Running Head: DECISION TREE 1 DECISION TREE 2 Assessing and Treating Clients with Alzheimer Disease Idalmis Espinosa Dr. Ridley Walden University Assessing and Treating Clients with Alzheimer Disease Introduction Alzheimer's disease is a neurodegenerative condition that is characterized by cognitive and behavioral impairment, which considerably affects social and occupational running. It is an irreversible, gradually worsening disease that affects the brain’s memory and thinking abilities. A person with Alzheimer’s will slowly start becoming forgetful until it is significantly noticeable among their family and friends. Later in the development of this disease, they will also begin to change in personality and require increasing assistance in completing simple everyday tasks. AD is a complex disease, and it is improbable that any treatment approach or intervention can successfully treat it. Approaches are currently focused on helping patients to maintain mental functions, manage behavioral symptoms, and reduce the associated symptoms. Alzheimer's disease has been associated with around 70% of all dementia cases in the world (Alzheimer Association, 2015). The most common first signs of AD include the loss of memory in the short term e.g., forgetting appointments, frequently misplacing objects, or asking repetitive questions. The patient’s comprehension and vocabulary become impoverished. Other cognitive deficits seem to involve several functions, such as language dysfunction exhibited by difficulty thinking of common words and errors in writing or speaking (Morris et al., 2014). Impaired reasoning is often witnessed, characterized by difficulty in handling tasks and poor judgment. Other signs and symptoms are seen from the visuospatial dysfunction, which is the inability to recognize common objects and faces. Spatial disorientation results in difficulty of circumnavigating objects. A large majority of Alzheimer patients show behavioral concerns during the course of the disease (Alzheimer Association, 2015). Depression, apathy, lack of or sleep disturbance may be seen at an early stage. Psychotic symptoms, physical and verbal aggression, psychomotor agitation, and inappropriate sexual conduct appears during the later stages of dementia. In the progressive stages of Alzheimer's, some patients tend to develop motor signs like urinary inconsistencies, myoclonus, gait disturbance, and tremor (Morris et al., 2014). Additionally, a seizure can also be witnessed in patients with AD. This case study examines the examination and treatment of an elderly Iranian man displaying strange behaviors. According to his son, Mr. Akkad has lost interest in some of the things that he used to enjoy. At the same time, the client forgets things ...

1. Running Head: DECISION TREE
1
DECISION TREE
2
Assessing and Treating Clients with Alzheimer Disease
Idalmis Espinosa
Dr. Ridley
Walden University
Assessing and Treating Clients with Alzheimer Disease
Introduction
Alzheimer's disease is a neurodegenerative condition that is
characterized by cognitive and behavioral impairment, which
considerably affects social and occupational running. It is an
irreversible, gradually worsening disease that affects the brain’s
memory and thinking abilities. A person with Alzheimer’s will
slowly start becoming forgetful until it is significantly
noticeable among their family and friends. Later in the
development of this disease, they will also begin to change in
personality and require increasing assistance in completing
simple everyday tasks. AD is a complex disease, and it is
improbable that any treatment approach or intervention can
successfully treat it. Approaches are currently focused on
helping patients to maintain mental functions, manage
behavioral symptoms, and reduce the associated symptoms.
Alzheimer's disease has been associated with around 70% of all
dementia cases in the world (Alzheimer Association, 2015). The
most common first signs of AD include the loss of memory in
the short term e.g., forgetting appointments, frequently

2. misplacing objects, or asking repetitive questions. The patient’s
comprehension and vocabulary become impoverished. Other
cognitive deficits seem to involve several functions, such as
language dysfunction exhibited by difficulty thinking of
common words and errors in writing or speaking (Morris et al.,
2014). Impaired reasoning is often witnessed, characterized by
difficulty in handling tasks and poor judgment. Other signs and
symptoms are seen from the visuospatial dysfunction, which is
the inability to recognize common objects and faces. Spatial
disorientation results in difficulty of circumnavigating objects.
A large majority of Alzheimer patients show behavioral
concerns during the course of the disease (Alzheimer
Association, 2015). Depression, apathy, lack of or sleep
disturbance may be seen at an early stage. Psychotic symptoms,
physical and verbal aggression, psychomotor agitation, and
inappropriate sexual conduct appears during the later stages of
dementia. In the progressive stages of Alzheimer's, some
patients tend to develop motor signs like urinary
inconsistencies, myoclonus, gait disturbance, and tremor
(Morris et al., 2014). Additionally, a seizure can also be
witnessed in patients with AD.
This case study examines the examination and treatment of an
elderly Iranian man displaying strange behaviors. According to
his son, Mr. Akkad has lost interest in some of the things that
he used to enjoy. At the same time, the client forgets things
frequently. In the last two years, the client has continued to
show a decline in behavioral and cognitive functioning.
Progressive reports show that Mr. Akkad continuously portrays
strange behaviors and thoughts, which have significantly
affected his personality to the level that he does not show any
interest in religious family engagements and criticizes those
around him. Mr. Akkad has also shown a dramatic change in
attitude, particularly on things that he used to take seriously,
which he tends to ridicule. Mr. Akkad’s son states that his

