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As per the given information in the case study, Mary Lou can be identified as suffering from two main medical issues. These underlying conditions are brain tumor and Alzheimer’s disease. The main clinical signs that point towards the indication of patient suffering from these conditions include memory loss and patient being disoriented to time and place. As a part of pathophysiology of the Alzheimer’s condition there are two main elements that play a vital role in development of this condition. These are intracellular neurofibrillary fibers and beta-amyloid concentration present extracellularly. There are multiple speculations that are made pertaining to the manifestation of the condition in patients. Some of these factors can be related to amyloid cascade hypothesis and other might be due to genetic components. Pathological steps include alterations in APP processing, which is then followed by the overproduction of beta components. This cumulatively results in plague formation, which is reflected in the patient in terms of symptoms of the neural disorder condition (Hung, 2018). The condition of brain tumor can be directly associated with immune system depression. Another major factor can be due to increased exposure to radiation therapy. This can bring about mutation eventually leading to development of brain tumor. Brain tumor exerts an additional pressure on the brain and thus, adding to the intracranial pressure. This is also one of the main complications of brain tumor. This increased intracranial pressure might also bring about a reduction of cerebrospinal fluid and thus, adding to the overall health burden.
The patient has been prescribed the medication of Fluoxetine. This medication is one of the most commonly used drugs belonging to the class of selective serotonin reuptake inhibitor. The main action of this medication is based on blocking the level of serotonin uptake, at the level of presynaptic terminal. This brings about an increase in the amount of serotonin uptake and thus, providing fast relief to the symptoms. With a gush of increase in the level of serotonin in brain, the person might feel mood elevation and a lowered depressive mood status (Davey, 2019). The main consideration while administering this medication is the restriction for intake of alcohol. Another drug provided to the patient Diazepine. This is an anti-anxiety medication which can also be administered to the patient to help with pattern of insomnia. Medication can also be a multi-purpose drug which can be helpful as a muscle-relaxant, sedative, anticonvulsive and many others. The mechanism of action of this drug is based on increasing the neurotransmitter’s capacity and impacting in the central nervous system to bring bout an evident change. This drug also acts by binding strongly with different regions in the spinal cord, to bring about responsive changes and impact on the person to whom the drug is administered. The drug also promotes a pattern of sleep induction in the patient and thus, relaxing them. The main consideration for this drug is not to be taken with alcohol or empty stomach.
The patient in the given case study can be deduced to be suffering from alcohol addiction. She has a considerably increased uptake of wine. The patient also requires the support of alcohol to go to sleep. The physician has also tried the method of medication for helping the patient with her alcohol addiction.
The main mechanism of alcohol addiction is regulated with the means of adaption of neural system in the body. The intake of alcohol in the patient leads to the release of dopamine. Therefore, with regular intake of excessive amount of alcohol in the patient, it creates a certain amount of dependency (Viscogliosi, 2017). This dependency can be observed to be increased in cases where the patient might experience certain amount of stress of anxiety. However, progressively long use of alcohol in patient can also lead to poor coordination, memory loss and display if irrational and uncoordinated behavioral display from the patient’s end. Dopamine release is the main attributing factor that leads to such behavioral and physiological changes in the patient thus it acts a trigger for the patient.
The process of drug administration can be a bit different and critical in older individuals. The adjustment or regulation of dose in the elderly population should be carried out by the help of acknowledging for drug action and mechanism. As older patients have an increased sensitivity to the drug administered to them. The alteration in the dosage is also to be carried out in respect with its overall impact on the central nervous system. The patient Mary Lou in the case study has been suggested administration of a reduced dosage of drug named MedX. This is mainly considered to lower the adverse impact of the drug on the functioning of liver of the patient. Any administered drug dose alters with the protein binding and metabolic elimination capacity of the liver (Mc, 2016). So, as to reduce the negative impact of the drug on the patient’s bodily functions, the dose alteration in terms of its reduced amount, should be rendered to the patient. It is also considered to ensure improved hepatic clearance and thus, improving the overall efficacy of the system in clearing out the additional drug dosage. With a reduced availability of protein binding capacity, the absorption of drug is also limited. The altered concentration of protein in the body also hinders with the overall plasma concentration of the drug. Overall, with the help of drug dosage alteration, the useful concentration of drug can be enhanced to stay in the body system for a longer duration. Therefore, to ensure safe drug administration, drug elimination and improved renal efficacy, alteration of drug dosage can be deemed as a useful method to be considered to older individuals.
