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Assignment: Decision Tree For Neurological And Musculoskeletal Disorders

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders NURS 6521

Your Instructor will assign you one of the decision tree interactive media pieces from the Resources for your Assignment. Consider how you could assess and treat patients exhibiting signs of neurological and musculoskeletal diseases as you go through the patient case studies in this module’s Resources.

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

The case study depicts a 43-year-old white male who presents with a complaint of pain. He uses a set of clutches when ambulating. The patient reports that he has been referred for psychiatric assessment by his family doctor since the doctor perceived that he had psychological pain (Laureate Education, 2016). The pain began seven years ago after sustaining a fall and landed on the right hip. Four years ago, it was revealed that the cartilage around the right hip joint had a 75% tear.  However, no surgeon was willing to perform a total hip replacement since they believed that there would be tissue repair over time (Laureate Education, 2016). He reports having severe cramping of the right extremity. A neurologist diagnosed him with complex regional pain syndrome (CRPS). He states that he gets low moods at times but denies being depressed.  He had been prescribed with Hydrocone but used it in low doses due to drowsiness and constipation, and the drug does not manage pain effectively (Laureate Education, 2016). The mental status exam is unremarkable.

Thank you for your response. This brings to mind King James Bible/New Living Translation 2005, Luke 8:17; For all that is secret will eventually turn to light. I was in Nursing school and happen to be tutoring a nursing student that was a class or two behind me. The student was prepared to take her med-surgical exam; we had reviewed the pathophysiology so that she would be able to look at, for example, be given a scenario regarding a patient’s lab values and know if the patient was in metabolic acidosis. We reviewed the ability to think critically. Prior to her taking the test we, both felt confident that she would pass. Day later she called and asked to come over and when she arrived, she was distraught. I was dumb founded; she explained that she had taken the exam, but it did not go very well because she decided to cheat. A couple of her classmates reassured her that they had the answers to the exam; She did not even read the exam to use anything that we had reviewed as far a critically thinking and using pathophysiology, lab values, and so on to arrive at the answers.

I was upset that she had taken up hours and days of my time to prepare for an exam and she just totally threw everything out the window and just put down answers. The class prior to hers had aced the exam, but the instructor and the Director of the Nursing department reviewed the class trends and knew that the class prior to her class should not have scored that many A’s. Therefore, the test was changed and the test that my friend took was different from the one the prior class had taken. On top of that she had to speak with the Director of the Nursing department and was expelled from the program. She needed to at least pass with a C to remain in the program. The class prior had students that were also expelled as well as the students that were in her class. I only knew about this as she confided in me regarding the situation; otherwise, the was emphasis in my class to make sure that all the concepts were understood; if not ask questions during/after lecture and because in clinical we were taking care of patients and need to know why we were administering some as simple as a vitamin E and the side effects. In my practice I have been conscientious regarding patient care. In the Neonatal Intensive Care everything we gave during the time I worked in the unit was doubled checked. If it did not fit into a 1cc syringe it was triple checked.

Decision Point One: Savella 12.5 mg orally once daily on Day 1, followed by 12.5 mg BD on Day 2 and 3, then 25 mg BD on days 4-7 and then 50 mg BD after that.

Reason: Savella is a serotonin-norepinephrine reuptake inhibitor that has NMDA antagonist activity, which brings analgesia at the nerve endings (Cording et al., 2015). It is indicated for fibromyalgia and thus effective for this client (Cording et al., 2015). I prescribed Savella to help in pain management and improve the overall mood.

Expected Result: I anticipated that Savella would lower the degree of pain. However, it was expected that the client would experience adverse effects such as nausea, constipation, headache, hot flushes, and insomnia.

Expected Vs. Actual Results: The client returned to the clinic after for weeks without using crutches but with a bit of limping. He states that the pain has been more manageable. The pain is severe in the morning but improves throughout the day (Laureate Education, 2016). On a scale of 1-10, the client rates the pain at four and states that he gets to a point on most days where he does not need crutches. Nevertheless, he reported having increased sweating, sleeping difficulties, nausea, and palpitations (Laureate Education, 2016). His BP was 147/92, and the pulse at 110. He denied having suicidal ideations and was still future-oriented.

