Healthcare Assignment: Patient Case Study and Treatment Plan

This healthcare assignment analyzes the case of a 77-year-old patient, Joyce, addressing her age-related skin changes, delayed wound healing, and potential complications like osteoporosis and constipation. The assignment explores the impact of aging on skin integrity, the role of Langerhans...Read More

Running head: HEALTHCARE
HEALTHCARE
Name of the Student
Name of the University
Author Note

HEALTHCARE
Answer 1 (i)
According to Bonifant and Holloway (2019), the structural integrity of the skin is
hampered with the process of healing. This is because, there occurs age-related change in the
epidermis and dermis of the skin. This change, decrease the ability of the skin to resist the
damage and injury. With age, the dermoepidermal junction of the skin becomes flattened.
This flattened structure predisposed the skin tissue to get exposed to shear and frictional
forces leading to skin injury. With the dermis of the skin, there also occurs alteration in the
amount of collagen deposition and structure of collagen. Hamper in the collagen deposition
decreases the tenderness of the skin making it more rigid and vulnerable to injury under
frictional forces (Bonifant & Holloway 2019). Joyce is 77-year old and thus it is evident that
structural integrity of the skin is poor.
Figure: Difference between structural integrity of young skin and ageing skin
(Source: Bonifant & Holloway 2019)
Answer 1 (ii)
The ageing of the skin is associated with increase in the susceptibility towards a
diverse range of age-related condition like pressure ulcers and chronic wound. Due to hamper

HEALTHCARE
in the overall integrity of the skin as a result of ageing, there occurs delay on the overall
process of wound healing (Bonifant & Holloway 2019). Farage et al. (2013) stated that
Langerhans cell (LC) are antigen-presenting cells located with the epidermis of the skin and
plays an important role in acute wound healing. The number of LCs is greatly reduced among
the older adults leading to delay in the process of wound healing. The decrease in the LC also
makes the surface of the skin susceptible of skin infection and thus making the skin of the
older adults vulnerable to wound formation. According to Farage et al. (2013), the dermal
layer of the older adults have fewer number of fibroblasts, macrophages, fibroblasts along
with the decrease integrity of the extra-cellular matrix like collagen. Fibroblasts are
responsible for the formation of collagen in the skin. Hamper in the integrity in the fibroblast
leads to further decrease in the collagen formation. Lack of collagen hamper the granulation
of the tissue and thus delaying the process of wound healing. Joyce is suffer from delay in the
process of wound healing as her son reported that she has previously suffered from falls and
fractures and her recovery takes time.
Answer 2 (i)
The common medication in case of Joyce will be non-steroidal anti-inflammatory
drugs (NSAIDs) for pain management and anticholinergic drugs that are used for the
treatment of neurological complications like Parkinsons’ and dementia. The increased
tendency of accidental fall in Joyce might be a clinical manifestation of neurodegenerative
disease common at this age. Accidental fall is further associated with and hence the use of
pain killers.
Fragakis et al. (2018) stated that constipation is the common side-effect of
anticholinergic drugs anticolinergic drugs mainly blocks the action of the neurotransmitter
acetyl-choline at the neuronal synapses and peripheral nerves and thus inhibiting the
parasympathetic impulses. Parasympathetic impulses play an important role in the regulating
the peristalsis movement of the stomach. The role of the stomach apart from digestion with
the help of bile juice is to ensure passage of the food from stomach to small intestine by
peristalsis movement. This is followed by the passage of undigested food from small intestine
to the large intestine for excretion. Hamper in the blockage in the parasympathetic impulses
create a barrier for normal peristalsis movement. In the absence of peristalsis movement, the
passage of undigested food from large intestine to the rectum gets hampered leading to
constipation (Fragakis et al. 2018).

HEALTHCARE
Crooks, Limdi and McLaughlin (2019) are of the opinion that NSAIDs induce both
gastropathy and enteropathy. Prolong use of the NSIADs (apart from aspirin) induce lower
gastro-intestinal injuries by inhibition of the activity of cyclo-oxygenase enzymes. NSAIDS
also solubilise the lipids present in the phospholipids bilayer of the stomach causing damage
in the mucosal lining of the stomach. Damage in the mucosal lining of the stomach and small
intestine increases the permeability of mucosal layer, this causes leakage of the bile juice
causing gastrointestinal ulcer and subsequent development of diarrhoea like symptoms.
NSAIDs also hamper the normal microbiom of the stomach that aids in the process of
digestion and thus increasing the chances of food poison and diarrhoea (Crooks, Limdi &
McLaughlin 2019).
Answer 2 (ii)
In order to relive from constipation, the potential dietary change for Joyce include
increasing the intake of fibre rich food (Roque & Bouras 2015). Fibre rich food (whole grain,
barley, carrot, wheat bread and fruits like banana) facilitates the bowel function by increasing
the water absorption capacity of stool and thus causing improved frequency of and
consistency of stool formation. The diet chart of Joyce must also include laxatives. It can be
used if fibre rich food (flaxseeds, berries, legumes) fails to produce any significant effect in
constipation management. Laxative promotes intestinal motility by promoting high-amplitude
contraction and thus promoting proper passage of stool (Roque & Bouras 2015).
Answer 3 (i)
I will explain to Joyce's son Matthew about the pathophysiology underlying
osteoporosis. Osteoporesis or porous bone disease is characterised by low bone mass along
with gradual structural deterioration of the skeletal tissues. This increases the fragility of the
bones and decrease in the strength of the overall skeletal structure (Lupsa & Insogna, 2015).
In case of Joyce, Mattew will be educated about how accidental fall for his mother is fatal at
present because she is prone to hip; spine and writs fracture by taking into consideration of
her skeletal health.
Answer 3 (ii)
Three factors responsible development of osteoporosis include

