NURS 6501 Module 5 Case Study Analysis

NURS 6501 Module 5 Case Study Analysis

NURS 6501 Module 5 Case Study Analysis

The provided case study demonstrates a 67 years old male patient who was accompanied to the clinic by his son as a result of tremors in his arms. Additional signs and symptoms reported by the patient include generalized stiffness and inability to perform tasks and get off a chair independently. Upon performing a physical examination, it was noted that the patient demonstrates hand tremors at rest, “pill-rolling” movement of the fingers, immobile face, uneven gait jerky movement,and shuffles when walking, in addition to his knee, hips, and head/neck flexed forward when walking. The patient also reported extreme sweating and flushing episodes which are not associated with any activity. The HCP ordered lab tests that displayed unremarkable results and went ahead to diagnosis the patient with Parkinson’s Disease. The purpose of this paper is to analyze the case of this patient in relation to the musculoskeletal and neurological pathophysiological process for a better understanding of the patient presenting symptoms, in addition to the racial or ethnic variable, which might affect the patient’s physiological functioning.

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Neurological and Musculoskeletal Pathophysiologic Processes

Parkinson’s disease (PD), initially known as ‘shaking palsy’ is a neurodegenerative disorder associated with both nonmotor and motor features. The 67 years old patient presents with rest tremor, rigidity, and bradykinesia, which are largely dependent on the dopaminergic nigrostriatal denervation in the early stages of PD. As the disease progressed, the patient started displaying dyskinesia and motor fluctuations which are contributed by severe nigrostriatal loss in addition to defects in the absorption of oral levodopa, and damage to the non-dopaminergic pathways leading to multisystem neurodegeneration and marked dopaminergic loss (Chen et al., 2020). Concerning the musculoskeletal system, the patient displayed motor problems such as lack of balance, inappropriate posture, and gait disturbances, which normally occur as a result of nondopaminergic dysfunction (Vázquez-Vélez et al., 2021). Lastly, the extreme sweating and flushing, displayed by the patient are due to defects in the autonomic nervous system controlling sweating, leading to hyperhidrosis.

Racial/Ethnic Variables

Studies confirm that PD does not affect different racial/ethnic groups equally. However, more focus has been directed towards the prevalence of the disease among African Americans and whites. Some studies show that the prevalence of PD is equal among these two ethnic groups, while some claim that it is lower among the black (Ball et al., 2019). This has been associated with melanin which is speculated to offer some kind of protection against PD. Studies show that malignant melanoma normally precedes PD, whereas an individual with decreased levels of melanin displays increased risks of developing melanoma (McCance et al., 2019). Additional racial factors include elevated uric acid levels which reduce the risks of PD, among the whites.

How Processes Interact to Affect the Patient

PD is a complex progressive disorder that occurs as a result of an interaction between both neurological and musculoskeletal processes in addition to environmental factors and ethnic variations. For instance, neurological processes such as loss of dopaminergic neuronsare associated with musculoskeletal features such as rest tremors and rigidity, whereas degeneration of non-dopaminergic pathwaysis associated with posture, balance, and gait (Raza et al., 2019). Melanin and uric acid on the other hand demonstrate racial variations contributing to reduced risk of developing PD.

Conclusion

The patient in the provided case study presents with symptoms of Parkinson’s disease such as tremors, rigidity, jerky movement, and uneven gait. These symptoms, mainly result from degeneration of the neurons, affecting dopamine. They however affect the musculoskeletal functioning contributing to the patient’s symptoms.

References

Ball, N., Teo, W. P., Chandra, S., & Chapman, J. (2019). Parkinson’s disease and the environment. Frontiers in neurology, 10, 218. https://doi.org/10.3389/fneur.2019.00218

Chen, Z., Li, G., & Liu, J. (2020). Autonomic dysfunction in Parkinson’s disease: Implications for pathophysiology, diagnosis, and treatment. Neurobiology of disease, 134, 104700. https://doi.org/10.1016/j.nbd.2019.104700

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (Eds.). (2019). Pathophysiology: The biologic basis for disease in adults and children. Elsevier.ISBN-10: 0323065848

Raza, C., & Anjum, R. (2019). Parkinson’s disease: Mechanisms, translational models and management strategies. Life sciences, 226, 77-90. https://doi.org/10.1016/j.lfs.2019.03.057

Vázquez-Vélez, G. E., & Zoghbi, H. Y. (2021). Parkinson’s disease genetics and pathophysiology. Annual Review of Neuroscience, 44, 87-108. https://doi.org/10.1146/annurev-neuro-100720-034518

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Module 5 Assignment: 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.

