Decision Tree for Neurological and Musculoskeletal Disorders
January 16, 2020
Advocating for the Nursing Role in Program Design
January 16, 2020

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

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

· 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

· 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:


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.


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.


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)


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


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).


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). 


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)

Academy of Family Physicians. (2019). Dementia. Retrieved from

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.

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


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