Nursing Case Study: Joyce - Anatomy and Physiology, Semester 1

This report presents a comprehensive analysis of a nursing case study involving a 77-year-old female named Joyce, who resides in a nursing home. The case study explores Joyce's health challenges, focusing on her prolonged recovery from falls and fractures, and the impact of aging on her skin integrity and wound healing. The report delves into the effects of aging on the integumentary system, highlighting the structural changes in the skin and their implications for wound healing. It also examines the impact of medications on the digestive system, specifically addressing the side effects of diarrhea and constipation. Furthermore, the report discusses the pathophysiology of osteoporosis, considering factors such as advanced age, sex, and nutritional intake, and their contributions to the development of the condition. The report also evaluates the effectiveness of vitamin D supplementation and explores alternative therapies like red clover and acupuncture for managing osteoporosis. References are provided to support the findings.

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

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Response 1:
The provided case information suggests that the patient Joyce is 77 year old and has
sustained injuries from a fall incident. The injury has resulted in tear of skin and on account
of her injury the ability to address activities of daily living has also been affected. The
evidence base suggests that the process of ageing induces significant changes within the skin
integrity. According to Blume-Peytavi et al. (2016), the process of ageing affects the
physiology of the epidermis which subsequently diminishes the ability of the dermis layer to
resist age related damage and infections. It should further be noted that research studies also
state that the dermo-epidermal junction with advancing age flattens and this results in
weakening of the skin due to the force of friction. As stated by Farage et al. (2017), the pace
of epithelisation gets delayed with advancing age and the density of the keratinocytes as well
as the langerhan cells reduces considerably. The keratinocytes and the Langerhans are
responsible for the maintenance of skin integrity among senior adults and with the poor
density of these cells, the skin becomes overtly sensitive to the process of wound healing and
infection and the recovery process gets delayed. Therefore, on account of the patient’s
advanced age, it can be said that the skin integrity is significantly impaired.

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(Source: Bpac.org.nz 2019)

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Research studies critically mention that there are four stages of wound healing which
comprises of the inflammatory stage, the proliferative phase and the remodelling phase
(Blume-Peytavi et al. 2016). The ageing process interferes with the cell signalling processing.
The signalling process is impacted by cytokine transduction which causes an imbalance of
the protein level for the process of healing and at the same time negatively impacts the
overall healing process (Farage et al. 2017). The process of senescence induced vascular
changes within the inflammatory steps which simultaneously impacts cell division due to
infiltration of the inflammatory macrophage (Farage et al. 2017). Also, in older adults,
remodelling of the injury takes a long time and thus it can be said that the patient would
require a lot of time for complete recovery due to impaired skin integrity.
(Source: Woulgan 2019)

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Response 2:
On evaluation of the evidence base, it can be said that a broad spectrum of drugs leads
to constipation and diarrhoea as side effects. A broad range of drugs such as antibiotics,
laxatives or analgesics might cause diarrhoea or constipation as a side-effect. Most of the
drugs elicit their action by absorbing the water into the gut and simultaneously interrupting
the water channel within the external layers of the intestine within the gastrointestinal system.
These drugs typically act by contracting the tissues of the small intestine which ultimately
causes high reabsorption of water. Research studies further reveal that a number of drugs
impact the intestinal cells when consumed in high doses (Mearin et al. 2016). It should
further be noted that the human intestine comprises of a diverse gut flora that help with the
digestion process and help in the retention of water (Greenwood-Van Meerveld et al. 2017).
However, a number of broad spectrum antibiotics work by destroying these beneficial
bacteria and promote the growth of Clostridium difficle which interferes with the digestion
process and causes watery diarrhoea (Greenwood-Van Meerveld et al. 2017; Mearin et al.
2016).
Constipation is caused by the slower movement of food substance from the colon
which absorbs a significant percentage of water and this results in the formation of hard stool
and causes distress. However, the condition can be treated by introducing dietary changes.
Research studies suggest that consumption of certain nutritious substances increases the
chances of constipation such as gluten calories, caffeine and fruits such as banana (Mearin et
al. 2016). These substances are known to retain maximum volume of water which would
ultimately lead to discomfort and constipation. However, consumption of nutritious
substances such as nuts, flaxseed and vegetables such as broccoli are known to ease bowel
movement. In addition to this, the patient would be encouraged to consume more water and
electrolyte solution so as to maintain the electrolyte balance within the body (Ryu & Choi

