Mr. Smith's Journey Through Aging and Memory Loss - Case Study

Introduction

This paper discusses the case of Mr. Smith (pseudonym) is a 79 years old man initially born in Japan. He, together with his wife, moved to Canada 45 years ago. The family opened a floral shop as Mr. Z had a great flair and love for nature, and he loved arranging flowers. When Mr. Smith reached 62 years, he started to develop a difficulty of arranging the flowers in his favorite design. The son had earlier noticed Mr. Smith misplacing things, losing essential documents of orders as well as forgetting vital picking moments. His wife had also realized that her husband had started having problems remembering recent activities. He had also started to wake up unusual hours at night as he thought it was time to open his floral shop. At times, Mr. Smith had begun to become so irritable at the shop and also at home.

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At age 75, Mr. Smith had increased trouble to remember the position of things, and when asked questions, he would become confused and angry. He had also started to become weak physically, although he never perceived his limits. He had many falls at home, and sometimes he got lost in the compound. The records show that earlier, a social worker nurse who met Mr. Smith diagnosed him with a moderate level Alzheimer disease and also osteoarthritis which had a urinary tract infection (Booker et al., 2015). Currently, Mr. Smith uses top and lower dentures and reading glasses, and he always requires a reminder to use the walker. Mr. Smith is presently on Memantine (Namenda) and donepezil (Namzaric) medication (McKeith,2017).

While examining Mr. Smith, it seems that his clinical condition is worsening. He says that he feels unadorned pain in his right-side chest as well as severe pain in the back characterized by breathing difficulty (Aggarwal, 2016). Mr. Smiths' RR is now 32 breaths / minute, and they are shallow ones. He has a problem with speaking and talks in brief sentences. His SPO2 is far-ranging to 89%. The repetitive blood, as well as arterial blood gases, were also examined, and the outcome revealed results as follows: PCO2 56 mmHg, K 5.3 mmol/L, Na 150 mmol/L, HCO3 19 mmol, creatinine 143 mol/L, glucose 12 mmol/L, SaO2 79%. WBC 14.8 x 109gL, Hb 11.5 g/L, INR 1.5, APTT 39 sec. ABG results reveal pH 7.2, PO2 53 mmHg, BE -5, He has continued to use supplementary oxygen, and his SPO2 have positively improved to 84%, but he is still very nervous (Nordstrom,2015). Besides, he suffers the following symptoms:

• Palpitations: Mr. Smith is having an irregular heartbeat and confirms the flip flop sensation in his chest.
• Weakness and fatigue: Mr. Smith complained of feeling a lot of tiredness, and he is no longer capable of doing his usual daily chores. He also experiences sudden and severe weakness.
• Coughing and whizzing: The patient has been having chronic coughs and wheezes, and he has been producing mucus which is pink and bloody sometimes.
• Narrow blood vessels: he has been feeling numbness in his feet when he is resting and sometimes feeling cool to touch. Part of his thighs look pale and pneumonia

Pathophysiology

From the look of the altered signs and symptoms found by examining the patient, the diagnosis shows that Mr. Smith had a cardiac issue, notably heart failure (Asgar et el.,2015). The primary pathophysiology of heart disease involves the reduction of heart muscle efficiency. It happens through either damage or overloading by many circumstances like myocardial infarction mostly when the heart muscles are deprived enough oxygen or dies (Berg & Wright,2016). Hypertension can also increase the contraction force, which is essential to pump the blood. It might also be caused by the amyloidosis where the misfolded proteins get deposited in the muscle of the heart, which results in stiffening. Mr. Smith's results of arterial blood gas result give evidence of a respiratory problem that comes as a result of heart failure.

The patient with heart issue has reduced contraction force as a result of the ventricle are overloaded. When the heart is healthy, the ventricle is filled with blood, thus increasing the force of contraction, which will raise the cardiac output. Due to the narrowed blood vessels, the automatic mechanism of contraction fails (Ter et el., 2015). This failure is also facilitated by the reduction in the ability of cross-link actin and myosin components in the heart muscle that is overstretched.

The patient is seen to be having problems in exercise. He is not able to exercise. The reason behind this is the decreased end-diastolic volume. When the systole and diastole fail, the stroke volume will fall. When the compliance of the ventricle reduces, there is impaired ventricular filling, which causes a decrease in end-diastolic volume (Ter et el., 2015). The heart will then work harder to maintain regular metabolic activity. By doing so, the three will be an increase in the cardiac output when more oxygen demanded like during the exercise. The result of this is the intolerance to exercise. The cardiac reserve is lost, which is the heart's ability to work harder in more strenuous physical activities (Ter et el., 2015). From the fact that the heart needs to work harder for meeting the demands of the norm metabolism, it becomes challenging to meet metabolic requirements at the times of exercising.

