Module 5 Assignment: Case Study Analysis

Instructions:  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.

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 “Course Announcements” section of the classroom for your assignment from your Instructor.

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.

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                                                               CASE SCENARIO

A 67-year-old man presents to the HCP with chief complaint of tremors in his arms. He also has noticed some tremors in his leg as well. The patient is accompanied by his son, who says that his father has become “stiff” and it takes him much longer to perform simple tasks. The son also relates that his father needs help rising from his chair. Physical exam demonstrates tremors in the hands at rest and fingers exhibit “pill rolling” movement. The patient’s face is not mobile and exhibits a mask-like appearance. His gait is uneven, and he shuffles when he walks and his head/neck, hips, and knees are flexed forward. He exhibits jerky or cogwheeling movement. The patient states that he has episodes of extreme sweating and flushing not associated with activity. Laboratory data unremarkable and the HCP has diagnosed the patient with Parkinson’s Disease.

Sample NURS 6521 Assignement

Case Study Analysis

As a progressive degenerative disorder, Parkinson's disease (PD) mainly results from the depletion of dopamine in the brain. The disorder manifests itself through the compromised activity of daily living, posterior instability, decreased movement, which is a combined effect of tremor, rigidity, and bradykinesia.  The causes may incorporate idiopathic, hereditary, autoimmune, family history, and brain stem effect. For instance, the patient showed posterior instability since he needs help to rise from his chair. The objective of the treatment prescribed for this patient is to restore the patient’s dopaminergic function in the brain by administering dopamine antagonist medications (Faustini et al., 2017). 

Pathophysiology

The pathophysiology of Parkinson’s disease involves the interaction of host susceptibility and the environmental factors (Ball et al., 2019). In its pathophysiology, synuclein protein is involved. The synuclein protein of neurons and glial cells binds into insoluble fibrils to produce lewy bodies. Therefore, the pathological feature of PD is the Lewy bodies, which are filled with synuclein in the nigrostriatal system, causing depletion of dopamine in the brain Faustini et al., 2017). The lewy bodies appear in a temporal sequence, resulting in many scholars terming PD a comparatively late development in systemic synucleinopathy (Weil et al., 207). The pigmented neurons of the substantia nigra, the locus ceruleus, and other dopaminergic groups of the brain stem degenerate, resulting in the loss of substantia nigra neurons, which consequently leads to depletion of dopamine on the dorsal part of the putamen leading to most of the motor signs and symptoms of PD. In some PD, a genetic predisposition is likely to happen. For instance, approximately 10% of patients have a family history of PD with various abnormal genes in a family being linked to PD. Further, the inheritance pattern of these PD causing genes is autosomal dominant for specific genes and autosomal recessive for others genes.Moreover, PD manifests the symptoms of other synucleinopathies, like autonomic dysfunction and dementia.

Genetically, the age of onset of Parkinson’s disease tends to be at a younger age. However, during these young years, the course of the disease is often more benign as compared to late-onset, which are presumably not genetic related. However, neurological symptoms like jerky or cogwheeling movement noted in the 67-year-old man are not related to Parkinsonism and may appear because synucleinopathy may happen in other areas of the central, peripheral, and autonomic nervous systems (Faustini et al., 2017). Other examples of the symptoms unrelated to Parkinsonism include the almost universal sympathetic denervation of the heart, which contributes to orthostatic hypotension; dysmotility of the esophagus, which contributes to dysphagia and increased risk of aspiration; a dysmotility of the large intestine, which contributes to constipation (the patient gait is uneven); strangury or urinary urgency, that may result in incontinence, Seborrheic dermatitis, and anosmia.

However, apart from the physiological variables that may impact the physiological functioning of this patient, there are also ethnic or racial variables such as being African-America, Hispanic, low level of education, old age, low income, or aging beliefs from different ethnic backgrounds. For instance, being an African-American or Hispanic racial groups with a low education and income increases the risk of being diagnosed with PD. Low education means that the individual does not have information concerning the risk factors of the disease and low income means that the individual cannot afford money to go to the hospital for checkup. The racial variation is due to biological differences observed in different racial groups in PD dues to healthcare inequalities and socio-cultural factors. Research indicates that African-Americans and Hispanic populations are twice more likely to be diagnosed with PD than the whites (Ball et al., 2019.

Overall, PD is a serious degenerative disease that is caused by insufficient dopamine in the brain. The main manifestations include decreased movement and posterior instability as well as compromised activity of daily living.  Therefore, understanding the pathophysiology of the disease can help design an appropriate treatment plan for the case study patient. The main aim of treatment in the case study patient is to restore the dopaminergic function in the brain. The min protein involved in the pathophysiology of PD is the synuclein is involved which can bind into insoluble fibrils and form Lewy bodies, that are responsible for the clinical manifestations of PD. Lastly, racial or ethnic variables such as being African-American or Hispanic, low income, and old age may also impact the physiological functioning of individuals with PD.

References

Ball, N., Teo, W. P., Chandra, S., & Chapman, J. (2019). Parkinson's disease and the environment. Frontiers in neurology, 10, 218.

Faustini, G., Bono, F., Valerio, A., Pizzi, M., Spano, P., & Bellucci, A. (2017). Mitochondria and α-Synuclein: Friends or Foes in the Pathogenesis of Parkinson’s Disease?. Genes, 8(12), 377.

Weil, R. S., Lashley, T. L., Bras, J., Schrag, A. E., & Schott, J. M. (2017). Current concepts and controversies in the pathogenesis of Parkinson’s disease dementia and dementia with Lewy bodies. F1000Research, 6.