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 when there are more than one.
- Your initial post should be at least 500 words, formatted using the questions or a phrase that summarize the question as heading. This should be bold and centered and responses to each question under the heading. You must cite in current APA style with support from at least 2 academic sources within the last 5 years. Your initial post is worth 8 points.
**Osteoarthritis vs. Osteoarthrosis:**
Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of cartilage in the joints, leading to pain, stiffness, and decreased mobility. Osteoarthrosis, on the other hand, is a term sometimes used synonymously with OA but may also refer to any joint disease involving abnormal growth or remodeling of bone. In this case, G.J.’s symptoms align more closely with OA due to her complaints of bilateral knee discomfort exacerbated by rainy weather, stiffness after periods of inactivity, and worsening pain with weight gain.
**Risk Factors for Osteoarthritis:**
Several risk factors contribute to the development of OA in this case:
- Age: G.J. is 71 years old, placing her at higher risk for OA.
- Overweight: G.J. has gained 20 pounds over the past nine months, increasing the stress on her weight-bearing joints.
- Family history: G.J. is concerned about osteoporosis, a condition that can coexist with OA and may have a genetic component.
- Previous joint injury: Although not explicitly mentioned, previous joint injury can predispose individuals to OA.
- Inactivity: Stiffness in joints after prolonged sitting or lying down suggests reduced physical activity, which can contribute to OA.
**Osteoarthritis vs. Rheumatoid Arthritis:**
Osteoarthritis:
– Clinical manifestations: Gradual onset of joint pain, stiffness, and swelling, typically worsening with activity.
– Major characteristics: Degeneration of joint cartilage, formation of bone spurs, and joint space narrowing on X-ray.
– Joints usually affected: Weight-bearing joints such as knees, hips, and spine, as well as hands and feet.
– Diagnostic methods: Clinical evaluation, X-rays, MRI, and blood tests to rule out other causes of joint pain.
Rheumatoid Arthritis:
– Clinical manifestations: Symmetrical joint involvement, morning stiffness lasting more than an hour, fatigue, and systemic symptoms.
– Major characteristics: Autoimmune inflammation leading to synovial membrane thickening, joint erosion, and deformity.
– Joints usually affected: Small joints of the hands and feet, wrists, knees, ankles, and elbows.
– Diagnostic methods: Clinical evaluation, blood tests (e.g., rheumatoid factor, anti-cyclic citrullinated peptide), imaging (X-rays, ultrasound, MRI).
**Treatment Alternatives for Osteoarthritis:**
Non-pharmacological:
– Weight management: Encourage gradual weight loss to reduce stress on joints.
– Physical therapy: Strengthening and range-of-motion exercises can improve joint function.
– Assistive devices: Braces, canes, or orthotics may help reduce pain and improve mobility.
Pharmacological:
– Acetaminophen: For mild to moderate pain relief.
– NSAIDs: Topical or oral NSAIDs can reduce inflammation and pain.
– Intra-articular injections: Corticosteroids or hyaluronic acid injections may provide relief for persistent symptoms.
– Opioids: Reserved for severe pain unresponsive to other treatments, with close monitoring for potential adverse effects and dependency.
The choice of treatment should be tailored to G.J.’s individual needs, taking into account her comorbidities, medication tolerance, and preference.
**Handling Concerns about Osteoporosis:**
Interventions and education for G.J. regarding osteoporosis:
- Bone density testing: Recommend a dual-energy X-ray absorptiometry (DXA) scan to assess bone density and fracture risk.
- Nutrition and supplements: Encourage adequate calcium and vitamin D intake through diet and supplementation.
- Weight-bearing exercise: Recommend weight-bearing exercises such as walking or strength training to improve bone density.
- Fall prevention: Educate on fall prevention strategies to reduce the risk of fractures.
- Medication management: Discuss the benefits and risks of osteoporosis medications such as bisphosphonates or denosumab, considering G.J.’s individual risk factors and preferences.
**Common Risk Factors for Alzheimer’s Disease:**
- Age: Advanced age is the greatest risk factor for Alzheimer’s disease.
