Patient Information Resource
Discuss how the pathogenesis of the disease involve the breakdown of cartilage as well as remodeling of bone owing to an active response of the chondrocytes located in the inflammatory cells and articular cartilage in the adjacent tissues.
Part A: Patient Information Resource
Identification of Diseases
The chronic ailments that Eleanor, a 68-year-old indigenous woman, is suffering from are osteoarthritis and asthma whereas the presenting condition is exacerbations. Osteoarthritis usually referred to the wear and tear arthritis, is the most apparent type of arthritis linked to the degradation of cartilage in joints and can affect any joint in the body. In most cases, the condition can present in weight-bearing joints of the spine, knees, and hips. On the other hand, asthma is a common chronic disease of the airways that embroils a complex interaction of bronchial hyperresponsiveness, airflow obstruction, and an underlying inflammation. The suggested interaction can be very daunting among patients over a given time. Exacerbations that occur due to chronic obstructive pulmonary disease are considered as an event in the natural progression of the disease that is described by an alteration in the patient’s baseline cough, dyspnea beyond daily variability as well as sufficient to permit a change in management.
Pathophysiology of Osteoarthritis
Traditionally, osteoarthritis is considered a wear and tear ailment that becomes more prominent as an individual grows old (Mobasheri & Batt, 2016). Nonetheless, recent studies suggest otherwise. The pathogenesis of the disease involves the breakdown of cartilage as well as remodeling of bone owing to an active response of the chondrocytes located in the inflammatory cells and articular cartilage in the adjacent tissues.
The cartilage is a distinct tissue with compressive and viscoelastic properties with are engulfed by its extracellular matrix, predominantly composed of proteoglycans and type II collagen. Under normal circumstances, this matrix is imperiled to an active remodeling procedure in which low levels of degradative as well synthetic enzyme activities are stabilized, in that the volume of cartilage in the joints is maintained (Mobasheri & Batt, 2016). In osteoarthritis, nonetheless, the enzymes responsible for matrix degradation are overpassed, shifting the balance in favor of net degradation, which results in a loss of proteoglycans and collagen from the matrix. When the underlying subchondral bone is exposed, sclerosis becomes eminent followed by reactive remodeling changes which lead to the formation of subchondral bone cysts and osteophytes. Cracking, erosion, and fibrillation starts appearing on the superficial layer of the affected cartilage and with time progresses into the deeper layers. Over time, the joint space progressively depreciates resulting in large observable erosions.
The common symptom of Osteoarthritis tends to build over time instead of showing up suddenly. Some of the symptoms include: swelling around joints, clicking or cracking sound when the affected joint is bent, buckling or joint instability, limited motions that may at times go away, stiffness at the joint during morning hours or after taking a rest, and aching or pain in the joint after a long activity.
Pathophysiology of Asthma
Inflammation has a vital role in the pathophysiology of asthma. In line with the description of the ailment, airway inflammation incorporates the interaction of many types of cells and multiple mediators within the airway that finally result in the distinct pathophysiological features of the ailment such as shortness of breath, wheezing, airflow limitation leading to a recurrent episode of cough. , and bronchial inflammation (Carpaij et al., 2019). The process by which the described events occur and result in clinical asthma re still under exploration. Furthermore, though specific phenotypes of asthma exist (e.g., severe, aspirin-sensitive, exercise-associated, persistent, or intermittent asthma) inflammation of the airways remains the consistent pattern.
In asthma, the most common physiological event causing its clinical symptoms is the narrowing of the airway and subsequent interference with airflow, a condition normally referred to as bronchoconstriction. In acute cases, the contraction of the bronchial smooth muscle occurs rapidly to narrow the airways when exposed to a mirage of stimuli including irritants and allergens. Another event associated with this disease is airway edema. As the condition worsens and inflammation becomes more progressive secondary factors further limit airflow (Carpaij et al., 2019). These include mucus hypersecretion and structural changes such as hyperplasia and hypertrophy of the airway muscles. Similarly, airway remodeling may occur. In some individuals who have asthma, limitation of airflow may at times become reversible. Permanent changes in the structure of the airway may occur. These are linked to a persistent loss of lung functions that is not fully reversible or prevented by current therapy. The remodeling of the airway involves the activation of different types of structural cells with respective permanent changes in the airway that enhance airflow obstruction as well as airway responsiveness that enders the patient less responsive to any therapy.