Decision Point 2: Continue with Savella but lower dose to 25 mg twice a day.

Reason: I selected this decision to lower the severity of the adverse effects of Savella, which include nausea, constipation, headache, hot flushes, and insomnia (Cording et al., 2015).

Expected Result: Reduction in the dose of Savella would help control the side effects but lower the degree of pain control.

Expected Vs. Actual Results: The client returned to the clinic in four weeks using crutches and rates his current pain at 7/10. He reports that his condition has declined since the previous month (Laureate Education, 2016). He states that he sleeps at night but frequently wakes up due to pain in the right leg and foot. The BP is at 124/87 and pulse at 87. He denies having palpitations and suicidal ideations but is discouraged by the slip in pain management and seems sad.

Decision Point 3: Change Savella to 25 mg in the morning and 50 mg at Bedtime.

I reduced the dosage in the morning since the pain is mostly under control and increased the dose at Bedtime when there is less control (Resmini et al., 2015).

Expected Result: By lowering the morning dose and increasing the bedtime dose, I expected that the client’s pain symptom would improve while at the same time controlling the side effects of Savella (Resmini et al., 2015).

Expected Vs. Actual Results: The client reported an improvement in the pain with a rate of 3/10 denied having any side effects from the drug.

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders NURS 6521 References

Cording, M., Derry, S., Phillips, T., Moore, R. A., & Wiffen, P. J. (2015). Milnacipran for pain in fibromyalgia in adults. Cochrane Database of Systematic Reviews, (10).

Laureate Education. (2016). Case Study: A Caucasian man with hip pain. Baltimore, MD: Author.

Resmini, G., Ratti, C., Canton, G., Murena, L., Moretti, A., & Iolascon, G. (2015). Treatment of complex regional pain syndrome. Clinical cases in mineral and bone metabolism: the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases12(Suppl 1), 26–30. https://doi.org/10.11138/ccmbm/2015.12.3s.026

Decision Tree for Neurological and Musculoskeletal Disorders

Introduction

According to Elsamadicy et al. (2018), Complex Regional Pain Syndrome (CRPS) is a complication led by injury or fracture. The first initiative based on the patient history is examining the clinical history and physical examination. In addition, I would consider assessing the steps towards pain relief. For instance, through a duplex, imaging is effective in determining the flow of blood or the presence of any obstruction in any location. The paper focuses on examining the patient case study and offering a treatment based on the neurological disorder symptoms.

Brief Summary of the Case Study

I will address about a 43 years old white male with a chief complaint of pain. The patient ambulates using a set of crutches. According to the patient, the family doctor has sent him for psychiatric assessment claiming that the pain originated from the head. However, the patient says that the pain originated after a fall at his work 7 years ago. He had numerous diagnoses such as MRI, X-rays, and CT scans. The neurologist report identified the patient as suffering from a complex regional pain syndrome (CRPS).

Decision Recommended to the patient based on Case Study

According to Saleh and Librianto (2021), the use of an MRI helps determine mechanical abnormalities such as osteoarthritis, pinched nerves, and radical pain. Moreover, I would consider ruling out the psychosis, infection, and depression before prescribing medication to the patient (Rosenthal & Burchum, 2021). The first decision I would make is to prescribe amitriptyline. Amitriptyline is an antidepressant that hinders the uptake of norepinephrine and serotonin neurotransmitters (Thour & Marwaha, 2019). The drug binds to muscarinic (MI), alpha–endoergic, and histamine (HI) receptors (Thour & Marwaha, 2019). Therapeutic action for Amitriptyline onset takes approximately 2 to 4 weeks. The initial dosage is 25 mg at bedtime.