- Genetics: Family history of Alzheimer’s increases the risk, especially if a first-degree relative has been affected.
- Lifestyle factors: Cardiovascular risk factors such as hypertension, diabetes, obesity, and smoking increase the risk of Alzheimer’s.
- Head trauma: History of head injuries, particularly repetitive concussions, is associated with a higher risk.
- Down syndrome: People with Down syndrome have an increased risk of developing Alzheimer’s due to the presence of an extra chromosome 21.
**Differences Between Alzheimer’s Disease and Other Dementia Types:**
Alzheimer’s Disease:
– Pathophysiology: Characterized by beta-amyloid plaques and tau protein tangles in the brain.
– Clinical Manifestations: Progressive memory loss, cognitive decline, confusion, and disorientation.
– Joints usually affected: Small joints of the hands and feet, wrists, knees, ankles, and elbows.
– Diagnostic methods: Clinical evaluation, cognitive testing, brain imaging (MRI, PET scan), and cerebrospinal fluid analysis.
Vascular Dementia:
– Pathophysiology: Caused by impaired blood flow to the brain, resulting in brain tissue damage.
– Clinical Manifestations: Cognitive impairment, executive dysfunction, and focal neurological deficits.
– Diagnostic methods: Brain imaging (MRI, CT scan) showing evidence of cerebrovascular disease.
Dementia with Lewy Bodies:
– Pathophysiology: Presence of Lewy bodies (abnormal protein deposits) in the brain.
– Clinical Manifestations: Fluctuating cognition, visual hallucinations, parkinsonism, and REM sleep behavior disorder.
– Diagnostic methods: Clinical evaluation, brain imaging, and sometimes, autopsies.
Frontotemporal Dementia:
– Pathophysiology: Degeneration of the frontal and temporal lobes of the brain.
– Clinical Manifestations: Changes in personality, behavior, language, and executive function.
– Diagnostic methods: Clinical evaluation, neuropsychological testing, brain imaging, and sometimes, genetic testing.
**Explicit and Implicit Memory:**
Explicit Memory:
– Also known as declarative memory.
– Involves conscious recollection of past experiences and factual information.
– Can be further categorized into semantic memory (general knowledge) and episodic memory (personal experiences).
Implicit Memory:
– Also known as non-declarative or procedural memory.
– Involves unconscious retention and retrieval of information.
– Includes skills, habits, and conditioned responses acquired through repetition and practice.
**Diagnosis Criteria for Alzheimer’s Disease:**
The National Institute on Aging and the Alzheimer’s Association (NIA-AA) established criteria for the diagnosis of Alzheimer’s disease, including:
- Progressive cognitive decline: Evidence of decline in cognition and function over time.
- Objective cognitive impairment: Based on neuropsychological testing or clinical assessment.
- Impairment in daily functioning: Difficulty performing everyday tasks due to cognitive decline.
- Exclusion of other causes: Rule out other medical, neurological, or psychiatric conditions that may cause similar symptoms.
**Therapeutic Approach for C.J.:**
Given H.M.’s symptoms, which include memory loss, confusion, repetition, and disorientation, along with the recent loss of her husband, a comprehensive assessment for dementia is warranted. The therapeutic approach for C.J. would include:
- Comprehensive evaluation
: Conduct a thorough medical, neurological, and neuropsychological assessment to determine the underlying cause of her cognitive decline.
- Supportive interventions: Provide emotional support and counseling to address grief and loss related to her husband’s death.
- Medication management: Consider pharmacological treatments such as cholinesterase inhibitors (e.g., donepezil) or memantine for cognitive symptoms associated with Alzheimer’s disease.
- Caregiver support: Engage H.M.’s children in the care plan and provide education on dementia management and resources for support services.
- Safety measures: Implement strategies to ensure H.M.’s safety at home, including fall prevention measures and supervision when necessary.
By addressing H.M.’s cognitive symptoms and providing comprehensive support, we can optimize her quality of life and help her maintain independence for as long as possible.
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