Symptoms of Asthma
At times, asthma can get worse for a short time, and this is referred to as an asthma attack. This attack can occur suddenly or gradually or suddenly within few days (Dave, 2016). Signs of an asthma attack include a fast heartbeat, breathing faster, drowsiness, confusion, dizziness, or exhaustion, wheezing, coughing, and chest tightness.
Pathophysiology of Exacerbations
Though it is always assumed that exacerbations are linked with increased airway inflammation owing to hormonal triggering by certain stimuli. Exacerbations of asthma are considered to describe worsening of an underlying chronic airway inflammation mainly caused by bacterial or viral infections as well as air pollution (Ponce-Gallegos et al., 2017). During exacerbations of asthma, a change in the inflammatory cellular pattern occurs. Despite the suggested occurrences, researchers have established that the pathophysiological of exacerbations is still uncertain. This is because there may be a determinant in the lack of response to asthma treatment.
The symptoms of exacerbations may vary across different patients owing to age and severity (Ponce-Gallegos et al., 2017). The common symptoms of exacerbations include: shortness of breath, chest tightness, coughing, wheezing, difficulty in speaking and breathing, agitation, increased heart rate, hyperventilation, and decreased lung function
Diagnostic of Osteoarthritis
In osteoarthritis, there is no blood test. Blood tests are performed to disclose ailments that can lead to secondary osteoarthritis and to distinguish other arthritis conditions that appear as osteoarthritis. On the affected joints, x-rays are conducted to determine the presence of osteoarthritis. The usual X-ray findings of the ailment include bone spur formation, narrowing of the space between joint or adjacent bones, and loss of joint cartilage (Zhu et al., 2018). Simple X-ray tests may be very significant to exclude other reasons for pain in the identified joint as the decision-making as to the time surgical interventions should be applied. Doctors usually perform arthroscopy by inserting a viewing tube into the identified joint space. Abnormalities or damage to the ligaments and cartilage can be determined and at times repaired via the arthroscope. A sterile needle can also be utilized to extract joint fluid for analysis. The joint fluid analysis is used to differentiate infection gout and other causes of arthritis.
Diagnostic of Asthma
The core test used to aid diagnose asthma is the FeNO test whereby the patient’s breaths into a machine that determines the levels of nitric oxide in their breath, which is a sign of inflammation in their lungs. Spirometry is another test whereby a patient blows into a machine that determines how fast an individual can breathe out as well as how much air one can hold in their lungs (Dave, 2016). Also, a peak flow test can be used to diagnose asthma whereby a patient blows into a handheld device that determines how fast they can breathe out. The process may be conducted many times over several weeks to measure if the rates are changing over time.
Diagnostic of Exacerbations
Diagnosis of exacerbations are commonly based upon an acute worsening of a patient’s normal pattern of respiratory symptoms such as sputum purulence, cough, and increased dyspnea. Pulse, oximetry may aid in the decision-making on whether or not a physician should perform arterial blood gas measure measurements (Ponce-Gallegos et al., 2017). These measurements are essential in identifying hypercapnia which may be present in patients with acute-on-chronic respiratory failure.
Problems associated with Osteoarthritis
For many patients with osteoarthritis, the major problem could be sleep disruptions. Painful tender joints interfere with restorative and restful sleep. Limited sleeping time can make one’s pain seem intensified (Zhu et al., 2018). Another complication associated with osteoarthritis is reduced productivity. Many patients with this condition tend to miss many days of work yearly due to chronic pain at the joints. In connection to this, the disease can also lead to decreased ability to undertake normal daily activities such as cooking, household chores, exercise, getting dressed, and other activities.
Problems associated with Asthma
One of the complications linked to asthma is interference with sleep and daily activities. During asthma attacks, the body of a patient becomes hyperactive owing to the secretion of hormone inhibitors or pain in the airways after coughing (Dave, 2016). Another complication is the permanent narrowing of the airways which will ultimately affect how a patient breaths.
Psychosocial Developmental, Cultural and Health Literacy Issues
The psychosocial issues related to Eleanor’s chronic and conditional ailment include anxiety and depression. Such an individual would easily develop low self-esteem due to the perception that they may never recover from these conditions (Mahdizadeh & Solhi, 2018). In terms of the cultural aspect of Eleanor’s conditions little studies have been made to determine the prevalence of this face. However, the common cultural risks liked to her ailment could be the denial of the apparent state whenever diagnostics have been carried out. In other communities, socioeconomic deprivations may occur since an individual is deemed negligible to undertake daunting tasks. Scholars have established that low health literacy linked to poor longitudinal asthma inclusive of the patient’s quality of life, and increase emergency utilization.
