Week 10: Therapy for Clients with DementiaIn so many countries, to be old is shameful; to be mentally ill as well as old is doubly shameful. In so many countries, people with elderly relatives who are also mentally ill are ashamed and try to hide what they see as a disgrace on the family.—Dr. Nori Graham, psychiatrist and honorary vice president of Alzheimer’s Disease InternationalIn this quote, Dr. Graham is expressing her observations and experiences in her work with numerous international organizations. Many patients and their families experience feelings of anxiety and shame upon receiving a diagnosis of dementia. Lynda Hogg, an Alzheimer’s patient, shares her feelings that “some people don’t want to be associated with someone with an illness affecting the brain” (Alzheimer’s Disease International, 2012). As a psychiatric mental health nurse practitioner providing care to clients presenting with dementia, it is critically important to consider the impact of these disorders on clients, caregivers, and their families. A thorough understanding of the health implications of these disorders, as well as each client’s personal concerns, will aid you in making effective treatment and management decisions.This week, you explore strategies to become a social change agent for psychiatric mental health. Then, as you examine the assessment and treatment of clients with dementia, you also consider related ethical and legal implications.Photo Credit: [Maskot]/[Maskot]/Getty ImagesAssignment: Assessing and Treating Clients With DementiaThe Alzheimer’s Association defines dementia as “a general term for a decline in mental ability severe enough to interfere with daily life” (Alzheimer’s Association, 2016). This term encompasses dozens of cognitive disorders of impaired memory formation, recall, and communication. The care and treatment of clients with dementia is dependent on multiple factors, including the stage of dementia, comorbidities, family support, and even the care setting. In your role, as the psychiatric mental health nurse practitioner, you must be prepared to not only treat clients with these various cognitive disorders, but also the multiple behavioral issues that often accompany them. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with dementia.Reference: Alzheimer's Association. (2016). What is dementia? Retrieved from http://www.alz.org/what-is-dementia.aspLearning ObjectivesStudents will:Assess client factors and history to develop personalized therapy plans for clients with dementiaAnalyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for dementiaEvaluate efficacy of treatment plansAnalyze ethical and legal implications related to prescribing therapy for clients with dementiaLearning ResourcesNote: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.Required ReadingsNote: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.To access the following chapter, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. Chapter 13, “Dementia and Its Treatment”Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.Review the following medications:For insomnia donepezilgalantaminememantinerivastigmineBui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.htmlNote: Retrieved from from the Walden Library databases.Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin receptor inverse agonist for the treatment of Parkinson's disease psychosis. Neuropsychopharmacology, 35, 881–891. Retrieved from http://www.nature.com/npp/journal/v35/n4/pdf/npp20...Required MediaLaureate Education. (2016h). Case study: An elderly Iranian man with Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.Note: This case study will serve as the foundation for this week’s Assignment.To prepare for this Assignment:Review this week’s Learning Resources. Consider how to assess and treat clients requiring therapy for dementia.The AssignmentExamine Case Study: An Elderly Iranian Man With Alzheimer’s Disease. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.At each decision point stop to complete the following:Decision #1Which decision did you select?Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?Decision #2Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?Decision #3Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?Also include how ethical considerations might impact your treatment plan and communication with clients.Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.BACKGROUNDMr. 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.SUBJECTIVEDuring 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 the PMHNP performs 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 EXAMMr. 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 the PMHNP 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 OneSelect what the PMHNP 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 BEDTIMEBegin Razadyne (galantamine) 4 mg orally BIDDecision Point One: Begin Aricept (donepezil) 5 mg orally at BEDTIMERESULTS OF 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 recallDecision Point TwoSelect Increase Aricept to 10 mg orally at BEDTIMEDiscontinue Aricept and begin Razadyne (galantamine) extended release 24 mg orally dailyDiscontinue Aricept and begin Namenda (memantine) extended release, 28 mg orally dailyDecision Point TwoIncrease Aricept to 10 mg orally at BEDTIMERESULTS OF 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 seriousDecision Point ThreeSelect what the PMHNP should do next:Continue Aricept 10 mg orally at BEDTIMEIncrease Aricept to 15 mg orally at BEDTIME x 6 weeks, then increase to 20 mg orally at BEDTIMEDiscontinue Aricept and begin Namenda 5 mg orally dailyDecision Point TwoIncrease Aricept to 10 mg orally at BEDTIMERESULTS OF 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 seriousDecision Point ThreeContinue Aricept 10 mg orally at BEDTIMEGuidance to StudentAt this point, it would be prudent for the PMHNP 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 the PMHNP 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.

