Nurs 6670-Week 8 Assignment 1 Essay

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. Nurs 6670-Week 8 Assignment 1 Essay 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.

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The case study involves a 76-year-old man named Wingate who presented with symptoms of neurocognitive disorders. Therefore, in this paper one decision will be made regarding the diagnosis for this client while the other two decisions will be on the treatment decisions for the client. The paper will conclude by discussing ethical issues likely to affect the client.

Decision Point One

The diagnosis for this client is major neurocognitive disorder with Lewy bodies (MNDLB). This decision was chosen since the symptoms the client is manifesting fit the diagnostic criteria of MNDLB. MNDLB is a neurocognitive disorder where there is contrinous decline of cognition, which significantly interferes with an individual’s ability to work, socialize, and perform activities of daily living (Donaghy & McKeith, 2014). Memory impairment indicated cognitive decline and also clients have deficits in executive function and attention. Other symptoms of MNDLB include rest tremor, inconsistent cognition, REM sleep behavior disorder, and intermittent visual hallucinations (McKeith et al, 2017). The client manifests a progressive decline in cognition and memory impairment that is interfering with his ability to perform activities of daily living and social functions. This is demonstrated where the client got lost when driving, forgets payment of monthly bills, forgets to close the door and also at one instance he forgot food when cooking. The client also has REM sleep behavior as manifested by his screaming while dreaming and kicking during sleep. The MSE also indicated that the client had deficits in attention and insight and also had concentration problems. All these symptoms the client is manifesting are consistent with clinical features of MNDLB (McKeith et al, 2017).Nurs 6670-Week 8 Assignment 1 Essay

By selecting the diagnosis of MNDLB, the expectation was that this was the correct diagnosis and thus would lead to the correct treatment for this client.

Decision Point Two

The treatment choice for this client is to begin Rivastigmine 1.5 mg orally twice a day. Rivastigmine was selected because as Jellinger & Amos (2018) indicate, the medication is a cholinesterase inhibitor that has been shown to be effective in improving global function, cognitive function, and also the ability of an individual to perform activities of daily living. In addition, the efficacy of Rivastigmine in improving psychiatric and cognitive symptoms in people with MNDLB has been demonstrated (McKeith et al (2017).

Selection of Rivastigmine hoped that the client would show some symptom improvement and also prevent deterioration of his condition. This is because the medication is a cholinesterase inhibitor that prevents deterioration of the condition (Jellinger & Amos, 2018). Moreover, it was expected that the client would tolerate the Rivastigmine because the medication is a transdermal preparation and thus has few side effects.

However, the client’s symptoms did not improve but his condition did not deteriorate either. This outcome is attributable to the fact that Rivastigmine slows the progress of the disease but does not treat present cognitive deficits (Jellinger & Amos, 2018). Moreover, the son reported that the client’s nightmares became worse and his “acting out” worsened. This is attributable to the disordered sleep and vivid dreams in people with MNDLB that get worse when an individual takes a cholinesterase inhibitor such as Rivastigmine (Boot, 2015).

Decision Point Three

The third decision is for the client to begin Clonazepam 0.5 mg orally at bedtime. The reason for choosing Clonazepam for the client is to treat the REM sleep behavior disorder for the client. According to Hogi & Stefani (2017), Clonazepam is effective in treating REM sleep behavior disorder and also decreasing the occurrence of injuries that people experience due to REM sleep behavior disorder.

By choosing this decision, the expectation was that the symptoms of REM sleep behavior disorder in this client would improve. This is due to the efficacy of Clonazepam in treating this disorder (Hogi & Stefani, 2017).Nurs 6670-Week 8 Assignment 1 Essay

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Ethical Considerations

Ethical considerations for this client include autonomy and decision-making capacity due to the existing cognitive impairment for the client (Dunn et al, 2015). For instance, the ability of the client to understand and select his treatment choices may be impacted by cognitive impairment and thus hindering his ability to make any treatment decision. Moreover, it is important to make sure that the son is actively involved in the treatment plan for this client because when the patient does not have the ability to make treatment decisions, his family members should be involved (Dunn et al, 2015).

Conclusion

The diagnosis for the client is major neurocognitive disorder with Lewy bodies because the symptom the client is manifesting fits the diagnostic criteria of MNDLB.  The second decision is for the client to begin Rivastigmine 1.5 mg since the efficacy of Rivastigmine in preventing deterioration of MNDLB symptoms has been shown. The last decision is for the client to begin clonazepam 0.5 mg to treat REM sleep behavior disorder. The ethical aspects relevant for this client include autonomy and decision-making capacity.

References

Boot B. (2015). Comprehensive treatment of dementia with Lewy bodies. Alzheimer’s Research & Therapy.7(45).

Donaghy P & McKeith I. (2014). The clinical characteristics of dementia with Lewy bodies and consideration of prodromal diagnosis. Alzheimers Res Ther. 6(4): 46.

Dunn L, Alici Y & Weiss R. (2015). Ethical Challenges in the Treatment of Cognitive Impairment in Aging. Current Behavioral Neuroscience Reports. 2(4), 226-233.

Hogi B & Stefani A. (2017). REM sleep behavior disorder (RBD). Somnology (Berl). 21(1): 1–8.

Jellinger K & Amos K. (2018). Is dementia with Lewy bodies and Parkinson’s disease dementia the same disease? BMC Med. 16(34).

McKeith I, Boeve B et al. (2017). Diagnosis and management of dementia with Lewy bodies. Neurology. 89(1): 88–100. Nurs 6670-Week 8 Assignment 1 Essay