Posted: June 26th, 2023

G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic

Musculoskeletal Function:
G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic for the first time complaining of a long history of bilateral knee discomfort that becomes worse when it rains and usually feels better when the weather is warm and dry. “My arthritis hasn’t improved a bit this summer though,” she states. Discomfort in the left knee is greater than in the right knee. She has also suffered from low back pain for many years, but recently it has become worse. She is having difficulty using the stairs in her home. The patient had recently visited a rheumatologist who tried a variety of NSAIDs to help her with pain control. The medications gave her mild relief but also caused significant and intolerable stomach discomfort. Her pain was alleviated with oxycodone. However, when she showed increasing tolerance and began insisting on higher doses of the medication, the physician told her that she may need surgery and that he could not prescribe more oxycodone for her. She is now seeking medical care at the Family Practice Clinic. Her knees started to get significantly more painful after she gained 20 pounds during the past nine months. Her joints are most stiff when she has been sitting or lying for some time and they tend to “loosen up” with activity. The patient has always been worried about osteoporosis because several family members have been diagnosed with the disease. However, nonclinical manifestations of osteoporosis have developed.
Case Study Questions

Define osteoarthritis and explain the differences with osteoarthrosis. List and analyze the risk factors that are presented on the case that contribute to the diagnosis of osteoarthritis.
Specify the main differences between osteoarthritis and rheumatoid arthritis, make sure to include clinical manifestations, major characteristics, joints usually affected and diagnostic methods.
Describe the different treatment alternatives available, including non-pharmacological and pharmacological that you consider are appropriate for this patient and why.
How would you handle the patient concern about osteoporosis? Describe your interventions and education you would provide to her regarding osteoporosis.
Neurological Function:
H.M is a 67-year-old female, who recently retired from being a school teacher for the last 40 years. Her husband died 2 years ago due to complications of a CVA. Past medical history: hypertension controlled with Olmesartan 20 mg by mouth once a day. Family history no contributory. Last annual visits with PCP with normal results. She lives by herself but her children live close to her and usually visit her two or three times a week.
Her daughter start noticing that her mother is having problems focusing when talking to her, she is not keeping things at home as she used to, often is repeating and asking the same question several times and yesterday she has issues remembering her way back home from the grocery store.
Case Study Questions

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Name the most common risks factors for Alzheimer’s disease
Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
Define and describe explicit and implicit memory.
Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association
What would be the best therapeutic approach on C.J.
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Include both case studies in your post.
Your initial post should be at least 250 words per case study, a total of 500 words for both, formatted and cited in current APA style with support from at least 2 academic sources per case study. Your initial post is worth 8 points.
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You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

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Musculoskeletal Function:

Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of cartilage in the joints. Osteoarthrosis, on the other hand, is a term sometimes used synonymously with OA but can also refer to joint changes without the typical features of OA. In this case, the patient's symptoms of long-standing bilateral knee discomfort, worsened by rain and relieved by warm and dry weather, are consistent with osteoarthritis.
The risk factors presented in the case that contribute to the diagnosis of osteoarthritis include being overweight, a family history of osteoporosis, aging (the patient is 71 years old), and recent weight gain. Other risk factors for OA include joint injury, repetitive stress on the joints, certain occupations involving manual labor, and genetic factors.

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Osteoarthritis and rheumatoid arthritis (RA) are two different types of arthritis with distinct characteristics. In osteoarthritis, the clinical manifestations include joint pain, stiffness after periods of inactivity, joint swelling, and limited range of motion. It usually affects weight-bearing joints such as the knees, hips, and spine. Diagnosis is typically made based on clinical examination, imaging (X-rays), and the absence of systemic inflammation markers.
Rheumatoid arthritis, on the other hand, is an autoimmune disease characterized by inflammation of the synovial joints. It typically presents with joint pain, swelling, stiffness, fatigue, and systemic symptoms like fever and weight loss. RA commonly affects small joints of the hands and feet. Diagnosis involves clinical assessment, blood tests (e.g., rheumatoid factor, anti-cyclic citrullinated peptide antibody), and imaging (X-rays, ultrasound, MRI).

Treatment alternatives for osteoarthritis include non-pharmacological and pharmacological approaches. Non-pharmacological interventions for this patient may include weight loss, physical therapy, exercise (such as low-impact activities and strengthening exercises), and the use of assistive devices (e.g., knee braces, walking aids) to reduce joint stress.
Pharmacological options may involve the use of analgesics such as acetaminophen or topical NSAIDs for pain relief. If these are not sufficient, oral NSAIDs or intra-articular corticosteroid injections may be considered. Given the patient's history of significant stomach discomfort with NSAIDs, caution should be exercised in prescribing these medications.

Neurological Function:

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Common risk factors for Alzheimer's disease include advanced age, family history of the disease, certain genetic factors (e.g., presence of the ApoE ε4 allele), history of head injury, cardiovascular risk factors (e.g., hypertension, diabetes, obesity), and lifestyle factors (e.g., sedentary lifestyle, poor diet).

Alzheimer's disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia are all forms of dementia, but they have distinct features. Alzheimer's disease is characterized by progressive memory loss, cognitive decline, disorientation, and impaired judgment. Vascular dementia results from reduced blood flow to the brain due to strokes or small vessel disease, leading to cognitive impairments. Dementia with Lewy bodies involves cognitive fluctuations, visual hallucinations, and motor symptoms similar to Parkinson's disease. Frontotemporal dementia primarily affects behavior, language, and personality.

Explicit memory refers to conscious and intentional recollection of facts and events, while implicit memory is the unconscious memory that influences behavior and performance without conscious awareness. Explicit memory can be further divided into episodic memory (specific events) and semantic memory (general knowledge).

The National Institute on Aging and the Alzheimer's Association have developed diagnostic criteria for Alzheimer's disease. These criteria include the presence of cognitive impairment that interferes with daily functioning, evidence of progressive decline, exclusion of other potential causes of dementia, and support from neuroimaging and biomarker evidence (e.g., beta-amyloid and tau protein levels in cerebrospinal fluid or PET scans).

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