Daisy's Medical Case Study

This case study focuses on Daisy, a patient experiencing multiple health challenges. She has diabetes, hyperthyroidism, and multiple sclerosis (MS), requiring specialized medical attention. Her condition also includes dental issues like jaw pain that need to be addressed by a dental hygienist or dentist. Furthermore, Daisy experiences bilateral numbness in her feet, blurred vision, necessitating daily assistance from a registered nurse for activities of daily living.

Running head: CASE STUDY
Nursing Case Study
Name of the Student
Name of the University
Author Note

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CASE STUDY
Table of Contents
Case Study: 1..............................................................................................................2
Case Study 2...............................................................................................................5
Case Study: 3............................................................................................................11
References................................................................................................................15

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Case Study: 1
1. Cardiovascular system of the body is complex framework consisting of
heart, blood vessels and blood. Heart here pumps the blood throughout the body,
which is circulated via the blood vessels. The blood vessels can have further
subdivision, arteries, veins and capillaries. Arteries transport the blood away from the
heart. Veins has opposite functions with-respect to arteries, it transport the blood
towards the heart from different parts of the body. Capillaries are regarded as the
connection between the arteries and the veins. They can also be termed as small
blood vessels (Stanfield, 2012).
2. The main function of the cardiovascular system is to deliver the transport
blood to different parts of the body and in turn bring away the deoxygenated blood
from the organs or the organs system to lungs where purification occurs. Blood
contains dissolved oxygen and this oxygenated blood when reaches to every cell of
the organs, it helps in the breakdown of ATP to release energy. Blood also contains
nutrients that help in nourishing the body (Stanfield, 2012).
3. There are three main parts of the respiratory system and these include a
pair of lungs, airways and the muscles. Here the airways consists of mouth, a pair of
nose, larynx, pharynx, trachea, bronchi and body’s exterior part. The pair of lungs act
as the main functional unit of the respiratory system. It performs exchange of oxygen
and carbon dioxide between the body and the exterior environment. The muscles of
the respiration are diaphragm and inter-coastal muscles. They act together to aid
lungs in pumping and pushing the air both inside and outside of the body via inflation
and deflation (Stanfield, 2012).

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4. The body’s oxygen transport system carries the oxygenated blood
throughout the body via the circulatory system. This circulatory system in exchange
of the oxygenated blood, brings out the deoxygenated blood from the organs to the
lungs or the respiratory system. While at lungs, the deoxygenated blood gets purified
via the exchanging carbon dioxide with oxygen. This exchange is done via
respiratory system (Stanfield, 2012).
5. Respiratory system undergoes several physiological, anatomical and
immunological changes. The structural change includes change in the structure of
the cell wall along with the thoracic deformity that impairs the overall breathing
process leading to laboured breathing. The parenchyma cell of the lungs also loses
its structure with the decrease in muscle strength, leading to dilation of air spaces.
Aging is also associated with a degenerative change in the cardiovascular system.
Aging causes a progressive increase hypertonic increase in the thickness in the wall
of the left ventricle. This increases cardiac overload followed by age-associated
arterial dilation and gradual loss of vascular compliance and peripheral resistance
(Stanfield, 2012).
6. Angina pectoris is disease of heart caused by the myocardial ischemia
resulting out of imbalance between oxygen demand and myocardial blood supply.
The main symptoms include retrosternal discomfort in chest characterised by
pressure, heaviness, burning and chocking sensation. The pain is localised mainly in
the back, neck, shoulders and jaws. Emphysema is defined as an abnormal
enlargement of the air spaces which are situated at the distal side of the terminal
bronchioles. The condition also causes destruction of the alveolar walls. Emphysema
is also popularly known as Chronic Obstructive Pulmonary Disease. The main

