Alzheimer’s Disease”

o 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.

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.

Interactive media piece case study below:

BACKGROUND

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

RESOURCES

§ Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.

Op

Options for Decisions below: Tips. Pick one that be a better option and answer all questions above. Need 3 x references

1. Begin Exalon 1.5 mg po bid with an increase to 3 mg po bid in two weeks( pt not feeling better).

2. Increase Exelon to 4.5mg orally bid( pt not feeling better)

3. Increase Exelon to 6mg po bid. ( Pt improved, dose could be maintained and checked in 4 wks, Namenda could also be added).

OR

1. Begin Aricept 5mg po bedtime ( pt no feeling better)

2. Increase Aricept to 10mg po ( Pt still not feeling Better NB Aricept at 5mg can be effective)

3. Continue Aricept 10 mg ( pt not any better) or ( 5mg with Namenda can be effective).

OR

1. Begin Razadyne 4 mg ( pt not feeling better)

2. Increase Razadyne to 24 mg extended release( Pt has seizures/SE)

3. Retart Razadyne ( pt has more s/e). Respidal not apprappriate.

Resource for references

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

· Chapter 10, “Basic Principles of Neuropharmacology” (pp. 73–77)

· Chapter 11, “Physiology of the Peripheral Nervous System” (pp. 79–90)

· Chapter 12, “Muscarinic Agonists and Antagonists” (pp. 91–107)

· Chapter 13, “Adrenergic Agonists” (pp. 109–119)

· Chapter 14, “Adrenergic Antagonists” (pp. 121–132)

· Chapter 15, “Indirect-Acting Antiadrenergic Agents” (pp. 133–137)

· Chapter 16, “Introduction to Nervous System Pharmacology” (pp. 139–141)

· Chapter 17, “Drugs for Parkinson Disease” (pp. 143–158)

· Chapter 18, “Drugs for Alzheimer Disease” (pp. 159–166)

· Chapter 19, “Drugs for Epilepsy” (pp. 167–189)

· Chapter 20, “Drugs for Muscle Spasm and Spasticity” (pp. 191–201)

· Chapter 57, “Drug Therapy of Rheumatoid Arthritis” (pp. 629–641)

· Chapter 58, “Drug Therapy of Gout” (pp. 643–651)

· Chapter 59, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 653–672)

American Academy of Family Physicians. (2019). Dementia. Retrieved from http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=5

This website provides information relating to the diagnosis, treatment, and patient education of dementia. It also presents information on complications and special cases of dementia.

Learning Resources

Required Media (click to expand/reduce)

Laureate Education (Producer). (2019b). Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease.

Assignment Description

Physical Activity Resource Guide

After having read the websites cited in the introduction and read your peers posts develop an out of the box physical activity resource guide (brochure). Imagine that your peers all live in the same general locale. Research fun and unusual but accessible activities that will meet the physical activity goals of you and your peers. Your resource guide should have a minimum of 6 different activities. Each entry should contain a description of the activity, costs, when and where, contact person, website or copy of the listing location. Feel free to include photos or graphics. You may submit your resource guide in PowerPoint, pdf, Word or Microsoft publisher format.

Remember to think out of the box-search for activities on Living Social, Groupon, Department of Recreation and Parks brochures, club and meetings sections of the newspaper, bulletin boards in your favorite neighborhood coffee shop or grocery store, etc.

Assignment Expectations:

Length: Minimum of 6 brochure pages (each activity should be given a page/slide), not including title page/slide and reference page/slide.

Structure: 6 brochure pages or slides; Include a title page/slide and reference page/slide in APA format.

References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of two (2) scholarly sources are required for this assignment.

During the last 5 weeks, you have explored various body systems: neurological, cardiovascular, respiratory, and hematological. These four systems work together along with other body systems to complete a myriad of functions. For this reason, when disorders occur within one body system, it can create potentially devastating effects throughout the entire body. For instance, Parkinson’s disease is a disorder of the central nervous system, yet its alterations actually affect multiple body systems from the cardiovascular system to the gastrointestinal system. In this Assignment, you examine alterations associated with disorders, as well as the impact of the alterations on multiple body systems.