The clinical condition of osteoporosis is one of the most commonly observed skeletal conditions in older individuals. It hinders with the overall bone strength and thus, increasing the incidence of fracture in older patients. Osteoporosis also degrades the overall quality mineral content and density of the bone and the bony structures. This diminishes the overall quality of bone, as the age progresses. This skeletal condition can develop in patients due to external factors such as stress, friction in between joint surface and so on. It can also manifest in the patient, due to underlying internal factors which can be closely related to physiology of the bone structure or due to genetic predisposition. The condition of osteoporosis is observed to be of greater gravity and impact in women as compared to their male counterparts. Some of the responsible factors for development of osteoporosis in women can be due to postmenopausal changes. This is also marked with the increased deficiency of estrogen production in the body. There is also an evident reduction in the normal ranges of vitamin-D produced and taken in diet, with advancing age. This can also contribute to lower concentration of vitamin-D and decreased bone mineral deficiency in patients (Dadra, 2019). This exposes the person to an increased chance of stress fracture. As the age progresses, there is evident bone remodeling which takes place. This phenomenon is marked by alteration in bone cells. The effects are observed in patient in the pattern of mobility issues, increased pain and discomfort and joint imbalance as well. This might limit the physical ability of the patient. The overall reduced bone mineral capacity, tagged along with structural alterations in joint structures can also lead to spinal fractures, impacting the vertebras.
Role of deficiency of calcium and vitamin D can be vital in formation of osteoporosis in older patients. Certain amount of calcium and Vitamin D also plays vital role in the process of bone metabolism. This helps in averting the development of osteoporosis in older patients. However, with the deficiency, this can impact with the overall functioning of health promotion in older individuals. The reduced deposits of both of these elements in the body can also lead to increased bone remodeling, eventually leading to the development of osteoporosis (Veldurthy, 2016). Apart from bone calcium deposits also help with muscle contraction and relaxation in a rhythmic pattern. Thus, its deficiency can lead to abrupt functioning as well. Certain hormones have also been observed to cause osteoporotic changes in the older patients. Some of these hormones are mainly responsible for ensuring sufficient reserves of calcium in the body to ensure normal functioning. Few examples of these hormones are thyroid hormone, parathyroid hormone, sex hormone and many others. Similar to the case of menopausal women, there is reduction of estrogen production. This hormone is also responsible for the manifestation of osteoporosis in patients due to reduced concentrations in the body.
The three main physiological factors which directly impact the overall process of fracture healing are hormonal alterations, alterations in the vascular system due to advancing age and reduced concentration of vitamin D in the skin (Foulk, 2016). As the age progresses, the production of growth hormones can be observed to be depleted. Skeletal structural growth can be directly associated with interaction of hormone like, growth factor and somatomedins. These are responsible for cell proliferation and thus, alter with the multiplication of bone cells, namely, osteoclasts, osteoblasts and osteocytes. These factors collectively cause a delayed bone promotion and thus, affecting the process of bone healing by hindering the same. It also eventually results in poor healing of fracture and altering with the mechanism of healing as a whole. The ability of the blood vascular system can also be observed to reduce with the advancing age. Due to hampered vascular perfusion marked with the ageing process, there is a lesser ability of the tissues to heal themselves properly (Nigro, 2019). With poor blood supply of blood to the site of injury, there is often tissue damage and delayed healing observed. Reduced levels of vitamin D production, also delays the process of fracture healing in older patients. With a reduction in vitamin D concentrations, there is a reduced calcium absorption and intake in the bone. Thus, hindering with the process of bone healing and altering with the bone density as well. This subjects the bone to further harm caused by impact injury or by being subjected to minimal forces.