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symptoms of COPD are recurrent respiratory infection along with shortness of
breath, fatigue and tightness in chest (Candamourty et al., 2012).
7. The common risk factors of emphysema are cigarette smoking which is
associated with the reduction in the association rate constant of the alpha-1
antitrypsin of the lungs for neutrophil elastase. The risk factors of angina is more or
less similar to emphysema and include, chewing of tobacco, active and passive
smoking that causes damage of the interior walls of the arteries. Other risk factor
includes high cholesterol in blood (Candamourty et al., 2012).
8. The immediate assessment in case of John is fever control, external supply
of oxygen in order improve shortness of breath along with a chest X-ray to ascertain
the degree of sputum congesting the heart. The rate of the external oxygen supply
will be determined only after calculation the respiratory rate and degree of oxygen
saturation (Dossey et al., 2012).
9. Other health professionals which may be involved in John’s case is a
physiotherapist who will help John to excrete his green thick cough via doing special
physiotherapy message over his back side of the chest. This message will help in
the easy excretion of the cough and thereby clearing his chest and promoting
improved breathing. Since his diet is poor, he needs a proper diet chart that can only
be supplied via a nutritionist who will help John to maintain a low cholesterol diet,
required for patients of COPD (Dossey et al., 2012).
10. Artificially acquired immunity is obtained via vaccines. The process
involves immunization with the help of antigen. In response to this artificially injected
antigen, body will develop antibodies along with memory B-cells to fight against the
recurrent infection (Owen, Punt & Stranford, 2013).

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Case Study 2
1. The endocrine structure is made up of endocrine glands. The endocrine
glands secrete hormones directly into the body fluid that is blood other than through
ducts. like hypothalamus, pituitary, parathyroid, reproductive organs (testes and
ovaries), adrenal glands and pineal gland. Pancreas though not a gland is also
included with within the endocrine system. This organ helps in secretion of hormone
like insulin (Stanfield, 2012).
2. The glands of the endocrine system produce hormones, which are
regarded as the chemical messenger the control and co-ordinated the activity of the
cells and the organs along with promotion of sexual development. Other functions of
hormones include metabolism and growth (Stanfield, 2012).
Position of the
Pituitary Gland
Name of the hormones Function of the hormones
Anterior Pituitary Somatotropic Hormone (STH) It is an anabolic hormone that
promotes muscle and skeletal
growth
Thyroid Stimulating Hormone
(TSH)
It promotes growth and
development of the thyroid gland
Adrenocorticotropic hormone Stimulates adrenal cortex to
release cortico steroid hormones

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Gonadotrophic hormone (Follicle
Stimulating Hormone and
Luteinizing Hormone)
Regulates the growth and the
function of the sexual organs or
gonads
Prolactin Promotes production of milk
Posterior Pituitary Oxytocin Promotes uterine contraction that
trigger labour pain during
pregnancy, at the time of child
birth
Antidiuretic hormone Helps in renal reabsorption
Table: Classification of Pituitary Hormones
(Source: Stanfield, 2012)
3.Graves disease is the major outcome of the hyperthyroidism. It occurs
mostly in the genetically predisposed population. Autoimmune problem is the driving
force behind the disease. The Immunoglobulin of the patients who are suffering from
grave’s disease show increase in the number of the thyroid-targeted activities that
increases in the thyroid stimulating hormone (TSH). This increases stimulation of
TSH is related to the interaction of immunoglobulin G (IgG) with the TSH receptors.
This constant secretion of TSH increases the level of thyroid hormone in blood (T3 &
T4) leading to hyperthyroidism or Grave’s disease (Owen, Punt & Stranford, 2013).

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The risk factor of Grave’s disease include genetic pre-disposition, family
history of auto-immune disease, increased intake of iodine, increase level of stress,
unwanted use of sex steroid hormones and uncontrolled smoking (Stanfield, 2012).
4. Isabella is suffering from Hypothyroidism or grave’s disease. Isabella’s
blood produces auto-antibodies which binds to the receptor of TSH while mimicking
the function of TSH. This activates adenylate cyclise and results in unregulated
synthesis of thyroid hormones, thyroxine (T4) and triiodothyronine (T3). It is due to
this condition that Isabella’s TSH concentration is within the normal limit while high
concentration of T3 and T4. Unlike TSH, auto-antibodies are not regulated via
negative feedback mechanism and thus they continuously stimulate thyroid hormone
(Stanfield, 2012). Hence they are also known as long-acting thyroid stimulating
antibodies (LATS) (Owen, Punt & Stranford, 2013).
Figure: Pathophysiology of Grave’s disease
(Source: Owen, Punt & Stranford, 2013)

