• Subject Name : Nursing

Essential of Anatomy and Physiology

Q1- (i)- Thermoregulation can be defined as a self-regulatory mechanism of the body which is used mainly to alter or balance the overall body temperature. This regulation is to be done in sync with the environmental temperature (D’Souza 2019, pp. 1383-1386). It is usually observed that along with the aging process the body temperature might not alter that well and gets difficult to be regulated on own. As the age of the person progresses it becomes difficult to maintain one’s own body temperature. The body might take a little longer than anticipated to get back to its normal temperature, as compared to young individuals. The body makes use of few voluntary and few involuntary mechanisms to regulate the body temperature. With progressing age, the involuntary mechanisms play a vital role in thermoregulation process (Stanhewicz 2016, pp. 1354-1362). These involuntary techniques can be observed as shivering and peripheral vasodilation. The general tendency of the body to not able to control the body temperature, usually deteriorates after the age of 50 years and above.

With the advancing age the blood vessels of the body tend to dilate more rapidly as compared to getting constricted. Due to this underlying factor the blood circulation is usually receded in older individuals. Body fat also plays a crucial role in temperature regulation or thermoregulation (Waldock 2018, pp. 163-170).The body fat deposition reduces as the person starts to age. With the reduced layering in the skin, the body finds it quite difficult to keep itself warm and thus, reduced thermoregulation can be observed in elderlies.

(ii)- There are vastly three mechanisms with which Katherine can attain thermoregulation of her body. These mechanisms can be observed as follow:

  1. Thermogenesis- It is an involuntary method by which the body produces heat. Generally, it is observed in the form of person experiencing shivering when exposed to a temperature considerably lower than his or her body temperature. With shivering, overall body organs tend to produce heat thus, attempting to keep the body warm against the cold temperature (Cheon 2017, pp. 456-466).
  2. Vasoconstriction- As with advancing age the blood vessels tend to dilate, the body reciprocates with the help of mechanism of vasoconstriction. During this phenomenon vasoconstriction, the skin under the vessels tend to get narrower, allowing a better blood flow through these channels. This method allows proper conduction of blood and thus, improving the overall circulation of heat in the body (Davoodi 2018, pp. 62-76). This is very useful for promoting and enhancing thermoregulation in older individuals.
  3. Thermogenesis through hormones- The thyroid gland in the body is mainly accountable for producing the hormones that help in regulation of the body temperature. The hormones discharged from thyroid gland help in improving and enhancing the overall metabolism of the body and thus, in directly helping in thermal regulation of the body by producing additional body heat (Bongers 2020, pp. 9-16).

Q2- (i)- Fracture can be considered as the disintegration of bone cortex that subject a bone to the incidence of fracture. Along with the bone the surrounding musculature is also affected with the impact of fracture (Meinberg 2019, pp. 62-65). The healing process of fracture is divided into four different stages as follow:

  1. Formation of hematoma- This is a common phenomenon which happens generally after every injury. With the occurrence of fracture, the surrounding tissue experiences rupture of blood vessels that directly leads to the formation of hematomas at the injury site.
  2. Formation of callus- The second stage leads to the formation of vascular endothelial growth factor which then leads to the formation of angiogenesis at the injury site. The site then experiences formation of fibrin- rich granulated tissue. The injury site is also impregnated with various cells used in promotion of healing known as fibroblasts, chondroblasts and osteoblasts. These cells combinedly help in developing a fresh layer of mesh work at the injury site.
  3. Formation of bony callus- The above-mentioned callus is then subjected to endochondral ossification. This leads to further differentiation of cells helpful in developing a mesh work around the injury site. This woven network of cartilage then gets reabsorbed and calcifies over the due course of time (Féron 2016, pp. 10-14). This is then followed by infiltration of mesenchymal stem cells leading to the formation of hard yet immature callus formed around the injury.
  4. Remodeling of bone- This stage lead to the settling of the newly formed bone into the injury site. The site undergoes the process of remodeling to adapt well in the injury site and get established there. This stage also aids in the reabsorption of the bone in a well-balanced and calcified manner (Ambrosi 2020, pp. 13-64). The bone then hardens gradually and sets in the place to sustain the loads and sheer stresses it is subjected to.

With the advancing age this process can be delayed and healing process can also be hampered from attaining the required standards as desired.

(ii)- There are underlying three factors that might have resulted in Katherine getting an easy fracture by falling off a chair:

  1. The patient might have an impaired cognitive functioning and thus she might not have been able to manage her balance and had an easy fall. Studies have shown that in elderlies the risk of fall is comparatively observed at a higher rate as compared to their young counterparts (Seijo 2016, pp. 1975-1987).
  2. The fracture could have happened due to low bine mass. This can be because of osteoporosis and advancing age as well.
  3. The level of bone density is also found to be low in older population, leading to reduced capacity of sustaining loads and stress on the bone when subjected to certain movement. Lower level of bone density can also be considered as one of the primary causes of fracture incidence in older individuals.

Q3- (i)- The bile produced in the body can have two main functions as mentioned below:

  1. Absorption- Bile has one of the primary functions in helping in absorption of food products. It helps in absorption of both fats and carbohydrates. It also helps in the emulsification of fat. This is helpful in breakdown of the fat and making it easier to absorb the same in the body. Bile also acts as a catalyst for lipase which further assists in breakdown of fats and carbohydrates (Chow 2017, pp. 34-44). All of these factors help in smooth facilitation of process of absorption in the body.
  2. Digestion- After helping with the breakdown of the product the bile also helps in complete digestion of the both fats and carbohydrates as well as other food products. Bile also help in emulsification of fat and thus, enhancing the process of breakdown of food to be easily soluble in the body. The enzymatic activity of bile, helps with the process of digestion, increasing its pace by multiple folds (Sarkar 2016, pp. 77-84).

