NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders

NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders – Step-by-Step Guide

The first step before starting to write the NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders, 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 NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders

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 NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders

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 NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders

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 NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders

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 NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders

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 NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders

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.

NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders Instructions

Sabrina is a 26-year-old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow-up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems.

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Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.

As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience? Have a look at NURS 6521 Midterm Exam Revision

This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.

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Decision Tree for Neurological and Musculoskeletal Disorders

For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

To 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.

BY DAY 7 OF WEEK 8

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.
• You will submit this Assignment in Week 8.

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Alzheimer’s Disease

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 difficulty “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 a 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.

Decision Point One

Select what you should do:

• Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks
• Begin Aricept (donepezil) 5 mg orally at BEDTIME
• Begin Razadyne (galantamine) 4 mg orally BID

Decision Point One : Begin Aricept (donepezil) 5 mg orally at BEDTIME

Results for Decision Point One

• Client returns to clinic in four weeks
• The client is accompanied by his son who reports that his father is “no better” from this medication
• He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors
• You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

Decision Point Two

Select what you should do next:

• Increase Aricept to 10 mg orally at BEDTIME
• Discontinue Aricept and begin Razadyne (galantamine) extended release 24 mg orally daily
• Discontinue Aricept and begin Namenda (memantine) extended release, 28 mg orally daily

Decision Point Two: Increase Aricept to 10 mg orally at BEDTIME

Results for Decision Point Two

• Client returns to clinic in four weeks
• Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better
• He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious

Decision Point Three

Select what you should do next:

• Continue Aricept 10 mg orally at BEDTIME
• Increase Aricept to 15 mg orally at BEDTIME x 6 weeks, then increase to 20 mg orally at BEDTIME
• Discontinue Aricept and begin Namenda 5 mg orally daily

Decision Point Three: Continue Aricept 10 mg orally at BEDTIME

Guidance to Student

At this point, it would be prudent to continue Aricept at 10 mg orally at bedtime. Recall that this medication can take several months before stabilization of deterioration is noted. At this point, the client is attending religious services with the family, which has made the family happy. Disinhibition may improve in a few weeks, or it may not improve at all. This is a counseling point that you should review with the son.

There is no evidence that Aricept given at doses greater than 10 mg per day has any therapeutic benefit. It can, however, cause side effects. Increasing to 15 and 20 mg per day would not be appropriate.

There is nothing in the clinical presentation to suggest that the Aricept should be discontinued. Whereas it may be appropriate to add Namenda to the current drug profile, there is no need to discontinue Aricept. In fact, NMDA receptor antagonist therapy is often used with cholinesterase inhibitors in combination therapy to treat Alzheimer’s disease. The key to using both medications is slow titration upward toward therapeutic doses to minimize negative side effects.

Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern.

NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders Example

Pharmacological Intervention for Major Neurocognitive Disorder Due to Alzheimer’s Disease

Alzheimer’s disease (AD), the most prevalent cause of cognitive decline, is severe enough to impede daily activities. It is a neurodegenerative condition that often affects persons over 65, affecting reasoning, memory, judgment, language, comprehension, and attention (Kumar & Tsao, 2019). Insidious onset and gradual impairment of cognition and behavioral functioning characterize Alzheimer’s disease (Cummings, 2021). Although many medicines may alleviate the symptoms of Alzheimer’s disease, the disease itself is incurable. This assignment examines pharmaceutical therapies for significant neurocognitive dysfunction with a presumptive Alzheimer’s diagnosis.

Case Summary

Mr. Akkad, a 76-year-old Iranian man, exhibits dementia symptoms such as forgetfulness, difficulty finding the right words, and behavioral changes. His family doctor found no organic cause for his conduct after normal blood and imaging tests. Mr. Akkad cooperated during the clinical interview but showed confabulation during the memory assessment. On the Mini-Mental State Test, he scored 18 out of 30, indicating mild dementia. During his mental status evaluation, he demonstrated poor eye contact, poor judgment, tangential speech, impaired insight, restricted affect, disorientation to time and event, and poor impulse control. The presumptive diagnosis is Alzheimer’s disease-related significant neurocognitive dysfunction.

Decision Point One

Treatment started with Razadyne (galantamine) 4 mg BID orally. Galantamine belongs to the group of medicines known as acetylcholinesterase inhibitors (Kalola & Nguyen, 2021). It is advised to start the medication at the lowest dosage possible and gradually increase it after determining its clinical efficacy and tolerability. The initial dosage for treatment is 4 mg twice daily. After at least four weeks, the dosage can be increased to 16 mg/day and then further escalated to a maximum of 24 mg/day (Kalola & Nguyen, 2021). When the patient with his son revisited the clinic in a month, the son reported that the medication had not improved his father. I keep noticing confabulation, and when I repeat the MMSE, the patient got 18 out of 30, with a deficiency in orientation, registration, attention, calculation, and recollection.

Decision Point Two

We stop Razadyne and start Exelon (rivastigmine) 1.5 mg orally BID. When the client comes to the facility in four weeks, his son notes he tolerates the medication appropriately but is still anxious that his father is not improving. Rivastigmine belongs to the cholinesterase inhibitor category of medications. (Patel & Gupta, 2023). According to studies, long-term rivastigmine treatment at the highest dosage results in the most substantial improvement in cognitive performance (Eldufani & Blaise, 2019). However, MMSE scores between 26 and 24, or 10 to 11, qualify for therapy.

Decision Three

We maintain the current Exelon dosage and reassess at the subsequent doctor visit. It may take months for cholinesterase inhibitors to show any stabilization in the degenerative course of Alzheimer’s disease. The Exelon dose should be increased to 3 mg orally BID as the client has no adverse effects. Exelon’s recommended dose is 12 mg, taken twice a day by mouth, spaced out to reduce the chance of side effects.

Perhaps now is not the right time to add Namenda. The optimal dose of Exelon should be reached before considering the addition of an NMDA receptor antagonist. Namenda dosage should begin at 5 mg orally daily and titrate up to 10 mg orally BID. The above 5 mg used orally daily should be divided into two doses, or an extended-release medication can be used instead (Kuns et al., 2020). The healthcare provider should emphasize that they need to assess the changes in the MMSE over months rather than weeks. If the MMSE has not improved after four weeks of treatment, that is not necessarily a cause for concern. Patients, families, and caregivers should be aware of the condition’s progressive nature and have reasonable expectations for treatment.

References

Cummings, J. (2021). The role of neuropsychiatric symptoms in research diagnostic criteria for neurodegenerative diseases. The American Journal of Geriatric Psychiatry, 29(4), 375–383. https://doi.org/10.1016/j.jagp.2020.07.011

Eldufani, J., & Blaise, G. (2019). The role of acetylcholinesterase inhibitors such as neostigmine and rivastigmine on chronic pain and cognitive function in aging: A review of recent clinical applications. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 5, 175–183. https://doi.org/10.1016/j.trci.2019.03.004

Kalola, U. K., & Nguyen, H. (2021). Galantamine. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK574546/

Kumar, A., & Tsao, J. W. (2019, August 18). Alzheimer disease. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499922/

Kuns, B., Rosani, A., & Varghese, D. (2020). Memantine. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK500025/

Patel, P. H., & Gupta, V. (2023). Rivastigmine. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557438/#:~:text=Rivastigmine%20is%20a%20medication%20used