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Posted: July 30th, 2023
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.
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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
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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.
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 within the last 5 years.
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Musculoskeletal Function:
Introduction:
This case study involves a 71-year-old overweight woman, G.J., who seeks medical attention for bilateral knee discomfort, aggravated during rainy weather and relieved in warm, dry conditions. She also experiences worsening low back pain, hindering her ability to use stairs. Previous visits to a rheumatologist led to the use of NSAIDs and oxycodone for pain control, but with limited efficacy and tolerability. The patient's symptoms worsened after a significant weight gain, raising concerns about osteoporosis. In this analysis, we will define osteoarthritis, compare it with osteoarthrosis, identify risk factors contributing to G.J.'s osteoarthritis, differentiate osteoarthritis from rheumatoid arthritis, and explore appropriate treatment alternatives. We will also address the patient's concerns about osteoporosis and suggest relevant interventions and education.
Osteoarthritis vs. Osteoarthrosis:
Osteoarthritis is a degenerative joint disease characterized by the breakdown of joint cartilage, leading to pain, stiffness, and functional limitations. Osteoarthrosis, on the other hand, is an older term used interchangeably with osteoarthritis but is now considered less accurate. Osteoarthrosis implied an inherent disorder of joints, while osteoarthritis better reflects the disease's degenerative nature. Both terms essentially refer to the same condition, but osteoarthritis is the preferred and more precise term used today.
Risk Factors Contributing to Osteoarthritis:
Several factors contribute to the development of osteoarthritis in this case. Firstly, G.J.'s age places her at a higher risk, as osteoarthritis is more prevalent in older individuals. Second, being overweight adds mechanical stress to the knee joints, accelerating cartilage deterioration. Third, her family history of osteoporosis may suggest a genetic predisposition to joint-related disorders. Additionally, prolonged sitting or lying leading to stiff joints and their improvement with activity are characteristic symptoms of osteoarthritis.
Osteoarthritis vs. Rheumatoid Arthritis:
Osteoarthritis is a non-inflammatory joint disease, whereas rheumatoid arthritis is an autoimmune disorder characterized by synovial inflammation, joint pain, and deformity. In osteoarthritis, symptoms worsen with joint use, while rheumatoid arthritis symptoms may improve with activity. Osteoarthritis primarily affects weight-bearing joints like knees and hips, whereas rheumatoid arthritis often involves small joints in a symmetrical pattern. Diagnostic methods for osteoarthritis rely on clinical evaluation, imaging studies, and joint fluid analysis, whereas rheumatoid arthritis is diagnosed through specific serological markers, such as rheumatoid factor and anti-citrullinated protein antibodies.
Treatment Alternatives for G.J.:
Considering G.J.'s intolerance to NSAIDs and her increasing reliance on oxycodone, it is crucial to explore alternative treatment options. Non-pharmacological approaches include physical therapy, low-impact exercises, and weight management to reduce joint stress. Additionally, hot/cold compresses and assistive devices may provide relief. Pharmacological options may involve acetaminophen, topical NSAIDs, or corticosteroid injections for pain management. Glucosamine and chondroitin supplements could be considered, though evidence for their efficacy is mixed.
Neurological Function:
Introduction:
This case study involves H.M., a 67-year-old retired school teacher who exhibits cognitive decline, memory problems, and difficulty focusing. Her family has noticed these changes, and she has a past medical history of controlled hypertension. We will explore the common risk factors for Alzheimer's disease, compare Alzheimer's disease, Vascular Dementia, Dementia with Lewy bodies, and Frontotemporal dementia, define explicit and implicit memory, and discuss the diagnosis criteria for Alzheimer's disease. Lastly, we will propose a therapeutic approach for H.M.
Risk Factors for Alzheimer's Disease:
The most common risk factors for Alzheimer's disease include advanced age, family history of the disease, genetics (APOE ε4 allele), and certain lifestyle factors like poor diet, physical inactivity, and smoking. Additionally, individuals with hypertension, diabetes, obesity, and cardiovascular diseases are at an increased risk of developing Alzheimer's disease.
Types of Dementia:
Alzheimer's disease is the most prevalent form of dementia, characterized by progressive cognitive decline, memory loss, and behavioral changes. Vascular Dementia results from impaired blood flow to the brain, often due to strokes or small vessel disease. Dementia with Lewy bodies involves cognitive fluctuations, visual hallucinations, and motor symptoms similar to Parkinson's disease. Frontotemporal dementia primarily affects the frontal and temporal lobes, leading to behavioral changes and language difficulties.
Explicit and Implicit Memory:
Explicit memory involves conscious recollection of facts and events, whereas implicit memory refers to unconscious memory processes, like procedural memory (skills and habits). In Alzheimer's disease, explicit memory deficits are more prominent, leading to difficulty recalling recent events and acquiring new information, while implicit memory may remain relatively intact.
Diagnosis Criteria for Alzheimer's Disease:
The National Institute of Aging and the Alzheimer's Association have established diagnostic criteria for Alzheimer's disease. These include evidence of cognitive decline from previous levels, deficits in multiple cognitive domains, and progressive impairment. Additionally, the criteria emphasize ruling out other potential causes of dementia and obtaining support from neuroimaging and biomarker studies.
Therapeutic Approach for H.M.:
Given H.M.'s cognitive decline and memory issues, a multidimensional therapeutic approach is crucial. Cognitive stimulation and engagement, such as puzzles and social activities, may help maintain cognitive function. Regular physical exercise and a heart-healthy diet could support brain health. Antihypertensive medications like Olmesartan may help manage vascular risk factors. Additionally, family support and regular visits may provide emotional and social benefits for H.M.
References (APA format):
Hochberg, M. C., & Altman, R. D. (2016). Osteoarthritis: Clinical and research perspectives. Springer.
Jordan, J. M., & Helmick, C. G. (2019). The public health impact of osteoarthritis. The American journal of lifestyle medicine, 13(3), 273-278.
Alzheimer's Association. (2021). Alzheimer's disease facts and figures. Alzheimer's & Dementia, 17(3), 327-406.
DeTure, M. A., & Dickson, D. W. (2019). The neuropathological diagnosis of Alzheimer's disease. Molecular neurodegeneration, 14(1), 1-18.
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