3. father’s memory loss is progressively getting worse and
experiences difficulty remembering certain things. In most
cases, he sometimes fails to make up the right words in a
conversation and tends to deviate from the main discussion to a
totally unrelated topic. The results of the memory test indicate
grey confabulations after the client is subjected to PMHNP
performance testing. This is a type of mini-mental state
examination. One major area of concern is that the client scored
18 out of 30 in the mini-mental state examination. Major
deficiencies were shown on calculation, orientation, attention,
and registration. It can be concluded that the client had
moderate dementia.
Decision Point 1
Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase
to 3 mg orally BID in 2 weeks.
I have chosen this treatment approach because Exelon is
considered as an effective and powerful drug that can treat
issues associated with the normal functioning of the brain in
aspects such as thought process, memory, and language. Exelon
can help improve the normal functioning of the brain’s nerve
cells (Fife, 2016). It is one of the first-line agents in the
treatment of Alzheimer's disease and also one of the most
effective. Aricept and Razadyne are second-line agents for
Alzheimer’s disease treatment; therefore, it would be wise not
to use them ahead of Exelon at the beginning of the therapy. It,
therefore, becomes the best option, to begin with.
Exelon is a very effective drug within the first two weeks of
treatment. In four weeks, the client returns to the clinic, and his
son reports a lack of improvement from the medication. Mr.
Akkad is still showing a lack of interest in religious services,
which used to interest him and continues to show disinhibited
behaviors. Confabulation can still be noted, and I administered
the MMSE once again, and the score was the same (18 out of
30).

4. There is a big difference between the actual results and the
results I expected. The client still experienced the same
symptoms and had no improvement from the medication. The
MMSE was administered, and the score was 18 out of 30. The
results are short of my expectations because I thought the client
would show some little improvement.
Decision Point 2
Increase Exelon to 4.5 mg orally BID
From the first line of treatment, it is clear that the patient does
not respond to the treatment and does not show any signs of
improvement. Increasing the Exelon to 4.5 mg orally BID would
help determine if the initial dosage was insufficient and could
fasten the recovery process. It helped restore the balance of
neurotransmitters in the brain and seems to improve the
awareness, memory, and ability to take part in the daily
activities (Fife, 2016).
By the end of 4 weeks, I expect the client to report a reduction
in the symptoms, start attending religious services, and starts
showing interest in some activities or events that he used to
enjoy. His thought process and personality should show some
improvement as well. When the client reported to the clinic, his
son reports that he is tolerating the medication well. This is per
my expectation. However, he is still concerned that Mr. Akkad
has not had much improvement. He also reports that he has
started joining the family for religious services, and the rest of
the family are very happy. However, he is still amused by some
of the things that he used to treat seriously. I am not worried
about the results because I believe the patient is heading in the
right direction, and therapy is starting to show effect.
Decision Point 3
Increase Exelon to 6 mg orally BID
From the second line of treatment, it is evident that the patient
started responding to the medication because he can now attend
religious family service but still amused by some things he used
to treat seriously. Increasing Exelon to 6 mg orally BID will

5. speed the recovery process and improve cognition, mood, and
ability to engage in daily activities.
It is expected that an increase in dose will be effective and
alleviate the generalized symptoms of Alzheimer's. No side
effects are expected because the dose is appropriate. The patient
should be able to overcome the condition within some time.
However, I would advise the client’s to be patient with him
because the trajectory of treating Alzheimer's is that the disease
is irreversible and can take a significantly long time to control
(Anderson, Murphy & Troyer, 2012).
Ethical Consideration
The clinician needs to educate the patient and family about the
available medical treatments that Mr. Akkad can be subjected to
and the reason for choosing Exelon as well as its associated side
effects. They should also be informed about the importance of
taking the medications regularly and a sufficient dosage for the
patients. The client’s son should also be counseled regarding
the trajectory of presumptive Alzheimer's disease, considering
the fact that it is an irreversible disease, and even though
cholinesterase inhibitors can stabilize the associated symptoms,
the process can take several months.
Conclusion
Exelon is one of the cholinesterase inhibitor drugs that can
temporarily stabilize and reduce the cognitive decline in
patients suffering from Alzheimer’s disease. In the treatment of
the disease, it is important to consider the first line of treatment
before considering the possibility of using the second line.
References
Alzheimer's Association. (2015). 2015 Alzheimer's disease facts
and figures. Alzheimer's & dementia: the journal of the
Alzheimer's Association, 11(3), 332.
Anderson, N. D., Murphy, K. J., & Troyer, A. K. (2012). Living
With Mild Cognitive Impairment: A Guide to Maximizing Brain
Health and Reducing Risk of Dementia. Oxford: Oxford

6. University Press.
Fife, B. (2016). Stop Alzheimer's Now: How to Prevent and
Reverse Dementia, Parkinson's, ALS, Multiple Sclerosis, and
Other Neurodegenerative Disorders. Colorado Springs, CO:
Piccadilly Books, US.
Morris, J. C., Storandt, M., Miller, J. P., McKeel, D. W., Price,
J. L., Rubin, E. H., & Berg, L. (2014). Mild cognitive
impairment represents early-stage Alzheimer's disease. Archives
of neurology, 58(3), 397-405.
Marketing Management Assignment ( APA FORMAT
REQUIRED )
1. A marketing intelligence system is a set of procedures and
sources managers use to obtain __________.
2. A trend is __________.
3. __________ shapes the beliefs, values, and norms that
largely define tastes and preferences.
4. The last step in the marketing research process is
__________.
5. Research that is designed to capture cause-and-effect
relationships by eliminating competing explanations of observed
findings is called ___________.
6. _____ is a coordinated collection of data, systems, tools, and
techniques with supporting software and hardware by which an
organization gathers and interprets relevant information from
business and environment and turns it into a basis for marketing
action.
Exercises:
1. What are the steps a company can take to improve the quality
of its marketing intelligence?
2. The text describes ten megatrends that help shape the
consumer landscape. Name these trends.

