consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.
A Gentleman with Neurocognitive Disorder
Assignment: Practicum: Decision Tree
REQUIRED MEDIA
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6670/08/mm/decision_tree/index.html
For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.
The Assignment:
Examine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
- Decision #1: Differential Diagnosis
- Which Decision did you select?
- 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 Decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
- Decision #2: Treatment Plan for Psychotherapy
- 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 Decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
- Decision #3: Treatment Plan for Psychopharmacology
- 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 Decision? Support your response with evidence and references to the Learning Resources.
- Explain any 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 impact your treatment plan and communication with clients and their family.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.
Week 8: Neurocognitive Disorders
My mother used to be a teacher—an elementary school teacher. We were all so proud of her when she completed her PhD when she was 50. Now she is 75 and has begun to have times when she does not know what day it is. We found her wandering around the neighborhood because she could not find her way home. Once, she forgot where she parked her car at the grocery store. She thought someone had stolen it. The manager was so kind to drive her around the parking lot until she recognized her car. We are afraid she might get hurt or lost.
Gary, age 50, son of Dorothy, age 75
The neurocognitive disorders are unique among the other psychiatric disorders you have studied in that the diseases that are to blame for the neurocognitive manifestations that have been extensively studied. Additionally, these conditions are also acquired and represent a decline from a previous level of functioning. The neurocognitive disorders present a diagnostic challenge to the PMHNP in that many of the signs and symptoms overlap.
This week, you will explore evidence-based psychotherapy and psychopharmacologic treatment for neurocognitive disorders. You will complete your final Decision Tree as you rationalize and justify your diagnosis and treatment of a patient with a mental health disorder.
Learning Resources
REQUIRED READINGS
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
- Chapter 21, “Neurocognitive Disorders” (pp. 694–741)
- Chapter 63, “Delirium”
- Chapter 64, “Neurocognitive Disorder Due to Alzheimer’s Disease”
- Chapter 65, “Frontotemporal Neurocognitive Disorder”
- Chapter 66, “Vascular Neurocognitive Disorder”
- Chapter 67, “Neurocognitive Disorder Due to Parkinson’s Disease”
- “Neurocognitive Disorders”
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
Note: All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. http://ezp.waldenulibrary.org/login?url=http://sta…
To access information on specific medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.
| Alzheimer disease | Delirium | Dementia | Parkinson’s disease dementia |
| caprylidene donepezil galantamine memantine rivastigmine | haloperidol (adjunct) lorazepam (adjunct) | donepezil galantamine memantine rivastigmine | rivastigmine pimavanserin |
Note: For more information on Pimavanserin, see:
Acadia Pharmaceuticals. (2017). Transform the treatment of Parkinson’s disease psychosis with NUPLAZID. Retrieved from https://www.nuplazidhcp.com/?gclid=CIHS5auvwtMCFQkaaQodrU0FGQ
U.S. Food and Drug Administration. (n. d.). Highlights of prescribing information: Nuplazid. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/207318lbl.pdf
REQUIRED MEDIA
Assignment: Practicum: Decision Tree
For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat adult and older adult clients presenting symptoms of a mental health disorder.
The Assignment:
Learning Objectives
Students will:
- Evaluate clients for treatment of mental health disorders
- Analyze decisions made throughout diagnosis and treatment of clients with mental health disorders
Examine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.
At each Decision Point, stop to complete the following:
- Decision #1: Differential Diagnosis
- Which Decision did you select?
- 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 Decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?
- Decision #2: Treatment Plan for Psychotherapy
- 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 Decision? Support your response with evidence and references to the Learning Resources.
- Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?
- Decision #3: Treatment Plan for Psychopharmacology
- 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 Decision? Support your response with evidence and references to the Learning Resources.
- Explain any 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 impact your treatment plan and communication with clients and their family.
Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.
BY DAY 7 OF WEEK 10
Submit your Assignment.
Case #3
Neurocognitive Disorders
Decision Point One
Major neurocognitive disorder with Lewy bodies
Decision Point Two
Begin Rivastigmine 1.5 mg orally twice a day
RESULTS OF DECISION POINT TWO
- Client returns to clinic in four weeks
- Upon his return to your office, Mr. Wingate’s son reported that Mr. Wingate seems to be tolerating the medication well, but he has not noticed any improvement in his father’s memory. He denies any worsening of other symptoms, but also reports no improvement either.
