NURS 530 Week 3 Assignment: Physiology and Pathophysiology Paper

NURS 530 Week 3 Assignment: Physiology and Pathophysiology Paper

Alzheimer’s disease (AD) is a neurodegenerative mental disorder that is prevalent and burdensome in people aged 65 and over. According to Bomasang-Layno & Bronsther (2021), approximately 44 million people currently grapple with AD-related neurodegenerative disorders, including dementia. In the United States, Alzheimer’s disease and AD dementia result in higher mortality than combined prostate cancer and breast cancer. Besides an increased mortality rate, the estimated cost of Alzheimer’s management passed the $355 billion threshold in 2021 (Bomasang-Layno & Bronsther, 2021). Although Alzheimer’s disease is burdensome, its etiology is complex. Current evidence links genetic, lifestyle, and environmental factors with increased individual susceptibility to this neurodegenerative disorder. Age, family history, sex, Down syndrome, excessive alcoholism, persistent exposure to air pollutants, and head trauma are significant risk factors for Alzheimer’s. Amidst a complex etiology, healthcare professionals should understand AD’s pathophysiology, diagnostic tests and rationale, and evidence-based treatment modalities.

The Pathophysiology of Alzheimer’s Disease

AD’s pathophysiology entails the accumulation of spherical microscopic lesions (plagues) and neurofibrillary tangles. Often, plagues are dense, insoluble proteins and cellular materials around the neurons. On the other hand, tangles are entangled fibers that accumulate inside the nerve cells. According to Kumar et al. (2022), plagues have a core of extracellular amyloid beta-peptide and axonal endings emanating from an amyloid precursor protein (APP). On the other hand, tangles originate from the protein tau responsible for stabilizing axonal microtubules (Kumar et al., 2022). Neurofibrillary tangles affect the hippocampus and entorhinal cortex, leading to a correlation to Alzheimer’s than plagues.

The clinical manifestation of Alzheimer’s disease involves different neurodegenerative symptoms. According to Lakhan (2022), signs and symptoms of mild to severe Alzheimer’s disease are memory loss, altered ability to complete activities of daily living, compromised judgment, confusion, agitation, hallucinations, delusions, weight loss, seizures, and lack of bladder and bowel control (Lakhan, 2022). In severe AD, patients grapple with frequent aspiration pneumonia and increased susceptibility to other infections that result in death.

Although age is the primary non-modifiable factor for Alzheimer’s disease, other environmental, genetic, and recreational factors can increase individual susceptibility to AD. According to Omura et al. (2022), family history of AD, physical inactivity, depression, obesity, diabetes, hypertension, and alcoholism are modifiable and non-modifiable risk factors for AD. Equally, head trauma, air pollution, Down syndrome, and poor sleeping patterns can increase an individual’s susceptibility to Alzheimer’s Disease and related dementias. It is essential to note that AD signs and symptoms vary across different stages. As a result, healthcare professionals should tailor interventions consistent with AD stages to achieve optimal health outcomes.

Diagnostic Tests and Their Rationale

The most effective diagnostic tests for AD are assessments of the patient’s medical history, physical, and mental status, lab tests, and neuroimaging. A comprehensive evaluation of a patient’s medical history and physical and psychological status examinations can provide clues and reveal an individual’s exposure to risk factors for Alzheimer’s Disease (Bomasang-Layno & Bronsther, 2021). On the other hand, lab tests and neuroimaging techniques are vital in differential diagnosis and identifying AD biomarkers in cerebrospinal fluid (CSF) and serum (Bomasang-Layno & Bronsther, 2021). Amidst significant amounts of scholarly research on appropriate diagnostic tests for Alzheimer’s Disease, advancements in positron emission tomography (PET) and magnetic resonance imaging (MRI) play a fundamental role in identifying AD biomarkers and conducting differential diagnoses. Other emerging diagnostic strategies are volumetric data, diffusion tensor imaging (DTI), and cerebrospinal fluid (CSF) tests.

Evidence-based Treatment Modalities

Although significant amounts of scientific research provide insights into AD’s pathophysiology, there is no cure for this neurodegenerative mental disorder, forcing clinicians to embark on pharmacological symptomatic treatment options and non-pharmacologic interventions for addressing the symptoms of Alzheimer’s Disease. Pharmacological approaches for AD management entail administering two medication classes: cholinesterase inhibitors like donepezil, galantamine, and rivastigmine and partial N-methyl D-Aspartate (NMDA) memantine (Kumar et al., 2022). The mechanism of action of cholinesterase inhibitors entails increasing the level of acetylcholine. This chemical is vital in improving nerve cell communication and facilitating multiple cognitive functions, including learning and memory. NMDA antagonist memantine regulates intercellular calcium accumulation and blocks NMDA receptors. The FDA-approved use of memantine includes treating moderate to severe AD.

