You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your responses must be substantive and not just agreeing with someone’s work. You need to add by explaining more, refuting a point or correcting a point.  a minimum of 150 words and one reference with in text citation, one reference for each respond.  

Discussion 1 (George)

Musculoskeletal case study

Introduction and Definition

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

Risk Factor

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 behavior 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> 

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

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

NIH, 2022. Alzheimer’s Disease Diagnostic Guidelines. [online] National Institute on Aging. Available at: <https://www.nia.nih.gov/health/alzheimers-disease-diagnostic-

Discussion 2 ( Rajimol)

Case Study Questions

Osteoarthritis versus osteoarthrosis

According to the Arthritis Foundation (n.d), osteoarthritis is a degenerative disease affecting the joints and tissues surrounding the joints. It is a disease affecting a large part of the global population and is one of the significant causes of immobility among adults. It primarily affects the bones, ligaments, and tissues surrounding the joints (Arthritis Foundation, n.d). Osteoarthritis also impacts the cartilage, causing inflammation in the affected areas. This can cause pain as well as compromise mobility (Arthritis Foundation, n.d). It usually manifests in joints of the hands, knees, hips, neck, as well as lower back (Arthritis Foundation, n.d).

As for osteoarthrosis, similarities can be seen with osteoarthritis. Mostly, however, osteoarthrosis is seen around the synovial joints and is noted more in older adults. Still, it also impacts on knees, hands, and hips (Atkinson, 1984). It is not common around the ankles, shoulders, and wrists. Symptoms of osteoarthritis include morning pain, stiffness of the joints, and immobility (Atkinson, 1984).

Risk Factors contributing to osteoarthritis diagnosis

Risk factors for osteoarthritis include age, obesity, injury of the joints, female gender, and genetics (Arthritis Foundation, n.d). Older adults have a higher risk of being afflicted with the disease due to their advanced age when the joints have gone through more wear and tear and extended strain (Arthritis Foundation, n.d). Women are also more at risk for this condition. Weight gain and obesity also place a person at greater risk for this condition (Arthritis Foundation, n.d). The patient manifested weight gain which would have put her at risk for osteoarthritis. She is also female and her previous history of lower back pain further adds up to the risk factors for the condition.

Differences between osteoarthritis and rheumatoid arthritis

The nature of these diseases varies with osteoarthritis being a degenerative joint disorder and rheumatoid arthritis an autoimmune disorder (Texas Joint Pain Management, 2022). Osteoarthritis initially sets in at a gradual pace, with the full-blown condition settling in after years following gradual wear and tear of the joints. Rheumatoid arthritis usually sets in quickly, in as short a time as weeks or months. Most areas affected by osteoarthritis include the hip, knees, neck, and finger joints while rheumatoid arthritis affects any joint, but is often noted in the hands, feet, and wrists (Texas Joint Pain Management, 2022). Joint stiffness is experienced in the morning and after walking in cases of osteoarthritis while such stiffness usually lasts longer and can set in any time even without exertion in rheumatoid arthritis (Texas Joint Pain Management, 2022). Radiological tests are used to diagnose osteoarthritis (Dewing et al., 2012). Rheumatoid arthritis is detected via radiologic tests (ultrasound, X-Rays, and MRI) (Dewing et al., 2012). Laboratory results show synovial fluids in instances of osteoarthritis while serology tests would assess ESR or C-reactive proteins in rheumatoid arthritis (Dewing et al., 2012).

Treatment alternatives

Options in treating the patient include performing exercises as well as using pharmacological alternatives. The use of NSAIDs would help relieve inflammation and reduce pain (Cleveland Clinic, 2019). When the swelling subsides and pain is reduced or eliminated, she can engage in low-impact exercises. She can walk, use the stationary bike, swim, and do yoga (Cleveland Clinic, 2019). Acupuncture can also be recommended for the patient as it has been known to relieve pain and reduce inflammation (Cleveland Clinic, 2019).

Addressing patient concerns

The patient’s concerns can be managed by reassuring her that she can actually improve her pain levels and live a relatively normal life. I would educate her about her condition and what can exacerbate her symptoms and why she is experiencing these symptoms now. This would help her understand her disease and to be more compliant with the treatment (Elam, 2021). I would teach her that she can undergo a bone density test to determine if she has osteoporosis. This test can then be used to guide treatment. I would also encourage her to have a healthy diet, a diet rich in fiber and calcium in order to help strengthen her bones and muscles. I would also encourage at least getting 10-15 minutes of sun exposure daily for Vitamin D. Along with calcium, Vitamin D helps protect the bones and joints of the body, strengthening them and eventually helping in preventing injury.

References

Arthritis Foundation (n.d). Osteoarthritis. https://www.arthritis.org/diseases/osteoarthritis

Atkinson, M. (1984). Osteoarthrosis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2153568/

Cleveland Clinic (2019). Osteoarthritis. https://my.clevelandclinic.org/health/diseases/5599-osteoarthritis (Links to an external site.)

Dewing, K., Setter, S., & Slusher, B. (2012). Osteoarthritis and rheumatoid arthritis 2012: pathophysiology, diagnosis, and treatment. https://www.clinicaladvisor.com/home/features/osteoarthritis-and-%E2%80%A8rheumatoid-%C2%ADarthritis-2012-pathophysiology-diagnosis-%E2%80%A8and-treatment/

Elam, R. (2021). How should patients be educated about osteoporosis?. https://www.medscape.com/answers/330598-82999/how-should-patients-be-educated-about-osteoporosis (Links to an external site.)