7. 3. Online research interviewing is estimated to make up 33% of
all survey-based research in 2006. Discuss the pros and cons of
using this method of data collection.
Case Study: 800
How does a company known for being conservative attract a
non-conservative target market?
As the company’s ad says, “You’re in good hands with
Allstate!” Allstate Insurance has used this famous phrase to
attract customers for some time. This mainstream market
approach has served the company well. But even though the
company is one of the industry’s leaders, observers began to
notice an erosion of market share in some non-traditional
sectors. Lifestyle strategies had not received much attention at
Allstate. Motorcycle riders, for example, chose competitors
Progressive and Geico over Allstate and other conservatively
oriented companies. Why would Allstate be interested in
targeting motorcycle riders?
The motorcycle market is growing thanks to increased interest
from baby boomers and Generation Y consumers. In 2006, 1.2
million motorcycles were sold according to the Motorcycle
Industry Council, and sales have been steadily climbing for the
last five years. Allstate decided it was time to conduct targeted
marketing research or risk losing this growing market. In
addition to learning some interesting facts about today’s
motorcycle riders, the company’s market research also found
that over 600 of its 14,800 agents were devout motorcycle riders
themselves. This interesting fact led the company to completely
revamp some of its advertising and marketing strategies.
To target motorcycle riders, Allstate has begun featuring some
of their bike-riding agents in their ads. The ads indicate that
Allstate knows the needs of motorcycle riders better than
competitors because the “good hands” are on handle bars. And
who knows the needs of bikers better than other bikers? Acting
on additional research information, the company has also begun
sponsoring motorcycle rallies and music downloads via Rolling
Stone magazine for those people who love the feel of the open

8. road. Follow-up research will determine the success of
Allstate’s attempt to bond with this market segment.
Adapted from “Let’s Ride—The Wild Ones at Allstate,” by Burt
Helm, Business Week, October 1, 2007, p. 16.
Case study developed by Dr. John R. Brooks, Jr., Houston
Baptist University.
Questions:
1. What marketing research facts led Allstate to review its
advertising and marketing strategies with respect to the
motorcycle market?
USW1.539.202010 - NURS-6521N-3/NURS-6521C-3-
ADVANCED PHARMACOLOGY2019 FALL QUARTER 08/26-
11/17-PT27
SafeAssign Drafts
Idalmis Espinosa on Wed, Oct 16 2019, 10:46 AM
53% highest match
Submission ID: 5ea3776a-d85d-4c32-a6e3-8df335eb5d3f
· WK8Assgn Espinosa I.(extension).doc
Word Count: 1,495
Attachment ID: 2231614230
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Citations (8/8)
1. 1Another student's paper
2. 2Another student's paper
3. 3https://www.studypool.com/questions/856597
4. 4Another student's paper
5. 5Another student's paper
6. 6Another student's paper
7. 7Another student's paper
8. 8Another student's paper

9. Running Head: DECISION TREE 1
DECISION TREE 2
Assessing and Treating Clients with Alzheimer Disease
Name: Idalmis Espinosa
Institution: Walden University
Date: 10/16/19
Assessing and Treating Clients with Alzheimer Disease
Introduction
1 Alzheimer's disease is a neurodegenerative condition that is
characterized by cognitive and behavioral impairment, which
considerably affects social and occupational running. It is an
irreversible, gradually worsening disease that affects the brain’s
memory and thinking abilities. A person with Alzheimer’s will
slowly start becoming forgetful until it is significantly
noticeable among their family and friends. Later in the
development of this disease, they will also begin to change in
personality and require increasing assistance in completing
simple everyday tasks. 1 AD is a complex disease, and it is
improbable that any treatment approach or intervention can
successfully treat it. Approaches are currently focused on
helping patients to maintain mental functions, manage
behavioral symptoms, and reduce the associated
symptoms. Alzheimer's disease has been associated with around
70% of all dementia cases in the world (Alzheimer Association,
2015). 1 The most common first signs of AD include the loss of
memory in the short term eg, forgetting appointments,
frequently misplacing objects, or asking repetitive
questions. The patient’s comprehension and vocabulary become
impoverished. Other cognitive deficits seem to involve several
functions, such as language dysfunction exhibited by difficulty
thinking of common words and errors in writing or speaking
(Morris et al., 2014). Impaired reasoning is often witnessed,
characterized by difficulty in handling tasks and poor
judgment. Other signs and symptoms are seen from the
visuospatial dysfunction, which is the inability to recognize
common objects and faces. Spatial disorientation results in

10. difficulty of circumnavigating objects. A large majority of
Alzheimer patients show behavioral concerns during the course
of the disease (Alzheimer Association, 2015). Depression,
apathy, lack of or sleep disturbance may be seen at an early
stage. Psychotic symptoms, physical and verbal aggression,
psychomotor agitation, and inappropriate sexual conduct
appears during the later stages of dementia. In the progressive
stages of Alzheimer's, some patients tend to develop motor
signs like urinary inconsistencies, myoclonus, gait disturbance,
and tremor (Morris et al., 2014). Additionally, a seizure can
also be witnessed in patients with AD.
This case study examines the examination and treatment of an
elderly Iranian man displaying strange behaviors. According to
his son, Mr Akkad has lost interest in some of the things that he
used to enjoy. At the same time, the client forgets things
frequently. 2 In the last two years, the client has continued to
show a decline in behavioral and cognitive
functioning. Progressive reports show that Mr Akkad
continuously portrays strange behaviors and thoughts, which
have significantly affected his personality to the level that he
does not show any interest in religious family engagements and
criticizes those around him. Mr Akkad has also shown a
dramatic change in attitude, particularly on things that he used
to take seriously, which he tends to ridicule. Mr Akkad’s son
states that his father’s memory loss is progressively getting
worse and experiences difficulty remembering certain things. In
most cases, he sometimes fails to make up the right words in a
conversation and tends to deviate from the main discussion to a
totally unrelated topic. The results of the memory test indicate
grey confabulations after the client is subjected to PMHNP
performance testing. 3 This is a type of mini-mental state
examination. 4 One major area of concern is that the client
scored 18 out of 30 in the mini-mental state examination. Major
deficiencies were shown on calculation, orientation, attention,
and registration. It can be concluded that the client had
moderate dementia.