The other symptom examined is the increased heart rate. It is mostly stimulated by a rising in sympathetic activity generate for the maintenance of plenty of cardiac outputs. The maintenance help was compensating heart failure through balancing the blood pressure as well as the perfusion (Cooper,2017). Also, it will bring more strain on the myocardium, which will increase the requirements of the coronary perfusion. Besides increased heart rate, the patient also exhibits abnormal heart rhythms. It is caused by the same sympathetic activity that causes higher heart rate, bringing about an increase in the hearts muscular layer physically. The primary cause of this is the differentiated fibers of muscle as a result of the attempt to balance the contractility.

Cardiac reserve ensures the heart is capable of increasing its activity beyond the levels of rest as it responds to the physical or emotional stresses. The consumption of oxygen rises from 250 ml per minute to 1500 ml per minute at peak exertion. This will increase the heart rate as well as the diastolic and systolic capacities. It will also increase stroke volume and the extraction of oxygen (Cooper,2017). The removal of oxygen is about 4 ml/dL at regular activity but will rise to 13dL/dL when the is an increase in demand.

When the heart muscle gets stiff, it reduces its ability to lessen in diastole cycle. The ventricles will also enlarge hence spherical look of the heart that is failing. The symptom of cardiac arrest on the patient with cardiac issue cardiac arrest as a result of the increased strains as well as the reduced cardiac output (Cooper,2017). Cardiac arrest is generally as a result of abnormal rhythms of the heart that lowers the supply of the blood to other parts of the body. It may reduce skeletal muscle perfusion, which brings about weakness and higher levels of fatigue.

The patient also experienced the shortness of his breath. The cause is the increased damage caused by higher peripheral resistance. It causes the myocardium damage. The vasoconstriction and the retention of fluid bring about the increase in hydrostatic pressure inside the capillaries (Robinson et el. 2016). The balance of force is thus shifted favoring the formation of interstitial fluid, causing the edema inside the tissues. The edema in the left-side heart failure occurs in the lungs as a result of the cardiogenic pulmonary edema. The space left for ventilation is reduced, causing a reduction in the active gaseous exchange through the increase of the space between blood and air. I will cause the shortness of breath or dyspnea.

Majority of pathologic variations that are related with heart failure leads to lung hyperinflation. As a result, their anomalous rise in the gas amount in the lungs towards the end of the gaseous exchange. The end effect will be issues of short breaths and breathing difficulties. Individual hitch that ascend due to heart failure is the occurrence of pneumonia, which is a serious inflammatory state in alveolar areas of the lungs that may result from microbial infections (Ho et al., 2016). The primary also associated, includes congested heart and chronic obstructive pulmonary disease (COPD), which may cause pneumonia development in patients with heart failure (Brandsma,2017). As a result, alveolar sacs are full of fluid. The unsatisfactory frequent coughing, wheezing, and breathing that occur as a result of pain of in the chest is due to building up of fluid and mucus inside the lung airways. This accretion facilitates the occurrence of more infections due to the growth microorganisms.

Research done viewed specific section of heart failure in defining its pathophysiology. There was an exploration of the Dilated Cardiomyopathy (DCM) condition. It is a cardiac muscle tissue that is composed of systolic dysfunction and a ventricular cavity dilation which cause heart failure (Cooper,2017). The risk factors cause the abnormality of the cardiac muscle. The findings from the DCM research also reveals that heart failure some elements of the pathophysiology of congestive heart failure is genetic and thus beyond lifestyle biomarkers.

The other pathophysiological signs in the heart failure patient are the fluid overload as well as the pulmonary congestions. They are among serious health issues identified during the diagnosis. There is much volume of oxygen inside the heart, which is not pumped out to other body parts which require it (Cooper,2017). Hence, the left side of the heart is overworked in pushing blood out that is blocked causing congestion. This causes an abnormal performance of the whole cardiac system.

The other pathophysiological sign of heart failure is the memory and nervous system issues. The cardiac system is largely related to other organs of the entire body. Heart issues impact the cardiovascular system and other systems of the body. One affected area by abnormal cardio performance is cognitive functioning. The research demonstrates that depression is associated with prognosis in patients of heart disease (Teerlink,2016). The cause of this being the serotonin release malfunction which is as a result of the pathophysiology of congestive heart failure (Ponikowski et el.,2016). Based on this study, the depression level increases the risk of a heart failure condition.

As the age change, there are related changes in the heart as well as the cardiovascular system. The interstitial collagen inside the myocardial relaxation is thus extended. There is a reduction in the diastolic of ventricular activity due to the changes. With the aging person, there is a notable decrease in the systolic activity, which impairs the cardiovascular system ability to respond to increased exercise activity. The peak exercise strength reduces by eight percent per decade beyond age 30. The older adults thus develop health failure issues while stressed by various cardiovascular insults like infections, hypoxia, and anemia (Legare et el., 2016).

As a result of the dysfunction of the right ventricular, there is an increase of systemic venous pressure which causes fluid extravasation and edema in the feet and ankles. There are dependent tissues and abdominal viscera which causes severe damage to the liver. There may be an accumulation of fluid in the peritoneal ascites.

Conclusion

In conclusion, this paper has extensively explored the case of Mr. Smith, who have cardiac issues and was previously diagnosed with dementia of type Alzheimer. H...