NURS 6630 Dementia Decision Tree Assignment Guide

The case is the assignment, so read it as a clinician rather than as a set of options. Mr. Akkad is elderly, Iranian, and brought to the clinic by his son — and every one of those three facts changes what a defensible decision looks like. Age narrows the safe starting dose and raises the weight you must give to bradycardia, falls and anticholinergic burden. The fact that a family member is the historian means your objective data on response arrives second-hand, so the reliability of that reporting is part of your clinical reasoning, not a detail. And the cultural context shapes what the family understands the diagnosis to be and what they expect a medication to do. Write the case back into your rationale explicitly, because a decision paragraph that would read identically for a 40-year-old with no family present is one that has not used the case at all.

The pharmacology you are being tested on is cholinesterase inhibition, and the three options are not interchangeable. Donepezil, rivastigmine and galantamine all raise synaptic acetylcholine, but they differ in half-life, in dosing frequency, in whether a transdermal route is available, and in how their gastrointestinal and cardiac effects present. That is the material difference the marker is looking for. Say why the agent you chose fits *this* patient — once-daily bedtime dosing where a son is supervising adherence is an argument; tolerability in an older man with unknown cardiac history is an argument; 'it is commonly used' is not. Name the pharmacokinetic property you are relying on, because the objective for this week asks you to analyse pharmacokinetic and pharmacodynamic processes and a rationale with no mechanism in it cannot satisfy that. Route matters too, since a transdermal option changes the conversation entirely when a family member is the one making sure a daily tablet is actually swallowed.

Decision Two is where most write-ups lose marks, because the case gives you a non-response and there are three genuinely different readings of it. A patient who shows no change at four weeks may be under-dosed, may be on the wrong agent, or may simply not have had enough time — cholinesterase inhibitors are conventionally judged over months rather than weeks. Your job is to say which of those you concluded and *why the other two were rejected*. Note also what the case tells you about side effects: an absence of adverse effects at the starting dose is positive evidence for titrating up rather than switching, and saying so shows you read the objective data rather than reaching for a change because the last decision did not work. The assignment asks you to explain any difference between what you expected and what happened, so state the expectation as a measurable one before you evaluate it.

Expected results have to be specific enough to be wrong. "The patient will improve" cannot be evaluated at the next decision point, which is precisely what the assignment then asks you to do. Commit to a domain, a magnitude and a timeframe — cognition on a repeatable measure, day-to-day function reported by the son, or a named behaviour such as returning to religious activity — and give the window over which you expect it. Then, when the case supplies the actual outcome, the comparison writes itself and the "why were they different" question has something to bite on. This is also what separates the three decision paragraphs from each other, since without stated expectations they collapse into three restatements of the same drug choice. A stated expectation also protects you at the next decision point, because a result you never predicted cannot be called a surprise and cannot be explained as one either.

The ethical and legal section is a required element and in dementia it is not generic. The specific problem is decisional capacity: the person taking the medication may not be the person consenting to it, and the son who brings his father to the clinic and reports on his response is not automatically his legal decision-maker. Address who holds capacity, how you would assess it rather than assume it, what surrogate arrangement applies, and how you would keep Mr. Akkad himself in the conversation to whatever extent he can be. Communication is named in the brief alongside the treatment plan, so say something concrete about how you would explain a slow, symptomatic, non-curative therapy to a family that may be hoping for reversal. Beneficence and autonomy are the right principles to reach for, but they earn nothing until they are attached to the specific decision you made about this patient.

Finally, the mechanics the brief states. Three academic resources minimum, and the course text does not count toward that three — so the Stahl chapters can support your reasoning but cannot be your evidence base. Each decision needs its rationale supported by references to the Learning Resources, which means citations distributed across the three decisions rather than banked in an introduction. And the structure is fixed by the brief itself: which decision, why, what you hoped to achieve, and how the result differed — four questions at Decision One and three at Decisions Two and Three. Answer them in that order under their own headings, because a marker working through a rubric built on those questions should not have to hunt for the answers. Give each decision its own citations as you draft rather than at the end, since a rationale written first and referenced afterwards tends to acquire sources that agree with it rather than sources that shaped it.