11. Decision Point 1
3 Begin Exelon (rivastigmine) 1.5 mg orally BID with an
increase to 3 mg orally BID in 2 weeks.
2 I have chosen this treatment approach because Exelon is
considered as an effective and powerful drug that can treat
issues associated with the normal functioning of the brain in
aspects such as thought process, memory, and language. Exelon
can help improve the normal functioning of the brain’s nerve
cells (Fife, 2016). It is one of the first-line agents in the
treatment of Alzheimer's disease and also one of the most
effective. Aricept and Razadyne are second-line agents for
Alzheimer’s disease treatment; therefore, it would be wise not
to use them ahead of Exelon at the beginning of the therapy. It,
therefore, becomes the best option, to begin with.
Exelon is a very effective drug within the first two weeks of
treatment. 4 In four weeks, the client returns to the clinic, and
his son reports a lack of improvement from the medication. Mr
Akkad is still showing a lack of interest in religious services,
which used to interest him and continues to show disinhibited
behaviors. Confabulation can still be noted, and I administered
the MMSE once again, and the score was the same (18 out of
30).
There is a big difference between the actual results and the
results I expected. The client still experienced the same
symptoms and had no improvement from the medication. The
MMSE was administered, and the score was 18 out of 30. The
results are short of my expectations because I thought the client
would show some little improvement.
Decision Point 2
5 Increase Exelon to 4.5 mg orally BID
From the first line of treatment, it is clear that the patient does
not respond to the treatment and does not show any signs of
improvement. Increasing the Exelon to 4.5 mg orally BID would
help determine if the initial dosage was insufficient and could
fasten the recovery process. 2 It helped restore the balance of
neurotransmitters in the brain and seems to improve the

12. awareness, memory, and ability to take part in the daily
activities (Fife, 2016).
By the end of 4 weeks, I expect the client to report a reduction
in the symptoms, start attending religious services, and starts
showing interest in some activities or events that he used to
enjoy. His thought process and personality should show some
improvement as well. 6 When the client reported to the clinic,
his son reports that he is tolerating the medication well. This is
per my expectation. However, he is still concerned that Mr
Akkad has not had much improvement. He also reports that he
has started joining the family for religious services, and the rest
of the family are very happy. However, he is still amused by
some of the things that he used to treat seriously. I am not
worried about the results because I believe the patient is
heading in the right direction, and therapy is starting to show
effect.
Decision Point 3
7 Increase Exelon to 6 mg orally BID
From the second line of treatment, it is evident that the patient
started responding to the medication because he can now attend
religious family service but still amused by some things he used
to treat seriously. Increasing Exelon to 6 mg orally BID will
speed the recovery process and improve cognition, mood, and
ability to engage in daily activities.
It is expected that an increase in dose will be effective and
alleviate the generalized symptoms of Alzheimer's. No side
effects are expected because the dose is appropriate. The patient
should be able to overcome the condition within some time.
However, I would advise the client’s to be patient with him
because the trajectory of treating Alzheimer's is that the disease
is irreversible and can take a significantly long time to control
(Anderson, Murphy & Troyer, 2012).
The clinician needs to educate the patient and family about the
available medical treatments that Mr Akkad can be subjected to
and the reason for choosing Exelon as well as its associated side
effects. They should also be informed about the importance of

13. taking the medications regularly and a sufficient dosage for the
patients. The client’s son should also be counseled regarding
the trajectory of presumptive Alzheimer's disease, considering
the fact that it is an irreversible disease, and even though
cholinesterase inhibitors can stabilize the associated symptoms,
the process can take several months.
Conclusion
Exelon is one of the cholinesterase inhibitor drugs that can
temporarily stabilize and reduce the cognitive decline in
patients suffering from Alzheimer’s disease. In the treatment of
the disease, it is important to consider the first line of treatment
before considering the possibility of using the second line.
References
Alzheimer's Association. (2015). 1 2015 Alzheimer's disease
facts and figures. Alzheimer's & dementia: 1 the journal of the
Alzheimer's Association, 11(3), 332.
Anderson, N. 8 D., Murphy, K. J., & Troyer, A. K.
(2012). 8 Living With Mild Cognitive Impairment: A Guide to
Maximizing Brain Health and Reducing Risk of
Dementia. Oxford: 8 Oxford University Press.
Fife, B. (2016). 8 Stop Alzheimer's Now: 2 How to Prevent and
Reverse Dementia, Parkinson's, ALS, Multiple Sclerosis, and
Other Neurodegenerative Disorders. Colorado Springs,
CO: 8 Piccadilly Books, US.
Morris, J. 1 C., Storandt, M., Miller, J. P., McKeel, D. W.,
Price, J. L., Rubin, E. H., & Berg, L. (2014). 1 Mild cognitive
impairment represents early-stage Alzheimer's disease. Archives
of neurology, 58(3), 397-405.
USW1.539.202010 - NURS-6521N-3/NURS-6521C-3-
ADVANCED PHARMACOLOGY2019 FALL QUARTER 08/26-
11/17-PT27
SafeAssign Drafts

