Reference no: EM133730626

Case Study Assignment

Case Study A

Ramandeep is an active 23-year-old. She works as a part-time nurse during the day and is studying for a postgraduate certificate in the evening. Ramandeep started to wear a bite plate at night after she began to experience jaw pain and headaches. Sometimes the pain radiated to her ear, and she would apply a hot water bottle to it to ease the discomfort. It was not until her husband mentioned to her that he heard her grinding her teeth at night while she was sleeping. She knew then that her headaches might be from temporomandibular joint syndrome, and she went to her dentist to confirm her thoughts. In addition to the bite plate, the dentist also recommended she should continue with the application of heat, use NSAIDs when needed, and incorporate regular relaxation exercises throughout her stressful days.

1. What effect does heat have on nociceptors so that it makes a good nonpharmacologic treatment for pain?

2. Heat and cold treatment are both hypothesized to have an effect on the release of endogenous opioids. What are these chemicals, and why are they hypothesized to be beneficial in the body?

3. Using your knowledge of physiology, how do NSAID analgesics function in the management of pain? Specifically address the arachidonic acid pathway and the COX-1 and COX-2. In what ways are they similar to steroidal anti-inflammatory medications?

Case Study B

Bonnie is a 70-year-old woman who lives alone. One evening, she felt light-headed and dizzy. When her head began to ache, she decided to take an analgesic and go to bed early. The following morning, upon awakening, she was unable to move the bed sheets with her right arm. At this point, she was experiencing tingling sensations in her limbs, and she had difficulty keeping her balance. She dialed 911 for help, and by the time the ambulance arrived, she was confused and unable to articulate her words although she knew what information he was asking of her. In the hospital, she was examined and treated for ischemic stroke.

1. Stroke, or brain attack, involves brain tissue injury. Describe ischemic penumbra and what factors contribute to the survival of the neurons involved. What happens if the cells of the penumbra are unable to be preserved?

2. Compare and contrast hypoxia and ischemia. What condition is more dangerous to the brain? Explain your answer.

3. Knowing what you do about the effects of ischemia on the brain, why would someone with ischemic stroke develop cerebral edema?

4. What type of aphasia was Bonnie exhibiting when talking to her caregivers? Explain your answer.

Case Study C

John is 63 years old and receives home care by an occupational therapist twice a week. His therapist is currently working with John on maintaining joint flexibility and balance. John demonstrates resting tremor, so his therapist is also working on adaptive techniques, so John can continue to use his hands to write, use the computer, and cook simple meals. John's wife assists with his mobility and walks slowly beside him, holding his arm. Sometimes she needs to help him open his prescription bottles, so he can take his medicine, a combination of levodopa and carbidopa.

1. What motor disease does John demonstrate? One of his signs is resting tremor. What is the difference between a resting tremor and an intention tremor?

2. What is the advantage of combining levodopa with carbidopa? What is the benefit of anticholinergic drugs in the management of Parkinson disease?

3. Parkinson disease involves the destruction of the substantia nigra and the nigrostriatal pathway. Where are these structures anatomically?

4. The patient with Parkinson disease typically presents with a masklike facial expression. Why does he or she have a masklike facial expression? How are the eyes, mouth, and laryngopharynx affected by this disease?

Case Study D

Ella is 88 years old and was living at home until very recently. Her children, who visited her regularly, noticed that she was becoming more forgetful. At first, she mislaid objects, and then she began to forget her doctor's appointments. With time, her personality changed, and she became withdrawn. At home, she would forget to turn off the stove or leave the kettle on until it boiled dry. After seeking advice from a gerontologist and social worker, Ella's children placed her in a nursing home with a unit equipped for patients with Alzheimer disease.

1. What is dementia? Why is Alzheimer disease based on a "diagnosis of exclusion"?

2. What are the macroscopic and microscopic features of the brain that are typical in Alzheimer disease?

3. One of Ella's children brought her a new pair of slippers to wear in the nursing home. A minute after she received them, Ella could not remember the exchange and asked what they were doing on her bed. What part of the brain has largely been affected to produce this behavior, and what is the pathophysiology involved?