Texas Joint Pain Management (2020). Osteoarthritis vs rheumatoid arthritis – explaining the pain. https://www.texasjointpain.com/osteoarthritis-vs-rheumatoid-arthritis/ (Links to an external site.)

 


Neurological Function: Case Study Questions

 

Risk factors for Alzheimer’s disease

The risk factors for Alzheimer’s are advancing age, a strong family history, genetics, and a previous head injury (Alzheimer’s Association, 2022a). Those who are 65 years old and over have a greater risk for Alzheimer’s and as individuals get even older, the risk increases. Families with a strong history of the disease are also likely to have other family members later developing it. The closer and more direct the relationship, the more likely an individual would later develop the disease (Alzheimer’s Association, 2022a). There are also genes that may place an individual at risk for Alzheimer’s. Risk genes (APOE-e4) are more likely to lead to Alzheimer’s as compared to deterministic genes (Alzheimer’s Association, 2022b).

Head injuries can also later lead to Alzheimer’s. This head injury may occur due to a stroke, a sports injury (boxing and other high-contact sports), or automobile accidents (Alzheimer’s Association, 2022a). A heart-head connection can also lead to Alzheimer’s. This can be noted in instances where an individual has cardiovascular disease. This includes hypertension, coronary artery disease, and other issues which can elevate blood pressure (National Health Services, 2021). Those with Down Syndrome can also be at risk for Alzheimer’s. Those who may have a tendency towards loneliness and depression also carry a higher risk for Alzheimer’s (National Health Services, 2021).

Similarities and differences between Alzheimer’s, Vascular dementia, Dementia with Lewy bodies, and Frontotemporal dementia

Alzheimer’s, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia are all types of dementia. These diseases, therefore, affect the memory of the individual, including their behavior and problem-solving skills (Alzheimer’s Society, 2022). They mostly also affect older adults.

Alzheimer’s is the most common of these diseases (Alzheimer’s Society, 2022). It is caused by neurofibrillary tangles as well as plaques in the amyloid (Better Health Victoria, 2022). These tangles and plaques give rise to cognitive issues as seen in the disorder (Better Health Victoria, 2022). In vascular Dementia, the blood vessels of the brain are mostly affected. There are issues and damage to the blood vessels which can then lead to cognitive issues (Better Health Victoria, 2022). The Lewy bodies are protein groupings that are noted in the nerve cells of the brain and they lead to symptoms of dementia (Alzheimer’s Society, 2022). Frontotemporal dementia mostly impacts the frontal and temporal lobes of the brain (Better Health Victoria, 2022). These symptoms cause changes in the individual’s behavior and in their personality (Better Health Victoria, 2022). Aside from memory loss, their self-control and judgment are also often compromised.

Explicit and implicit memory

Implicit memory also refers to unconscious memories. These can be hard to express as they are mostly emotional. They often affect current attitudes but sometimes individuals may not be conscious that their memory is affecting their behavior (McLaughlin, 2020). Memories like playing games or playing music are for example part of unconscious memories and usually become second nature to individuals (McLaughlin, 2020). Individuals often have a specific reaction to stimuli due to their implicit memory. These memories can therefore manipulate their reactions and behavior (McLaughlin, 2020). Classical conditioning is associated with implicit memories (McLaughlin, 2020).

Explicit memory notes the presence of more conscious memories, intentionally remembered and consciously expressed (McLaughlin, 2020). These are memories that are anchored on personal experiences and actual events taking place which are recalled by the individual (McLaughlin, 2020). As for semantic memories, these refer to more specific data and ideas (McLaughlin, 2020). Autobiographical memories are more related to events.

Diagnosis and criteria for Alzheimer’s disease

The diagnostic criteria set by the National Institute of Aging and the Alzheimer’s Association cover primary clinical standards related to mild cognitive impairment. This would refer to the symptomatic stage. Updates in the stages of Alzheimer’s now include three new stages (National Institute of Aging, n.d). In the preclinical stage, there are changes in the brain as seen in the amyloid buildup and differences in nerve cells (National Institute of Aging, n.d). No symptoms are present as yet. For mild cognitive impairment, symptoms are present. Most symptoms are related to thinking issues not matching the individual’s knowledge and age (National Institute of Aging, n.d). They are still independent. The disease progresses at this point, with symptoms becoming more pronounced. The memory loss worsens and there is a greater difficulty in finding the right words to use. The individual’s independence is now affected (National Institute of Aging, n.d).

Best Therapeutic Approach

CJ needs diagnostic tests to establish if she has Alzheimer’s. When this is confirmed, she needs to be prescribed the appropriate medications. These medications would help manage the symptoms. Cholinesterase inhibitors work to stem the progression of the disease. Memantine helps with memory and learning. Antidepressants help manage mood and anxiety while antipsychotics can also help reduce aggression (Salamon, 2020). Cognitive Stimulation Therapy can be applied to CJ to help promote mental engagement (Salamon, 2020). Reality Orientation Time Therapy can also improve the individual’s awareness of her surroundings, where she is, what she is doing, what day it is, and what she has done (Salamon, 2020).

 

References

Alzheimer’s Association (2022a). Causes and risk factors for Alzheimer’s disease. https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors

Alzheimer’s Association (2022b). Is Alzheimer’s Genetic?