14. Idalmis Espinosa on Wed, Oct 16 2019, 10:46 AM
53% highest match
Submission ID: 5ea3776a-d85d-4c32-a6e3-8df335eb5d3f
· WK8Assgn Espinosa I.(extension).doc
Word Count: 1,495
Attachment ID: 2231614230
53%
Citations (8/8)
1. 1Another student's paper
2. 2Another student's paper
3. 3https://www.studypool.com/questions/856597
4. 4Another student's paper
5. 5Another student's paper
6. 6Another student's paper
7. 7Another student's paper
8. 8Another student's paper
Running Head: DECISION TREE 1
DECISION TREE 2
Assessing and Treating Clients with Alzheimer Disease
Name: Idalmis Espinosa
Institution: Walden University
Date: 10/16/19
Assessing and Treating Clients with Alzheimer Disease
Introduction
1 Alzheimer's disease is a neurodegenerative condition that is
characterized by cognitive and behavioral impairment, which
considerably affects social and occupational running. It is an
irreversible, gradually worsening disease that affects the brain’s
memory and thinking abilities. A person with Alzheimer’s will
slowly start becoming forgetful until it is significantly
noticeable among their family and friends. Later in the
development of this disease, they will also begin to change in
personality and require increasing assistance in completing
simple everyday tasks. 1 AD is a complex disease, and it is

15. improbable that any treatment approach or intervention can
successfully treat it. Approaches are currently focused on
helping patients to maintain mental functions, manage
behavioral symptoms, and reduce the associated
symptoms. Alzheimer's disease has been associated with around
70% of all dementia cases in the world (Alzheimer Association,
2015). 1 The most common first signs of AD include the loss of
memory in the short term eg, forgetting appointments,
frequently misplacing objects, or asking repetitive
questions. The patient’s comprehension and vocabulary become
impoverished. Other cognitive deficits seem to involve several
functions, such as language dysfunction exhibited by difficulty
thinking of common words and errors in writing or speaking
(Morris et al., 2014). Impaired reasoning is often witnessed,
characterized by difficulty in handling tasks and poor
judgment. Other signs and symptoms are seen from the
visuospatial dysfunction, which is the inability to recognize
common objects and faces. Spatial disorientation results in
difficulty of circumnavigating objects. A large majority of
Alzheimer patients show behavioral concerns during the course
of the disease (Alzheimer Association, 2015). Depression,
apathy, lack of or sleep disturbance may be seen at an early
stage. Psychotic symptoms, physical and verbal aggression,
psychomotor agitation, and inappropriate sexual conduct
appears during the later stages of dementia. In the progressive
stages of Alzheimer's, some patients tend to develop motor
signs like urinary inconsistencies, myoclonus, gait disturbance,
and tremor (Morris et al., 2014). Additionally, a seizure can
also be witnessed in patients with AD.
This case study examines the examination and treatment of an
elderly Iranian man displaying strange behaviors. According to
his son, Mr Akkad has lost interest in some of the things that he
used to enjoy. At the same time, the client forgets things
frequently. 2 In the last two years, the client has continued to
show a decline in behavioral and cognitive
functioning. Progressive reports show that Mr Akkad

16. continuously portrays strange behaviors and thoughts, which
have significantly affected his personality to the level that he
does not show any interest in religious family engagements and
criticizes those around him. Mr Akkad has also shown a
dramatic change in attitude, particularly on things that he used
to take seriously, which he tends to ridicule. Mr Akkad’s son
states that his father’s memory loss is progressively getting
worse and experiences difficulty remembering certain things. In
most cases, he sometimes fails to make up the right words in a
conversation and tends to deviate from the main discussion to a
totally unrelated topic. The results of the memory test indicate
grey confabulations after the client is subjected to PMHNP
performance testing. 3 This is a type of mini-mental state
examination. 4 One major area of concern is that the client
scored 18 out of 30 in the mini-mental state examination. Major
deficiencies were shown on calculation, orientation, attention,
and registration. It can be concluded that the client had
moderate dementia.
Decision Point 1
3 Begin Exelon (rivastigmine) 1.5 mg orally BID with an
increase to 3 mg orally BID in 2 weeks.
2 I have chosen this treatment approach because Exelon is
considered as an effective and powerful drug that can treat
issues associated with the normal functioning of the brain in
aspects such as thought process, memory, and language. Exelon
can help improve the normal functioning of the brain’s nerve
cells (Fife, 2016). It is one of the first-line agents in the
treatment of Alzheimer's disease and also one of the most
effective. Aricept and Razadyne are second-line agents for
Alzheimer’s disease treatment; therefore, it would be wise not
to use them ahead of Exelon at the beginning of the therapy. It,
therefore, becomes the best option, to begin with.
Exelon is a very effective drug within the first two weeks of
treatment. 4 In four weeks, the client returns to the clinic, and
his son reports a lack of improvement from the medication. Mr
Akkad is still showing a lack of interest in religious services,