However, a patient should continue using amitriptyline for longer than three months, which is an effective way to overcome depression. The half-life for amitriptyline is 10 to 28 hours (Thour & Marwaha, 2019). The administration routine is through the intramuscular route, and the peak happens within 2 to 12 hours (Thour & Marwaha, 2019). The most common adverse effect are dizziness, constipation, drowsiness, and headache. I would continue on the current medication and increase it to 125 mg/ day at bedtime that week. I would instruct the patient to increase the intake to 200mg/day in the following week, which should be taken an hour earlier than starting tonight.

I would also advise the patient to call the office 3 days in the morning for a report. If the patient reports that the pain is fading away, the medication plan is effective. Therefore, the decision point seems to be helping the patient in pain control. The third decision point is to continue with the current amitriptyline dose of 125 mg/day. In addition, I would encourage the patient to have a counselor for life coach therapy for both exercise and dietary behavior. I will also consider warning the patient against adverse effects such as cardiovascular risk and ensure that I monitor the cardiac function and the serum levels.

I would also not on the effect on the blood pressure and mood changes. I would discourage reducing the dose and adding Gabapentin which is not applicable. Gabapentin helps in relaxing the muscles, thus an anticonvulsive medication (Manville & Abbott, 2018). Gabapentin has a chemical structure that consists of the cyclohexyl group (Manville & Abbott, 2018). It consists of a half-life estimated between 5 to 7 hours, and the body takes two days to eliminate it from the system.

What I was Hoping to Achieve with the Decision Recommended

I expected the patient health to improve after using amitriptyline and reduce the pain on a scale of 10 points. The drug effectively manages insomnia and anxiety while it also helps in neuropathic pain management. Therefore, more to increasing the patient dosage, I would consider encouraging the need for peer support groups, pain care specialists, and rehabilitation psychology. Physical therapy is essential in balancing the patient’s mobility.

The Difference Between was expected in each decision

After 3 months, the patient returned to the hospital walking without any support and reported a reduction of pain to between 4 to 10 point scales. The patient was joyous and willing to continue with the treatment plan, which reduces pain. The assessment result on blood pressure was 120/84mm/hg, while the pulse rate was 86 beats/min. The patient was aware that the pain did not disappear completely but was controlled at a tolerable level. He was encouraged on the benefits of incorporating heat therapy for better outcomes.

Conclusion

Patient with Complex Regional Pain Syndrome (CRPS) changes the nervous systems by causing trauma of the peripheral sensory neurons. CRPS makes a patient more sensitive to pain. In addition, it inhibits the uptake of serotonin thus restoring the brain chemical balance and producing analgesic effects.

References

Elsamadicy, A. A., Yang, S., Sergesketter, A. R., Ashraf, B., Charalambous, L., Kemeny, H., … & Lad, S. P. (2018). Prevalence and cost analysis of complex regional pain syndrome (CRPS): a role for neuromodulation. Neuromodulation: Technology at the Neural Interface21(5), 423-430. https://www.sciencedirect.com/science/article/pii/S1094715921022571

Manville, R. W., & Abbott, G. W. (2018). Gabapentin is a potent activator of KCNQ3 and KCNQ5 potassium channels. Molecular Pharmacology94(4), 1155-1163. https://molpharm.aspetjournals.org/content/94/4/1155.short

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier.

Saleh, I., & Librianto, D. (2021). Surgical treatment of spondylolisthesis using long arm screw: A literature review. Annals of Medicine and Surgery, 103200. https://www.sciencedirect.com/science/article/pii/S204908012101150X

Thour, A., & Marwaha, R. (2019). Amitriptyline. https://europepmc.org/article/nbk/nbk537225

 

Alzheimer’s is one of the most common progressive neurological disorders among the elderly caused by dementia. Patients will present with mild to moderate cognitive signs and symptoms at the onset of the disorder, which will progress to severe memory loss with time, as they grow much older (Li et al., 2019). However, several treatment options have been proven to be effective in the management of Alzheimer’s disorder among the elderly. The purpose of this discussion is to illustrate the decision process in selecting the most effective drug, based on pharmacokinetic and pharmacodynamic factors, for treating an elderly patient diagnosed with Alzheimer’s disease.

