List and Analyze the Risk Factors that are Presented in the Case that Contribute to the Diagnosis of Osteoarthritis.

# 1

Ostoarthritis definition and difference with osteoarthrosis
Osteoarthritis (OA) is one of the leading causes of disability amongst older adults it is the most common form of arthritis, impacting millions globally. It is characterized by the degradation of cartilage, the smooth, elastic tissue that covers the ends of bones at joints. After a while, this degradation leads to pain, swelling, reduced joint motion, and sometimes the formation of bone spurs. Osteoarthrosis, while often used interchangeably with OA, specifically refers to the degenerative process of the cartilage itself without causing the inflammation typically associated with “arthritis.” Therefore, while both terms describe aspects of joint degeneration, osteoarthrosis focuses more on the structural deterioration and less on the inflammatory or symptomatic components of the condition (Hunter & Bierma-Zeinstra, 2019).

1.List and Analyze the Risk Factors that are Presented in the Case that Contribute to the Diagnosis of Osteoarthritis
The diagnosis of osteoarthritis in G.J. is influenced by several risk factors that are evident in her case. First, G.J. is in the higher risk category for OA at age 71, as age is a major risk factor. Because cartilage loses its ability to heal and joints accumulate wear and tear over time, osteoarthritis (OA) usually advances more quickly as people age. Furthermore, G.J.’s obesity status makes her condition worse, especially in the knees and other weight-bearing joints. Being overweight puts extra strain on these joints, hastening the deterioration of cartilage. Her symptoms most likely became much worse after she gained twenty pounds recently. Her apparent physical inactivity, as evidenced by joint stiffness after extended periods of sitting or lying, is another noteworthy factor. This rigidity implies inactivity, which can exacerbate OA symptoms by reducing joint fluid flow and suppleness. Lastly, given her family’s history of osteoporosis, it’s possible that she has a genetic predisposition to degenerative bone diseases, such as OA (Glyn-Jones et al., 2015).

Differences Between Osteoarthritis and Rheumatoid Arthritis
Osteoarthritis and Rheumatoid Arthritis (RA) are distinct in several important ways. Clinically, OA is primarily characterized by pain and stiffness that increase following extended activity, reflecting the ‘wear and tear’ of joints. In contrast, RA is marked by morning stiffness lasting more than one hour and systemic symptoms such as fatigue, which are indicative of its autoimmune nature. From a pathophysiological standpoint, OA involves the mechanical breakdown of cartilage and subsequent bone changes, whereas RA is an autoimmune condition where the body’s immune system attacks synovial tissues, leading to joint inflammation and systemic effects. Typically, OA affects the knees, hips, lower back, and small hand joints, whereas RA commonly involves multiple joints in a symmetrical pattern, including hands, feet, and wrists. Diagnostically, OA is dragonized through clinical evaluation and radiographic evidence of joint space narrowing and osteophytes. RA diagnosis requires serological tests for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies, along with the presence of clinical symptoms (Aletaha et al., 2010).

Pharmacological and nonpharmacological treatment options
For G.J., a combination of non-pharmacological and pharmacological treatments is advisable to manage her OA effectively. Non-pharmacological interventions should include weight management to reduce stress on her joints, physical therapy to improve flexibility and muscle strength, and possibly occupational therapy to adapt her daily activities to minimize joint strain. These measures can help alleviate symptoms without the side effects associated with medications. Pharmacologically, given her previous adverse reactions to NSAIDs and issues with opioid tolerance, alternatives like topical NSAIDs or capsaicin could be considered for localized pain management. Acetaminophen might be used cautiously for systemic pain control, considering its lower risk profile concerning gastrointestinal irritation. The therapeutic approach should be closely monitored to balance efficacy with potential side effects, particularly given her complex medical history (McAlindon et al., 2014).

Education and intervention
Addressing G.J.’s concern about osteoporosis involves both diagnostic and educational interventions. First a bone density test (DEXA scan) would be appropriate to assess her current bone health status and clarify whether she has osteoporosis or is at increased risk. This information is crucial for targeted treatment strategies. Nutritionally, ensuring adequate intake of calcium and vitamin D is vital for bone health, which can be addressed through diet and supplements if necessary. Weight-bearing exercises should be encouraged to strengthen bones and improve mobility. Educating G.J is important to discuss the nature of osteoporosis, its risk factors, and the impact of lifestyle on bone density. Explaining the benefits of smoking cessation and limiting alcohol consumption, which can negatively affect bone health, would also be part of comprehensive patient education (Compston et al., 2019).

