Dementia is a general term for diseases and disorders that are characterized by a reduction in language, memory, problem-solving, and other thinking abilities that impacts someone's capability to carry out daily activities. Alzheimer’s primarily causes of dementia. Alzheimer’s is a loss of memory, and it occurs when the brain cells located in the hippocampus region, which is the center for memory and learning, are affected, declining the ability of someone's mind to acquire and store new information. This assignment involves assessing and treating an Iranian male adult with Alzheimer’s disorder as well as outlines an ethical consideration that will impact the treatment (Robinson et al., 2015 ).
Decision 1
Begin the client with Aricept (donepezil) 5 mg orally at Bedtime
Aricept is a medication that deters cholinesterase, which serves as a neurotransmitter. The drug works by releasing acetyl-cholinesterase inhibitors. The inhibitors prevent the acetyl-cholinesterase enzyme from synthesizing acetylcholine into acetate and choline, thereby increasing the level as well as the duration of the neurotransmitter in the central nervous system, which reduces cognitive delays in patients with Alzheimer condition and promotes their mental wellness. In additional, Aricept drug is accepted since it is highly effective in cognitive regeneration and hence assists in treating Alzheimer's disorder (Cummings et al., 2015 ).
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The primary reason for putting the client on the Aricept medication treatment regimen was to quickly relieve him from Alzheimer’s symptoms so that he can resume performing his daily activities. I was hoping the medication would reduce the client's symptoms after weeks with no side effects.
After four weeks, the patient was accompanied by his son to the clinic, who reported that his father was “no better,” and still, he does not attend religious activities. Furthermore, his behavior progresses to deteriorate and experiences confabulation. The results were a complete deviation from the anticipated outcome, and this was due to a low dosage, which reduced the effectiveness of the drug.
Decision 2
Increase Aricept to 10 mg orally at bedtime
Since 5mg dosage of Aricept did not manage Alzheimer’s symptoms effectively, and as a result, the patient conditions progressed to deteriorate. This called for an increase in the dosage of Aricept medication from 5 mg to 10 mg orally at bedtime every day. According to a study performed by Pedrini et al. (2019), administering a client with 10 mg/day Aricept drug for a single year resulted in minimized atrophy of the ganglia of the brain signifying that the dosage is effective in curing Alzheimer’s illness. The objective of this treatment was that the patient's Alzheimer’s symptoms would reduce, and he would become oriented to participate in religious activities, and his behavior would improve as well as be able to carry out his daily activities chores (Meguro et al., 2014).
After four weeks, the client visited the clinic accompanied by his son, who reported that his father is taking the medication, but his health is no better. He also indicates that his father, together with his family, is attending religious services, and his entire family members are happy. Alzheimer's symptoms in the client have reduced substantially than reported in the first treatment, and this shows that Aricept 10mg/daily is effective in treating Alzheimer’s condition. Also, the dosage did not cause any side effects to the patient.
Decision 3
Continue the patient on Aricept 10 mg orally at bedtime
Medicating the client with Aricept 10 mg orally at bedtime assisted in the reduction of the client's Alzheimer’s side effects significantly with fewer side effects. Therefore it would be medically correct to continue the client on 10mg of Aricept drug orally at bedtime and inform him as well as the son that the medication would take several months before managing the client symptoms effectively (Stahl, 2014). Raising the dosage to 15mg/day is not a good idea since it could contribute to cardiac and gastrointestinal side effects.
Ethical Consideration
In healthcare, ethical considerations are significant and should be observed when treating a patient, and all aspects should be upheld. For example, the Psychiatric-mental health nurse practitioner should obtain informed consent from the client before the treatment. Also, the nurse should ensure the confidentiality of patient health information.
References
Cummings, J., Lai, T. J., Hemrungrojn, S., Mohandas, E., Yun Kim, S., Nair, G., & Dash, A. (2016). Role of donepezil in the management of neuropsychiatric symptoms in Alzheimer's disease and dementia with Lewy bodies.: CNS neuroscience & therapeutics , 22 (3), 159-166
Meguro, K., Ouchi, Y., Akanuma, K., Meguro, M., & Kasai, M. (2014). Donepezil can improve daily activities and promote rehabilitation for severe Alzheimer's patients in long-term care health facilities. BMC neurology, 14, 243. doi:10.1186/s12883-014-0243-7
Pedrini, S. Morici, M., & Martins, R. N. (2019). Current and Prospective Treatments for Alzheimer's Disease (and Other Neurodegenerative Diseases). Neurodegeneration and Alzheimer's Disease: The Role of Diabetes, Genetics, Hormones, and Lifestyle , 391-442.
Robinson, L., Tang, E., & Taylor, J. P. (2015). Dementia: timely diagnosis and early intervention. Bmj , 350 , h3029.
Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press