Photo Credit: jijomathai – stock.adobe.com
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.

 

CASE STUDY:
Scenario 4: 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.

Learning Resources
Note: The below resources were first presented in Week 7. If you have previously reviewed them, you are encouraged to read or view them again here.

Required Readings (click to expand/reduce)

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
• Chapter 15: Structure and Function of the Cardiovascular and Lymphatic Systems (stop at Aging and the nervous system)
• Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory Function (stop at Sleep); Summary Review
• o Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function; pp. 504–511, pp. 516–530 (start at Acute confusional states and delirium) (stop at Alterations in neuromotor functions); (Parkinson’s Disease); Summary Review
• Chapter 18: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction (stop at Degenerative disorders of the spine); (start at Cerebrovascular disorders) (stop at Tumors of the central nervous system); Summary Review
• Chapter 44: Structure and Function of the Musculoskeletal System (stop at Components of muscle function); Summary Review
• Chapter 45: Alterations of Musculoskeletal Function (stop at Bone tumors); (start at Disorders of joints); Summary Review

Chin, L. S. (2018). Spinal cord injuries. Retrieved from https://emedicine.medscape.com/article/793582-overview#a4

Required Media (click to expand/reduce)

Khan Academy. (2019b). Ischemic stroke. Retrieved from ttps://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/stroke/v/ischemic-stroke
Note: The approximate length of the media program is 8 minutes.

Osmosis.org. (2019, June 12). Osteoporosis – causes, symptoms, diagnosis, treatment, pathology [Video file]. Retrieved from https://www.youtube.com/watch?v=jUQ_tt_zJDo
Note: The approximate length of the media program is 9 minutes.

Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 15, 16, 18, and the sections of Chapters 44 and 45 that relate to the neurological and musculoskeletal systems. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/

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RUBRIC:

Excellent Good Fair Poor
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. 28 (28%) – 30 (30%)
The response accurately and thoroughly describes the patient symptoms.

The response includes accurate, clear, and detailed explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by evidence and/or research, as appropriate, to support the explanation. 25 (25%) – 27 (27%)
The response describes the patient symptoms.

The response includes accurate, explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by evidence and/or research, as appropriate, to support the explanation. 23 (23%) – 24 (24%)
The response describes the patient symptoms in a manner that is vague or inaccurate.

The response includes explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by explanations that are vague or based on inappropriate evidence/research. 0 (0%) – 22 (22%)
The response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing.

The response does not include explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms, or the explanations are vague or based on inappropriate evidence/research.
Explain how the highlighted processes interact to affect the patient. 28 (28%) – 30 (30%)
The response includes an accurate, complete, detailed, and specific explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation. 25 (25%) – 27 (27%)
The response includes an accurate explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation. 23 (23%) – 24 (24%)
The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate evidence/research. 0 (0%) – 22 (22%)
The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate or missing evidence/research.
Explain any racial/ethnic variables that may impact physiological functioning. 23 (23%) – 25 (25%)
The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation. 20 (20%) – 22 (22%)
The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation. 18 (18%) – 19 (19%)
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations that are based on inappropriate evidence/research. 0 (0%) – 17 (17%)
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.
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. 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

The purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

The purpose, introduction, and conclusion of the assignment are vague or off topic. 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English Writing Standards:
Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors. 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors. 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
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. 5 (5%) – 5 (5%)
Uses correct APA format with no errors. 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors. 3 (3%) – 3 (3%)
Contains several (3 or 4) APA format errors. 0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100