This isn't apart of the requirements of my paper but just a heads up. I have COMPLETED the paper! I am BRUTALLY burnt out and need help with fixing different sections of it with feedback from the professor. In all, I'm sure it won't be that difficult for someone to help (at least I hope not). I have done my Capstone Project on Adidas. The attached documents are my paper, the scoring guide, and finally the feedback from the professor.IntroductionThis course revolves around the creation of a single, significant capstone project. In other words, a project that caps off your learning and your program, allowing you to demonstrate the competencies of leadership and collaboration, ethical and evidence-based decision making, and innovative and strategic thinking. For your capstone, you will choose a real company and analyze it in a way that demonstrates your understanding of the MBA program outcomes. You will turn your analysis of that company into a written report with recommendations and a formal presentation for your intended audience.Having a solid, doable scope is an important part of creating a successful capstone project, and the exact scope is up to you. To help you establish a realistic scope, you will start with the project summary. Be careful to consider the scalability of your project scope, ensuring that it demonstrates your ability to lead in a business environment and showcases your achievement of all MBA program outcomes.ExamplesA scope that is poorly defined:I want to write a general analysis of the bookseller, Barnes & Noble.This topic is too broad, and it would probably require hundreds of pages to address all of the possible analyses.A scope that is better defined:I want to focus on how Barnes & Noble has managed to survive the Internet age while Borders has crumbled.What makes this a better scope? The scope is grounded in a problem (such as how to survive Internet competition) or opportunity (such as the area lacking a business that you plan to open), which allows you to focus the analysis.It must also allow for you to analyze and suggest evidence-based recommendations, takeaways, or actionable next steps as the crux of your project.PreparationRead the MBA Capstone Project Description [PDF].Assessment DescriptionFor this assessment, introduce the organization you have chosen to research, why you chose it, and how it will allow you to demonstrate all of the MBA program outcomes.Write a 2–3 page paper, in an academic writing style, that details the topic and scope of your capstone project. Your project summary should be clear and concise yet thorough enough for faculty to provide feedback and guidance. Your project summary should be well organized and include the following sections:Describe the background of your chosen organization. Provide a brief background of your selected organization. For instance, discuss its product lines, number of years in business, organization structure, location, et cetera.If you choose an organization for which you work, your introduction must include a statement that you received permission to use the company from a supervisor.Describe a business topic, problem, or opportunity that you intend to research.Describe the problem or opportunity you see that makes this company a good choice. Explain the scope of your project by clearly identifying the topics or areas you intend to research. Explain the level of accessibility to data necessary to examine the chosen business topic, problem, or opportunity.Address how you will go about obtaining the data.Identify any special requirements that you might need to meet to access the data you will need. Explain risks you think will be encountered and the mitigation plan to manage those risks.Explain how your topic will allow you to showcase your leadership ability by demonstrating each MBA program outcome. List out each program outcome clearly, and then explain in 3–4 sentences how your topic will allow you to demonstrate each. The MBA program outcomes are listed in the MBA Capstone Project Description.Identify specific items of your project summary that you believe demonstrates the outcome. Wrap up your paper with a clear, concise conclusion that summarizes your plan. Just a couple sentences is fine.Your project summary should have these sections:Introduction.Statement of scope.Demonstration of outcomes.Conclusion. Submission RequirementsStyle: Your paper should follow the corresponding MBA Academic and Professional Document guidelines (available in the MBA Program Resources) for academic style. It should be double spaced, use subheadings, and be well organized and well written.Communication: Ensure written communication is free of errors that detract from the overall message and quality.APA guidelines: Format your paper according to current APA style and formatting.Resources: At least one resource should be a scholarly article or other content found in the Capella library, and one should be from the Wall Street Journal. If using Internet sources, evaluate them appropriately to make sure they are credible resources. Length: Your paper should be between 2–3 pages.Font and font size: Use 12 point, Times New Roman.EvaluationBy successfully completing this assessment, you will demonstrate your proficiency in the following course competencies through corresponding scoring guide criteria:Competency 2: Integrate information across disciplines and from differing perspectives.Describe the background of the chosen organization.Competency 3: Think critically and analytically to provide evidence-based solutions to business challenges and opportunities.Describe an intended business topic, problem, or opportunity to research.Explain the level of accessibility to data necessary to examine the chosen business topic, problem, or opportunity. Explain how the topic will allow showcasing of leadership ability by demonstrating some MBA program outcomes.Competency 7: Communicate clearly and effectively in a business environment.Write coherently to support a central idea with correct grammar, usage, and mechanics as expected of a business professional.

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