To Prepare

• From the list below, select a disorder of interest to you:
  • Alzheimer’s disease
  • Asthma in children
  • Chronic obstructive pulmonary disease (COPD)
  • Congestive heart failure
  • Hepatic disease (liver disease)
  • Hypertension
  • Hyperthyroidism and hypothyroidism
  • Seizures
  • Sepsis
• Identify alterations associated with your selected disorder. Consider the pathophysiology of the alterations. Think about how these alterations produce pathophysiological changes in at least two body systems.
• Reflect on how patient factors such as genetics, gender, ethnicity, age, and behavior might impact the pathophysiology of the alterations you identified, as well as the diagnosis and treatment of your selected disorder.
• Review the “Mind maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology and clinical presentation of your selected disorder.

To Complete

Develop a 5- to 10-slide PowerPoint presentation that addresses the following:

• Describe your selected disorder, as well as associated alterations. Explain the pathophysiology of the alterations, including changes that occur in at least two body systems.
• Explain how genetics, gender, ethnicity, age, and behavior might impact the pathophysiology of the alterations you identified, as well as diagnosis and treatment of your selected disorder.
• Construct a mind map for the disorder you selected. Include the epidemiology, pathophysiology of alterations, risk factors, and clinical presentation, as well as the diagnosis and treatment of the disorder.

Discussion 2: Managing Conflict in the Workplace

 

High-pressure environments, life-or-death implications, constant change, and long days of exhausting work … It is not surprising that conflicts arise in health care settings. In the fast-paced environment in which nurses work, small differences in decision making, processes, work ethic, and personal characteristics can quickly escalate

As a nurse manager, you need to develop and model skills that effectively address conflict situations. Stephen Covey, author of The 7 Habits of Highly Effective People, offers sound advice that can be applied to conflict management and resolution. In Habit 4, Think Win-Win, Covey (2004) explains, “[m]any people think in terms of either/or: either you’re nice or you’re tough. Win-win requires that you be both. It is a balancing act between courage and consideration.” Ultimately, how you manage conflict in your setting will determine whether you foster an environment that breeds contempt or one that fosters growth.

 

Conflict abounds in any workplace; it is a normal part of organizational life. Instead of avoiding or ignoring conflict, the role of the nurse manager is to coach employees through conflict situations and to exercise judgment on how and when to intervene. When managed effectively and focused on substantive issues, conflict can actually lead to better outcomes. However, when interpersonal conflicts go unaddressed, employee morale and engagement–two factors that can seriously impact quality of patient care—will dwindle.

 

When nurse managers observe employees engaging in toxic or inappropriate workplace behaviors, they must prepare to give difficult feedback. Delivering difficult feedback can be challenging for nurse managers, as they must address employees in a way that is authoritative, supportive, and resolute. One strategy nurse managers can use to deliver difficult feedback is to employ the scripting framework. In this week’s Discussion, you gain experience with using the scripting framework to resolve a conflict situation that you have observed in your past or present workplace.

 

To prepare

 

Review this week’s Learning Resources, focusing on the various forms of conflict that can occur in the workplace.

Consider the types of conflict, including bullying, horizontal violence, toxic and disruptive employees, misuse of social media, unbalanced power, harassment, and favoritism, that exist in your current organization or past place of employment.

 

Select one type of conflict you have observed. How has conflict impacted your work environment? How have nurse mangers attempted to address conflict situations?

Examine the six-step scripting framework for delivering difficult feedback in Chapter 7 of the course text, From Management to Leadership: Strategies for Transforming Health Care. Then, use this framework to script a conversation between you and the employee(s) involved in the conflict situation you selected.

When drafting your script, reflect on how HR might be able to help you in addressing this issue, both before you talk to this employee and if the problem continues to exist.

 

 

Post a brief overview of the conflict you selected and how this specific type of conflict has impacted the work environment. Share the script you drafted and explain at least one way you would enlist HR’s help in managing this situation. Support your response by referencing authentic examples from the workplace and the Learning Resources as applicable.

 

Read a selection of your colleagues’ responses.

 

Managing conflict effectively includes receiving feedback on your own performance. As such, respond on or before Day 6 to at least two of your colleagues on two different days using the following approach:

Critically appraise the effectiveness of your colleague’s script by placing yourself in the position of the employee receiving this difficult feedback. How would you feel if a manager said this to you? Would this conversation prompt you to change your behavior? Why or why not? What strengths did the script have, and where might clarification be needed?