17. which used to interest him and continues to show disinhibited
behaviors. Confabulation can still be noted, and I administered
the MMSE once again, and the score was the same (18 out of
30).
There is a big difference between the actual results and the
results I expected. The client still experienced the same
symptoms and had no improvement from the medication. The
MMSE was administered, and the score was 18 out of 30. The
results are short of my expectations because I thought the client
would show some little improvement.
Decision Point 2
5 Increase Exelon to 4.5 mg orally BID
From the first line of treatment, it is clear that the patient does
not respond to the treatment and does not show any signs of
improvement. Increasing the Exelon to 4.5 mg orally BID would
help determine if the initial dosage was insufficient and could
fasten the recovery process. 2 It helped restore the balance of
neurotransmitters in the brain and seems to improve the
awareness, memory, and ability to take part in the daily
activities (Fife, 2016).
By the end of 4 weeks, I expect the client to report a reduction
in the symptoms, start attending religious services, and starts
showing interest in some activities or events that he used to
enjoy. His thought process and personality should show some
improvement as well. 6 When the client reported to the clinic,
his son reports that he is tolerating the medication well. This is
per my expectation. However, he is still concerned that Mr
Akkad has not had much improvement. He also reports that he
has started joining the family for religious services, and the rest
of the family are very happy. However, he is still amused by
some of the things that he used to treat seriously. I am not
worried about the results because I believe the patient is
heading in the right direction, and therapy is starting to show
effect.
Decision Point 3
7 Increase Exelon to 6 mg orally BID

18. From the second line of treatment, it is evident that the patient
started responding to the medication because he can now attend
religious family service but still amused by some things he used
to treat seriously. Increasing Exelon to 6 mg orally BID will
speed the recovery process and improve cognition, mood, and
ability to engage in daily activities.
It is expected that an increase in dose will be effective and
alleviate the generalized symptoms of Alzheimer's. No side
effects are expected because the dose is appropriate. The patient
should be able to overcome the condition within some time.
However, I would advise the client’s to be patient with him
because the trajectory of treating Alzheimer's is that the disease
is irreversible and can take a significantly long time to control
(Anderson, Murphy & Troyer, 2012).
The clinician needs to educate the patient and family about the
available medical treatments that Mr Akkad can be subjected to
and the reason for choosing Exelon as well as its associated side
effects. They should also be informed about the importance of
taking the medications regularly and a sufficient dosage for the
patients. The client’s son should also be counseled regarding
the trajectory of presumptive Alzheimer's disease, considering
the fact that it is an irreversible disease, and even though
cholinesterase inhibitors can stabilize the associated symptoms,
the process can take several months.
Conclusion
Exelon is one of the cholinesterase inhibitor drugs that can
temporarily stabilize and reduce the cognitive decline in
patients suffering from Alzheimer’s disease. In the treatment of
the disease, it is important to consider the first line of treatment
before considering the possibility of using the second line.
References
Alzheimer's Association. (2015). 1 2015 Alzheimer's disease
facts and figures. Alzheimer's & dementia: 1 the journal of the
Alzheimer's Association, 11(3), 332.
Anderson, N. 8 D., Murphy, K. J., & Troyer, A. K.
(2012). 8 Living With Mild Cognitive Impairment: A Guide to

19. Maximizing Brain Health and Reducing Risk of
Dementia. Oxford: 8 Oxford University Press.
Fife, B. (2016). 8 Stop Alzheimer's Now: 2 How to Prevent and
Reverse Dementia, Parkinson's, ALS, Multiple Sclerosis, and
Other Neurodegenerative Disorders. Colorado Springs,
CO: 8 Piccadilly Books, US.
Morris, J. 1 C., Storandt, M., Miller, J. P., McKeel, D. W.,
Price, J. L., Rubin, E. H., & Berg, L. (2014). 1 Mild cognitive
impairment represents early-stage Alzheimer's disease. Archives
of neurology, 58(3), 397-405.
Rubric Detail
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Content
Name: NURS_6521_Week8_Assignment_Rubric
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Excellent
Good
Fair
Poor
Briefly summarize the patient case study you were assigned,
including each of the three decisions you took for the patient
presented. Be specific.
Points:
Points Range: 18 (18%) - 20 (20%)
The response accurately and thoroughly summarizes in detail
the patient case study assigned, including specific and complete
details on each of the three decisions made for the patient
presented.
Feedback:
Points:

20. Points Range: 16 (16%) - 17 (17%)
The response accurately summarizes the patient case study
assigned, including details on each of the three decisions made
for the patient presented.
Feedback:
Points:
Points Range: 14 (14%) - 15 (15%)
The response inaccurately or vaguely summarizes the patient
case study assigned, including details on each of the three
decisions made for the patient presented.
Feedback:
Points:
Points Range: 0 (0%) - 13 (13%)
The response inaccurately and vaguely summarizes the patient
case study assigned, including details on each of the three
decisions made for the patient presented, or is missing.
Feedback:
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.
Points:
Points Range: 23 (23%) - 25 (25%)
The response accurately and thoroughly explains in detail how
the decisions recommended for the patient case study are
supported by the evidence-based literature.
The response includes specific and relevant outside reference
examples that fully support the explanation provided.
Feedback:
Points:

21. Points Range: 20 (20%) - 22 (22%)
The response accurately explains how the decisions
recommended for the patient case study are supported by the
evidence-based literature.
The response includes relevant outside reference examples that
lend support for the explanation provided that are accurate.
Feedback:
Points:
Points Range: 18 (18%) - 19 (19%)
The response inaccurately or vaguely explains how the
decisions recommended for the patient case study are supported
by the evidence-based literature.
The response includes inaccurate or vague outside reference
examples that may or may not lend support for the explanation
provided or are misaligned to the explanation provided.
Feedback:
Points:
Points Range: 0 (0%) - 17 (17%)
The response inaccurately and vaguely explains how the
decisions recommended for the patient case study are supported
by the evidence-based literature, or is missing.
The response includes inaccurate and vague outside reference
examples that do not lend support for the explanation provided,
or is missing.
Feedback:
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.
Points:

22. Points Range: 18 (18%) - 20 (20%)
The response accurately and thorough explains in detail what
they were hoping to achieve with the decisions recommend for
the patient case study assigned.
The response includes specific and relevant outside reference
examples that fully support the explanation provided.
Feedback:
Points:
Points Range: 16 (16%) - 17 (17%)
The response accurately explains what they were hoping to
achieve with the decisions recommended for the patient case
study assigned.
The response includes relevant outside reference examples that
lend support for the explanation provided that are accurate.
Feedback:
Points:
Points Range: 14 (14%) - 15 (15%)
The response inaccurately or vaguely explains what they were
hoping to achieve with the decisions recommended for the
patient case study assigned.
The response includes inaccurate or vague outside reference
examples that may or may not lend support for the explanation
provided or are misaligned to the explanation provided.
Feedback:
Points:
Points Range: 0 (0%) - 13 (13%)
The response inaccurately and vaguely explains what they were
hoping to achieve with the decisions recommended for the
patient case study assigned, or is missing.

23. The response includes inaccurate and vague outside reference
examples that do not lend support for the explanation provided,
or is missing.
Feedback:
Explain any difference between what you expected to achieve
with each of the decisions and the results of the decisions in the
exercise. Describe whether they were different. Be specific and
provide examples.
Points:
Points Range: 18 (18%) - 20 (20%)
The response accurately and clearly explains in detail any
differences between what they expected to achieve with each of
the decisions and the results of the decisions in the exercise.
The response provides specific, accurate, and relevant examples
that fully support whether there were differences between the
decisions made and the decisions available in the exercise.
Feedback:
Points:
Points Range: 16 (16%) - 17 (17%)
The response accurately explains any differences between what
they expected to achieve with each of the decisions and the
results of the decisions in the exercise.
The response provides accurate examples that support whether
there were differences between the decisions made and the
decisions available in the exercise.
Feedback:
Points:
Points Range: 14 (14%) - 15 (15%)
The response inaccurately or vaguely explains any differences
between what they expected to achieve with each of the

24. decisions and the results of the decisions in the exercise.
The response provides inaccurate or vague examples that may or
may not support whether there were differences between the
decisions made and the decisions available in the exercise.
Feedback:
Points:
Points Range: 0 (0%) - 13 (13%)
vaguely explains in detail any differences between what they
expected to achieve with each of the decisions and the results of
the decisions in the exercise, or is missing.
The response provides inaccurate and vague examples that do
not support whether there were differences between the
decisions made and the decisions available in the exercise, or is
missing.
Feedback:
Written Expression and Formatting - Paragraph Development
and Organization:
Paragraphs make clear points that support well developed ideas,
flow logically, and demonstrate continuity of ideas. Sentences
are carefully focused--neither long and rambling nor short and
lacking substance.
Points:
Points Range: 5 (5%) - 5 (5%)
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity.
Feedback:
Points:
Points Range: 4 (4%) - 4 (4%)
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity 80% of the time.
Feedback:

25. Points:
Points Range: 3.5 (3.5%) - 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity 60%–79% of the time.
Feedback:
Points:
Points Range: 0 (0%) - 3 (3%)
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity less than 60% of the time.
Feedback:
Written Expression and Formatting - English writing standards:
Correct grammar, mechanics, and proper punctuation
Points:
Points Range: 5 (5%) - 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
Feedback:
Points:
Points Range: 4 (4%) - 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors
Feedback:
Points:
Points Range: 3.5 (3.5%) - 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation
errors
Feedback:
Points:
Points Range: 0 (0%) - 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors
that interfere with the reader’s understanding
Feedback:

26. Written Expression and Formatting - The paper follows correct
APA format for title page, headings, font, spacing, margins,
indentations, page numbers, running head, parenthetical/in-text
citations, and reference list.
Points:
Points Range: 5 (5%) - 5 (5%)
Uses correct APA format with no errors
Feedback:
Points:
Points Range: 4 (4%) - 4 (4%)
Contains a few (1–2) APA format errors
Feedback:
Points:
Points Range: 3.5 (3.5%) - 3.5 (3.5%)
Contains several (3–4) APA format errors
Feedback:
Points:
Points Range: 0 (0%) - 3 (3%)
Contains many (≥ 5) APA format errors
Feedback:
Show Descriptions Show Feedback
Briefly summarize the patient case study you were assigned,
including each of the three decisions you took for the patient
presented. Be specific.--
Levels of Achievement:
Excellent 18 (18%) - 20 (20%)
The response accurately and thoroughly summarizes in detail
the patient case study assigned, including specific and complete
details on each of the three decisions made for the patient
presented.
Good 16 (16%) - 17 (17%)
The response accurately summarizes the patient case study

27. assigned, including details on each of the three decisions made
for the patient presented.
Fair 14 (14%) - 15 (15%)
The response inaccurately or vaguely summarizes the patient
case study assigned, including details on each of the three
decisions made for the patient presented.
Poor 0 (0%) - 13 (13%)
The response inaccurately and vaguely summarizes the patient
case study assigned, including details on each of the three
decisions made for the patient presented, or is missing.
Feedback:
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.--
Levels of Achievement:
Excellent 23 (23%) - 25 (25%)
The response accurately and thoroughly explains in detail how
the decisions recommended for the patient case study are
supported by the evidence-based literature.
The response includes specific and relevant outside reference
examples that fully support the explanation provided.
Good 20 (20%) - 22 (22%)
The response accurately explains how the decisions
recommended for the patient case study are supported by the
evidence-based literature.
The response includes relevant outside reference examples that
lend support for the explanation provided that are accurate.
Fair 18 (18%) - 19 (19%)
The response inaccurately or vaguely explains how the
decisions recommended for the patient case study are supported
by the evidence-based literature.