- Wingate’s son does report that Mr. Wingate’s nightmares appear to be getting worse in that he seems to “act out” his nightmares more.
Decision Point Three
Begin Clonazepam 0.5 mg orally at bedtime
Guidance to Student
In the case of Mr. Wingate, he meets the diagnostic criteria for major neurocognitive disorder as evidenced by a decline from a previous level of performance in more than one cognitive domain—in this case, complex attention and executive function. The decline is based on a knowledgeable informant, as well as a clinician (the patient’s primary care provider) who referred him to you, as well as substantial impairment in another quantified clinical assessment (the MMSE). Cognitive deficits that Mr. Wingate demonstrates interfere with independence in everyday activities and he requires help with complex IADLs such as medication management and paying bills.
Nothing in the scenario suggests that delirium could be responsible for the cognitive decline, nor is anything in the scenario suggestive of another mental disorder.
While one may be initially inclined to consider major neurocognitive disorder due to Alzheimer’s disease, probable Alzheimer’s would require evidence of a causative genetic mutation either from family history or genetic testing, and/or decline in memory and learning and at least one other cognitive domain; steadily progressive, gradual decline in cognition without extended plateaus; and no evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to the cognitive decline). Similarly, while there is some evidence of mild apathy, and decline in executive abilities, there is insufficient evidence of three or more behavioral symptoms that would be needed to make a diagnosis of major frontotemporal neurocognitive disorder (e.g., behavioral disinhibition, loss of sympathy or empathy, perseverative, stereotyped or compulsive/ritualistic behavior, hyperorality and dietary changes, or prominent decline in social cognition and/or executive abilities) nor is there evidence of prominent decline in language ability, in the form of speech production, word finding, object naming, grammar, or word comprehension that would suggest major frontotemporal neurocognitive disorder.
In Mr. Wingate’s case, there is clear evidence of fluctuating cognition, and spontaneous features of Parkinsonism, which had their onset subsequent to the development of cognitive decline. These symptoms, coupled with the presence of a rapid eye movement sleep behavior disorder, are suggestive of MNDLB. Diagnostic testing should focus on determining the presence of a synucleinopathy.
Since Mr. Wingate’s symptoms are more consistent with MNDLB, the addition of Seroquel may result in severe side effects that could be life threatening and include severe sedation, muscle rigidity, delirium, neuroleptic malignant syndrome, and depending on the source of the study reviewed, neuroleptics may be associated with a 2- to 3-fold increase in mortality, including cerebral vascular accident. Although Seroquel can be used off-label to induce sleep in some patients, there is an FDA warning against the use of antipsychotics in older adults with dementia as they have been associated with an increase in mortality. Therefore, in consideration of the probably diagnosis and presenting symptoms, antipsychotics would not be appropriate.
Acetylcholinesterase inhibitors may be useful in the treatment of NDAD, but there is limited data of their efficacy with MNDLB. If the PMHNP decides to try an acetylcholinesterase inhibitor, the PMHNP should always begin with the lowest starting dose, and then slowly titrate upward, being mindful of the development of side effects. Mr. Wingate and his son should be educated on the fact that acetylcholinesterase inhibitors may slow disease progression, but will not have a significant impact on existing cognitive deficits.
The addition of low-dose Clonazepam (0.25 or even 0.125 mg) may be considered as a treatment for REM sleep disorders in individuals with MNDLB. Since clonazepam has a long half-life, the PMHNP should begin at a low dose, and slowly titrate upward, being mindful to educate the client and family about potential side effects and therapeutic end-goals. Remember that safety is always the first priority with prescribing.
There is no evidence that Rivastigmine has any effect on REM sleep disorders; therefore, the PMHNP should not tell Mr. Wingate or his son that this is an expected outcome of the drug.
11 hours ago
REQUIREMENTS
2 pages, Double Spacing Walden University
Nursing,
Hi
are u able to watch view this link, if not i will need to send you the information on the different decissions
REQUIRED MEDIA
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6670/08/mm/decision_tree/index.html
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