Understanding Of The Neurological And Musculoskeletal Systems Discussion

Case overview

A 67-year old man is accompanies by his son with complains of tremors in his arms and legs. The son also reports that he has noticed that his father has become stiff and takes him much longer to execute tasks such as rising from his chair. On physical examination, the patient has at rest tremors in the hands and fingers exhibit pin rolling movement.  His face is immobile and exhibits mask like appearance. He has an uneven and he shuffles when he walks and his head/neck, hips and knees are flexed forward. He exhibits jerky or cog wheeling movement. The patient reports of extreme incidents of flushing and sweating not associated with activity. The laboratory findings were unremarkable and a diagnosis of Parkinson’s disease was made. Understanding Of The Neurological And Musculoskeletal Systems Discussion

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Neurological and musculoskeletal pathophysiologic processes

Parkinson’s disease is a complex progressive neurodegenerative disorder that manifests with symptoms of movement disorders such as; tremors at rest, rigidity, bradykinesia, and postural imbalance arising at a later stage.  Parkinson’s involves the extrapyramidal structures which consist motor components of the basal ganglia and is characterized by loss of dopaminergic function resulting in loss of motor function causing the clinical manifestation of the disease (Kouli et al., 2018)Understanding Of The Neurological And Musculoskeletal Systems Discussion. Dopamine is a neurotransmitter that is responsible for movement and coordination.

Various clinical researchers have pointed out striatal dopamine deficiency as a leading causative agent of the motor clinical manifestation, even though; the clinical presentation of non-motor symptoms supports the involvement of other neurotransmitters of the cholinergic, adrenergic, glutamatergic, and serotonergic systems. Researchers also propose that the disease origin may arise from the glossopharyngeal and vagal nerves dorsal motor nucleus and in the anterior olfactory nucleus proposing that the disease begins in the brain stem ascending to the higher cortical system (Zafar & Yaddanapudi, 2021)Understanding Of The Neurological And Musculoskeletal Systems Discussion. Clinical studies have continuously shown that Parkinson’s comprises of a disseminated global network dysfunction at varying levels in the nervous system.

Racial/ethnic variables that may impact physiologic functioning

There is an unclear understanding of the specific ethnic variables that impact Parkinson’s disease.  Contributors to ethnic variables are classified as biological and non-biological (Ben-Joseph et al., 2020)Understanding Of The Neurological And Musculoskeletal Systems Discussion.  Biological factors include; vascular diseases, comorbidities, and genetics. On the other hand non-biological factors are; health inequalities and under-reporting symptoms.

How the processes interact to affect the patient

The most common monogenic forms of PD are as a result of gene mutation such as SNCA, PARK2, LRRK2 and DJ-1. They are associated with varying phenotypes and their predominance differs in different ethnic groups. Comorbidities such as type 2 diabetes which is prevalent among south Asians and Asia has been shown to have a close association with Parkinson’s disease. African-Americans have an increased risk of cerebral vascular burden than white Americans (Ben-Joseph et al., 2020)Understanding Of The Neurological And Musculoskeletal Systems Discussion.  The cerebral small vessel disease is closely associated with gait disturbance, postural instability, freezing gait and worsening cognitive impairment. Therefore, ethnic variation in cerebral vascular disease is likely to be an influence and also a causative agent of Parkinson’s disease.

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Studies have shown that the prevalence is increased in sub-Saharan Africa compared to European countries. This is because in low-middle income areas, there is less access to Parkinson’s disease medication and neurology services.   Also Chinese-Americans and African Americans have an increased likelihood of perceiving Parkinson’s symptoms as the normal part of ageing as compared to white Americans.

References

Ben-Joseph, A., Marshall, C. R., Lees, A. J., & Noyce, A. J. (2020). Ethnic Variation in the Manifestation of Parkinson’s Disease: A Narrative Review. Journal of Parkinson’s Disease, 10(1), 31–45. https://doi.org/10.3233/jpd-191763

Kouli, A., Torsney, K. M., & Kuan, W.-L. (2018). Parkinson’s Disease: Etiology, Neuropathology, and Pathogenesis. Parkinson’s Disease: Pathogenesis and Clinical Aspects, 3–26. https://doi.org/10.15586/codonpublications.parkinsonsdisease.2018.ch1

Zafar, S., & Yaddanapudi, S. S. (2021, August 11). Parkinson Disease. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470193/ Understanding Of The Neurological And Musculoskeletal Systems Discussion

‌Module 5 Assignment: Case Study Analysis
An understanding of the neurological and musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that these two systems can have on each other. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.

Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as, racial and ethnic variables can play a role. Understanding Of The Neurological And Musculoskeletal Systems Discussion

An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

ASSIGNED CASE STUDY:
A 67-year-old man presents to the HCP with chief complaint of tremors in his arms. He also has noticed some tremors in his leg as well. The patient is accompanied by his son, who says that his father has become “stiff” and it takes him much longer to perform simple tasks. The son also relates that his father needs help rising from his chair. Physical exam demonstrates tremors in the hands at rest and fingers exhibit “pill rolling” movement. The patient’s face is not mobile and exhibits a mask-like appearance. His gait is uneven, and he shuffles when he walks and his head/neck, hips, and knees are flexed forward. He exhibits jerky or cogwheeling movement. The patient states that he has episodes of extreme sweating and flushing not associated with activity. Laboratory data unremarkable and the HCP has diagnosed the patient with Parkinson’s Disease. Understanding Of The Neurological And Musculoskeletal Systems Discussion

Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
Any racial/ethnic variables that may impact physiological functioning.
How these processes interact to affect the patient.

Day 7 of Week 8
Submit your Case Study Analysis Assignment by Day 7 of Week 8.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, conclusion, and references. A clear and comprehensive purpose statement, introduction, and conclusion are required. For sources/references, please include 1-2 course sources and 1-2 outside resources.

COURSE SOURCES/REFERENCES:
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Chapter 15: Structure and Function of the Cardiovascular and Lymphatic Systems (stop at Aging and the nervous system)
Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory Function (stop at Sleep); Summary Review
Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function; pp. 504–511, pp. 516–530 (start at Acute confusional states and delirium) (stop at Alterations in neuromotor functions);Understanding Of The Neurological And Musculoskeletal Systems Discussion (Parkinson’s Disease); Summary Review

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Chapter 18: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction (stop at Degenerative disorders of the spine); (start at Cerebrovascular disorders) (stop at Tumors of the central nervous system); Summary Review
Chapter 44: Structure and Function of the Musculoskeletal System (stop at Components of muscle function); Summary Review
Chapter 45: Alterations of Musculoskeletal Function (stop at Bone tumors); (start at Disorders of joints); Summary Review

Chin, L. S. (2018). Spinal cord injuries. Retrieved from https://emedicine.medscape.com/article/793582-overview#a4 Understanding Of The Neurological And Musculoskeletal Systems Discussion