NURS 6501 Module 5 Assignment: Case Study Analysis
Advanced pathophysiology
Hyperuricemia is a health condition known to be commonly caused by a decrease in renal excretion. Patients utilizing diuretics such as hydrochlorothiazide are at a higher risk of developing the disease. However, the disease might also be genetically passed from parents to children. An increase in the turnover of nucleoprotein in the hematologic condition may result to an increase in urate production (Singh & Gaffo, 2020). Nucleoprotein turnover occurring in conditions of high rate of cell death and cellular proliferation may also impact high production of urate. Obesity which is an abnormal body weight may also cause an increased urate production which correlates with surface area to volume ratio of body size.
Neurological processes
An acute gout flare is characterized by pain as the primary symptom. Several factors may account for the felt pain. Bradykinin and prostaglandins production may be one factor that might impact the pain. Nociceptors’s sensitization may also account for this pain. Stimulation of unmyelinated nerve fibres results to neuropeptides release (Mei et al., 2019). For instance substance P which is an example of neuropeptides might be released. A release of substance P results to production of cytokines and PGs. It is also characterized by processes such as leukocytes recruitment, vasodilation, mast cell degranulation and plasma extravasation.
Musculoskeletal process
Continuous and multiple flare-ups makes gout to become persistent and severe. Due to this reason deformity of a joint is developed. As time goes by, one progressively develops difficulties in joint motions. The uric acid crystals accounts for the damage in these joints and tendons. Developing gout is characterized by urate precipitation that results in monosodium-urate crystals that are needle-shaped. These crystals are found as deposits in vascular tissues such as cartilage and in other avascular tissues such as walls of bursae, tendons, ligaments and tendon sheaths (Zhang et al., 2018). The crystals may also be deposited within the skin closer to tissues and cooler distal joints such as those of the ears.
Racial/ethnic variables that may impact physiological functioning.
African-American men are reported to have more cases of gout arthritis compared to white men. From previous research studies, it has been found out that several differences exist in the genetic constituents of renal urate between African-American and white men. These differences account for the difference in number of gout Hyperuricemia cases. The higher prevalence of co-morbidities such as renal failure, hypertension and obesity also cause an increased burden of gout to the African-American men (Singh & Gaffo, 2020). Furthermore, delays in diagnosis and treatments as well as utilization of medications that are predisposing such as diuretics account for the higher number of gout patients among African-American men.
How these processes interact to affect the patient.
Having a history of diabetes mellitus and hypertension pose high possibilities of the patient developing gout. Increased uric acid also forms a higher risk of developing gouty arthritis. The patient’s obese condition and a recent history of hydrochlorothiazide intake also form a crucial role in gout pathogenesis. A sterile auto-inflammatory response to the crystals of monosodium-urate represents the gout flare. The auto-inflammatory response is characterized by erythema, heat, pain, swelling and loss of joint movement (Zhang et al., 2018). These are the exact signs and symptoms that the patient complains about. Moreover, the patient complains of having problems in the movement of the right first metatarsophalangeal which is the primary location where gout is known to attack. Although the patient is a white male who is less prevalent to gout attacks, his medical history suggest a higher chance of Hyperuricemia which is a primary cause of gouty arthritis.
References
Mei, J., Zhou, F., Qiao, H., Li, H., & Tang, T. (2019). Nerve modulation therapy in gouty
arthritis: targeting increased sFRP2 expression in dorsal root ganglion regulates
macrophage polarization and alleviates endothelial damage. Theranostics, 9(13), 3707.
https://doi: 10.7150/thno.33908
Singh, J. A., & Gaffo, A. (2020, June). Gout epidemiology and comorbidities. In Seminars in
arthritis and rheumatism (Vol. 50, No. 3, pp. S11-S16). WB Saunders.
https://doi.org/10.1016/j.semarthrit.2020.04.008
Zhang, Q., Gao, F., Sun, W., Ma, J., Cheng, L., & Li, Z. (2018). The diagnostic performance
of musculoskeletal ultrasound in gout: a systematic review and meta-analysis. PLoS
One, 13(7), e0199672. https://doi.org/10.1371/journal.pone.0199672
After evaluating the details given in the case study there is a high probability that the symptoms are associated with migraines. Migraine is a neurological illness that may cause a range of symptoms in individuals. Individuals with this condition frequently encounter problems such as extreme crippling headaches, sensations of tingling and numbness, articulation difficulties, intensified sound sensitivity, light sensitivity, vomiting, and nausea (Weatherspoon, 2017). Furthermore, there is commonly a trend of migraine headaches in the family after evaluation of family background with patients. Symptoms may last for days or hours, and pain that is experienced sometimes disrupts the day-to-day practices. Certain people state that they experience aura during or prior to the period of headache. The aura can result in blind spots, flashing lights, or even obstruction (Weatherspoon, 2017).