Priorities of Nurse Management of Eleanor
The main form of management for Eleanor’s condition is monitoring vital signs as it helps in giving a general glimpse of the patient’s well-being (Anekwe & Rahkovsky, 2018). Another form of management that could be performed by nurses is asserting the patient’s history and physical exam which will help to address manifestations like inflammations, swelling, tenderness, and stiffness of joints. Extra-articular changes such as rate of fatigue enlargement of lymph nodes, sensory changes, and weight loss could also suffice.
- Patient Information Resource
Description of Eleanor’s Condition
Eleanor, a 68-year-old indigenous woman, is suffering from two chronic ailments which are osteoarthritis and asthma. Also, the patient has a presenting condition known as exacerbations.
Pathophysiology of Osteoarthritis
Osteoarthritis is viewed as the wear and tear of cartilage as well as remodeling of bone because of an active response of the chondrocytes located in the inflammatory cells and articular cartilage in the adjacent tissues. In osteoarthritis, the enzymes responsible for matrix degradation are overpassed, causing an imbalance in favor of net degradation.
Symptoms of Osteoarthritis
Some of the symptoms include: swelling around joints, clicking or cracking sound when the affected joint is bent, buckling or joint instability, limited motions that may at times go away, stiffness at the joint.
Pathophysiology of Asthma
Asthma is associated with the inflation of the airway caused by the interaction of many types of cells and multiple mediators within the airway that finally result in the distinct pathophysiological features of the ailment such as shortness of breath, wheezing, airflow limitation leading to a recurrent episode of cough, and bronchial inflammation.
Symptoms of Asthma
Signs of an asthma attack include a fast heartbeat, breathing faster, drowsiness, confusion, dizziness, or exhaustion, wheezing, coughing, and chest tightness.
Diagnostics Treatments and Medication of Osteoarthritis
X-rays are conducted to determine the presence of osteoarthritis. Simple X-ray tests may be very significant to exclude other reasons for pain in the identified joint as the decision-making as to the time surgical interventions should be applied.
The treatment of osteoarthritis includes lifestyle measures such as eating nutritious meals and exercising regularly to maintain good health-supportive measures could also be applied. In terms of medication paracetamol, capsaicin cream, and non-steroidal anti-inflammatory drugs could suffice to reduce pain.
Diagnostics, Treatments, and Medication of Asthma
FeNO is the common test for asthma whereby Eleanor’s breaths into a machine that determines the levels of nitric oxide in her breath, which is a sign of inflammation in their lungs. Spirometry is another test whereby a patient blows into a machine that determines how how much air she can hold in their lungs. Also, a peak flow test can be used.
The treatment of asthma include inhalers such as intravenous corticosteroid, theophylline, nutritious meals, allergy medications such as allergy immunotherapy, and biologics
The best approach from containing these two conditions is monitoring vital signs as it helps in giving a general glimpse of the patient’s well-being. Taking medications as prescribed and eating nutritious foods could be effective in reducing the severity of the diseases. Exercising regularly would also be appropriate.
Link to the Resource
To clearly understand the prevalence of asthma and osteoarthritic in Eleanor’s body, one could visit the following links;
Anekwe, T. D., & Rahkovsky, I. (2018). Self-management: A comprehensive approach to management of chronic conditions. American Journal of Public Health, 108(S6), S430-S436.
Carpaij, O. A., Burgess, J. K., Kerstjens, H. A., Nawijn, M. C., & van den Berge, M. (2019). A review on the pathophysiology of asthma remission. Pharmacology & therapeutics, 201, 8-24.
Dave, P. H. (2016). Pathogenesis and Novel Drug for Treatment of Asthma-A Review. Research Journal of Pharmacy and technology, 9(9), 1519.
Mahdizadeh, M., & Solhi, M. (2018). Relationship between self-care behaviors and health literacy among elderly women in Iran, 2015. Electronic physician, 10(3), 6462.
Mobasheri, A., & Batt, M. (2016). An update on the pathophysiology of osteoarthritis. Annals of physical and rehabilitation medicine, 59(5-6), 333-339.
Ponce-Gallegos, M. A., Ramírez-Venegas, A., & Falfán-Valencia, R. (2017). Th17 profile in COPD exacerbations. International journal of chronic obstructive pulmonary disease, 12, 1857.
Zhu, Z., Li, J., Ruan, G., Wang, G., Huang, C., & Ding, C. (2018). Investigational drugs for the treatment of osteoarthritis, an update on recent developments. Expert opinion on investigational drugs, 27(11), 881-900.