 

Required Readings

 

Manion, J. (2011). From management to leadership: Strategies for transforming health care (3rd ed.). San Francisco, CA: Jossey-Bass.

Chapter 7, “Coaching and Developing Others” (pp. 339–341)

Review the scripting model on these pages. In this chapter, Manion discusses motivation and explains how leaders can make the most of it through coaching. She explains the leader’s role, the coaching role, and the difference between coaching and being a coach.

Alichnie, C. (2012). Social media and nursing. Pennsylvania Nurse, 67(1), 3–10.

Retrieved from the Walden Library databases.

 

This article discusses the use of social media in nursing. The author determines that social media can be a means to an end if it’s used wisely, professionally, and within legal and ethical boundaries.

Barrett, A., Piatek, C., Korber, S., & Padula, C. (2009). Lessons learned from a lateral violence and team-building intervention. Nursing Administration Quarterly, 33(4), 342–351.

Retrieved from the Walden Library databases.

 

This study focuses on nurse interaction in relation to lateral violence. The authors conclude that the key to a cohesive work environment is a nurse leader who is able to drive and sustain change.

Barton, S. A., Alamri, M. S., Cella, D., Cherry, K. L., Curll, K., Hallman, B. D., et al. (2011). Dissolving clique behavior. Nursing Management, 42(8), 32–37.

Retrieved from the Walden Library databases.

 

This article addresses clique behavior in health care settings. The argument is that the current economic climate encourages regression in health care workers.

Brinkert, R. (2010). A literature review of conflict communication causes, costs, benefits and interventions in nursing. Journal of Nursing Management, 18(2), 145–156.

Retrieved from the Walden Library databases.

 

The author assesses the effects of conflict communication on nursing. The study concludes that conflict will always be a part of nursing but that it can be mitigated if nurse managers use employee-effective intervention methods.

Cronquist, R., & Spector, N. (2011). Nurses and social media: Regulatory concerns and guidelines. Journal of Nursing Regulation, 2(3), 37–40.

Retrieved from the Walden Library databases.

 

Cronquist and Spector’s article provides nurses with social media guidelines. They also give the reader examples of what happens when social media is used outside of professional, legal, and ethical boundaries.

Greenlund, L. (2011). ED violence: Occupational hazard? Nursing Management, 42(7), 28–32.

Retrieved from the Walden Library databases.

 

This article analyzes the effects of workplace violence on hospitals’ productivity. Because workplace violence can be costly, the author provides prevention methods.

Hader, R. (2009). Tweeting—not just for the birds. Nursing Management, 40(12), 6.

Retrieved from the Walden Library databases.

 

This article focuses on what nurse leaders should do about social media in the workplace. New leadership challenges have risen because of this form of communication. Nurse leaders need to ensure that their employees are not violating a patient’s rights to privacy.

Issues & answers. Social media: Implications for nursing: Nursing Practice Statement NP 85. (2011). Ohio Nurses Review, 86(2), 6–7.

Retrieved from the Walden Library databases

 

This article informs the reader about the laws and rules that apply to nursing and social media. The authors take a stance on the use of social media and list its benefits and drawbacks.

Kuhns, K. A. (2012). Social media and professional nursing: Friend or foe? Pennsylvania Nurse, 67(1), 4–8.

Retrieved from the Walden Library databases.

 

Kuhn’s article introduces the reader to the many different types of social media and argues that there is more to social media than Facebook and Twitter. The article then goes on to discuss the pros and cons of the use of social media in the workplace.

Macleod, L. (2011). Avoiding “group think”: A manage’s challenge. Nursing Management, 42(10), 44–48.

Retrieved from the Walden Library databases.

 

Macleod’s article focuses on the increasing costs of health care. He says that changes need to happen both within and outside of health care settings for this change to be sustainable.

Robinson, M.-A. (2012). Closing perspectives: Navigating the world of social media. Alberta RN, 67(6), 42.

Retrieved from the Walden Library databases.

 

Robinson’s article addresses the hesitation that many organizations have with social networking. While there are professional benefits, there are also risks and new challenges.