Last Updated on January 27, 2023 by Admin
Sabrina is a 26 year old female who has just been diagnosed with multiple sclerosis.
For the assignment we will use the decision tree on COMPLEX REGIONAL PAIN DISORDER. The decision tree is available under Resources, Required Media for Week 6. I included a screen shot below for your convenience. Please DO NOT use the decision tree on Alzheimer’s disease. You will receive a zero.
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.
- In this scenario, pretend you are seeing this patient for a visit at your office. Decide which one of the three decisions would be most appropriate (decision point 1).
- Once you click on your decision, the tree will provide information on what happened since the last visit (4 weeks ago) and you need to decide which of the next three options will be the best (decision point 2). Once you click on your decision, the tree will guide you to the final visit (4 weeks later), provide information on what happened the last 4 weeks and present you with the next three decisions (decision point 3).
- Include a brief description of the most important information from the patient case.
- Then describe your decisions at decision points #1, #2 and #3. Note, points are not awarded based on what your decision at each step was (there is no wrong answer, though there is a more appropriate choice at each decision point).
- 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 (EBL). Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
- EBL refers to primary research studies done on this disease state and the treatments at each decision point. Primary research includes randomized controlled trials and systematic reviews.
- You need to provide a short summary of the research study and cite the study. Make sure the study fits your patient.
- Do NOT cite a textbook or any Walden material. You can use the Reference Lists from the textbook, Walden material and treatment guidelines to identify primary research studies, but you must cite the primary research studies.
- 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.
- All of us wants our patients to improve. EBL indicates a.) time to therapeutic effect, b.) the size of the therapeutic effect, c.) side effects one can expect from a drug treatment and d.) if one treatment is more effective than others.
- For this section, you need to include the results from the study you based your decision on for decision points #1, #2 and #3. You must cite the primary research studies.
- 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.
- Here you need to compare the results from the EBL to what happened in practice (the feedback provided by the decision tree).
- Refer to a.) time to therapeutic effect, b.) the size of the therapeutic effect, c.) side effects one can expect from a drug treatment and d.) if one treatment is more effective than others.
HERE IS THE CASE STUDY:
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.
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?
DECISION TREE LINK FOR COMPLEX REGIONAL PAIN RELIEF:
http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_07/index.html
REQUIRED READING
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
- Chapter 11, “Basic Principles of Neuropharmacology” (pp. 67–71)
- Chapter 12, “Physiology of the Peripheral Nervous System” (pp. 72–81)
- Chapter 12, “Muscarinic Agonists and Cholinesterase Inhibitors” (pp. 82–89)
- Chapter 14, “Muscarinic Antagonists” (pp. 90-98)
- Chapter 15, “Adrenergic Agonists” (pp. 99–107)
- Chapter 16, “Adrenergic Antagonists” (pp. 108–119)
- Chapter 17, “Indirect-Acting Antiadrenergic Agents” (pp. 120–124)
- Chapter 18, “Introduction to Central Nervous System Pharmacology” (pp. 125–126)
- Chapter 19, “Drugs for Parkinson Disease” (pp. 127–142)
- Chapter 20, “Drugs for Alzheimer Disease” (pp. 159–166)
- Chapter 21, “Drugs for Seizure Disorders” (pp. 150–170)
- Chapter 22, “Drugs for Muscle Spasm and Spasticity” (pp. 171–178)
- Chapter 59, “Drug Therapy of Rheumatoid Arthritis” (pp. 513–527)
- Chapter 60, “Drug Therapy of Gout” (pp. 528–536)
- Chapter 61, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 537–556)
Grading Rubric
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific.–
Excellent18 (18%) – 20 (20%)
Good16 (16%) – 17 (17%)
Fair14 (14%) – 15 (15%)
Poor0 (0%) – 13 (13%)
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.–
Excellent23 (23%) – 25 (25%)
Good20 (20%) – 22 (22%)
Fair18 (18%) – 19 (19%)
Poor0 (0%) – 17 (17%)
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.–
Excellent18 (18%) – 20 (20%)
Good16 (16%) – 17 (17%)
Fair14 (14%) – 15 (15%)
Poor0 (0%) – 13 (13%)
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.–
Excellent18 (18%) – 20 (20%)
Good16 (16%) – 17 (17%)
Fair14 (14%) – 15 (15%)
Poor0 (0%) – 13 (13%)
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.–
Excellent5 (5%) – 5 (5%)
Good4 (4%) – 4 (4%)
Fair3.5 (3.5%) – 3.5 (3.5%)
Poor0 (0%) – 3 (3%)
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation–
Excellent5 (5%) – 5 (5%)
Good4 (4%) – 4 (4%)
Fair3.5 (3.5%) – 3.5 (3.5%)
Poor0 (0%) – 3 (3%)
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.–
Excellent5 (5%) – 5 (5%)
Good4 (4%) – 4 (4%)
Fair3.5 (3.5%) – 3.5 (3.5%)
Poor0 (0%) – 3 (3%)
Total Points: 100
EXPERT ANSWER AND EXPLANATION
Decision Tree for Neurological and Musculoskeletal Disorders
The assigned case was about a 26-year-old woman of Korean descent who visited my office for her first appointment after being admitted for acute mania for 21 days. The patient was diagnosed with bipolar 1 disorder. The patient looked quite busy upon arriving at the office. She shifted from side to side and played with things on my desk. She noted that she does not believe that she has bipolar because she likes to sing, talk, cook, and dance.
