NR565 Week 4 Collaborative Case Study Discussion
NR565 Week 4 Collaborative Case Study Discussion – Step-by-Step Guide
The first step before starting to write the NR565 Week 4 Collaborative Case Study Discussion, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment.
It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.
How to Research and Prepare for NR565 Week 4 Collaborative Case Study Discussion
The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list.
You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.
How to Write the Introduction for NR565 Week 4 Collaborative Case Study Discussion
The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.
How to Write the Body for NR565 Week 4 Collaborative Case Study Discussion
The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.
How to Write the In-text Citations for NR565 Week 4 Collaborative Case Study Discussion
In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:
The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.
How to Write the Conclusion for NR565 Week 4 Collaborative Case Study Discussion
When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.
How to Format the Reference List for NR565 Week 4 Collaborative Case Study Discussion
The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication.
Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:
References
Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456
Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.
NR565 Week 4 Collaborative Case Study Discussion Instructions
Preparing the Assignment
Read the case study below.
In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT.
Provides a minimum of two responses weekly on separate days; e.g., replies to a post from a peer; AND faculty member’s question; OR two peers if no faculty question using appropriate resources, before Sun., 11:59 pm MT.
Case Scenario
A 76-year -old man is brought to the primary care office by his wife with concerns about his worsening memory. He is a retired lawyer who has recently been getting lost in the neighborhood where he has lived for 35 years. He was recently found wandering and has often been brought home by neighbors. When asked about this, he becomes angry and defensive and states that he was just trying to go to the store and get some bread.
His wife expressed concerns about his ability to make decisions as she came home two days ago to find that he allowed an unknown individual into the home to convince him to buy a home security system which they already have. He has also had trouble dressing himself and balancing his checkbook. At this point, she is considering hiring a day-time caregiver help him with dressing, meals and general supervision why she is at work.
Past Medical History: Gastroesophageal reflux (treated with diet); is negative for hypertension, hyperlipidemia, stroke or head injury or depression
Allergies: No known allergies
Medications: None
Family History
Father deceased at age 78 of decline related to Alzheimer’s disease
Mother deceased at age 80 of natural causes 
No siblings
Social History
Denies smoking
Denies alcohol or recreational drug use 
Retired lawyer
Hobby: Golf at least twice a week
Review of Systems
Constitutional: Denies fatigue or insomnia
HEENT: Denies nasal congestion, rhinorrhea or sore throat.  
Chest: Denies dyspnea or coughing
Heart: Denies chest pain, chest pressure or palpitations.
Lymph: Denies lymph node swelling.
Musculoskeletal: denies falls or loss of balance; denies joint point or swelling
General Physical Exam
Constitutional: Alert, angry but cooperative
Vital Signs: BP-128/72, T-98.6 F, P-76, RR-20
Wt. 178lbs., Ht.6’0″, BMI 24.1
HEENT
Head normocephalic; Pupils equal and reactive to light bilaterally; EOM’s intact
Neck/Lymph Nodes: No abnormalities noted
Lungs: Bilateral breath sounds clear throughout lung fields.
Heart: S1 and S2 regular rate and rhythm, no rubs or murmurs.
Integumentary System: Warm, dry and intact. Nail beds pink without clubbing.
Neurological: Deep tendon reflexes (DTRs): 2/2; muscle tone and strength 5/5; no gait abnormalities; sensation intact bilaterally; no aphasia
Diagnostics: Mini-Mental State Examination (MMSE): Baseline score 12 out of 30 (moderate dementia)
MRI: hippocampal atrophy
Based on the clinical presentation and diagnostic findings, the patient is diagnosed with Alzheimer’s type dementia.
Discussion Questions
Compare and contrast the pathophysiology between Alzheimer’s disease and frontotemporal dementia.
Identify the clinical findings from the case that supports a diagnosis of Alzheimer’s disease.
Explain one hypothesis that explains the development of Alzheimer’s disease
Discuss the patient’s likely stage of Alzheimer’s disease.
Describe your assigned client’s situation. Why are they presenting to the clinic? What
medications are they currently taking? Have a look at NR565 Week 6 Respiratory Protocol Assignment.
Assess the applicable clinical practice guideline (CPG) for your assigned client. What
treatment is recommended by the CPG for your client’s situation?
Discuss your personal professional assessment of the client’s situation provided in the
scenario. What pharmacological treatment is necessary and why?
Reflect on additional questions you have about your assigned client that may influence
treatment. What else do you need to know? What follow-up assessments, labs, or
conversations are required to ensure optimal health outcomes?
