Decision Tree for Neurological and Musculoskeletal Disorders

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.
By Day 7 of Week 8
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.

Psychopharmacologic Approaches to Treatment of Psychopathology (laureate.net)
http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html

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Decision Tree for Neurological and Musculoskeletal Disorders
The case study involved a man diagnosed with major neurocognitive disorder due to Alzheimer’s disease (presumptive). Exelon (rivastigmine) 1.5 mg orally BID was the first treatment decision for the client. Rivastigmine was chosen as its efficacy in improving symptoms of Alzheimer’s disease has been shown. The medication improves cholinergic function and consequently improves cognitive functions (Li et al., 2019). Therefore, it was expected that by taking this medication the client would manifest symptom improvements such as improved memory and improved cognitive functions. The treatment outcomes were different from the treatment goals because after four weeks the client did not manifest any symptom improvement and this can be due to the low start dose of rivastigmine as it was expected. For example, after four weeks the son reported that the client was still exhibited disinhibited behaviours and continued being disinterested in attending religious activities.
The second decision was thus to increase the rivastigmine dose to 4.5 mg orally BID. This decision was chosen in order to increase the efficacy of rivastigmine because higher doses are associated with higher efficacy (Yatawara et al., 2021). This decision hoped that the client would demonstrate symptom improvement and tolerate the increased dose without adverse effects. There was no differene between the expected results and the treatment outcomes because with this decision, the client manifested some symptom improvement and did not report adverse effects. For example, the client started attending religious services and did not report any side effects. This is due to the improved efficacy of the increased Rivastigmine dose (Khoury et al., 2018).
The third decision was thus to have the rivastigmine dose increased to 6 mg orally BID. This decision was considered to further increase the efficacy of the Rivastigmine dose. By increasing the dose, it was hoped that the client would continue manifesting symptom improvement. It was also hoped he would tolerate the increased rivastigmine dose (Li et al., 2019). It is however important to educate the son that already occurred cognitive damage from Alzheimer’s Disease cannot be reversed using the prescribed medication, as the medication can only slow the disease progress.

References
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 safety, 9(3), 171-178.
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 neuroscience, 13, 472.
Yatawara, C., Zailan, F. Z., Chua, E. V., Lim, L. L. H., Silva, E., Wang, J. S., … & Kandiah, N. (2021). The Efficacy of Transdermal Rivastigmine in Mild to Moderate Alzheimer’s Disease with Concomitant Small Vessel Cerebrovascular Disease: Findings from an Open-Label Study. Clinical interventions in aging, 16, 301.