Therapeutic Patient Education in Alzheimer Disease Essay

Additional Objective and Subjective Data

In evaluating Mrs. Collin, it would be crucial to gather additional subjective and objective data to comprehensively understand her current health status. Subjectively, obtaining information on her recent cognitive changes, sleep patterns, mood, and any notable behaviours would be essential. Objectively, conducting a more detailed neurological examination, assessing her hydration status, reviewing recent laboratory results, and obtaining a thorough medication history, including doses and adherence, would provide a more comprehensive understanding (Porsteinsson et al., 2021). Additionally, exploring her recent hospitalization experience, including any complications or changes in her routine, could reveal insights into her current state of well-being. Moreover, involving the family in discussions about her recent decline and treatment plan preferences would be valuable. Therapeutic Patient Education in Alzheimer Disease Essay

Differential Diagnoses and Diagnostic Tests

Mrs. Collin’s altered mental status and cognitive decline could stem from various factors. Firstly, a thorough assessment would include investigating potential exacerbations of her Alzheimer’s disease (AD). Given her recent illness and hospitalization, infectious causes such as urinary tract infections or pneumonia could contribute, warranting urinalysis and chest imaging (Arti, 2019). Additionally, considering the possibility of medication side effects or interactions, a review of her current medications and levels, particularly those related to cognitive function, may be necessary.

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Other neurodegenerative conditions, beyond AD, could be explored, necessitating neuroimaging studies like MRI or CT scans to detect structural abnormalities or signs of vascular dementia. Metabolic causes like electrolyte imbalances or nutritional deficiencies may contribute to cognitive decline; thus, blood tests assessing electrolyte levels, B12, and thyroid function would be pertinent. Moreover, the recent dehydration episode raises concerns about potential hypoperfusion or vascular events, emphasizing the importance of vascular imaging studies such as carotid Doppler or angiography (Khan et al., 2020). Moreover, given her age, consideration of delirium triggered by acute medical illness or medications is crucial. Therefore, an in-depth review of her hospital course, including medications administered during her stay, and a comprehensive metabolic panel would be valuable. Combining these assessments would enable a more nuanced understanding of the potential contributors to her cognitive decline and guide appropriate interventions. Therapeutic Patient Education in Alzheimer Disease Essay

National Guidelines for Consideration

I would consider the Alzheimer’s Association and National Institute on Aging offer guidelines for the diagnosis and management of Alzheimer’s disease, emphasizing the importance of cognitive assessments, functional evaluations, and considering pharmacological interventions. The American Geriatrics Society provides guidelines on the management of persistent pain in older adults, which could be relevant given Mrs. Collin’s age and potential for discomfort contributing to her cognitive symptoms.

For assessing and managing dehydration in older adults, the Centers for Disease Control and Prevention (CDC) and the American Geriatrics Society provide guidance, emphasizing the importance of hydration in preventing cognitive decline (Abadir et al., 2023). The American Medical Directors Association (AMDA) offers guidelines on the care of individuals with dementia in long-term care settings, which may provide insights into appropriate care and interventions for Mrs. Collin. Therapeutic Patient Education in Alzheimer Disease Essay

Furthermore, for the potential addition of Namenda to Donepezil therapy, guidelines from the American Academy of Neurology and the American Psychiatric Association on the pharmacological management of Alzheimer’s disease could be considered. These guidelines collectively offer a comprehensive framework for assessing and managing the complexities associated with cognitive decline in older adults, ensuring a patient-cantered and evidence-based approach to Mrs. Collin’s care.

Treatment Recommendation

Given Mrs. Collin’s recent exacerbation of cognitive decline, the consideration of adding Namenda to her current medication regimen appears reasonable. Research suggests that combining cholinesterase inhibitors like Donepezil with memantine (Namenda) may provide synergistic benefits in managing moderate to severe Alzheimer’s disease (Guo et al 2020). This dual approach targets different aspects of the neurodegenerative process, potentially offering enhanced cognitive and functional outcomes. Additionally, the recent episode of dehydration and hospitalization may have contributed to her cognitive decline, emphasizing the need for a multifaceted treatment approach. Therapeutic Patient Education in Alzheimer Disease Essay

However, it is crucial to weigh the potential benefits against any risks or adverse effects, considering her overall health status and individual response to medications. Regular monitoring and close collaboration with the healthcare team, including family involvement, are essential to assess the treatment’s efficacy and adjust as needed. The decision to add Namenda should be based on a comprehensive evaluation, considering Mrs. Collin’s clinical presentation, preferences, and the latest evidence supporting the combination therapy in the management of moderate-stage Alzheimer’s disease.

