Two diseases identified in case of Mary-Lou are depression and dementia. Depression is a mood disorder of individual and patients suffering from depression loose interests in doing day-to-day activities and they behave abnormally with others. Dementia disease causes memory loss or concentration of individuals. All these three diseases are inter-related with each other.
The characteristic symptoms of diseases in Mary Lou are listed below:
Low Self Esteem
Loss of interests in doing things like gardening and going to Bingo with friends
Forgetting things such as keys location
Forgetting topics of conversation with her daughter on phone
Mary Lou has been very teary for a long time. After the death of her husband, she completely broke down and lost interests in doing things. She also staggers while walking. She also started consuming alcohol and this significantly eroded her memory power and she also forgets things such as whether she has opened the refrigerator or not. Her past medical records also state that she was diagnosed with Alzheimer disease. These conditions are symptoms of depression and dementia.
Fluoxetine/Prozac is anti-depressant drug that removes acute depression, panic disorder and obsessive compulsive disorder of individuals. It is selective serotonin reuptake inhibitor and should not be given to patients with monoamine oxidase inhibitors. This drug is prescribed for adults and should also be given to children who are above 10 years of age.
Diazepam is a muscle relaxant, sedative and anticonvulsant and anxiolytic used to treat sleeping and anxiety disorders and control alcohol abuse. Mary Lou has been very teary and after the demise of her husband, she completely lost his memory power and became addicted to alcohol. Mary’s daughter said that her mother also forgets home address when she goes on walks in outside. Due to excessive consumption of alcohol, she started forgetting things such as key location and topics of conversation with daughter on phone. All these are symptoms of depression and dementia.
a) The two pharmacokinetic factors of drug are water solubility and metabolism. The antidepressant Fluoxetine/Prozac prescribed to Mary Lou is highly water soluble and it gets excreted by kidney in 1 to 4 days. It is highly enriched in protein and has nonlinear pharrmacokinetic properties. This drug should therefore, be prescribed to adults who do not have metabolic disorders. Mary-Lou is an elderly woman who has been suffering from mental trauma situation after the demise of her husband. She also suffers from sleeping disorder. Elderly persons mostly develop metabolic disorder and low concentration on things. Due to her old age, the medicine may take more time in dissolving in her body. She is also addicted to alcohol and this may also inhibit metabolism function of the prescribed drug.
b) Mary-Lou is addicted to alcohol and also poor memory power. She is prescribed with two drugs Prozac and Diazepam to treat her depression and dementia diseases. Prozac may generate some side effects such as insomnia, tremor, nose bleeding, abnormal muscle functions in alcohol addict persons. Therefore, it should be provided in small dosage i.e., 30 mg or less to her. Diazepam is muscle relaxant and treat anxiety, alcohol abuse and muscle disorders of patients and based on clinical history of Marie, the dosage of Diazepam should be increased from 10 mg. to 20 mg. or more to her. She should also be get involved in daily activities by family for faster results from the both drugs.
Mary faces difficulty in sleeping and as a result started consuming alcohol. She states that drinking alcohol helps her in sleep and she feels relaxed and happy. Her daughter told that she consumes alcohol even in a day. Earlier she used to drink 1 glass of alcohol in night and now she drinks 2 or 3 glass of alcohol in a day. According to the clinical report, Mary’s face always look flushed. All these are signs of an alcoholic person.
Mary suffered extreme mental shock from the death of her husband. She is an elderly woman and has had emotional disorder. The death of her husband has severely impacted her thinking power and she fails to remember things. While talking with her daughter, she often forgets conversation topics .Due to excessive drinking of alcohol, her loose physical balance. Her neighbour reported to her daughter one day that she was wandering on the street side and forgot her home address. She also fails to remember whether she has opened the refrigerator or not. These signs indicate that Mary becomes more dependent on her family for her daily activities.
Crepitus is the joint pain mostly caused due to arthritis or bone injury. After recovering from her past diseases, Marie Lou went alone for GP appointment and fell down over a branch and received pain on her hip. Her X-ray report revealed that she had broken her femur and this fracture resulted due to her weakened bone structure. She had been experiencing severe joint pains for quite long time. Marie’s joint disease may also be due to her age factor and confinement inside the home for some period. The two other signs of crepitus are swelling around the joint and crackling sound when a person moves his/her shoulder.
Marie Lou said that she had been feeling extreme joint pains for a long time and this may be due to her hereditary abnormal bone structure. She was unable to perform routine activities for some time due to her depression and dementia diseases. The most common form of joint disease is osteoarthritis that occurs due to diminishing cartilage cover of the bone. The situation of osteoarthritis patients worsen with the passage of time. This disease is mostly related with ageing in which protein build-up of cartilage due to increase of water quantity inside the cartilage and this results swelling and extreme pain around the joints.
Musculoskeletal disease is also an age related disease that leads to bone, joint and muscle pains in persons. This disorder appears due to excessive physical movements, prolonged immobility, accidents causing fracture in the bones or dislocation of muscle. From the clinical study of Marie Lou’s case, it seems that she had been suffering from joint pain for a longer period. Though Marie is an elderly woman and also fell down over a branch recently and broke down her hip joint, it can be said that her joint disease is mainly due to her hereditary bone formation.