Patient Case Study Summary

The assigned case study demonstrates a 76-year-old Iranian male with symptoms of Alzheimer’s disorder. The patient displays strange behavior upon arrival at the clinic reporting symptoms of memory loss, forgetfulness, confusion, and diminished interest in religious activities for the last 2 years. Pharmacokinetic and pharmacodynamic patient factors which contributed to the selection of drugs for this patient include his advanced age, male gender, Iranian race, and presenting symptoms in addition to the mini-mental exam results of moderate dementia. the patient’s diagnosis of Alzheimer’s disorder will also be considered.

Treatment Decisions

Based on the patient history and the pharmacokinetic and pharmacodynamic factors mentioned above, the most appropriate intervention is to initiate Exelon 1.5mg twice daily. Exelon (rivastigmine) is an FFDA-approved drug for treating mild to moderate Alzheimer’s disease (Fish et al., 2019). Previous studies support great effectiveness, and safety profile for use of the drug among the elderly diagnosed with Alzheimer’s (Khoury et al., 2018). The second decision was to increase the dose of Exelon to 4.5 mg twice daily as recommended by most clinical practice guidelines for patients who have displayed great tolerance but with minimal effectiveness. The last decision was to increase the dose further to 6mg twice daily, to promote optimal effectiveness as the patient still displayed limited remission of symptoms with the previous intervention.

Expected Outcome

Studies show that Exelon when administered appropriately takes between 8 to 12 weeks to completely manage symptoms of Alzheimer’s among elderly patients. As such, with the initial intervention of 1.5mg Exelon twice daily, the patient was expected to display approximately 50% remission of symptoms (Nguyen et al., 2021). The dose was however to be titrated to obtain the optimum outcome, not exceeding 6mg twice daily. The same results were expected with the second and third interventions with no side effects expected.

Difference Between Expected Outcome and Actual Outcome

Just like expected, the patient displayed a minimal reduction of symptoms of Alzheimer’s with no side effects reported with the first intervention. After the dose was increased in the second intervention, the patient reported further remission of symptoms, but at a slow rate, hence increasing the dose in the last intervention, which led to optimal remission of Alzheimer’s symptoms just as expected (Huang et al., 2020).

Conclusion

Alzheimer’s is a common disorder among the elderly compromising their quality of life and well-being. For the patient in the provided case study, it was necessary to administer Exelon at a starting dose of 1.5 mg which was titrated to 4.5mg then 6.5mg twice daily. The patient displayed great effectiveness with this medication in the management of his Alzheimer’s symptoms, with no side effects reported.

 

 

 

References

Fish, P. V., Steadman, D., Bayle, E. D., & Whiting, P. (2019). New approaches for the treatment of Alzheimer’s disease. Bioorganic & medicinal chemistry letters29(2), 125-133. https://doi.org/10.1016/j.bmcl.2018.11.034

Huang, L. K., Chao, S. P., & Hu, C. J. (2020). Clinical trials of new drugs for Alzheimer’s disease. Journal of biomedical science27(1), 1-13. https://doi.org/10.1186/s12929-019-0609-7

Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current therapies for Alzheimer’s disease: focus on rivastigmine. Therapeutic Advances in Drug Safety9(3), 171-178. https://doi.org/10.1177/2042098617750555

Li, D. D., Zhang, Y. H., Zhang, W., & Zhao, P. (2019). Meta-analysis of randomized controlled trials on the efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer’s disease. Frontiers in neuroscience13, 472. https://doi.org/10.3389/fnins.2019.00472

Nguyen, K., Hoffman, H., Chakkamparambil, B., & Grossberg, G. T. (2021). Evaluation of rivastigmine in Alzheimer’s disease. Neurodegenerative Disease Management11(1), 35-48. https://doi.org/10.2217/nmt-2020-0052

Photo Credit: KATERYNA KON/SCIENCE PHOTO LIBRARY / Science Photo Library / Getty Images

To Get Ready for Assignment: Decision Tree for Neurological and Musculoskeletal Disorders NURS 6521

