Exelon (rivastigmine) 1.5 mg decision tree essay

Exelon (rivastigmine) 1.5 mg decision tree essay

Decision Point One

Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

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RESULTS 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. Exelon (rivastigmine) 1.5 mg decision tree essay.Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall

Decision Point Two

 

Increase Exelon to 4.5 mg orally BID

 

RESULTS 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 serious
  • Exelon (rivastigmine) 1.5 mg decision tree essay

Decision Point Three

 

Increase Exelon to 6 mg orally BID

 

Guidance to Student

At this point, the client is reporting no side effects and is participating in an important part of family life (religious services). This could speak to the fact that the medication may have improved some symptoms. The PMHNP needs to counsel the client’s son on the trajectory of presumptive Alzheimer’s disease in that it is irreversible, and while cholinesterase inhibitors can stabilize symptoms, this process can take months. Also, these medications are incapable of reversing the degenerative process. Some improvements in problematic behaviors (such as disinhibition) may be seen, but not in all clients. Exelon (rivastigmine) 1.5 mg decision tree essay.

At this point, the PMHNP could maintain the current dose until the next visit in 4 weeks, or the PMHNP could increase it to 6 mg orally BID and see how the client is doing in 4 more weeks. Augmentation with Namenda is another possibility, but the PMHNP should maximize the dose of the cholinesterase inhibitor before adding augmenting agents. However, some experts argue that combination therapy should be used from the onset of treatment. Exelon (rivastigmine) 1.5 mg decision tree essay.

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. Exelon (rivastigmine) 1.5 mg decision tree essay.

 

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