Fiji National University Advanced Pathophysiology Case Study

Musculoskeletal Function: 

G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic for the first time complaining of a long history of bilateral knee discomfort that becomes worse when it rains and usually feels better when the weather is warm and dry. “My arthritis hasn’t improved a bit this summer though,” she states. Discomfort in the left knee is greater than in the right knee. She has also suffered from low back pain for many years, but recently it has become worse. She is having difficulty using the stairs in her home. The patient had recently visited a rheumatologist who tried a variety of NSAIDs to help her with pain control. The medications gave her mild relief but also caused significant and intolerable stomach discomfort. Her pain was alleviated with oxycodone. However, when she showed increasing tolerance and began insisting on higher doses of the medication, the physician told her that she may need surgery and that he could not prescribe more oxycodone for her. She is now seeking medical care at the Family Practice Clinic. Her knees started to get significantly more painful after she gained 20 pounds during the past nine months. Her joints are most stiff when she has been sitting or lying for some time and they tend to “loosen up” with activity. The patient has always been worried about osteoporosis because several family members have been diagnosed with the disease. However, nonclinical manifestations of osteoporosis have developed.

Case Study Questions

• Define osteoarthritis and explain the differences with osteoarthrosis. List and analyze the risk factors that are presented on the case that contribute to the diagnosis of osteoarthritis.

Specify the main differences between osteoarthritis and rheumatoid arthritis, make sure to include clinical manifestations, major characteristics, joints usually affected and diagnostic methods.

Describe the different treatment alternatives available, including non-pharmacological and pharmacological that you consider are appropriate for this patient and why.

• How would you handle the patient concern about osteoporosis? Describe your interventions and education you would provide to her regarding osteoporosis.

Neurological Function:
H.M is a 67-year-old female, who recently retired from being a school teacher for the last 40 years. Her husband died 2 years ago due to complications of a CVA. Past medical history: hypertension controlled with Olmesartan 20 mg by mouth once a day. Family history no contributory. Last annual visits with PCP with normal results. She lives by herself but her children live close to her and usually visit her two or three times a week.
Her daughter start noticing that her mother is having problems focusing when talking to her, she is not keeping things at home as she used to, often is repeating and asking the same question several times and yesterday she has issues remembering her way back home from the grocery store.

Case Study Questions

Name the most common risks factors for Alzheimer’s disease

Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.

Define and describe explicit and implicit memory.

Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association

What would be the best therapeutic approach on C.J.

Submission Instructions:

You must complete both case studies.

1. Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
2. You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
3. All replies must be constructive and use literature where possible
4. ResourcesTextbook(s)
   · Delugash, L., Story, L. (2020). Applied Pathophysiology for the Advanced Practice
   Nurse. Burlington, MA: Jones and Bartlett Learning. ISBN: 978-1284150452
   · American Psychological Association. (2019). Publication manual of the American
   Psychological Association (7th ed.). ISBN: 9781433832154
   Recommended
   · McCance, C. K., Huether, E. S., Brashers, L. V., & Rote, S. N. (2019). Pathophysiology:
   The biologic basis for disease in adult and children (8th ed). Elsevier. ISBN:
   9780323413176
   · Maria T. Codina Leik N-C, A. (2017). Family nurse practitioner certification intensive
   review: Fast facts and practice questions (3rd ed.). Springer Publishing Company
   · Fitzgerald, A. M. (2017). Nurse Practitioner Certification Examination and Practice
   Preparation. Philadelphia, PA: F.A. Davis Company. ISBN: 978-0803660427
   · Barkley, T. W., Jr. (2021). Family nurse practitioner certification review/clinical
   update continuing education course. Barkley & Associates, Inc.