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Similarly, non-pharmacologic interventions profoundly manage AD symptoms and improve patients’ health and wellness. Wang et al. (2020) contend that physical therapy, cognitive stimulation, rehabilitation, music therapy, and acupuncture therapy improve physical and mental functioning in patients with Alzheimer’s Disease. For example, exercise interventions increase peripheral concentrations, promote hippocampal synaptic plasticity, and affect cellular and molecular-level mechanisms. Essential considerations for non-pharmacologic strategies include the stage of AD, proper progress evaluation, adherence to plans, and follow-up.

How does the information, in this case, inform the practice of master’s prepared nurses?

Information regarding the pathophysiology of Alzheimer’s Disease is profound in informing care plans and evidence-based interventions embraced by master’s prepared nurses. Firstly, a comprehensive understanding of AD’s stage and the patient’s psychosocial history enables healthcare professionals to tailor interventions consistent with the patient’s health needs and priorities. According to Jessen et al. (2022), AD patients in the preclinical and mild cognitive impairment (MCI) stages can live independently, while those in later stages of Alzheimer’s Disease require around-the-clock support from healthcare professionals. As a result, understanding the disease stages and the severity of symptoms can underpin the determination to provide patient-centered care (PCC).

How should the master’s prepared nurse use this information to design a patient education session for someone with the condition?

Patients grappling with preclinical and mild cognitive impairment stages of Alzheimer’s Disease can achieve positive outcomes by adhering to pharmacological and non-pharmacologic interventions, including medications, physical exercise, and lifestyle modification. Unlike patients in the later stages of Alzheimer’s, people with mild dementia can benefit from education programs. Villars et al. (2021) argue that educational programs for patients with Alzheimer’s Disease should focus on increasing awareness of self-management behaviors, self-monitoring, and lifestyle modification through smoking cessation, physical exercise, and healthy diets. Master’s prepared nurses should use information regarding AD stages and the severity of symptoms to design a patient-centered education program.

What was the most important information presented in this case?

Healthcare professionals should understand the intricacies of providing care for patients with Alzheimer’s disease. In this sense, they should rely massively upon diagnostic information and the clinical manifestation of the condition to understand its extent and stage. The most crucial information in the context of Alzheimer’s disease includes the patient’s psychosocial history, genetic predisposition, the ability to partner with healthcare professionals in implementing a care plan, the extent of degenerative symptoms, social support systems, and self-management competencies.

What was the most confusing and challenging information presented in this case?

In a case scenario of a patient with Alzheimer’s disease, the most confusing and challenging information is the patient’s decision-making capacity, considering the degenerative nature of AD’s symptoms. According to Wolfe et al. (2020), allowing patients with Alzheimer’s disease to determine care trajectories and influence decisions underpins the bioethical principle of autonomy. However, the patient’s inability to make informed decisions and effectively participate in collaborative care plans due to cognitive declines poses an ethical question to healthcare professionals (Boumans et al., 2018). Healthcare professionals can safeguard patient autonomy by improving two-way communication, expanding the patient’s social support systems, ensuring frequent contact through follow-ups, involving family members in collaborative care plans, and incorporating technology to enhance care coordination.

Patient Safety

A patient with Alzheimer’s disease is susceptible to adverse events that pose significant safety concerns. Häikio et al. (2019) identify polypharmacy, falls, food safety, wandering around disoriented, and traffic safety as issues that affect the quality of life and dignity of patients with Alzheimer’s disease. Healthcare professionals can address these safety concerns by promoting tailored use of protective aids, frequent monitoring of the patient’s medication adherence, modifying the environment to prevent falls, providing emotional support to address loneliness, and assisting the patient in completing activities of daily living, including grooming and eating.

Conclusion

Alzheimer’s disease and associated dementias result in adverse effects like cognitive degeneration, increased care costs, death, and compromised quality of care. Alzheimer’s disease’s etiology is complex, limiting the scope of pharmacological and non-pharmacologic interventions. Healthcare professionals should understand the disease’s pathophysiology, clinical manifestations, diagnostics, and advancements in symptomatic treatment modalities when caring for patients with Alzheimer’s. Also, it is essential to safeguard patient autonomy and self-determination by involving patients and family members in all stages of decision-making and care delivery processes. Finally, clinicians should address safety concerns emanating from patients’ vulnerability to falls, polypharmacy, traffic, and food safety to achieve optimal health outcomes.