Examine the interactive media work that your instructor assigned you.
Consider the patient’s symptoms as well as the features of the condition described in the interactive media piece.
Consider how you would assess and treat patients who presented with the symptoms described in the patient case study.
You will be prompted to make three decisions about this patient’s diagnosis and treatment. Consider any co-morbid physical and patient conditions that may influence the patient’s diagnosis and therapy.
Week 8’s seventh day

Create a one- to two-page summary paper that tackles the following topics:

Briefly outline the assigned patient case study, covering each of the three decisions you made for the patient.
Explain whether you believe the decisions you recommended for the patient case study were supported by the evidence-based literature. Provide specifics and instances. Make sure to back up your answer with proof and references from outside sources.
What did you hope to accomplish with the recommendations you made for the patient case study you were assigned? Provide information and references from other sources to back up your response.
Explain any discrepancy between what you anticipated to achieve with each decision and the outcome of the exercise decision. Describe how they were distinct. Provide specifics and instances.
This assignment will be due in Week 8.

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders NURS 6521

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.
Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 8 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Grading Criteria

To access your rubric:

Week 8 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 8 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 8

To participate in this Assignment:

Week 8 Assignment

What’s Coming Up in Week 7?

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders NURS 6521

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Next week, you will continue working on your Assignment started in Week 6, and you will complete your Midterm Exam.

Next Week

To go to the next week:

Week 7

Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Assignment: Decision Tree for Neurological and Musculoskeletal Disorders NURS 6521  

Week 7: Midterm Exam
This week, you will continu Assignment: Decision Tree for Neurological and Musculoskeletal Disorders NURS 6521 e working on your Assignment started in Week 6, and you will complete your Midterm Exam.

Learning Objectives
Students will:

Identify key terms, concepts, and principles related to prescribing drugs to treat patient disorders

Midterm Exam
The Exam covers the content you have explored throughout the first 6 weeks of this course.

This exam is a test of your knowledge in preparation for your certification exam. No outside resources—including books, notes, websites, or any other type of resource—are to be used to complete this quiz. You are not allowed to take screenshots or record the exam questions in any other format while taking the exam. You are expected to comply with Walden University’s Code of Conduct.

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders NURS 6521

Photo Credit: Getty Images/Hero Images

By Day 7 of Week 7
Complete the Midterm Exam. You have 120 minutes to complete the exam. You may only attempt this exam once.

Submission and Grading Information
Complete the Exam by Day 7 of Week 7

To Complete this Exam:

Week 7 Exam

 

What’s Coming Up in Module 6?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In the next module, you will examine types of drugs prescribed to patients who present with psychological disorders.

In the next module, you will examine types of drugs prescribed to patients who present with psychological disorders.

Next Week

To go to the next week:

Module 6

 

Module 6: Psychological Disorders

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act…mental health is important at every stage of life, from childhood and adolescence through adulthood.

—Centers for Disease Control and Prevention, 2018

As an advanced practice nurse, treating patients who may present with psychological disorders requires critical clinical decision making. It is your expertise in clinical decision making that will ensure that the pharmacotherapeutics and other suggested treatments prescribed to your patients will not only promote positive patient health outcomes but will lead to sustained health and well-being.

Reference: Centers for Disease Control and Prevention. (2018). Mental health. Retrieved from https://www.cdc.gov/mentalhealth/index.htm

What’s Happening This Module? Assignment: Decision Tree for Neurological and Musculoskeletal Disorders NURS 6521
Module 6: Psychological Disorders is a 1-week module, Week 8 of the course. In this module, you will examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

What do I have to do?
When do I have to do it?
Review your Learning Resources
Days 1-7, Week 8
Discussion: Decision Making When Treating Psychological Disorders
Post by Day 3 of Week 8, and respond to your colleagues by Day 6 of Week 8.
Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders
Submit your Assignment by Day 7 of Week 8.
Go to the Week’s Content

Week 8

Week 8: Pharmacology for Psychological Disorders

How does an advanced practice nurse determine the best treatment option or pharmacotherapeutic to recommend for patients with psychological disorders?

