Change To Prevent Matching: Assessing And Treating Clients ✓ Solved

11 Change to Prevent Matching. Assessing and Treating Clients

Assessing and treating clients with dementia involves understanding the complexities of Alzheimer's disease (AD), which is characterized by progressive cognitive decline and is becoming increasingly prevalent in older adults. This paper discusses a case scenario of a 76-year-old Iranian male with moderate dementia exhibiting troubling symptoms over the past two years. His symptoms include memory loss, personality changes, and behavioral issues, indicating a significant decline in cognitive function as assessed by a Mini-Mental State Exam (MMSE) score of 18 out of 30. Such cases necessitate careful decision-making regarding pharmacological interventions while considering ethical implications.

Decision Point One: Initiation of Treatment

For this case, the first decision involved initiating treatment with Donepezil (Aricept), a cholinesterase inhibitor. This decision was influenced by the understanding that AD results from a decrease in acetylcholine due to the degeneration of cholinergic neurons (Stahl, 2014). By increasing the availability of acetylcholine, we aim to enhance cognitive functions such as memory and attention.

The expectation of using Donepezil was to observe improvements in MMSE scores and the patient's engagement in social activities. However, after four weeks of treatment, the son reported minimal improvements. The MMSE score remained at 18, indicating a lack of anticipated therapeutic response, which can occur as medications like Donepezil often take time to manifest their effects (Birks & Harvey, 2018).

Decision Point Two: Dose Adjustment

Given the limited response to the initial dose, the second decision was to increase the dosage of Donepezil to 10 mg at bedtime. Evidence suggests that higher doses can yield better therapeutic outcomes (Birks & Harvey, 2018). The rationale for this adjustment aimed to bolster the therapeutic response and alleviate the patient's symptoms.

The goal was to improve the patient's engagement in familial and religious activities, thereby enhancing the quality of life. Following this decision, the son reported that the patient appeared to respond better to the 10 mg dose, participating more actively during family interactions. However, the family also raised concerns about the patient's new behaviors, such as inappropriate laughter at previously serious matters, indicating potential side effects or neurobehavioral changes (Stahl, 2014).

Decision Point Three: Continued Treatment

The third decision was to maintain the patient on Donepezil 10 mg. Although the patient displayed some improvements, there was a need for ongoing evaluation to determine the dosage's efficacy and side effects. Longitudinal treatment often requires time to observe significant changes in symptoms (Stahl, 2014).

The focus on maintaining the dosage stemmed from the notion that abrupt changes could lead to further instability in symptoms, and given the patient's gains in social interaction, it was deemed prudent to allow additional time for adaptation.

Ethical Considerations

Throughout this process, ethical considerations were paramount. It is vital to provide care that respects patient dignity, particularly since most dementia patients are elderly and often vulnerable to adverse drug interactions due to polypharmacy (Casey et al., 2010). Understanding the risks of diminished hepatic function is essential in minimizing toxicity and side effects from medication.

Furthermore, the importance of involving family members in care discussions is critical, as they are integral to the support network for patients with dementia. Educating families about the nature of AD and realistic expectations for pharmacological treatment can alleviate burdens and emotional distress (McCormack et al., 2017).

Conclusion

The increasing prevalence of dementia necessitates strategic approaches to assessment and treatment, emphasizing both medical interventions and ethical considerations. As treatment for patients with Alzheimer's progresses, healthcare providers must remain vigilant regarding the balance between efficacy, side effects, and the patient's overall well-being.

References

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