 POST

Musculoskeletal FunctionDefine osteoarthritis and explain the differences with osteoarthrosis. List and analyze the risk factors that are presented on the case that contribute to the diagnosis of osteoarthritis. Osteoarthritis (OA) is a condition in which the joints become inflamed (Dlugasch & Story, 2019, p. 611). It’s also known as degenerative joint disease or wear and tear arthritis (Dlugasch & Story, 2019, p. 611). Osteoarthritis is frequently confused with osteoarthrosis, which refers to joint degradation (Dlugasch & Story, 2019, p. 611).In middle-aged and older people, OA is the most frequent form of joint disease and the major cause of disability (McCance & Huether, 2018, p. 1445). It is more common in women than in males over the age of 50, and it rises with age (McCance & Huether, 2018, p. 1445). It is widely dispersed throughout the body’s peripheral and central joints (hips, hands, knees, and spine) (McCance & Huether, 2018, p. 1445). C.J. risk factors that contribute to the diagnosis of osteoarthritis are her age and gender, weight, complaints of a long history of bilateral knee discomfort, and she has also suffered from low back pain for many years that has become worse.Specify the main differences between osteoarthritis and rheumatoid arthritis, make sure to include clinical manifestations, major characteristics, joints usually affected and diagnostic methods. OA is a localized joint disease marked by degeneration of articulating cartilage and its underlying bone, as well as bony outgrowth (Dlugasch & Story, 2019, p. 611). Rheumatoid arthritis (RA) is a multi-joint autoimmune disease that affects the entire body (Dlugasch & Story, 2019, p. 615). The synovial membrane is affected by the inflammatory process, but it can also impact other organs such as the heart, skin, and eyes (Dlugasch & Story, 2019, p. 615).Joint pain that is aggravated by movement or weight bearing and relieved by rest, joint tenderness with light pressure, joint stiffness, especially when rising in the morning, limited joint range of motion, joint deformities, enlarged hard joints due to bone thickening and hypertrophy of the joint capsule, crepitus, and minimal swelling are all clinical manifestations of OA (Dlugasch & Story, 2019, pp. 612–613). Fever, exhaustion, weakness, anorexia, weight loss, and widespread soreness and stiffness are common symptoms of RA (McCance & Huether, 2018, p. 1452).  The knuckles and proximal interphalangeal joints of the fingers, as well as the interphalangeal joints of the thumbs, the wrist, and the metatarsophalangeal joints of the toes, are the joints most afflicted (Dlugasch & Story, 2019, pp. 614–615). Elbows, shoulders, ankles, and knees are among the other joints that are impacted. In most cases, the joints become painfully sore and rigid (Dlugasch & Story, 2019, pp. 614–615). The joint may feel soggy or mushy due to synovial thickness, and if an effusion is present, the joint may feel fluctuant (Dlugasch & Story, 2019, pp. 615). Increased levels of inflammatory exudate in the synovial membrane, hyperplasia of inflamed tissues, and production of new bone induce widespread and symmetrical joint swelling (McCance & Huether, 2018, p. 1452).A history and physical examination, as well as laboratory tests such as the erythrocyte sedimentation rate or other inflammatory markers, are used to diagnose OA (Dlugasch & Story, 2019, p. 613). RA diagnostic techniques include serum rheumatoid factor and anticyclic citrullinated peptide antibody testing, x-ray, MRI, ultrasound, CBC, liver and kidney function tests, and synovial fluid analysis, in addition to a history and physical exam (Dlugasch & Story, 2019, pp. 615–616).Describe the different treatment alternatives available, including non-pharmacological and pharmacological that you consider are appropriate for this patient and why.Physical therapy, weight loss management, ambulatory assistance, orthopedic devices, pharmaceutical treatments, and surgery are among options for treating OA (Dlugasch & Story, 2019, p. 613). Weight reduction management should be part of G.J.’s treatment plan to assist her lose weight and relieve weight bearing load on her knees. Physical therapy is recommended to assist loosen the stiffness and promote exercise. Since NSAIDS and oxycodone are not providing pain relief, it may be recommended that she try heat/cold applications, topical medicines that provide a cool or hot sensation, water treatment, acupuncture, tai chi, or yoga (Dlugasch & Story, 2019, p. 613). In addition, corticosteroids or synthetic synovial fluid can be injected directly into the joints (Dlugasch & Story, 2019, p. 613). Surgery will only be recommended if pain management has failed to relieve her discomfort or if her condition has worsened (Dlugasch & Story, 2019, p. 613).How would you handle the patient concern about osteoporosis? Describe your interventions and education you would provide to her regarding osteoporosis.Due to the patients’ concerns about osteoporosis, I would inform her that women aged 65 and older be checked for osteoporosis on a regular basis as part of their health preventive and maintenance (Dlugasch & Story, 2019, pp. 