References

Bomasang-Layno, E., & Bronsther, R. (2021). Diagnosis and treatment of Alzheimer’s disease: Delaware Journal of Public Health, 7(4), 74–85. https://doi.org/10.32481/djph.2021.09.009

Boumans, J., van Boekel, L. C., Baan, C. A., & Luijkx, K. G. (2018). How can autonomy be maintained and informal care improved for people with dementia living in residential care facilities: A systematic literature review. The Gerontologist, 59(6), e709–e730. https://doi.org/10.1093/geront/gny096

Häikiö, K., Sagbakken, M., & Rugkåsa, J. (2019). Dementia and patient safety in the community: A qualitative study of family carers’ protective practices and implications for services. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4478-2

Jessen, F., Georges, J., Wortmann, M., & Benham-Hermetz, S. (2022). What matters to patients with Alzheimer’s disease and their care partners? Implications for understanding the value of future interventions. The Journal of Prevention of Alzheimer’s Disease, 550–555. https://doi.org/10.14283/jpad.2022.22

Kumar, A., Sidhu, J., Goyal, A., & Tsao, J. W. (2022). Alzheimer disease. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499922/#

Lakhan, S. E. (2022). Alzheimer’s disease: Practice essentials, background, anatomy. EMedicine. https://emedicine.medscape.com/article/1134817-overview#a1

Omura, J. D., McGuire, L. C., Patel, R., Baumgart, M., Lamb, R., Jeffers, E. M., Olivari, B. S., & Croft, J. B. (2022). Modifiable risk factors for Alzheimer’s disease and related dementias among adults aged ≥45 years— United States, 2019. MMWR. Morbidity and Mortality Weekly Report, 71(20), 680–685. https://doi.org/10.15585/mmwr.mm7120a2

Villars, H., Cantet, C., de Peretti, E., Perrin, A., Soto-martin, M., & Gardette, V. (2021). Impact of an educational program on Alzheimer’s disease patients’ quality of life: Results of the randomized controlled trial THERAD. Alzheimer’s Research & Therapy, 13(1). https://doi.org/10.1186/s13195-021-00896-3

Wang, L.-Y., Pei, J., Zhan, Y.-J., & Cai, Y.-W. (2020). Overview of meta-analyses of five non-pharmacological interventions for Alzheimer’s disease. Frontiers in Aging Neuroscience, 12. https://doi.org/10.3389/fnagi.2020.594432

Wolfe, S. E., Greenhill, B., Butchard, S., & Day, J. (2020). The meaning of autonomy when living with dementia: A q-method investigation. Dementia, 20(6), 147130122097306. https://doi.org/10.1177/1471301220973067

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Week 3 Case Study
Due Jan 29 by 11:59 pm Points 90 Submitting a text entry box, a website url, a media recording, or a file upload
The purpose of the case study is to have you expand on the pathophysiological disease process by searching for evidence-based practice treatment and advanced practice nursing role implications related to the disease.

Case Study Topic:

Select either a type of pain syndrome or a neurologic disease process (headache, CVA, acute bacterial meningitis, Alzheimer’s, anxiety, depression, chronic pain syndrome) and discuss the pathophysiologic process involved.


Identify current evidence-based treatment modalities for the selected syndrome or disease and discuss how the treatment impacts the disease process.

Conduct an evidence-based literature search to identify the most recent standards of care/treatment modalities from peer-reviewed articles and professional association guidelines (www.guideline.gov)

Links to an external site.

. These articles and guidelines can be referenced, but not directly copied into the clinical case presentation. Cite a minimum of three resources.

Include the following in your clinical case presentation:

A discussion of the pathophysiology of the disease, including signs and symptoms.
An explanation of diagnostic testing and rationales for each.
A review of different evidence-based treatment modalities for the disorder obtained from guideline.gov or a professional organization.
Next, address the following questions:

How does the information in this case inform the practice of a master’s prepared nurse?
How should the master’s prepared nurse use this information to design a patient education session for someone with this condition?
What was the most important information presented in this case?
What was the most confusing or challenging information presented in this case?
Discuss a patient safety issue that can be addressed for a patient with the condition presented in this case.
The use of medical terminology and appropriate graduate level writing is expected.

Your paper should be 3–4 pages (excluding cover page and reference page).

Your resources must include research articles as well as reference to non-research evidence-based guidelines.

Use APA format to style your paper and to cite your sources. Your source(s) should be integrated into the paragraphs. Use internal citations pointing to evidence in the literature and supporting your ideas. You will need to include a reference page listing those sources. Cite a minimum of three resources.

Review the rubric for more information on how your assignment will be graded.