Racial/Ethnic Variables That May Impact Physiological Functioning
When looking at the population of people with migraine headaches, there are certain racial differences. In Caucasian women, the incidence of migraines is a little higher. The percentage of Caucasian women suffering from migraines is 20% while that of Asian Americans and African Americans is 9% and 16% respectively. Related phenomena have been found while examining males with migraines (Tao, 2017) where Caucasians account for 8% while Asian Americans and African Americans account for 4% and 7% respectively (Chawia, 2019). Studies have also demonstrated that the racial effects differ in regard to clinical manifestations. In African American people suffering from migraines, vomiting and nausea were less common, but the pain registered was significantly high (Tao, 2017). Nevertheless, African Americans experienced less weak points. In addition, studies have established that in people with migraines, socioeconomic aspects can be established. This is assumed to involve healthcare access, habits, and diets (Chawia, 2019). When examining racial disparities, in conjunction with socio-economic factors and genetic elements, it is considered that these elements directly affect the diagnosis of migraine headaches.
Process Interactions Impacting Patient
Migraine studies tend to leave numerous research gaps as to why patients suffering from migraines present symptoms that are so different. Alterations in brainstem connections involving the trigeminal nerve have been reported to be associated with migraine headaches. Further studies reveal that there is a link associated with brain chemical imbalance involving mostly calcitonin gene-related peptides and serotonin (Chawai, 2019).
Moreover, several elements can be linked to the occurrence of migraine headaches in a diverse patient population. One of the likely factors includes hormonal shifts in women with migraines (Weatherspoon, 2017). Fluctuations of levels of estrogen prior to or after menstruation, the beginning of menopause, and pregnancy have been found to cause migraines (Lagman-Bartolome & Lay, 2019). Another factor is hormone replacement therapy and the intake of contraceptive pills. They have been shown to exacerbate migraines and decrease the time between incidents. Higher stress levels, as well as the usage of alcohol and OTC medications, are also associated with migraines. Certain individuals may discover that sensory triggers may affect migraine incidents. Some of these include loud sounds, secondhand smoke, smells like perfume, sunlight, and bright light, which may cause migraines. Environmental elements like weather changes have been found to often be associated with migraine headaches, particularly that of elevated biometric pressure. Lastly, food additives including aspartame and monosodium glutamate are among factors that can trigger migraines (Weatherspoon, 2017).
References
Chawia, J. (2019, November 9). How does the prevalence of migraine headache vary by race? Latest Medical News, Clinical Trials, Guidelines – Today on Medscape. https://www.medscape.com/answers/1142556-170218/how-does-the-prevalence-of-migraine-headache-vary-by-race.
Lagman-Bartolome, A. M., & Lay, C. (2019). Migraine in women. Neurologic Clinics, 37(4), 835-845.
Tao, F. (2017). Migraine Prevalence and its Differences among Races and Ethnicities in the United States (2010-2015) (Doctoral dissertation, UC Irvine).
Weatherspoon, D. (2017, December 20). Everything you want to know about migraine. Healthline. https://www.healthline.com/health/migraine.
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Case Study Analysis
An understanding of the neurological and musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that these two systems can have on each other. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.
Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as, racial and ethnic variables can play a role.
An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.
The Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
- Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
- Any racial/ethnic variables that may impact physiological functioning.
- How these processes interact to affect the patient.
By day 7 of Week 8
Submit your Case Study Analysis Assignment by Day 7 of Week 8.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates
Links to an external site.). All papers submitted must use this formatting.
submission information
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- To submit your completed assignment, save your Assignment as MD5Assgn_LastName_Firstinitial
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The case analysis is based on a 67 years old man who presents to the HCP with chief complaints of arm tremors. The patient has some tremors in the leg. According to the son, the father was stiff, taking him longer to perform simple tasks. Based on a physical examination, the patient hand was at rest, and the fingers exhibited movement. He exhibited a mask-like appearance since his face was not mobile while his gaits were uneven. In addition, the patient shuffled when he walked while his knees and hips flexed forward. Therefore, he exhibited a cog wheeling movement. The patient also identified that he had extreme sweating when engaging in activities. The paper will provide the neurological and musculoskeletal pathophysiologic process based on the patient’s symptoms.