Much like assessing or recommending pharmacotherapeutics for other conditions or disorders, as an advanced practice nurse, you may encounter a patient who presents with a psychological disorder. Understanding the guiding principles related to treating patients with psychological disorders as well as the effects of pharmacotherapeutics on a patient’s overall health and well-being is critical for the safe and effective delivery of care.

This week, you examine types of drugs prescribed to patients with psychological disorders. You also examine potential impacts of pharmacotherapeutics used to treat psychological disorders on a patient’s pathophysiology.

Learning Objectives

Students will:

Evaluate patients for treatment of psychological disorders
Analyze decisions made throughout the diagnosis and treatment of patients with psychological disorders
Analyze impacts of pharmacotherapeutics for psychological disorders on patient pathophysiology
Evaluate patients for treatment of neurological and musculoskeletal disorders
Analyze decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders
Justify decisions made throughout the diagnosis and treatment of patients with neurological and musculoskeletal disorders

Learning Resources

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 26, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 203–213)
Chapter 27, “Antidepressants” (pp. 214–226)
Chapter 28, “Drugs for Bipolar Disorder” (pp. 228–233)
Chapter 29, “Sedative-Hypnotic Drugs” (pp. 234–242)
Chapter 30, “Management of Anxiety Disorders” (pp. 243–247)
Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 248–254)

Required Media (click to expand/reduce)

 

Laureate Education (Producer). (2019a). Adult geriatric depression [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 adult geriatric depression.

Laureate Education (Producer). (2019c). Attention deficit hyperactivity disorder [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 attention deficit hyperactivity disorder.

Laureate Education (Producer). (2019d). Bipolar therapy [Interactive media file]. Baltimore, MD: Author.

 

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics for bipolar therapy.

Laureate Education (Producer). (2019g). Generalized anxiety disorder [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 generalized anxiety disorder.

Week 6: Neurologic and Musculoskeletal Disorders and Opioids

Sabrina is a 26 year old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems. Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.

As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?

This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.

Learning Objectives

Students will:

  • Evaluate patients for treatment of neurologic and musculoskeletal disorders
  • Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders
  • Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

Learning Resources

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 24, “Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics” (pp. 183–194)
  • 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)
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.

Laureate Education (Producer). (2019e). Complex regional pain disorder [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 complex regional pain disorders.

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)

 

Speed Pharmacology. (2019). Drugs for Parkinson’s Disease (Made Easy) [Video]. https://www.youtube.com/watch?v=Z84iypHdftQ&t=13s
Note:
 This media program is approximately 9 minutes.

Speed Pharmacology. (2019). Pharmacology- Drugs for Alzheimer’s Disease (Made Easy) [Video]. https://www.youtube.com/watch?v=euzRPrvrwj0&t=31s
Note:
 This media program is approximately 7 minutes.

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6521_Week8_Assignment_Rubric
Grid View
List View
Excellent Good Fair Poor
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific.
18 (18%) – 20 (20%)
The response accurately and thoroughly summarizes in detail the patient case study assigned, including specific and complete details on each of the three decisions made for the patient presented.
16 (16%) – 17 (17%)
The response accurately summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.
14 (14%) – 15 (15%)
The response inaccurately or vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.
0 (0%) – 13 (13%)
The response inaccurately and vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented, or is missing.
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.
23 (23%) – 25 (25%)
The response accurately and thoroughly explains in detail how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes specific and relevant outside reference examples that fully support the explanation provided.
20 (20%) – 22 (22%)
The response accurately explains how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.
18 (18%) – 19 (19%)
The response inaccurately or vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.
0 (0%) – 17 (17%)
The response inaccurately and vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature, or is missing.

The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.
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.
18 (18%) – 20 (20%)
The response accurately and thorough explains in detail what they were hoping to achieve with the decisions recommend for the patient case study assigned.

The response includes specific and relevant outside reference examples that fully support the explanation provided.
16 (16%) – 17 (17%)
The response accurately explains what they were hoping to achieve with the decisions recommended for the patient case study assigned.