# 2

Question 1. Alzheimer’s disease is a progressively degenerative neurological disorder. It is a progressive disease that affects older individuals over the years. Alzheimer’s disease begins with a gradual decline in memory, thinking patterns, reasoning, and understanding. Alzheimer’s patient behavior can go from calm and relaxed to agitated and aggressive. According to Dlugasch & Story (2024), the exact etiology of Alzheimer’s disease is unknown, but a common feature is overproduction and/or decreased clearance of beta-amyloid peptides. The characteristics include amyloid plaques that contain fragments of beta-amyloid peptide protein, a collection of neuron remnants. Neurofibrillary tangles form abnormal tau which is a protein clamped together. These abnormalities result in a disruption in the neuro communication and can lead to cell death in the brain. Risk factors for AD include genetics with a family history of the disease, advanced age, females have a higher risk than males, diabetes mellitus, hypertension, hypercholesterolemia, sedimentary lifestyle, obesity, poor diet, a history of traumatic brain injury, and obesity (Dlugasch & Story, 2024).

Symptoms of AD begin with bouts of confusion and/or memory loss of recent events. As the disease progresses, irreversible mental impairment destroys the ability to recall events, make rational decisions, have difficulty with language, and difficulty learning new things. A change in personality and behavior is noted. In the later stages of AD, patients could lose the ability to care for themselves and need around-the-clock care.

If a patient is suspected to have AD should undergo a diagnostic test including a neurological exam. A magnetic resonance imaging (MRI) will be ordered to affect neurons. Special makers of vitamin B12 such as elevated homocysteine are thought to cause brain damage due to oxidative stress, increasing calcium influx and apoptosis. A serum laboratory test is ordered to examine serum vitamin B12 deficiency (Breijyeh & Karaman, 2020).

Question 2. The similarities between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, and Frontotemporal dementia are a progressive decline in cognitive functions such as memory, reasoning, and problem-solving. These diseases have a risk factor of advanced age. They have changes in mood and behavior such as depression, irritability, and anxiety with a progressive need of assistance in daily activities.

The difference in the diseases is that Alzheimer’s is characterized by amyloid plaques and tau tangle. Vascular dementia is associated with cerebrovascular events and causes focal neurological deficits. Dementia with Lewy bodies cause visual hallucinations and Parkinson’s symptoms. Frontotemporal dementia has atrophy to the frontal and temporal lobes (Hobson, 2019).

Question 3. Explicit memory, also called declarative memory, is an intentional reflection of events and facts. This includes semantic memory, general knowledge, episodic memory, specific events, and individual experiences. Implicit memory includes unconscious or automatic memory of motor skills. Procedural memories like driving are a form of implicit memory as you do not usually recall every detail of each step. (Dawidowicz et al., 2021)

Question 4. The diagnosis criteria developed for Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association includes progressive memory and cognitive decline. An elevated tau protein with decreased amyloid-beta. PET and MRI testing will reveal atrophy in the medial temporal lobe. Biomarkers are suggested.

Question 5. The best therapeutic approach for H.M. is to encourage her to get involved with activities that will increase her thinking skills and memory such as work puzzles. Implementing routine to use memory such as a calendar with pictures of daily activities. H.M. should also increase physical exercise with a healthy diet. Managing a safe home environment by wearing non-slip house shoes or socks and night lights throughout the house at night. Medications to manage symptoms such as cholinesterase inhibitors (Donepezil, Rivastigmine, or galantamine) and Memantine which block NMDA receptors of glutamate receptors.

SUBMISSION INSTRUCTIONS
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Use at least one academic source for each response to your peers other than your textbook.
All replies must be constructive, and literature must be used accordingly.
Your replies must be at least 150 words each.

Discussion Rubric
Criteria Ratings Points
Identification of Main Issues, Problems, and Concepts

Distinguished – 5 points
Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts.

Excellent – 4 points
Identifies and demonstrates an accomplished understanding of most issues, problems, and concepts.

Fair – 1-3 points
Identifies and demonstrates an acceptable understanding of most issues, problems, and concepts.

Poor – 0 points
Identifies and demonstrates an unacceptable understanding of most issues, problems, and concepts. Or nothing was posted.

5 points
Use of Citations, Writing Mechanics, and APA Formatting Guidelines

Distinguished – 3 points
Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.

Excellent – 2 points
Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.

Fair – 1 point
Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.

Poor – 0 points
Ineffectively uses the literature and other resources to inform their work. Unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention. Or nothing was posted.

3 points
Response to Posts of Peers
Distinguished – 2 points
Student constructively responded to two other posts and either extended, expanded, or provided a rebuttal to each.

Fair – 1 point
Student constructively responded to one other post and either extended, expanded, or provided a rebuttal.

Poor – 0 points
Student provided no response to a peer’s post.

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