HEALTHCARE
1. Menopause: Menopause causes lack of estrogen secretion. Menopause causes lack of
estrogen secretion. Estrogen deficiency in post-menopausal women leads to the development
of osteoporesis. Under estrogen deficiency, there occurs increase in bone resorption under
increased activity of osteoclast. Thus bone resorption (breakdown) of bones overtakes the
building of new bones. This decay in bone causes osteoporosis (Jeremiah et al. 2015).
Decrease in the estrogen secretion resulting out of menopause hampers the secretion of the
calcium ion metabolism and secretion and thus further increasing the severity of bone
fragility. Menopuse also hampers the regulation of other sex hormones that further
complicates the bone health (Jeremiah et al. 2015).
2. Calcium deficiency: Calcium deficiency occurs among the older adults especially women
who are above 60 years of age. Calcium is an important nutrient in the skeletal muscles.
Obligatory loss of calcium among the older adults leads to the development of calcium
deficiency and thus impairing bone growth and delay in the consolidation of the skeletal
muscles (Sözen, Özışık & Başaran 2017).
3. Aging: Aging is another reason behind the formation of the osteoporosis. Lack of Vitamin
D secretion is common among the older adults. The decrease in the secretion of Vitamin D
weakens the bone and at the same time increases bone loss. Calcitriol or vitamin deficiency
thus increases the chance of osteoporosis (Sözen, Özışık & Başaran 2017).
Answer 4
Vitamin D supplement and increase in her daily intake of calcium is prescribed in
order to prevent her bone decay. The randomised control trial conducted by Zhao et al.
(2017) stated that vitamin C supplementation along with increase in the dietary calcium
intake helps to decrease the risk of bone injury among the community dwelling older. The
vitamin D supplements and dietary calcium intake helps to increase the bone density while
preventing fragility of the bones. However, Anderson et al. (2016) stated that increase in the
calcium intake through diet or taking calcium supplements increases the risk of developing
several cardio-vascular diseases like coronary artery disease among the older adults. On the
other hand, increase in the total intake of calcium decreases the risk of developing
atherosclerosis. Older adults with like Joyce who are over 70 years of age are prone to
cardiac anomalies like myocardial infarction and atrial fibrillation (Williamson et al., 2017).
Thus, the regulation of the calcium intake in case of Joyce must be undertaken under the

HEALTHCARE
controlled supervision of professional dietician. Her calcium content in the body must be
monitored regularly in order to prevent calcium over dose.

HEALTHCARE
References
Anderson, J.J., Kruszka, B., Delaney, J.A., He, K., Burke, G.L., Alonso, A., Bild, D.E.,
Budoff, M. & Michos, E.D., 2016. ‘Calcium intake from diet and supplements and the risk of
coronary artery calcification and its progression among older adults: 10‐year follow‐up of the
Multi‐Ethnic Study of Atherosclerosis (MESA)’. Journal of the American Heart
Association, 5(10), p.e003815.
Bonifant, H., & Holloway, S. 2019. ‘A review of the effects of ageing on skin integrity and
wound healing’. British journal of community nursing, 24(Sup3), S28-S33.
Crooks, B., Limdi, J.K. & McLaughlin, J., 2019. ‘How to manage chronic diarrhoea in the
elderly?’. Frontline Gastroenterology, pp.flgastro-2018.
Farage, M.A., Miller, K.W., Elsner, P. & Maibach, H.I., 2013. ‘Characteristics of the aging
skin. Advances in wound care’, 2(1), pp.5-10.'
Fragakis, A., Zhou, J., Mannan, H. & Ho, V., 2018. ‘Association between drug usage and
constipation in the elderly population of greater Western Sydney Australia’. International
journal of environmental research and public health, 15(2), p.226.
Jeremiah, M.P., Unwin, B.K., Greenawald, M.H. & Casiano, V.E., 2015. ‘Diagnosis and
management of osteoporosis’. Am Fam Physician, 92(4), pp.261-268.
Lupsa, B.C. & Insogna, K., 2015. Bone health and osteoporosis. Endocrinology and
Metabolism Clinics, 44(3), pp.517-530.
Roque, M.V. & Bouras, E.P., 2015. ‘Epidemiology and management of chronic constipation
in elderly patients’. Clinical interventions in aging, 10, p.919.

HEALTHCARE
Sözen, T., Özışık, L. & Başaran, N.Ç., 2017. ‘An overview and management of
osteoporosis’. European journal of rheumatology, 4(1), p.46.
Williamson, J.D., Supiano, M.A., Applegate, W.B., Berlowitz, D.R., Campbell, R.C.,
Chertow, G.M., Fine, L.J., Haley, W.E., Hawfield, A.T., Ix, J.H. & Kitzman, D.W., 2016.
Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults
aged≥ 75 years: a randomized clinical trial. Jama, 315(24), pp.2673-2682.
Zhao, J.G., Zeng, X.T., Wang, J. and Liu, L., 2017. Association between calcium or vitamin
D supplementation and fracture incidence in community-dwelling older adults: a systematic
review and meta-analysis. Jama, 318(24), pp.2466-2482.