NR565 Week 4 Collaborative Case Study Discussion Example
Alzheimer’s disease (AD) and frontotemporal dementia (FTD) are distinct neurodegenerative conditions, each with unique pathophysiological mechanisms and clinical presentations. AD is characterized by the accumulation of amyloid-beta plaques and neurofibrillary tangles, which are composed of hyperphosphorylated tau, leading to extensive neuronal loss, particularly in the hippocampus and cortex. This leads to memory impairment, cognitive dysfunction, and a gradual decline in independence. Genetic factors, such as mutations in the APP, PSEN1, and PSEN2 genes, as well as the presence of the APOE 4 allele, increase the risk, particularly in early-onset cases (Kumar et al., 2023).
FTD predominantly impacts the frontal and temporal lobes, resulting in initial alterations in behavior, personality, and language, while memory remains intact until the later stages of the disease. FTD is associated with the accumulation of tau or TDP-43 proteins (Khan & De Jesus, 2023). The most common form, the behavioral variant FTD, causes disinhibition, apathy, and loss of empathy, while primary progressive aphasia impacts language (Alzheimer’s Association, 2020). FTD generally affects younger individuals between 45 and 65 years old, compared to AD, which is more common after age 65 (Khan & De Jesus, 2023).
- Identify the clinical findings from the case that support a diagnosis of Alzheimer’s disease:
- Memory Impairment: The patient’s worsening memory, such as getting lost in a familiar neighborhood and forgetting everyday tasks like dressing and balancing a checkbook, is a hallmark of Alzheimer’s.
- Difficulty in Decision Making: The patient’s poor judgment, allowing a stranger to sell him a security system despite already having one, aligns with the cognitive deficits seen in Alzheimer’s.
- Defensive Behavior: His anger and defensiveness when confronted about his memory lapses are commonly observed in Alzheimer’s patients who are aware of their declining cognitive abilities.
- MMSE Score: The patient’s Mini-Mental State Examination (MMSE) score of 12 out of 30 indicates moderate dementia, which is consistent with Alzheimer’s disease.
- The MRI shows hippocampal atrophy, a classic finding in Alzheimer’s; the hippocampus is among the first regions affected by the disease.
Explain one hypothesis that explains the development of Alzheimer’s disease:
The Amyloid Cascade Hypothesis posits that the accumulation of amyloid-beta (Aβ) peptides is central in initiating the neurodegenerative process in AD. In AD, the abnormal breakdown of amyloid precursor protein (APP) by beta- and gamma-secretase enzymes yields toxic Aβ42 peptides that form amyloid plaques (Agarwal et al., 2020). These plaques interfere with the transmission of signals across the neurons and cause inflammation of the neurons, resulting in their death.
Amyloid-beta deposition also causes tau hyperphosphorylation, leading to the formation of neurofibrillary tangles that continue to impair neuronal function. These aggregates of protein amyloid plaques, along with the tau tangles, result in the core manifestation of AD, memory loss, and other forms of cognitive impairment alongside a progressive course (Kumar et al., 2023). Although amyloid-beta is responsible for the onset of the disease, its progression is through the combination of tau pathology and neuroinflammation.
- Discuss the patient’s likely stage of Alzheimer’s disease:
The middle or moderate stage of Alzheimer’s disease, as evidenced by :
- Significant memory loss problems lead to being lost in familiar surroundings and unable to remember everyday tasks.
- Cognitive decline is evidenced by difficulty in decision-making and poor judgment, such as allowing a stranger into the home.
- MMSE Score: A score of 12 out of 30 on the MMSE suggests moderate dementia.
- Daily Function: The wife is considering hiring a caregiver to assist with activities of daily living, such as dressing and supervision, indicating he is no longer entirely independent.
In the moderate stage of Alzheimer’s, patients usually need increasing assistance with daily activities, show more significant confusion and memory loss, and may become frustrated or angry when confronted with their impairments.
References
Agarwal, M., Alam, M. R., Haider, M. K., Malik, Md. Z., & Kim, D.-K. (2020). Alzheimer’s disease: An overview of major hypotheses and therapeutic options in nanotechnology. Nanomaterials, 11(1), 59. https://doi.org/10.3390/nano11010059
Alzheimer’s Association. (2020). Frontotemporal Dementia. Alzheimer’s Disease and Dementia. https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/frontotemporal-dementia
Khan, I., & De Jesus, O. (2023). Frontotemporal lobe dementia. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559286/
Kumar, A., Tsao, J. W., Sidhu, J., & Goyal, A. (2022, June 5). Alzheimer disease. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499922/
NR565 Week 4 Collaborative Case Study Discussion Example 2
- Describe your assigned client’s situation. Why are they presenting to the clinic? What medications are they currently taking?