Her genetic test shows that she is positive for the CYP2D6*10 allele. She notes that she has not taken lithium since getting out of the hospital two weeks ago. The mental status exam shows that she is oriented and alert and she reports that her mood is euthymic. The patient denies hallucinations and has a broad affect. She underwent the Young Mania Rating Scale (YMRS) test and scored 22, meaning that she has bipolar 1 disorder.
Hence, I recommended that she beings Lithium 300 mg orally BID. My second decision was to assess the patient’s rationale for non-compliance to elicit the reason for non-compliance and educate the client re: drug effects and pharmacology. My last decision was to change lithium to sustained-release preparation at the same dose and frequency.
Justification of the Decisions
Lithium has been recommended by many evidence-based studies as the most effective treatment for manic symptoms in bipolar 1 disorder. For instance, a study done by Malhi et al. (2017) found that lithium is an efficient mood stabilizer mostly used to treat patients with bipolar disorder.
Also, Berk et al. (2017) conducted a single-blinded equivalence randomized controlled maintenance trial using 41 patients to identify the most effective medication in treating bipolar 1 disorder by comparing quetiapine and lithium.
The authors found that lithium is the best medication in limiting white matter reduction in bipolar patients during the onset of the disease. Another study done by Liu et al. (2020) found that lithium is effective in the treatment of manic symptoms, especially when combined with SGAs.
Intended Achievements
I was hoping to reduce the patient’s manic symptoms by recommending that she starts Lithium 300 mg orally BID. I based my decision on the studies done by Berk et al. (2017), Malhi et al. (2017), and Liu et al. (2020). All these authors support the role of lithium in treating bipolar conditions. I hoped to understand why the patient is not compliant with the prescribed medications and improve her compliance rate through education.
López-Campos et al. (2019) note that caregivers can improve patients’ compliance and adherence to treatment plans by becoming aware of the issues related to compliance and educate the patient as soon as they reach the health system. The authors note that more informed patients are more likely to comply with treatment plans.
Difference Between Treatment Expectations and Results
I expected that the patient’s symptoms will reduce significantly after taking Lithium 300 mg orally BID for four weeks. However, when she returned, she reported that she was feeling the same way she came for her first visit. The second decision expected that the patient will improve her adherence to the treatment plan, and hence the medication will become more effective and improve her symptoms.
However, when she returned, she reported diarrhea, nausea, and that she does not take the medication as prescribed. Hence, my last decision was aimed at reducing the side effects of the medication and improve her symptoms.
References
Berk, M., Dandash, O., Daglas, R., Cotton, S. M., Allott, K., Fornito, A., … & Yücel, M. (2017). Neuroprotection after a first episode of mania: a randomized controlled maintenance trial comparing the effects of lithium and quetiapine on grey and white matter volume. Translational psychiatry, 7(1), e1011-e1011. https://www.nature.com/articles/tp2016281
Liu, Y., Liang, J., Xia, Q., Zhou, X., & Xie, X. (2020). Effects of Lithium Combined with Second-Generation Antipsychotics for the Treatment of Manic Episodes in Patients with Bipolar Disorder: A Naturalistic Study in China. Neuropsychiatric disease and treatment, 16, 2623–2632. https://doi.org/10.2147/NDT.S270596
López-Campos, J. L., Quintana Gallego, E., & Carrasco Hernández, L. (2019). Status of and strategies for improving adherence to COPD treatment. International journal of chronic obstructive pulmonary disease, 14, 1503–1515. https://doi.org/10.2147/COPD.S170848
Malhi, G. S., Gessler, D., & Outhred, T. (2017). The use of lithium for the treatment of bipolar disorder: recommendations from clinical practice guidelines. Journal of affective disorders, 217, 266-280. https://doi.org/10.1016/j.jad.2017.03.052
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