Case Study 1 Questions:
Define osteoarthritis and explain the differences with osteoarthrosis.
Many people confuse osteoarthritis with osteoporosis. This is because most people have the two conditions concurrently. However, there is a difference because osteoarthritis involves a complex illness causing joint pains and reduced joint mobility and functioning. On the other hand, osteoporosis involves loss of bone mass, leading to the risk of fractures (Portyannikova et al., 2019).
List and analyze the risk factors that are presented in the case that contribute to the diagnosis of osteoarthritis.
Various risk factors lead to a diagnosis of osteoarthritis for this patient. One of the risk factors is joint overuse or injury. The patient has reported continued history of knee discomfort. Similarly, the knee is stressed because the patient must constantly use the stairs, which is becoming difficult. Age and gender are other risk factors leading to this diagnosis. Research shows that women about 50 years are likely to develop osteoarthritis. In this case, the patient is a woman aged 71 years. Obesity is another risk factor because excessive weight strains the joints more. The patient reported that the pain had increased after they added 20 pounds. Genetics also plays a vital role because the patient has many members in the family who have the condition (Portyannikova et al., 2019).
Specify the main differences between osteoarthritis and rheumatoid arthritis, and include clinical manifestations, major characteristics, joints usually affected, and diagnostic methods.
There is a difference between rheumatoid arthritis and osteoarthritis. Osteoarthritis is a condition that occurs after the smooth cartilage joint wears out. Normally, it begins as an isolated joint. On the other hand, rheumatoid arthritis is an autoimmune condition. Instead of attacking foreign bodies, the immune system attacks the body. When the synovial membrane, which protects the joint, is attacked, an individual develops rheumatoid arthritis. The symptoms include fatigue, fever, loss of appetite, and anemia. While osteoarthritis begins with an isolated joint, rheumatoid arthritis attacks different joints simultaneously (Gessl et al., 2021). Rheumatoid arthritis can be diagnosed by the use of the magnetic resonance imaging (MRI) and the ultra sound during the early stages. These imaging tests can ensure the evaluation of the extent of the damage. Imaging is also necessary in the osteoarthritis diagnosis where the X-rays can be used to show the loss of the joint space.
Describe the treatment alternatives available, including non-pharmacological and pharmacological, that you consider appropriate for this patient and why.
The non-pharmacological treatment for osteoarthritis includes body and mind practices. The patient can be engaged in exercises such as deep breathing, Tai chi, acupuncture, yoga, massage, meditation, and other relaxation techniques. On the other hand, pharmacological treatment of osteoarthritis includes over-the-counter medications. Examples include Naproxen sodium (Aleve) and ibuprofen (Motrin I.B., Advil, among others). Acetaminophens are another recommended medication because they relieve mild to moderate pain. Duloxetine (Cymbalta) is used as an antidepressant but also helps in relieving osteoarthritis pain (R.M. et al., 2019).
How would you handle the patient’s concern about osteoporosis? Describe the interventions and education you would provide to her regarding osteoporosis.
Osteoporosis is a familiar condition that causes bones to be abnormally weak and easily fractured. Women have a higher risk for the condition, especially after menopause, because of decreased estrogen levels. I would offer the patient education and ways of preventing osteoporosis. One of the ways is to use a diet by ensuring the food contains enough calories and protein, and high levels of calcium and vitamin D. Calcium intake is recommended for premenopausal women. Vitamin D intake is also significant, and it is recommended for individuals above 70 years to consume 800 units of vitamin D daily. Milk supplements offer vitamin D. The patients must avoid alcohol because drinking more than two bottles increases exposure to fractures. The education intervention also covers the importance of exercises because they decrease the fracture risk. Teaching the patient about avoiding smoking is essential because it accelerates bone loss (Gregson et al., 2019).
Case Study 2 Questions:
Name the most common risk factors for Alzheimer’s disease.
There are many common risk factors associated with Alzheimer’s disease. Genetics can play a huge role of susceptibility of this disease. Patients who are elder, female and of African American and Hispanic descent are non-modifiable risk factors for Alzheimer’s disease (Atri, 2019). In addition, certain diseases like hypertension and diabetes can have a higher risk of acquiring Alzheimer (Atri, 2019). Neurological incidents like severe head trauma or traumatic brain injury as well as a low cognitive function such as low intelligent and low education can lead to a progress of Alzheimer’s (Atri, 2019).
Name and describe the similarities and differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, and Frontotemporal Dementia.
Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia are different types of dementia however differentiae by pathophysiology, presentation and progression. Alzheimer’s disease is the most common where its characterized by accumulation of beta-amyloid plaques which progress to neuronal death and brain shrinkage (Alzheimer’s Association, 2021). The progression of this disease is gradual as patients experience behavioral changes and difficulty with daily activities (Alzheimer’s Association, 2021). Vascular dementia pathophysiology is a reduction of blood to the brain due to a stroke (Alzheimer’s Association, 2021). Patients experience mood swings, depression, apathy and difficulty in decision making (Alzheimer’s Association, 2021). Dementia with Lewy body is an accumulation of proteins called Lewy bodies that form clusters in the brain (Alzheimer’s Association, 2021). These proteins can cause hallucinations and visual disturbances (Alzheimer’s Association, 2021). In addition, dementia with Lewy bodies in patients can show similar movements of Parkinson’s disease (Alzheimer’s Association, 2021). Lastly, frontotemporal dementia is a degeneration of the frontal and temporal lobes of the brain. These lobes are responsible for personality, behavior and language which leads to difficulty speaking and changes in displaying emotion (Alzheimer’s Association, 2021).
Define and describe explicit and implicit memory.
Explicit and implicit memory are two primary systems of long-term memory (Wagner, 2019). Explicit memory involves conscious, intentional recollection of past events, and includes two subtypes. Episodic memory are memories of personal experiences and semantic memory are general knowledge and facts (Wagner, 2019). To differentiate from episodic, implicit memory is an unconscious, unintentional form of memory that can influence behavior without conscious awareness (Wagner, 2019).
Describe the diagnosis criteria developed for Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association.
According to National Institute of Aging and the Alzheimer’s Association, there are multiple cognitive or behavioral symptoms to aid to the diagnosis of Alzheimer’s. Symptoms present are interference to function at work, decline from previous performance , non-explained delirium and declined cognitive impairment (Atri, 2019). In addition, patient must have a minimum of two of the following requirements: impaired ability to remember new information, compromised reasoning of complex tasks which leads to poor judgement, diminished visuospatial abilities, language, and lastly changes in their personality plus behavior (Atri, 2019). Finally, these criteria’s and characteristics must follow the duration of months to years to help rule out evidence of other neurological diseases like a CVA (Atri, 2019).
What would be the best pharmacological and non-pharmacological therapeutic approaches for H.M.?
Approaching pharmacological and non-pharmacological approaches for patients like H.M and her children is important in reaching appropriate approaches to her care. It’s important to incorporate behavioral strategies based on symptoms H.M is experiencing as well as identifying problem behaviors that can lead to resistance of care (Atri, 2019). Understand that patients like H.M will show a decline through the years is an important idea to note and that behaviors can change day by day (Atri, 2019). Psychoeducation should be included to incorporate strategies and avoid behavioral triggers to better communicate and take care of H.M (Atri, 2019). It helps to create simple routines and maintain consistency (Atri, 2019). Cholinesterase inhibitors and NMDA-antagonist memantine are the FDA approved medications in aid of dementia (Atri, 2019).
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