Health People 2030 and Patient Education

I will engage in a comprehensive education plan for Mrs. Collin and her family, recognizing the importance of empowering them with knowledge and strategies to enhance her well-being. Firstly, I will emphasize the nature of Alzheimer’s disease (AD), explaining its progressive nature and the potential impact on cognitive function. It’s crucial to convey that the recent exacerbation in her symptoms may be multifactorial, involving factors such as dehydration and hospitalization (Bloom et al., 2021). In discussing medications, I will explain the rationale behind combining Donepezil and Namenda, highlighting the potential benefits of this dual approach in managing moderate-stage AD. I will outline potential side effects and the importance of regular follow-up appointments to monitor treatment response and adjust medications if necessary. Therapeutic Patient Education in Alzheimer Disease Essay

Addressing daily care, I will provide practical tips for supporting Mrs. Collin’s activities of daily living, ensuring her environment is conducive to her cognitive abilities. This may include creating a consistent routine, minimizing distractions, and maintaining a familiar setting (Cartz-Piver at al., 2020). Regarding nutrition and hydration, I will stress the significance of maintaining proper fluid intake and a balanced diet. I’ll educate the family on the potential impact of dehydration on cognitive function and the importance of encouraging Mrs. Collin to eat regularly.

Given her recent hospitalization, I will discuss the risk of preventable hospitalizations in older adults with dementia and educate the family on strategies to minimize such risks. This could involve clear communication with healthcare providers, maintaining a record of medications and allergies, and promptly addressing any concerning symptoms. Therapeutic Patient Education in Alzheimer Disease Essay

Furthermore, I will encourage open communication between the family and healthcare providers. It’s essential for them to feel comfortable discussing changes in Mrs. Collin’s condition, potential side effects of medications, and any emerging concerns promptly. Considering Healthy People 2030 objectives, I will specifically address DIA-01 by ensuring that Mrs. Collin and her family are well-informed about her diagnosis. This knowledge empowers them to actively participate in her care and decision-making processes. I will also touch upon DIA-02, emphasizing the importance of proactive measures to reduce preventable hospitalizations, aligning with the goal of optimizing care and minimizing disruptions to Mrs. Collin’s routine.

Moreover, I will discuss DIA-03 by encouraging open dialogue about cognitive symptoms. It is crucial for Mrs. Collin and her family to communicate any changes promptly to facilitate timely interventions and adjustments to her care plan. Incorporating broader objectives related to older adults, such as OA-01 focusing on physical activity, I will stress the benefits of regular exercise in promoting overall health, including cognitive well-being (Jackson et al., 2023). Additionally, addressing OA-04, I will discuss preventive measures to reduce the risk of pressure ulcers, considering Mrs. Collin’s mobility and potential vulnerabilities associated with her condition. By tailoring education to Mrs. Collin’s specific needs and aligning with Healthy People 2030 objectives, the aim is to foster a collaborative and informed approach to her care, enhancing both her quality of life and the support provided by her family. Therapeutic Patient Education in Alzheimer Disease Essay

Ethical and Legal Considerations

In the case of Mrs. Collin, several legal and ethical considerations should be considered. Firstly, respecting her autonomy and involving her in decision-making to the extent possible is crucial (Ventura et al., 2021). This may involve discussions about her treatment plan, including the potential addition of Namenda, while considering her cognitive abilities and preferences.

The principle of beneficence guides the healthcare team to act in Mrs. Collin’s best interests. Balancing the potential benefits of medication interventions with potential risks and side effects is essential, ensuring that the chosen course aligns with her overall well-being (Cheraghi et al., 2023). Regarding legal considerations, adherence to patient confidentiality is paramount. Information sharing with the family should be done with Mrs. Collin’s consent, keeping in mind her right to privacy. Additionally, legal representatives or advance directives, if available, should be consulted to ensure decisions align with Mrs. Collin’s wishes. Therapeutic Patient Education in Alzheimer Disease Essay

Given her cognitive impairment, the healthcare team should consider the appointment of a legal guardian or a healthcare proxy if necessary, ensuring that decisions made on her behalf are in her best interest and align with her previously expressed preferences (Ploeg et al., 2020). End-of-life care considerations should also be addressed, with discussions about advanced care planning, including the designation of a healthcare proxy, and the exploration of Mrs. Collin’s preferences regarding life-sustaining interventions.

