How to solve a Musculoskeletal And Neurological Function Case Study

Musculoskeletal Function prompt:
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.

Table of Contents

Case Study Questions

1. 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.
2. Specify the main differences between osteoarthritis and rheumatoid arthritis, make sure to include clinical manifestations, major characteristics, joints usually affected and diagnostic methods.
3. Describe the different treatment alternatives available, including non-pharmacological and pharmacological that you consider are appropriate for this patient and why.
4. 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

1. Name the most common risks factors for Alzheimer’s disease
2. Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
3. Define and describe explicit and implicit memory.
4. Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association
5. What would be the best therapeutic approach on C.J.

SOLUTION TO THE CASE STUDY

Musculoskeletal case study

Osteoarthritis is the degeneration of joint cartilage and underlying bones characterized by stiffness and pain in the affected area (Roth, 2022). It mostly affects the thumb, hip and knee joints, but it can affect any joint in the body—the disease is commonly known to affect the middle-aged and elderly. Osteoarthrosis is the disorder of synovial joints. The most affected joints in osteoarthrosis are the hands, hip, knee and first metatarsophalangeal joint.

Risk factors

G.J presents with the following risk factors for osteoarthritis. She is older (71 years), overweight, and her sex (woman). The risk of osteoarthritis rises with age. Also, women are more susceptible to osteoarthritis compared to men. Increased weight adds weight to joints increasing the chances of individuals suffering osteoarthritis (Roth, 2022).

Differences Between Osteoarthritis and Rheumatoid Arthritis

Osteoarthritis is a degenerative joint disorder resulting from the wear and tear of cartilage, while rheumatoid arthritis is an autoimmune disorder that attacks tissues lining the joints (Roth, 2022). Also, osteoarthritis starts later in life, whereas rheumatoid arthritis starts at any age. Another distinctive feature is rheumatoid arthritis develops fairly quickly (weeks to months), but osteoarthritis develops slowly over time. Rheumatoid Arthritis is characterized by muscle aches, low-grade fever and fatigue affecting the entire body, including the lungs and heart, while osteoarthritis is limited to joint pain.

Rheumatoid Arthritis commonly starts in smaller joints (fingers) with symmetrical symptoms, which might later affect larger joints. At the same time, osteoarthritis often develops in hands and sometimes fingers joints but is less symmetrical (Roth, 2022). Finally, the treatment modality for rheumatoid arthritis includes biologics and disease-modifying medications targeting the immune system, while osteoarthritis entails corticosteroid and anti-inflammatory medications.

Pharmacological and non-pharmacological treatment

Pharmacological treatment includes NSAIDs and steroid injections. NSAIDs are strong pain relievers and anti-inflammatories, for example, topical capsaicin cream and ibuprofen tablets making them effective in managing osteoarthritis (Versus, 2022). For non-pharmacological treatment, the patient should focus on reducing weight through lifestyle changes and exercise.

Health education on osteoporosis

I will educate my patient on the link between osteoarthritis and osteoporosis and advise her to eat a healthy diet, avoid smoking and exercise more frequently.

Neurological Function Case Study

The major risk factors for Alzheimer’s disease are cardiovascular disease, head injuries, down syndrome, genetics, older age, untreated depression, hearing loss and social isolation (NIH, 2022). Alzheimer’s interferes with the brain’s ability to store and retrieve new information while affecting cognitive brain functions, i.e. reasoning and problem-solving abilities (NIH, 2022). Vascular dementia is the most common form of dementia associated with brain blood vessels. In contrast, frontotemporal dementia is a less common type of dementia affecting the language and behaviour of individuals.

Explicit and Implicit Memory

Both explicit and implicit memories memory are types of long-term memory. Explicit memory is the state of remembering information consciously to work, while implicit memory is remembering information effortlessly and unconsciously (Cherry, 2022).

Diagnosis criteria for Alzheimer’s disease

The diagnosis criteria for preclinical Alzheimer’s entail no dementia, concern about changes in cognition and cognitive abilities such as problem-solving skills and memory loss expected for the level of education and age (NIH, 2022). Also, preserved ability to function and work independently is an indicator of Alzheimer’s disease.

Therapeutic Approach

Firstly, health care providers should consider her overall health, the severity of the disease and past medical history before deciding on treatment modalities and therapies (Versus, 2022). Also, they should acknowledge family and patient’s preferences on medication and how it will affect their lifestyle.

References

Roth, E., 2022. What’s the Difference Between Rheumatoid Arthritis and Osteoarthritis?. [online] Healthline. Available at: <https://www.healthline.com/health/rheumatoid-arthritis/ra-vs-oa#symptoms> [Accessed 4 June 2022].

Versus, 2022. Osteoarthritis (O.A.). [online] Versus arthritis. Available at: <https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/> [Accessed 4 June 2022].

NIH, 2022. Alzheimer’s Disease Diagnostic Guidelines. [online] National Institute on Aging. Available at: <https://www.nia.nih.gov/health/alzheimers-disease-diagnostic-guidelines#:~:text=A%20diagnosis%20of%20MCI%20requires,the%20person’s%20age%20and%20education.> [Accessed 4 June 2022].

Cherry, K., 2022. What’s the Difference Between Implicit and Explicit Memory?. [online] Verywell Mind. Available at: <https://www.verywellmind.com/implicit-and-explicit-memory-2795346#:~:text=Implicit%20memory%20and%20explicit%20memory,is%20known%20as%20explicit%20memory.> [Accessed 4 June 2022].