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5. The main structure of the digestive system includes stomach, gall bladder,
pancreas, liver, large intestine (colon), small intestine. Other associated structures
include salivary glands, pharynx, esophagus, rectum and mouth (Stanfield, 2012).
6. The alimentary canal or the digestive system functions via channelizing
food through the gastrointestinal (GI) tract. The process of digestion starts in mouth
with the help f the salivary glands and chewing and ends in the small intestine. Food
during its passage through the GI tract, gets mixed with the digestive juices, helping
the large food molecules to break down into smaller counter parts (Stanfield, 2012).
7. Immune system is a versatile defence system that protects animals from
the invading micro-organisms that are pathogenic in nature. Immune system is
divided into two parts, innate and adaptive immunity. Innate immunity provides
preliminary line of defence against infection. It is regarded as inborn immunity that is
majorly acquired from the maternal antibodies. Adaptive immunity develops during
the course of life and is stronger than innate immunity as it has memory response to
combat recurrent infection (Owen, Punt & Stranford, 2013).
8. Myasthenia gravis is an autoimmune disease that is mediated by a class of
blocking auto antibodies. A patient suffering from Myasthenia gravis produces auto-
antibodies that bind with the acetylcholine receptors. This trigger complement
mediated lyses of the cells. Cell lyses weakens the skeletal muscles. In extreme
cases the auto antibodies destroys the cell bearing those receptors resulting in
complete loss of the signalling (Owen, Punt & Stranford, 2013).

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Figure: The pathophysiology of Myasthenia gravis
(Source: Owen, Punt & Stranford, 2013)
9.
Interventions Rationale
Administration of thyroid hormone antagonist It will help to prepare patients for the surgery
Administration of non-selective beta blockers
(propranolol)
Helps in the reduction of the thyrotoxic
effects and also blocks the synthesis of
thyroid hormones and also blocks the
peripheral conversion of T4 to T3.
Table: Nursing plan for Hyperthyroidism
(Source: Smallridge et al., 2014)

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Figure: Algorithm for Diagnostic Hyperthyroidism
(Source: Kravets, 2016)
10. Dietician: Isabella since running on high thyroid hormones and loos in
weight, she needs a diabetic chart from better management of the insulin hormone
secretion and regulation of thyroid hormones (American Diabetes Association,
2013).
Ophthalmologist: High thyroid hormones (T3 and T4) in the blood affect the
eye, creating vision problem and hence a thorough check up of ophthalmologist is
must (American Diabetes Association, 2013).
Nephrologists: Increase in the concentration of the thyroid hormones in
blood affects the renal development and physiology negatively. Thyroid hormones
are attributed to have a pre-renal and intrinsic renal affect and this increase the renal
blood flow along with the glomerular filtration rate. Hence, multidisciplinary health
care team of Isebella must contain a nephrologist in order to side-pass associated
renal complications (Basu & Mohapatra, 2012).

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Case Study: 3
1. Nervous system has three basic function and these are sensory function,
interpretative function and motor function. The role of sensory function is to gather
information from both the internal and external environment. The collected
information is then transported by the nerves into the central nervous system (CNS).
The motor nerves collect in the information from the muscle cells and convey the
information to the CNS (Stanfield, 2012).
2. Multiple sclerosis is an inflammatory disease mediated by immune
response that attacks the central nervous system via destroying the myelin sheet
and the axon terminal. Pathological hallmark of Multiple Sclerosis (MS) inflammatory
plaques arising out of the demyelination with in the Central Nervous System (CNS).
The inflammation in the MS is not restricted to the white matter of the CNS. It also
occurs in the region, which has high synaptic density like cerebral cortex (Owen,
Punt & Stranford, 2013).
3. Inflammation arising out of the MS contributes to visual loss as and this goes in
sync with the symptoms of Daisy who reports blurred vision. Inflammation also
contributes towards the neurological deficit via modifying the characteristics of the
gilial cells like microglia and astrocytes. Here the astrocytes are believed to be
important in regulating several factors in brain. The modification in the astrocytes
affects the memory function and leading to frequent loss of memory in case of Daisy.
Demyelination of neurons causes loss of the signal transduction from the neurons
and this loss of the transmission of the nerve impulses from one axon terminal to
another leads to a burning sensation, which ultimately creates numbness in leg.