607–608). To begin, I’d assess the patient’s knowledge of osteoporosis. Proper nutrition, including increasing calcium and vitamin D consumption, increased physical activity to include weight-bearing activities, changing risk factors, the use of pharmacologic therapy, the use of assistive devices and safety precautions to prevent falls and fractures will all be included in education with the patient (Dlugasch & Story, 2019, pp. 607–608).Neurological FunctionName the most common risks factors for Alzheimer’s disease.Age and family history are the two most significant risk factors (McCance & Huether, 2018, p. 520). Diabetes, midlife hypertension, hyperlipidemia, midlife obesity, smoking, depression, cognitive inactivity or low educational attainment, female gender, estrogen deficit at menopause, physical inactivity, head trauma, elevated serum homocysteine and cholesterol levels, oxidative stress, and neuroinflammation are some of the other proposed risk factors (McCance & Huether, 2018, p. 520).Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.The fact that they are all a collection of conditions in which cortical function is impaired, compromising cognitive abilities and motor coordination, is a common thread (Dlugasch & Story, 2019, p. 548). Memory problems, behavioral abnormalities, and personality changes are all prevalent (Dlugasch & Story, 2019, p. 548). Alzheimer’s disease is caused by abnormal brain shrinkage and has an impact on all brain activities that result in major alterations, especially in terms of behavior and interpersonal interactions (Dlugasch & Story, 2019, p. 549). The inability to remember time, place, or recent events, for example, or even depressive behavior is one of the first symptoms of this disease (Dlugasch & Story, 2019, pp. 549-550).Dementia with Lewy Bodies has Alzheimer type symptoms, and additionally has symptoms that are similar to Parkinson’s, such as tremors and stiffness and is accompanied by sleeping problems and visual hallucinations (Dlugasch & Story, 2019, p. 551).Vascular Dementia occurs due to damage of the blood vessels (Dlugasch & Story, 2019, p. 550). Every stroke or vascular catastrophe causes tissue loss as well as brain impairment and as a result, following a minor setback, Alzheimer’s-like symptoms can emerge, including memory problem (Dlugasch & Story, 2019, pp. 550-551). It can occur without a stroke and manifestations can be similar to Alzheimer disease and the two can coexist (Dlugasch & Story, 2019, p. 551).Frontotemporal Dementia (FTD) is a type of dementia that affects the frontal and temporal lobes of the brain (Dlugasch & Story, 2019, p. 552). The lobes are more affected by neurodegeneration, resulting in significant behavioral and personality alterations (Dlugasch & Story, 2019, p. 552). Language problems, mobility issues, and memory loss are all possible symptoms (Dlugasch & Story, 2019, p. 552).Define and describe explicit and implicit memory.  Explicit memory is used to remember facts and requires awareness and consciousness (Dlugasch & Story, 2019, p. 549). Explicit memories are those that are consciously recalled and include memories of events from personal history and experiences, as well as the remembering of facts and other taught knowledge (Dlugasch & Story, 2019, p. 549). The hippocampus, sections of the temporal lobe, and parts of the cortex are all involved in memory retention (Dlugasch & Story, 2019, p. 549).Implicit memory does not require conscious awareness, and it does not rely on the hippocampus for retention (Dlugasch & Story, 2019, p. 549). Implicit memories, which include recollections of how to accomplish tasks that you undertake every day, are unconscious and automatic (Dlugasch & Story, 2019, p. 549).Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association.A brain MRI and a brain PET scan are used to diagnose Alzheimer’s disease (Dlugasch & Story, 2019, p. 550). For people with early-onset Alzheimer’s disease, genetic testing is conducted (Dlugasch & Story, 2019, p. 550). Although Alzheimer’s disease induces cortical abnormalities, neuroimaging is frequently used to rule out alternative causes of dementia (Dlugasch & Story, 2019, p. 550).What would be the best therapeutic approach on H.M.?In mild to moderate Alzheimer’s disease, cholinesterase inhibitors are utilized (McCance & Huether, 2018, p. 525). In moderate to severe Alzheimer’s dementia, an N-methyl-D-aspartate (NMDA) receptor antagonist reduces glutamate action and may delay disease development (McCance & Huether, 2018, p. 525).  Memory assistance, nutritional support, physical activity, cognitive exercises, safety considerations, maintaining a calm atmosphere, and interactions are some of the other therapeutic approaches (Dlugasch & Story, 2019, p. 550). Stress and anxiety can be reduced through coping strategies and support for both the patient and the caregiver (Dlugasch & Story, 2019, p. 550).ReferencesDlugasch, L., & Story, L. (2019). Applied Pathophysiology for the Advanced Practice Nurse (1st ed.). Jones & Bartlett Learning.McCance, K. L., & Huether, S. E. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). Mosby. ReplyReply to Comment