Marianne Terra is a 69-year-old female presenting today with complaints of heartburn and difficulty swallowing. She is diagnosed with esophagitis related as an adverse effect of her medications. Ms. Terra takes Alendronate (Fosamax) 10 mg daily, Calcium Acetate (Phoslo) 1334 mg twice daily, and Cholecalciferol (Vitamin D3) 600 IU daily. All medications are taken by mouth. She has an allergy to Penicillin; she has never smoked but drinks alcohol once per month.
- Assess the applicable clinical practice guideline (CPG) for your assigned client. What treatment is recommended by the CPG for your client’s situation?
CPG guidelines by Qaseem et al (2023) have 4 recommendations for individuals who have primary osteoporosis, whether it is men or women who are postmenopausal. Recommendation 1a is to start the use of Bisphosphonates for initial treatment to reduce the risk of fractures in postmenopausal women, 1b is the same recommendation, but it is for males diagnosed with primary osteoporosis. 2a recommends the use of RANK ligand inhibitor (Denosumab) as a second line of treatment in postmenopausal women who have a contraindication or experience adverse effects from the Bisphosphonates, 2b also recommends switching to a RANK ligand inhibitor in men with primary osteoporosis who have contraindications or adverse effects from the Bisphosphonates.
Recommendation 3 is the use of a sclerostin inhibitor or recombinant PTH, followed by a Bisphosphonate to reduce the risk only in females with primary osteoporosis; this is a conditional recommendation. Recommendation 4, the final recommendation, suggests that clinicians adopt an individualized approach to determining whether to initiate pharmacological treatment with a Bisphosphonate in females over 65 years of age with low bone mass to reduce the risk of fracture. This is also a conditional recommendation.
- Discuss your personal professional assessment of the client’s situation provided in the scenario. What pharmacological treatment is necessary and why?
The treatment for Ms. Terra in this situation would be to switch her to Denosumab. She had already started on a Bisphosphonate and started to have adverse effects. In an article by Curtis et al (2024), they found meaningful reduction in the risk of fractures for patients treated with denosumab vs. alendronate in a cohort of almost half a million treatment-naïve women with postmenopausal osteoporosis in the US.
This indicates that Denosumab is comparable to Alendronate. With that being said, this is a good medication to try while taking a drug “holiday” from Alendronate. After taking a drug holiday, alendronate could be re-evaluated, and the retrial of this medication should be discussed should similar side effects recur, since both these medications have similar side effects. In an article by Fan et al. (2024), they state that esophageal adverse reactions occur only to a small extent with Alendronate and are closely related to inappropriate dosage methods.
- Reflect on additional questions you have about your assigned client that may influence treatment. What else do you need to know? What follow-up assessments, labs, or conversations are required to ensure optimal health outcomes?
After discussing the medication options with Ms. Terra, it would be beneficial to start by asking her how she currently takes her medication. Denosumab is an injection and is given every 6 months, compared to taking Alendronate every day. Finding out if she is comfortable with providing herself with injections or coming back to the office can affect whether to start this medication or not. If she is okay with this medication, educating her on the adverse effects and side effects that can happen to her is very important.
There are more side effects with Denosumab compared to Alendronate. It is important to educate her to report abnormalities immediately. It is also important to educate her to monitor her sites of administration for adverse reactions, so that she may report them as well. She should also be educated on the need for routine basic metabolic panels (BMPs) to monitor her electrolytes, more specifically her calcium levels. Ms. Terra must be educated on the signs and symptoms of hypocalcemia.
Ms. Terra is already taking a Vitamin D supplement, which is necessary when taking Denosumab; the recommended dosage is at least 400 IU with a calcium supplement to prevent hypocalcemia. If Ms. Terra were to develop adverse effects from Denosumab or were to switch back to Alendronate, proper education on when to take her medication is essential to discuss. Reporting adverse effects is very important to decide if her medication is properly dosed and she is taking it correctly.
References
Curtis, J. R., Arora, T., Liu, Y., Lin, T.-C., Spangler, L., Brunetti, V. C., Robert Kees Stad, McDermott, M., Bradbury, B. D., & Kim, M. (2024). Comparative effectiveness of Denosumab vs alendronate among postmenopausal women with osteoporosis. Journal of Bone and Mineral Research. https://doi.org/10.1093/jbmr/zjae079
Fan, Z., Khizar, H., Lu, J., Wang, A., Xun, T., Zhang, X., & Zhao, H. (2024). From pill to pain: Alendronate induced esophageal injury—A case report and review. JGH Open, 8(6). https://doi.org/10.1002/jgh3.13080
Qaseem, A., Hicks, L. A., Etxeandia-Ikobaltzeta, I., Shamliyan, T., & Cooney, T. G. (2023). Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults: A living clinical guideline from the American College of Physicians. Annals of Internal Medicine, 176(2), 224–238. https://doi.org/10.7326/m22-1034
