted. At this signal, the client is attending religious services with the family, which has made the family happy. Disinhibition may amend in a few weeks, or it may non improve at all. This is a counseling point that the PMHNP should review with the son.
There is no evidence that Aricept given at doses greater than x mg per day has any therapeutic do good. It tin can, even so, cause side effects. Increasing to 15 and 20 mg per day would not be advisable.
In that location is nothing in the clinical presentation to suggest that the Aricept should exist discontinued. Whereas it may be appropriate to add Namenda to the electric current drug profile, there is no demand to discontinue Aricept. In fact, NMDA receptor antagonist therapy is often used with cholinesterase inhibitors in combination therapy to treat Alzheimer'south illness. The key to using both medications is slow titration upwardly toward therapeutic doses to minimize negative side effects.
Finally, it is important to note that changes in the MMSE should exist evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of business.

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Attached.

Running head: ASSESSING AND TREATING A Customer WITH DEMENTIA

Assessing and Treating a Client with Dementia
Name
Institution

Running head: ASSESSING AND TREATING A CLIENT WITH DEMENTIA

Assessing and Treating a Client with Dementia
Dementia is a mental affliction in which an individual experiences different types of
symptoms such equally disability to reason effectively, dumb advice, difficulties in
language expression, and retentiveness loss (Cummings et al., 2018). In most cases, dementia leads to
changes in moods and personality, in which Alzheimer's disease (AD) is among the Dementia
weather. Since Alzheimer's disease is considered to be a progressive condition, the more the
patient continues without seeking medical help, the more the affliction becomes more severe.
The person involved in the case study presented was found to take a neurocognitive disorder every bit a
event of Advertisement. AD is the nigh prevalent dementia condition since it accounts for more than 50%
of the people diagnosed with dementia. Based on the issue of dementia, three decisions need to
be fabricated for a customer diagnosed with Alzheimer's disease likewise as the ethical consideration.
Decision I
The get-go conclusion involves beginning with 5gm Aricept (donepezil) orally during
bedtime. The reason for selecting this drug is because information technology is considered to be a cholinesterase
inhibitor and its effectiveness to treat Alzheimer'due south disease has been approved by the Nutrient and
Drugs Association (FDA) (Stahl, 2017). Virtually of the studies regarding dementia indicate that
cholinesterase inhibitors are amidst the best drugs that are effective in treating all levels of
Alzheimer'due south affliction, including mild, moderate, ...