The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned.

The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned, or is missing.

The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decisions in the exercise. Describe whether they were different. Be specific and provide examples.
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides specific, accurate, and relevant examples that fully support whether there were differences between the decisions made and the decisions available in the exercise.
16 (16%) – 17 (17%)
The response accurately explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides accurate examples that support whether there were differences between the decisions made and the decisions available in the exercise.
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides inaccurate or vague examples that may or may not support whether there were differences between the decisions made and the decisions available in the exercise.
0 (0%) – 13 (13%)
vaguely explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise, or is missing.

The response provides inaccurate and vague examples that do not support whether there were differences between the decisions made and the decisions available in the exercise, or is missing.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
4 (4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%)
Uses correct APA format with no errors
4 (4%) – 4 (4%)
Contains a few (1–2) APA format errors
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors
Total Points: 100
Name: NURS_6521_Week8_Assignment_Rubric

Alzheimer’s is one of the most common progressive neurological disorders among the elderly caused by dementia. Patients will present with mild to moderate cognitive signs and symptoms at the onset of the disorder, which will progress to severe memory loss with time, as they grow much older (Li et al., 2019). However, several treatment options have been proven to be effective in the management of Alzheimer’s disorder among the elderly. The purpose of this discussion is to illustrate the decision process in selecting the most effective drug, based on pharmacokinetic and pharmacodynamic factors, for treating an elderly patient diagnosed with Alzheimer’s disease.

Patient Case Study Summary

The assigned case study demonstrates a 76-year-old Iranian male with symptoms of Alzheimer’s disorder. The patient displays strange behavior upon arrival at the clinic reporting symptoms of memory loss, forgetfulness, confusion, and diminished interest in religious activities for the last 2 years. Pharmacokinetic and pharmacodynamic patient factors which contributed to the selection of drugs for this patient include his advanced age, male gender, Iranian race, and presenting symptoms in addition to the mini-mental exam results of moderate dementia. the patient’s diagnosis of Alzheimer’s disorder will also be considered.

Treatment Decisions

Based on the patient history and the pharmacokinetic and pharmacodynamic factors mentioned above, the most appropriate intervention is to initiate Exelon 1.5mg twice daily. Exelon (rivastigmine) is an FFDA-approved drug for treating mild to moderate Alzheimer’s disease (Fish et al., 2019). Previous studies support great effectiveness, and safety profile for use of the drug among the elderly diagnosed with Alzheimer’s (Khoury et al., 2018). The second decision was to increase the dose of Exelon to 4.5 mg twice daily as recommended by most clinical practice guidelines for patients who have displayed great tolerance but with minimal effectiveness. The last decision was to increase the dose further to 6mg twice daily, to promote optimal effectiveness as the patient still displayed limited remission of symptoms with the previous intervention.

Expected Outcome

Studies show that Exelon when administered appropriately takes between 8 to 12 weeks to completely manage symptoms of Alzheimer’s among elderly patients. As such, with the initial intervention of 1.5mg Exelon twice daily, the patient was expected to display approximately 50% remission of symptoms (Nguyen et al., 2021). The dose was however to be titrated to obtain the optimum outcome, not exceeding 6mg twice daily. The same results were expected with the second and third interventions with no side effects expected.

Difference Between Expected Outcome and Actual Outcome

Just like expected, the patient displayed a minimal reduction of symptoms of Alzheimer’s with no side effects reported with the first intervention. After the dose was increased in the second intervention, the patient reported further remission of symptoms, but at a slow rate, hence increasing the dose in the last intervention, which led to optimal remission of Alzheimer’s symptoms just as expected (Huang et al., 2020).

Conclusion

Alzheimer’s is a common disorder among the elderly compromising their quality of life and well-being. For the patient in the provided case study, it was necessary to administer Exelon at a starting dose of 1.5 mg which was titrated to 4.5mg then 6.5mg twice daily. The patient displayed great effectiveness with this medication in the management of his Alzheimer’s symptoms, with no side effects reported.

