PHYSIOLOGICAL FINDINGS/PROCESS

case study

Normal Physiological Processes:

1. Aging: The patient is an 83-year-old woman, and the natural process of aging contributes to changes
in cognitive function and physical abilities over time.

Abnormal Physiological Processes:

1. Alzheimer's Disease: The patient was diagnosed with probable Alzheimer's disease nine years ago.
Alzheimer's disease is a progressive neurodegenerative disorder characterized by cognitive decline,
memory loss, changes in personality, impaired judgment, and difficulty with daily tasks.

2. Cognitive Manifestations: The patient experiences short-term memory loss, misplacing items,
difficulty with logical thinking, and getting lost in familiar surroundings. These are common cognitive
manifestations associated with Alzheimer's disease.

3. Personality Changes: The patient has become quiet, passive, and lost interest in previously enjoyed
activities. These changes in personality are characteristic of Alzheimer's disease.

4. Medication Side Effects: The patient experienced adverse effects, including nausea, vomiting, and
abdominal pain, with the initial medication (tacrine) and had to switch to donepezil, which helped with
memory and mood.

5. Disease Progression: Over time, the patient's symptoms have worsened. She now has difficulty with
numbers, balancing her checkbook, and playing a game she previously enjoyed. She also exhibits poor
judgment and safety concerns.

6. Cerebral Atrophy: The CT scan revealed moderate-to-severe cerebral atrophy in the temporal and
parietal lobes. Cerebral atrophy is a common finding in Alzheimer's disease and contributes to the
decline in cognitive function.

7. Behavioral and Psychological Symptoms of Dementia (BPSD): The patient has recently demonstrated
sudden outbursts of anger, confusion, and violent behavior. These BPSD symptoms can occur in
Alzheimer's disease and can be challenging for caregivers to manage.

8. Urinary Incontinence: The patient has started experiencing occasional urinary accidents, which can
be a result of both age-related changes and the progression of Alzheimer's disease.

9. Caregiver Considerations: The patient's children are considering admitting her to a long-term
nursing care facility due to the increasing challenges in managing her care at home.

Treatment options.

1. Cholinesterase Inhibitors: Medications such as donepezil, rivastigmine, and galantamine are

cholinesterase inhibitors. They work by increasing the levels of acetylcholine, a neurotransmitter
involved in memory and learning, in the brain. Cholinesterase inhibitors can help improve cognitive
symptoms and may temporarily stabilize or slow down the progression of Alzheimer's disease.
2. NMDA Receptor Antagonist: Memantine is an NMDA receptor antagonist that helps regulate
glutamate activity, another neurotransmitter involved in learning and memory. It is prescribed for
moderate to severe Alzheimer's disease and may help with cognitive and functional symptoms.

3. Supportive Therapies: Non-pharmacological approaches are important in managing Alzheimer's

disease. These may include cognitive stimulation therapies, behavior management techniques, and
activities that promote social engagement and reduce agitation. Supportive therapies aim to enhance
cognitive function, manage behavioral symptoms, and provide emotional support for both patients and
caregivers.

4. Healthy Lifestyle Modifications: Encouraging a healthy lifestyle can have a positive impact on
managing Alzheimer's disease. This includes regular physical exercise, a balanced diet, adequate sleep,
and social engagement. Physical exercise has been shown to improve cognitive function and overall well-
being in individuals with Alzheimer's disease.

5. Management of Coexisting Conditions: It is important to manage any coexisting medical conditions

that may worsen cognitive function or interact with Alzheimer's medications. This may involve treating
conditions such as hypertension, diabetes, depression, or anxiety.

6. Caregiver Support: Alzheimer's disease places a significant burden on caregivers. Providing support
and resources for caregivers, such as education, respite care, and support groups, is crucial for their
well-being and the overall management of the disease.

PHYSICAL EXAMINATION:

BP: The patient has a 140/80 blood pressure which indicates that she is experiencing hypertension. According
to the chart of American Heart Association (2023), The normal range of blood pressure is systolic of less than
120 mmHg and diastolic of less than 80 mmHg.

RR: The patient's respiratory rate is at 15 breaths per minute and unlabored which indicates normal and is not
performing any difficulty of breathing. The normal range of respiratory rate is 12 to 20 breaths per minute
according to the University of Rochester Medical Center (2024).

Temperature: The patient is experiencing a normal temperature. The normal range of temperature of an
individual is 97.7 degree F to 99.5 degree F according to the National Library of Medicine (2023).

Skin: This reveals that the patient is experiencing aging skin.

Head, Eyes, Ears Nose and Throat: The clinical observation of the patient's HEENT appears to be healthy
and free from abnormal findings such as sores or discharge.

Neck and Lymph Nodes: The patient's node found no swelling which means there are no enlargement of
lymph nodes. Carotid pulses are also in normal blood flow without any abnormal sounds and absense of JVD
(Jugular Venous Distention), which indicates also a normal venous pressure.

Chest and Lungs: the patient's experiencing Chronic Obstructive Pulmonary Disease (COPD) which plays a
pejorative role on cognitive or functional autonomy in patients with dementia.

Heart: The patient's RRR (regular, rate, and rhythm) is within normal and there are no abnormal sounds.

Abdomen: There are no abnormalities detected in patient's abdomen.

Breasts: There are no abnormalities detected in patient's breasts.

Musculosketeal and Extremities: There are no abnormalities detected in patient's musculoskeletal and
extremities.

Nuerologic: The patient's has the inability to perform rapid alternating movements which may cause
Dysdiadochokinesia (diadochokinesia) or diadochokinesis which often sign of a cerebellar injury. Also, the
patient is experiencing slightly wide-based gait which caused by cerebellar disease or bilateral knee or hip
disease.

Lab Results:

Na: Normal

K: Normal

Cl: Normal

HCO3: Normal

Hb: Normal

Hct: Normal

RBC: Normal

Plt: Normal

WBC: Normal

AST: Normal

ALT: Normal

Alk Phos: Normal

T Bilirubin: Normal

D Biliburin: Normal

BUN: Normal

Cr: Normal

Glu: Normal

Cholesterol: Normal

Trig: Normal

T Protein: Normal

HDL: Low

LDL: Elevated
Uric acid: Normal

Vitamin B12: Normal

Ca: Normal

Po4: Normal

Mg: Normal

TSH: High TSH value

If the TSH value is high, it may indicate that the patient’s thyroid isn't making enough thyroid hormone.

T4: Normal

Alb: Normal

Other Test Result: The patient's Folstein Mini-Mental State Examination was 9/30 which is labeled severe
and indicating possible cognitive impairment.