Marie-Lou is an elderly widow and had been suffering from joint pain before her accident. She also underwent treatment for depression and dementia and remained at home for some time. This caused immobility in her bone. The common type of joint pain is osteoarthritis that occurs mainly in elderly person and worsens over the time due to degradation of cartilage protein covering the joints such as hip and elbow. In younger people, bone cartilage is well structured and therefore, fracture to the bone is quickly healed than elderly. The three physiological factors influencing the healing of fracture are nutrition, skin moisture and repeated trauma. Proper nutrition helps human body to develop basic healing capability of wounds, pains, swelling or fracture. Healing process disrupts in a person having dry skin as skin needs adequate amount of moisture for wound healing. Repeated trauma is multiple wounds or fractures in human body and this adversely affects the human immunity against viruses, wounds or cuts.
Ageing affects the normal diet intake of individuals and human body lacks adequate nutrients required for healing. It affects the skin moisture level of the body and elderly people suffer from dry skin, infection and lesions. The immunity level of elderly gets weakened and this affects the wound healing process of the body. The complications of hip fracture in elderly are further loss of muscle mass restricting the physical movement and urinary tract infections.
T-score of -2.5 or lower indicates that a person suffers from osteoporosis which is low bone density. Mary’s T-score was recorded at -3.0 which indicate that she suffers from osteoporosis. She has been suffering from multiple factors such as trauma, memory loss, ageing and physical injuries. The pathogenesis of her osteoporosis is the result of her immobility, hereditary joint pains, past medication and old age. The bone mass of human body degrades with the growing age and this weakens the bone density in the body and elderly persons are more vulnerable to accidents or fall due to weak bones. The Tobacco or alcohol addiction is also responsible for fragile bone density of males and females. Obese persons suffer from several metabolic disorders that affect the bone and tissue repair processes and results osteoporosis with the passage of time.
Bisphosphonate is the specific drug that slows the bone degradation and helps human body to gain bone mass. Mary-Lou is an elderly female and her clinical scan report suggests that she suffers from osteoporosis i.e., weak bone system. Bisphosphonate rebuilds the weak bone and reduce the risks of fall and fractures and therefore, will help Mary in gaining her bone mass. She is also advised to take calcium tablets along with this medicine daily.
The two triggers for Hilda’s Asthma are respiratory infections and smoky environment. Respiratory infection is the infection into the human respiratory system such as lungs due to virus, bacteria, fungus, smokes or dusts. She was diagnosed with Asthma in childhood and her first asthma attack was horrific with shortness of breath, heavy sweating and wheezing. Smoky environment is presence of smokes, fumes and dusts in the atmosphere. Dust and smoke particles are particularly injurious to the Asthma and allergic persons. The triggers for Hilda’s asthma lasted till her adulthood that further worsens her Asthma situation and she develops wheeze and continuous cough and becomes dependent on inhaler for relief from shortness of breath situation.
The two symptoms of Hilda’s Asthma are shortness of breath and Chest tightness. Shortness of breath is caused due to insufficient supply of oxygen into lungs of human body. Hilda experienced shortness of breath in her first Asthma attack. The triggers for her Asthma are cold weather, smoky environment, respiratory infection that continued throughout her adulthood. She visited several times early to control triggers and get relief shortness of breath and chest tightness. However, after some control on her Asthma condition, she again develops allergic rhinitis or hay fever in her 20’s and her husband gives her inhaler for relief. She feels stressed due to coronavirus outbreak and uses outside gardening for relaxation even in cold weather condition and that further worsens her asthma condition.
The anti-asthma medication prescribed for Hilda is corticosteroids. This medicine removes inflammation or itching in the body and also reduce allergic symptoms and asthma disease. Hilda has been suffering from Asthma condition such as shortness of breath, wheezing, chest tightness since her childhood. She also experiences non-stop coughing and hay fever. Corticosteroids such as prednisolone carry immunosuppressive and anti-allergic properties. When injected into the body in prescribed doses, corticosteroid removes allergic symptoms, itching or inflammation through numerous transitions into the human cells. The pharmacodynamics of corticosteroids is it binds the glucocorticoid receptors inside the nucleus of human cells and alters the protein synthesis and gene sequences of cells. It prevents allergic symptoms or inflammation in affected cells. The reduction in airway inflammation by Corticosteroids results significant clinical improvement in the respiratory condition of Hilda and her Asthma is now under complete control.
Novel coronavirus is a new type of virus that mainly attacks human respiratory system. Hilda has already been suffering from Asthma conditions such as shortness of breath, cough, wheezing, and chest tightness. All these conditions are related with the body respiratory system. Her GP told her that she will be monitored for coronavirus infection in the hospital and asked the hospital staff to take adequate preventions such as PPE kits and hand hygiene during treatment. After treatment, her asthma condition is regulated and she is discharged from hospital. Hilda should take appropriate hygienic care such as washing hands and face with sanitizers and remain in home isolation. These two measures will reduce her chance of being infected with coronavirus.
There is no vaccine available for coronavirus infection at present. Social distancing, covering face with masks, use of hand sanitizers and self-isolation are the only way to break the chain of coronavirus infection. Coronavirus infection may worsen the Asthma condition of Hilda and generate more severe respiratory symptoms into her body.
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