 References

Fish, P. V., Steadman, D., Bayle, E. D., & Whiting, P. (2019). New approaches for the treatment of Alzheimer’s disease. Bioorganic & medicinal chemistry letters29(2), 125-133. https://doi.org/10.1016/j.bmcl.2018.11.034

Huang, L. K., Chao, S. P., & Hu, C. J. (2020). Clinical trials of new drugs for Alzheimer’s disease. Journal of biomedical science27(1), 1-13. https://doi.org/10.1186/s12929-019-0609-7

Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current therapies for Alzheimer’s disease: focus on rivastigmine. Therapeutic Advances in Drug Safety9(3), 171-178. https://doi.org/10.1177/2042098617750555

Li, D. D., Zhang, Y. H., Zhang, W., & Zhao, P. (2019). Meta-analysis of randomized controlled trials on the efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer’s disease. Frontiers in neuroscience13, 472. https://doi.org/10.3389/fnins.2019.00472

Nguyen, K., Hoffman, H., Chakkamparambil, B., & Grossberg, G. T. (2021). Evaluation of rivastigmine in Alzheimer’s disease. Neurodegenerative Disease Management11(1), 35-48. https://doi.org/10.2217/nmt-2020-0052

NURS_6521_Week8_Assignment_Rubric

Excellent Good Fair Poor
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific.
Points Range: 18 (18%) – 20 (20%)
The response accurately and thoroughly summarizes in detail the patient case study assigned, including specific and complete details on each of the three decisions made for the patient presented.
Points Range: 16 (16%) – 17 (17%)
The response accurately summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.
Points Range: 14 (14%) – 15 (15%)
The response inaccurately or vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.
Points Range: 0 (0%) – 13 (13%)
The response inaccurately and vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented, or is missing.
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.
Points Range: 23 (23%) – 25 (25%)

The response accurately and thoroughly explains in detail how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes specific and relevant outside reference examples that fully support the explanation provided.

Points Range: 20 (20%) – 22 (22%)

The response accurately explains how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.

Points Range: 18 (18%) – 19 (19%)

The response inaccurately or vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.

Points Range: 0 (0%) – 17 (17%)

The response inaccurately and vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature, or is missing.

The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.

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.
Points Range: 18 (18%) – 20 (20%)

The response accurately and thorough explains in detail what they were hoping to achieve with the decisions recommend for the patient case study assigned.

The response includes specific and relevant outside reference examples that fully support the explanation provided.

Points Range: 16 (16%) – 17 (17%)

The response accurately explains what they were hoping to achieve with the decisions recommended for the patient case study assigned.

The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.

Points Range: 14 (14%) – 15 (15%)

The response inaccurately or vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned.

The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.

Points Range: 0 (0%) – 13 (13%)

The response inaccurately and vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned, or is missing.

The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.

Explain any difference between what you expected to achieve with each of the decisions and the results of the decisions in the exercise. Describe whether they were different. Be specific and provide examples.
Points Range: 18 (18%) – 20 (20%)

The response accurately and clearly explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides specific, accurate, and relevant examples that fully support whether there were differences between the decisions made and the decisions available in the exercise.

Points Range: 16 (16%) – 17 (17%)

The response accurately explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides accurate examples that support whether there were differences between the decisions made and the decisions available in the exercise.

Points Range: 14 (14%) – 15 (15%)

The response inaccurately or vaguely explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides inaccurate or vague examples that may or may not support whether there were differences between the decisions made and the decisions available in the exercise.

Points Range: 0 (0%) – 13 (13%)

vaguely explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise, or is missing.

The response provides inaccurate and vague examples that do not support whether there were differences between the decisions made and the decisions available in the exercise, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
Points Range: 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
Points Range: 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
Points Range: 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
Points Range: 4 (4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors
Points Range: 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors
Points Range: 4 (4%) – 4 (4%)
Contains a few (1–2) APA format errors
Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors
Points Range: 0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors
Total Points: 100