28. The response includes inaccurate or vague outside reference
examples that may or may not lend support for the explanation
provided or are misaligned to the explanation provided.
Poor 0 (0%) - 17 (17%)
The response inaccurately and vaguely explains how the
decisions recommended for the patient case study are supported
by the evidence-based literature, or is missing.
The response includes inaccurate and vague outside reference
examples that do not lend support for the explanation provided,
or is missing.
Feedback:
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.--
Levels of Achievement:
Excellent 18 (18%) - 20 (20%)
The response accurately and thorough explains in detail what
they were hoping to achieve with the decisions recommend for
the patient case study assigned.
The response includes specific and relevant outside reference
examples that fully support the explanation provided.
Good 16 (16%) - 17 (17%)
The response accurately explains what they were hoping to
achieve with the decisions recommended for the patient case
study assigned.
The response includes relevant outside reference examples that
lend support for the explanation provided that are accurate.
Fair 14 (14%) - 15 (15%)
The response inaccurately or vaguely explains what they were
hoping to achieve with the decisions recommended for the
patient case study assigned.

29. The response includes inaccurate or vague outside reference
examples that may or may not lend support for the explanation
provided or are misaligned to the explanation provided.
Poor 0 (0%) - 13 (13%)
The response inaccurately and vaguely explains what they were
hoping to achieve with the decisions recommended for the
patient case study assigned, or is missing.
The response includes inaccurate and vague outside reference
examples that do not lend support for the explanation provided,
or is missing.
Feedback:
Explain any difference between what you expected to achieve
with each of the decisions and the results of the decisions in the
exercise. Describe whether they were different. Be specific and
provide examples.--
Levels of Achievement:
Excellent 18 (18%) - 20 (20%)
The response accurately and clearly explains in detail any
differences between what they expected to achieve with each of
the decisions and the results of the decisions in the exercise.
The response provides specific, accurate, and relevant examples
that fully support whether there were differences between the
decisions made and the decisions available in the exercise.
Good 16 (16%) - 17 (17%)
The response accurately explains any differences between what
they expected to achieve with each of the decisions and the
results of the decisions in the exercise.
The response provides accurate examples that support whether
there were differences between the decisions made and the
decisions available in the exercise.
Fair 14 (14%) - 15 (15%)
The response inaccurately or vaguely explains any differences
between what they expected to achieve with each of the

30. decisions and the results of the decisions in the exercise.
The response provides inaccurate or vague examples that may or
may not support whether there were differences between the
decisions made and the decisions available in the exercise.
Poor 0 (0%) - 13 (13%)
vaguely explains in detail any differences between what they
expected to achieve with each of the decisions and the results of
the decisions in the exercise, or is missing.
The response provides inaccurate and vague examples that do
not support whether there were differences between the
decisions made and the decisions available in the exercise, or is
missing.
Feedback:
Written Expression and Formatting - Paragraph Development
and Organization:
Paragraphs make clear points that support well developed ideas,
flow logically, and demonstrate continuity of ideas. Sentences
are carefully focused--neither long and rambling nor short and
lacking substance.--
Levels of Achievement:
Excellent 5 (5%) - 5 (5%)
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity.
Good 4 (4%) - 4 (4%)
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity 80% of the time.
Fair 3.5 (3.5%) - 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity 60%–79% of the time.
Poor 0 (0%) - 3 (3%)
Paragraphs and sentences follow writing standards for flow,
continuity, and clarity less than 60% of the time.
Feedback:
Written Expression and Formatting - English writing standards:

31. Correct grammar, mechanics, and proper punctuation--
Levels of Achievement:
Excellent 5 (5%) - 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
Good 4 (4%) - 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors
Fair 3.5 (3.5%) - 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation
errors
Poor 0 (0%) - 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors
that interfere with the reader’s understanding
Feedback:
Written Expression and Formatting - The paper follows correct
APA format for title page, headings, font, spacing, margins,
indentations, page numbers, running head, parenthetical/in-text
citations, and reference list.--
Levels of Achievement:
Excellent 5 (5%) - 5 (5%)
Uses correct APA format with no errors
Good 4 (4%) - 4 (4%)
Contains a few (1–2) APA format errors
Fair 3.5 (3.5%) - 3.5 (3.5%)
Contains several (3–4) APA format errors
Poor 0 (0%) - 3 (3%)
Contains many (≥ 5) APA format errors
Feedback:
Total Points: 100
Name: NURS_6521_Week8_Assignment_Rubric
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Required Readings (click to expand/reduce)
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)

34. · 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)
American Academy of Family Physicians. (2019). Dementia.
Retrieved from
http://www.aafp.org/afp/topicModules/viewTopicModule.htm?to
picModuleId=5
This website provides information relating to the diagnosis,
treatment, and patient education of dementia. It also presents
information on complications and special cases of dementia.
Document: Mid-Term Summary & Study Guide (PDF)
Required Media (click to expand/reduce)
Laureate Education (Producer). (2019b). Alzheimer’s disease
[Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of
decisions for prescribing and recommending
pharmacotherapeutics to treat Alzheimer’s disease.
Laureate Education (Producer). (2019e). Complex regional pain
disorder [Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of
decisions for prescribing and recommending
pharmacotherapeutics to treat complex regional pain disorders.