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2015). The meals consumed by the patient must comprise of green vegetables and substances
rich in fibre. Optimal care must be undertaken so as to ensure that the patient remains
hydrated and does not consume meals rich in oil or fatty substances as this would interfere
with the smooth digestion process (Ryu & Choi 2015). Intake of the proposed optimal diet is
expected to yield positive results.
Response 3 (i):
Research studies suggest that osteoporosis is a bone disorder that is characterized by
lower bone mass and structural anomaly of the bone tissue (Sheu and Diamond 2016). The
disorder invariably results in the fragility of bones and increases the risk of fractures of the
spine, wrist and the hip. As stated by Mirza and Cannalis (2015), bone maintenance is one of
the delicate processes that involve a cascade of biological reactions. It should be mentioned
in this regard that advancing age is accompanied with the regular process of removal of
minimal amount of bone mineral which is known as reabsorption. However, it is integral to
ensure that the process of reabsorption must be balanced with the process of equal mineral
deposition. Instances when the process of reabsorption exceeds the process of deposition, the
bone weakens and this leads to the formation of brittle and weakened bones. Thus, it can be
mentioned in this regard that bone mineral and bone remodelling are tightly linked with the
pathophysiology of osteoporosis. Therefore, Mathew would be explained about the
pathophysiology of Osteoporosis and would be explained how Joyce’s skeletal health has
become fragile and on account of her poor bone strength she is placed at a high risk of falls
and accidents which would lead to adverse consequences.

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(Source: Osteopenia, O. 2019)
Response 3 (ii):
On critically analysing the case scenario, it can be stated that the three factors that
might have contributed to the development of the physical health condition of Osteoporosis
can be explained as:
Advanced age: As has been mentioned in the case scenario, the patient is 77 years old and
the evidence base suggests that advanced age placed an individual at a greater risk of
developing osteoporosis. As mentioned by Sheu and Diamond (2016) with the advancement
of age, the bones tend to become thinner and weaker and this could be considered as one of
the primary factors that has facilitated the development of Osteoporosis in the patient.
Sex: The evidence base critically suggests that the risk of developing osteoporosis is higher
in women than in men at an advanced age. The reason for the same has been explained as the
presence of lower bone tissue among women. Also, the process of removal of bone mineral is
faster in women than in men on account of the hormonal impact post menopause. Post
menopause, the level of oestrogen synthesis decreases in women and research studies suggest
that oestrogen elicits its direct effect on the osteoclasts and interacts with the specific proteins
or receptors present on the surface of the osteoblasts and osteoclasts which in turn regulate
the process of reabsorption (Alswat 2017).

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Poor nutritional intake of Calcium: It might be probable that the patient consumed a life
time diet poor in calcium or vitamin intake. The evidence base reveals that a poor diet lower
in calcium or vitamin D intake makes the body highly susceptible to bone loss which in turn
affects the quality of overall health outcome (Stott and Wells 2016).
Response 4:
The evidence base suggests that Vitamin D supplementation encourages the faster
reabsorption of minerals such as Calcium and Phosphorus which are integral for maintaining
the bone health (Stott and Wells 2016). However, considering the advanced age (<70 years)
of the patient, it can be stated that the digestive system of the patient has deteriorated in terms
of functional output. The consumed Vitamin D supplement is absorbed within the intestinal
cells which subsequently facilitates enhanced transportation of the calcium ion that helps to
improve the bone density of the patient (Bandela et al. 2015). However, on account of the
poor physiology of the intestinal cells, it can be said that the process of absorption of Vitamin
D would be impaired (Johnson and Grundy 2017). This would subsequently interfere with the
absorption of the minerals Calcium and Phosphorus which are known as the integral minerals
that help to maintain the bone health. Therefore, on account of poor vitamin D absorption the
complete physiology of calcium reabsorption and transportation would be hampered and this
would subsequently interfere with the process of regeneration of the osteoclasts and thus the
patient health would not improve.
The evidence further suggests that certain alternative therapies can help to acquire
positive health outcome. For instance, administration of Red clover which is an oestrogen
containing compound helps to achieve positive outcome for the physical health condition of
osteoporosis (Gupta and March 2016). Considering the effect of senescence on the overall
physiology of the body processes, recommendation of alternative therapies such as

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acupuncture in combination with red clover supplementation can help acquire positive
outcome.