Ultimately, navigating the legal and ethical landscape requires a patient-cantered approach, honouring Mrs. Collin’s autonomy and dignity while considering the legal frameworks that guide decision-making in healthcare. Open communication with both Mrs. Collin and her family, along with adherence to relevant legal principles, will contribute to a more ethically sound and legally compliant care plan. Therapeutic Patient Education in Alzheimer Disease Essay

The Circle of Caring

In the circle of caring for Mrs. Collin, a multidisciplinary approach is essential to ensure comprehensive and person-cantered care. Beyond the primary healthcare provider, involving a geriatrician specializing in the care of older adults can contribute valuable expertise in managing complex health issues associated with aging. A neurologist could provide further insights into the neurological aspects of Alzheimer’s disease and guide treatment decisions. Engaging a registered dietitian can address nutritional concerns and develop a tailored diet plan to support Mrs. Collin’s overall well-being.

Additionally, incorporating the expertise of a physical therapist can help design an exercise regimen suitable for her cognitive and physical abilities, promoting mobility and reducing the risk of complications such as pressure ulcers. In the circle of caring, the nursing staff plays a pivotal role (Nuzum et al., 2020). Regular communication with the nursing team ensures continuity of care, enabling them to monitor Mrs. Collin’s condition closely and provide timely interventions. Social workers are crucial in addressing psychosocial aspects, assisting the family in coping with the challenges of caregiving and connecting them with support services. Therapeutic Patient Education in Alzheimer Disease Essay

Follow- up and Evaluation

I will recommend a comprehensive follow-up plan for Mrs. Collin, involving regular assessments by her primary care physician and specialists, including neurology and geriatrics. Regular monitoring of cognitive function, medication efficacy, and potential side effects is crucial. Collaboration with nursing staff for ongoing care coordination and communication with family members will be prioritized (Jeremic et al., 2021). Additionally, scheduled consultations with a registered dietitian, physical therapist, and mental health professional will ensure a holistic approach to her well-being.

Billing Codes

Billing codes for Mrs. Collin’s care would align with the services provided. Common codes may include Evaluation and Management (E/M) codes for physician visits, such as CPT codes 99214 or 99215 for comprehensive assessments. Additionally, specific codes for cognitive assessments, such as CPT code 96127, may be applicable. If procedures are performed, relevant procedural codes should be used. Billing for specialists, such as neurology or geriatrics, would involve their respective E/M codes. Therapeutic Patient Education in Alzheimer Disease Essay

Conclusion

This paper has reflected the case of an elderly patient with Alzheimer’s disease and the holistic approach in the management. Incorporating multidisciplinary care, involving specialists, nursing staff, and community resources, ensures comprehensive support. The addition of Namenda to her medication regimen is considered, balancing potential benefits and risks. Education for Mrs. Collin and her family, alignment with Healthy People 2030 objectives, and attention to legal/ethical considerations contribute to a patient-cantered care plan. Therapeutic Patient Education in Alzheimer Disease Essay

References

Abadir, P. M., Bandeen‐Roche, K., Bergeman, C., Bennett, D., Davis, D., Kind, A., … & Whitson, H. E. (2023). An overview of the resilience world: Proceedings of the American Geriatrics Society and National Institute on Aging State of Resilience Science Conference. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.18388

https://doi.org/10.1111/jgs.18388

Bloom, D., Chen, S., Counts, N., Han, R., Malik, S., Nandi, A., … & Vigo, D. (2021). Addressing Alzheimer’s disease and related dementias to realise the promise of the UN’s ‘Decade of Healthy Ageing’. VoxEU. org, 26.

Cartz-Piver, L., Polin, C., Diebolt, C., Chouly, M., Garçonnot, L. A., Clément, J. P., … & Couratier, P. (2020). Therapeutic patient education in Alzheimer’s disease and related disorders: Clinical experience and perspectives. Revue Neurologique, 176(3), 200-207. https://doi.org/10.1016/j.neurol.2019.07.028

Cheraghi, R., Valizadeh, L., Zamanzadeh, V., Hassankhani, H., & Jafarzadeh, A. (2023). Clarification of ethical principle of the beneficence in nursing care: an integrative review. BMC nursing, 22(1), 89. https://doi.org/10.1186/s12912-023-01246-4

Guo, J., Wang, Z., Liu, R., Huang, Y., Zhang, N., & Zhang, R. (2020). Memantine, Donepezil, or Combination Therapy-What is the best therapy for Alzheimer’s Disease? A Network Meta-Analysis. Brain and behavior, 10(11), e01831. https://doi.org/10.1002/brb3.1831

Jackson, E. M., O’Brien, K., McGuire, L. C., Baumgart, M., Gore, J., Brandt, K., … & Lamont, H. (2023). Promoting healthy aging: Public health as a leader for reducing dementia risk. Public Policy & Aging Report, 33(3), 92-95.

