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Assessing and Treating Clients with Dementia
NURS 6630N
Assessing and Treating Clients with Dementia
Introduction
Major Neurocognitive Disorder due to Alzheimer’s disease is a common condition that clinicians often come across. Treating this condition requires clinicians to make the best decisions. In Mr. Akkad’s case, he needs Aricept to help reduce the impact of the disease on his brain. Monitoring his progress before increasing the dose to 10mg is important. During treatment, it’s also crucial to respect his cultural background and educate him about the treatment for informed consent (Stahl, 2013). This paper aims to describe the decisions made, their reasons, and the expected results, all while considering ethical considerations.
Decision #1
The initial decision is to prescribe 5mg of Aricept orally at bedtime.
Reasoning
Aricept 5mg at bedtime was chosen because it has a proven record of effectiveness in elderly patients. It’s FDA-approved for mild and moderate Alzheimer’s treatment (Kumral & Zirek, 2017). This makes it suitable for Mr. Akkad, who has shown signs for the past two years. Aricept is a type of cholinesterase inhibitor for Alzheimer’s (Kumral & Zirek, 2017). It prevents the breakdown of acetylcholine, improving communication between brain cells, enhancing memory, thinking, and judgment.
Aricept helps slow Alzheimer’s progression, which can lead to severe dementia. It’s effective with minimal side effects, improving cognitive functions for daily tasks (Steenblock, 2018). Temporary relief from dementia allows Mr. Akkad to engage in religious activities with his family. It also enhances memory, preventing loss of focus or conversation (Steenblock, 2018). For example, Aricept improves reasoning and language skills. It helps Mr. Akkad avoid getting overly upset about issues and improves his ability to converse clearly.
Aricept was a better choice than other options like Razadyne and Exelon. Polypharmacy, using multiple drugs, isn’t safe for mental conditions like dementia (Luck et al., 2017). Exelon doesn’t stop Alzheimer’s progression as expected during treatment (Canevelli et al., 2017). Razadyne triggers adverse effects (Atukeren et al., 2017), making Aricept a safer choice.
PMHNP didn’t choose Exelon due to side effects like bleeding, heart problems, and liver issues (Finn et al., 2017). Aricept’s benefits outweigh Exelon’s risks. Razadyne’s non-compliance risk, side effects, and need for precautions made Aricept the best choice (Lee et al., 2020).
Expected Results
Prescribing Aricept aims to slow memory loss. It won’t reverse Alzheimer’s but can slow its progression (Quitterer & AbdAlla, 2020). The patient should understand this, and family consent is vital. Adhering to the treatment is important, even if changes aren’t immediate (Quitterer & AbdAlla, 2020). Informing the patient about possible side effects helps them stay committed to treatment.
After four weeks, minimal progress is expected. Gradual improvement in conversations, family activities, and memory should occur. Returning for Assessment ensures medication adherence and monitors any side effects.
Decision #2
Increasing the dose to 10mg of Aricept at bedtime is the second decision.
Reasoning
Increasing the dose aims to enhance therapeutic effects. Starting with 5mg ensured safety; now, increasing to 10mg with no adverse effects justifies the decision (Quitterer & AbdAlla, 2020). Gradual dose increase is safer (Smagula et al., 2019). Changing medication or dose carelessly can harm patients’ progress (Smagula et al., 2019). Adding more drugs is considered if Aricept doesn’t work, not as a first step (Rees et al., 2019).
Expected Results
Continued medication with improved compliance is expected. After 10 weeks, better conversation, cognitive abilities, and family participation are likely. Reminding the patient of gradual progress is necessary. Educating the son about the treatment’s purpose and duration is important.
Decision #3
Continuing Aricept 10mg at bedtime is the third decision.
Reasoning
Continuing because of effective symptom reduction is logical. Changing or increasing doses unnecessarily can lead to adverse effects (Stahl, 2013). Monitoring for adverse effects is crucial (Kumral & Zirek, 2017).
Expected Outcomes
Continued medication for about 6 weeks is planned. Significant improvement in conversations and activities is expected. Memory should continue to improve. Patients like Mr. Akkad should understand that treatment’s duration helps prevent further disease progression.
Ethical Considerations
Cultural competency, respect, and education are important in treatment. Patients need to be informed, consent to treatment, and understand possible side effects (Steenblock, 2018). Clinicians must prioritize patient well-being and make informed decisions (Finn et al., 2017).
Conclusion
Treating dementia requires careful decisions and ethical considerations. Medication choices, dosage adjustments, and patient education impact outcomes. Cultural sensitivity and adherence to ethical principles ensure better patient experiences and results.