Neurological and Musculoskeletal Pathophysiology Processes
The patient is diagnosed with Parkinson’s disease. Parkinson’s disease affects movement; thus, a progressive nervous system disorder (McCance & Huether, 2019). Therefore, Parkinson’s disease is caused by degeneration of the brain, causing the impairment or death of the neurons in the body (McCance & Huether, 2019). This leads to the depletion of dopamine due to the formation of the substantia nigra. Notably, when the neurons are normal, dopamine production takes place. Patients with Parkinson’s disease lack dopamine, which effectively improves the blood flow in the body (Taylor et al., 2020).
Therefore, the patient experienced tremors, stiffness, and difficulties walking due to dopamine insufficiency in the body. This shows that dopamine is effective in achieving smooth muscle movement. In addition, a patient with depleted dopamine is also likely to experience other nonmotor symptoms such as autonomic –neuroendocrine changes (Chung et al., 2018).
Moreover, patients who have Parkinson’s disease lose the nerve endings responsible for producing the norepinephrine. The chemical helps control the main function in the body, such as blood pressure and heart rate, thus a messenger to the sympathetic nervous system (Chung et al., 2018). The patient with Parkson’s has a brain cell that consists of Lewy bodies that impact the movement, mood, or behavior (Chung et al., 2018). Lewy bodies are abnormal clumped proteins that develop in the nerve cells and are located in the substantia nigra of a person’s brain.
Racial/Ethnic Variables
Parkinson’s disease is common to neurodegenerative disease among the elderly. The large insurance database identifies that the most affected ethnicity is the Hispanic, with the highest incidence, followed by the black with the lowest (Hayes, 2019). Based on gender, males experience Parkinson’s disease more than women, while the number of patients diagnosed increases with age (McCance & Huether, 2019). The main reason for the increase in the risk of Parkinson’s among men is due to the toxicant exposure, head trauma, and the X linkage of the genetic risk factors (Hayes, 2019).
Interaction of the Processes
A patient with Parkinson’s disease suffers limited movement. This is due to degeneration of the basal ganglia, which causes a decline in level of dopamine that is inhibited in acetylcholine (Yaday & Kumar, 2022). However, levels of acetylcholine remain active, leading to imbalance in inhibitory neuronal activity and excitatory (Yaday & Kumar, 2022). Therefore, excess neurons cause the ability to generate the voltage of the rapid membrane, whose response is a very small stimulus.
Conclusion
Parkinson’s disease affects a person’s movement since it is a progressive nervous system disorder. Several factors increase the risk of developing Parkinson’s disease, including age, ethnicity, and gender. Men are most likely to suffer from the disease, which can also be hereditary. The early signs of the disease include tremors and trouble in movement.
References
Chung, S. J., Yoo, H. S., Oh, J. S., Kim, J. S., Ye, B. S., Sohn, Y. H., & Lee, P. H. (2018). Effect of striatal dopamine depletion on cognition in de novo Parkinson’s disease. Parkinsonism & related disorders, 51, 43-48. https://www.sciencedirect.com/science/article/pii/S1353802018301147 Hayes, M. T. (2019). Parkinson’s disease and parkinsonism. The American journal of medicine, 132(7), 802-807. https://www.sciencedirect.com/science/article/pii/S0002934319302359 McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier. Taylor, J. P., McKeith, I. G., Burn, D. J., Boeve, B. F., Weintraub, D., Bamford, C., … & T O’Brien, J. (2020). New evidence on the management of Lewy body dementia. The Lancet Neurology, 19(2), 157-169. https://www.sciencedirect.com/science/article/pii/S147444221930153X Yadav, D., & Kumar, P. (2022). Restoration and targeting of aberrant neurotransmitters in Parkinson’s disease therapeutics. Neurochemistry International, 105327. https://www.sciencedirect.com/science/article/pii/S0197018622000523
Rubric
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Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following:Explain both the neurological and musculoskeletal pathophysiologic processes of why the patient presents these symptoms. |
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Explain how the highlighted processes interact to affect the patient. |
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Explain any racial/ethnic variables that may impact physiological functioning. |
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Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
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Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation |
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Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
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Total Points: 100
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