Scoring of T-value index of -3.0 can be a direct indication of patient having clinical status of severe osteoporosis (Zhuang, 2020). With the progression of age, the parathyroid gland tends to release lower concentration of calcium deposits. The gland also hinders with the function of kidney in ensuring sufficient release of calcium so as to establish a metabolic balance. With an increased concentration of calcium released from the bone, there is a relatively marked increase in bone reabsorption. This exerts a negative impact on the bone structure and thus, leading to bone degeneration. The role of biphosphates has been established as beneficial in helping with the condition of osteoporosis (Tsartsalis, 2018). This component can help in promoting overall strength of the bone structure and ensuring less damage and risk to the same. It can also be fruitful in helping with the process of bone healing in cases of injury to the structure. The administration of biphosphates also makes sure that the process of bone remodeling is restricted. This helps in increasing the bine density and mass and protecting it from any harm evidently.
Patients might not be aware of the common medical terms that are generally used to refer to certain conditions. Malignancy is a common term used to explain the spread of cancerous cells from the point of their origin to the adjacent and distant tissues as well. Malignant cells have a property to multiple quite frequently and thus, infiltrate easily and rapidly (Burger, 2018) Benign tumor on the other hand, restricts itself to the point of origin and not spreading any further away from eth vicinity. Cancer cells generally mimic the normal cells; however, they might differ completely in function. As Bruce is having the cancer of metastatic nature, his overall health prognosis can be deemed as poor. The malignant spread of tumor is generally life threatening for the patient suffering from the same.
Cancer cells can be observed to have specific clinical features which can make them invasive in nature. These features of the cancerous cells help them to infiltrate the neighboring tissues and organs and affecting the cells by establishing frequent multiplication in the organ. Metastasis process is usually followed by three main salient processes, namely, invasion, intravasation and extravasation. Cancerous cells tend to secrete substances which help them in attaching themselves to the base of extracellular matrix (Brown, 2019). This matric is mainly responsible for migration and motility process. Thus, it helps the cancerous cells to be deposited to new sites and organs structures. Loss of adhesion helps in smoother motility, carried out with the process of invasion. These abnormal cells also have a capacity to attach themselves to the existing blood vessels and using them as a medium of transportation. This process of multiplication of cancerous cells can be observed as extravasation. With invasion to newer sites cancer cells further penetrate the endothelium and thus manifesting itself in the tissue structure.
In the given case study, the condition of neutropenia can pose an evident risk to the overall well-being of Bruce’s health. Neutrophils or the white blood cells makes up for an integral part of the immune system of the body. With strict chemotherapy regimens, the immunity of the patient is generally lowered (Averin, 2020). This tagged along with reduced number of white blood cells can be a major threat to Bruce, who is on active and rigorous medication regimen. These neutrophils are also liable to bring a phagocytotic response in the body and thus, helping the immune system to prevent any un-called-for situation. The treatment selected for Bruce involves removal of polyps. The patient might suffer a struct blood loss during surgery and with reduced level of white blood cells there is an increased risk of infection and life danger for the patient.
With his condition and type of treatment option, Bruce is liable to catch potential infection from the hospital environment. In order to prevent the spread and transmission of infection the person contact for Bruce should be minimized. There should be a strict use of personal protective gear while managing care for him and also for the purpose of paying him a visit. The role of healthcare professionals can also be vital in helping in reduction of hospital acquired infection ad marinating a sterile environment. These protocols can be effective in reducing the overall transmission of infection and its spread to other patients and within the hospital environment as well. Aseptic measures will also help in reducing the viral load and thus, limiting its further transmission (Clare, 2018).
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Dadra, A., Aggarwal, S., Kumar, P., Kumar, V., Dibar, D. P., & Bhadada, S. K. (2019). High prevalence of vitamin D deficiency and osteoporosis in patients with fragility fractures of hip: A pilot study. Journal of Clinical Orthopaedics and Trauma, 10(6), 1097-1100. https://doi.org/10.1016/j.jcot.2019.03.012
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Viscogliosi, G., Ettorre, E., & Chiriac, I. M. (2017). Dementia correlates with anticoagulation underuse in older patients with atrial fibrillation. Archives of Gerontology and Geriatrics, 72, 108-112. https://doi.org/10.1016/j.archger.2017.05.014
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