Jeremic, D., Jiménez-Díaz, L., & Navarro-López, J. D. (2021). Past, present and future of therapeutic strategies against amyloid-β peptides in Alzheimer’s disease: a systematic review. Ageing research reviews, 72, 101496. https://doi.org/10.1016/j.arr.2021.101496

Khan, S., Barve, K. H., & Kumar, M. S. (2020). Recent Advancements in Pathogenesis, Diagnostics and Treatment of Alzheimer’s Disease. Current neuropharmacology, 18(11), 1106–1125. https://doi.org/10.2174/1570159X18666200528142429

Nuzum, H., Stickel, A., Corona, M., Zeller, M., Melrose, R. J., & Wilkins, S. S. (2020). Potential Benefits of Physical Activity in MCI and Dementia. Behavioural neurology, 2020, 7807856. https://doi.org/10.1155/2020/7807856

Ploeg, J., Northwood, M., Duggleby, W., McAiney, C. A., Chambers, T., Peacock, S., Fisher, K., Ghosh, S., Markle-Reid, M., Swindle, J., Williams, A., & Triscott, J. A. (2020). Caregivers of older adults with dementia and multiple chronic conditions: Exploring their experiences with significant changes. Dementia (London, England), 19(8), 2601–2620. https://doi.org/10.1177/1471301219834423

Porsteinsson, A. P., Isaacson, R. S., Knox, S., Sabbagh, M. N., & Rubino, I. (2021). Diagnosis of Early Alzheimer’s Disease: Clinical Practice in 2021. The journal of prevention of Alzheimer’s disease, 8(3), 371–386. https://doi.org/10.14283/jpad.2021.23

Ventura, C. A. A., Austin, W., Carrara, B. S., & de Brito, E. S. (2021). Nursing care in mental health: Human rights and ethical issues. Nursing ethics, 28(4), 463–480. https://doi.org/10.1177/0969733020952102 Therapeutic Patient Education in Alzheimer Disease Essay

or this plan of care/case study, please use the following guidelines and criteria. Also, please refer to the rubric for point allocation and assignment expectations. The expected length of the paper is approximately 6-7 pages, which does not include the cover page and reference page(s).

Introduction (including purpose statement)
Case Summary or Synopsis
Include a short (75-100 word) description of the patient in terms of age, sex, race, height, weight, marital status, occupation, social/cultural history, previous hospital admissions, and chief complaints on the current visit. This serves to orient the reader to the case study patient and provides an overview of clinical issues of the patient.
Discussion Questions and Answers
Conclusion

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In regards to APA format, please use the following as a guide:

Include a cover page (this is not part of the 6-7 page limit)
Include transitions in your paper (i.e., headings or subheadings)
Use in-text references throughout the paper
Use double-spaced 12-point Times New Roman font
Apply appropriate spelling, grammar, and organization
Include a reference list (this is not part of the 6-7 page limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e., NCSBN, AANP) Therapeutic Patient Education in Alzheimer Disease Essay

Case Study #2:

Mrs. Collin is a 79 y.o. Caucasian female living in the dementia center in assisted living. She was diagnosed with Alzheimer’s disease by her primary care physician about 4 years ago and was started on Donepezil, which appeared to slow progression for a time. Safety concerns resulted in her placement in assisted living about 2 years ago. She recently had gastroenteritis, became dehydrated, and was hospitalized. After a 3-day stay, she was admitted to a skilled nursing facility when the assisted living staff evaluated her in the hospital and saw her cognitive impairment was much worse. Her primary care physician completed the initial exam 4 days ago, and you are asked to see her at the request of the family who does not understand why she could not return to assisted living. You review the physician’s note and he believes her AD has progressed to the moderate stage and is considering adding Namenda to Donepezil therapy.

The nursing staff reports that she appears to be confused but is pleasant and cooperative and has improved since her admission. She is eating about 50% of her meals and continues to need encouragement to drink. She is continent and able to do her activities of daily living with minor assistance. She has no known co-morbidities and is on no other medications.

Physical exam: Patient is alert and disoriented. Her MMSE is 24/30. Patient is pleasant and cooperative. Skin turgor is adequate. Patient is ambulatory with full muscle strength. Vital signs are within normal limits. Therapeutic Patient Education in Alzheimer Disease Essay

Case Study Questions:

What additional subjective and objective data would you gather?
What is the list of differential diagnoses? What additional diagnostic tests would you include to confirm or rule out each condition?
What national guidelines are appropriate to consider?
Based on your assessment and current research, what treatment would you recommend? Do you believe that adding Namenda to her medication regimen at this time should be advised?
What else should you teach your patient and her family? Are there any Healthy People 2030 objectives that you should consider?
Are there any legal/ethical considerations?
Using the circle of caring, what or who else should be involved to hear the patient’s voice, getting him/her and family involved in the care to reach optinal health?
What is your evaluation/follow-up plan?
What billing code Therapeutic Patient Education in Alzheimer Disease Essay