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References:
Alswat, K.A., 2017. Gender disparities in osteoporosis. Journal of clinical medicine
research, 9(5), p.382. DOI: 10.14740/jocmr2970w
Bandela, V., Munagapati, B., Karnati, R.K.R., Venkata, G.R.S. and Nidudhur, S.R., 2015.
Osteoporosis: its prosthodontic considerations-a review. Journal of clinical and diagnostic
research: JCDR, 9(12), p.ZE01. DOI: 10.7860/JCDR/2015/14275.6874
Blume-Peytavi, U., Kottner, J., Sterry, W., Hodin, M.W., Griffiths, T.W., Watson, R.E., Hay,
R.J. and Griffiths, C.E., 2016. Age-associated skin conditions and diseases: current
perspectives and future options. The Gerontologist, 56(Suppl_2), pp.S230-S242. DOI:
https://doi.org/10.1093/geront/gnw003
Bpac.org.nz 2019. Preventing and managing dry skin in older people - BPJ63 September
2014. [online] Bpac.org.nz. Available at:
https://bpac.org.nz/BPJ/2014/September/dryskin.aspx [Accessed 16 Aug. 2019].
Farage, M.A., Miller, K.W. and Maibach, H.I., 2017. Degenerative changes in aging
skin. Textbook of aging skin, pp.15-30. Retrieved from:
https://link.springer.com/referenceworkentry/10.1007%2F978-3-662-47398-6_4
Greenwood-Van Meerveld, B., Johnson, A.C. and Grundy, D., 2017. Gastrointestinal
physiology and function. In Gastrointestinal Pharmacology (pp. 1-16). Springer, Cham.
Retrieved from: https://link.springer.com/chapter/10.1007/164_2016_118
Gupta, A. and March, L., 2016. Treating osteoporosis. Australian prescriber, 39(2), p.40.
DOI: 10.18773/austprescr.2016.028
Mearin, F., Ciriza, C., Mínguez, M., Rey, E., Mascort, J.J., Pena, E., Canones, P. and Judez,
J., 2016. Clinical Practice Guideline: Irritable bowel syndrome with constipation and

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functional constipation in the adult. Rev EspEnferm Dig, 108(6), pp.332-6. Retrieved from:
https://www.researchgate.net/profile/Javier_Judez/publication/303530240_Clinical_Practice_
Guideline_Irritable_bowel_syndrome_with_constipation_and_functional_constipation_in_the
_adult/links/577b8e0708aece6c20fcb943/Clinical-Practice-Guideline-Irritable-bowel-
syndrome-with-constipation-and-functional-constipation-in-the-adult.pdf
Osteopenia, O. 2019. Strong and Stable | Osteopenia, Osteoporosis and Exercise. [online]
Strongandstable.com.au. Available at: http://strongandstable.com.au/2017/10/osteopenia-
osteoporosis-and-exercise/ [Accessed 16 Aug. 2019].
Ryu, H.S. and Choi, S.C., 2015. Recent updates on the treatment of constipation. Intestinal
research, 13(4), p.297. DOI: 10.5217/ir.2015.13.4.297
Sheu, A. and Diamond, T., 2016. Secondary osteoporosis. Australian prescriber, 39(3), p.85.
DOI: 10.18773/austprescr.2016.038
Stott, A. and Wells, L., 2016. Arthritis and musculoskeletal conditions. Chronic care
nursing: A framework for practice, pp.194-209. Retrieved from:
https://books.google.co.in/books?
hl=en&lr=&id=fFWJDAAAQBAJ&oi=fnd&pg=PA194&dq=Australian+journal+pathophysi
ology+of+osteoporosis&ots=DuydW3UWvL&sig=fZoYOKevdy9inuAPFRWrMFrfY-
g&redir_esc=y#v=onepage&q=Australian%20journal%20pathophysiology%20of
%20osteoporosis&f=false
Woulgan 2019. Stalled wound and wound healing - A brief overview. [online] Woulgan.
Available at: https://woulgan.com/wound-healing-stalled-wounds-brief-overview/ [Accessed
16 Aug. 2019].