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Here Daisy is experiencing bilateral numbness in both of her leg, arising out of the
demyelination of MS (Goldenberg, 2012).
4. The main structural parts of the urinary system include a pair of kidneys,
ureter, bladder and urethra. Kidneys are bean-shaped organs that are located on the
back side of the abdominal wall, just behind the peritoneum. The right hand side
kidney is located slightly lower than the left hand side kidney in order to
accommodate liver. Ureters are long and thin tube shaped organs, which are made
up of smooth muscles. Contraction of smooth muscles, push the urine down the
ureters and the bladder. The female urethra is shorter than the male urethra
(Stanfield, 2012).
5. In the domain of anatomy and medicine, the special senses are defined as
those senses that have some specialized organs devoted for them like vision (a pair
of eyes), hearing and maintenance of body balance (a pair of ears), smell or odorant
sense (nose) taste (tongue). The information from the special senses is carried via
special somatic afferents and visceral afferents. Touch is also a special sense also
known as somatic sense but it does not have specialized organ, apart from skin
(Stanfield, 2012).
6. Vision: Vision is the first sign of the disease manifestation in MS. It occurs
due to the inflammation occurring in the optic nerves, a condition known as optic
neuritis.
Hearing: Problem with hearing is pretty much rare in case of patient with MS.
Problem generally arise from the inflammation or scarring centering the auditory
nerves as it enters inside the brain stem.

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Taste: MS significantly affects the taste buds. The lesions that appears in
large section on the frontal side of the brain and on the temporal lobe of the brain
cause loss of taste in the taste buds.
Smell: 45% of the patient suffering from MS, witness the symptom of loss of
smell. It occurs due to the reduction of the olfactory bulb (the region specific in the
brain that is responsible for detecting smell) and grey matter. This reduction in grey
matter then leads to loss in memory.
Touch: The symptoms affecting the touch senses may be mild or severe. The
symptoms are exacerbated via fatigue or heat (Stanfield, 2012).
7. A person who has lost his or her teeth either partially or completely is
known as edentulous or edentate. Organisms that are completely devoid of teeth are
also classified under edentulous like sloths and anteaters. Organisms who have not
lost any teeth is known as dentate (Pettersson et al., 2012).
8. Multiple sclerosis and periodontal disease both have inflammatory origin
and thus is inter-related. In case of MS, due to difficulty in nerves, patients fail to
observe through dental hygiene, which further aggravates the dental problem
(Elemek & Almas, 2013). In case of Daisy, problem in the nerve endings arising out
of the MS, is resulting in jaw pain.
9.
Nature of complications Assessment Interventions
Difficulty in walking Manual test of the muscle
6 minutes walk
Gait analysis along with
Proper gait assistive device
and gait training
Behavioral and

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functional gait assessment
and dynamic gait
assessment
environmental modifications
Poor body balance with a
risk of fall
Manual test of the muscle Strength training along with
behavioral modification
(Source: Karampampa et al., 2012)
10. The treatment of the dental problems as experienced by Daisy should be
done by a professional dental hygienists or a dentist. Here the dentist will take care
of Daisy's jaw pain via assisting her in maintaining proper dental hygiene and
thereby preventing periodontal disease (Elemek & Almas, 2013).
Daisy also needs a daily assistance from a trained registered nurse in order to
carry out her daily activities. She is experiencing bilateral numbness in both her feet
along with blurred vision and here a constant assistance of a nurse is must for her.

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References
American Diabetes Association. (2013). Executive summary: Standards of medical
care in diabetes—2013. Diabetes care, 36(Supplement 1), S4-S10.
Basu, G., & Mohapatra, A. (2012). Interactions between thyroid disorders and kidney
disease. Indian journal of endocrinology and metabolism, 16(2), 204.
Candamourty, R., Venkatachalam, S., Babu, M. R., & Kumar, G. S. (2012). Ludwig's
Angina–An emergency: A case report with literature review. Journal of natural
science, biology, and medicine, 3(2), 206.
Dossey, B. M., Certificate, C. D. I. N. C., Keegan, L., & Co-Director International
Nurse Coach Association. (2012). Holistic nursing. Jones & Bartlett
Publishers.
Elemek, E., & Almas, K. (2013). Multiple sclerosis and oral health: an update. The
New York state dental journal, 79(3), 16-21.
Goldenberg, M. M. (2012). Multiple sclerosis review. Pharmacy and
Therapeutics, 37(3), 175.
Karampampa, K., Gustavsson, A., Miltenburger, C., Kindundu, C. M., & Selchen, D.
H. (2012). Treatment experience, burden, and unmet needs (TRIBUNE) in
multiple sclerosis study: the costs and utilities of MS patients in Canada. J
Popul Ther Clin Pharmacol, 19(1), 11-25.
Kravets, I. (2016). Hyperthyroidism: Diagnosis and Treatment. American family
physician, 93(5).