(ii)- Liver is responsible for metabolizing various metabolites. This function can however, be reduced as the age will increase. There are certain drugs that might hamper with eth normal functioning of the systems as well. Liver and other body parts might not be able to bear the additional stress of the medications and other metabolites, and thus, directly affecting the production of bile in the body. Reduced bile production will be directly reflected in reduced digestion, absorption and excretion of products out of the body. As the toxins will not be washed out of the body, the body might experience ailments like development of gall stones, drug-induced cholestasis and so on. With severe toxicity in the body the threat can be life- serving in extreme cases as well.

Q4- Vitamin D deficiency is very commonly observed in elder population. This is more commonly observed in patients above the age of 50 year and plus. This deficiency is often observed more in females than in males. Osteoporosis and vitamin D deficiency go hand in hand in elderly population. The level of vitamin D also decreases as the age progresses. Inclusion of an additional source or supplement of vitamin D in diet can be helpful for these patients in compensating the loss that may occur due to age related changes (Kotlarczyk 2017, pp. 1347-1353). There are multiple underlying factors that may lead to depreciation of vitamin D in elders. These factors can be development of osteoporosis, low calcium in blood as well as in bones, reduced exposure to natural sunlight. The last-mentioned factor can be considered the main cause for development of vitamin D deficiency in the given case scenario. These reduced levels can be replenished with the help of nutritional supplements that are rich in vitamin D value. This can be inclusive of milk and milk products such as cheese, curd etc.

Taking additional and external intake of calcium is also required in the given case scenario. Calcium intake is important for both bone and muscle strength of the patient in the given case scenario. Additional intake of calcium will be helpful in maintaining overall bone strength and improving their stress and endurance for sustaining additional stresses and strains. This intake of calcium in diet is also important for promoting bone strength and keeping them less prone to fracture as anticipated. It is also vital in promoting bone mineralization process and thus, promotes bone healing once it gets fractured. With the lack of production of calcium within the body, it becomes imperative to take external dosage of calcium as a supplement to suffice for the deficiency (Malihi 2019, pp. 29-37). Katherine is also prone to the risk of osteoporosis and thus, she had fracture with a minute movement. Additional source of calcium will help in reducing this added risk of developing fracture and helps with promoting muscle contractibility as well. Thus, it is also helpful in promoting overall balance and coordination of the body and reducing the risk of fall all together.

References for Katherine Case Study

Ambrosi, T.H., Goodnough, L.H., Steininger, H.M., Hoover, M.Y., Kim, E., Koepke, L.S., Marecic, O., Zhao, L., Seita, J., Bishop, J.A. and Gardner, M.J. 2020. Geriatric fragility fractures are associated with a human skeletal stem cell defect. Aging Cell19(7), pp. 13-64. DOI https://doi.org/10.1111/acel.13164

Bongers, K.S., Salahudeen, M.S. and Peterson, G.M. 2020. Drug-associated non-pyrogenic hyperthermia: a narrative review. European journal of clinical pharmacology76(1), pp.9-16. DOI https://doi.org/10.1007/s00228-019-02763-5

Cheon, Y.M. and Yoon, H. 2017. The effects of 30-minutes of pre-warming on core body temperature, systolic blood pressure, heart rate, postoperative shivering, and inflammation response in elderly patients with total hip replacement under spinal anesthesia: A randomized double-blind controlled trial. Journal of Korean Academy of Nursing47(4), pp.456-466. DOI https://doi.org/10.4040/jkan.2017.47.4.456

Chow, M.D., Lee, Y.H. and Guo, G.L. 2017. The role of bile acids in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Molecular Aspects of Medicine56, pp.34-44. DOI https://doi.org/10.1016/j.mam.2017.04.004

D’Souza, A.W., Notley, S.R., Meade, R.D. and Kenny, G.P. 2019. Intermittent sequential pneumatic compression does not enhance whole-body heat loss in elderly adults during extreme heat exposure. Applied Physiology, Nutrition, and Metabolism44(12), pp.1383-1386. DOI https://doi.org/10.1139/apnm-2019-0364

Davoodi, F., Hassanzadeh, H., Zolfaghari, S.A., Havenith, G. and Maerefat, M. 2018. A new individualized thermoregulatory bio-heat model for evaluating the effects of personal characteristics on human body thermal response. Building and Environment136, pp.62-76. DOI https://doi.org/10.1016/j.buildenv.2018.03.026

Féron, J.M. and Mauprivez, R. 2016. Fracture repair: general aspects and influence of osteoporosis and anti-osteoporosis treatment. Injury47, pp.10-14. DOI https://doi.org/10.1016/S0020-1383(16)30003-1

Kotlarczyk, M.P., Perera, S., Ferchak, M.A., Nace, D.A., Resnick, N.M. and Greenspan, S.L. 2017. Vitamin D deficiency is associated with functional decline and falls in frail elderly women despite supplementation. Osteoporosis International28(4), pp.1347-1353. DOI https://doi.org/10.1007/s00198-016-3877-z

Malihi, Z., Wu, Z., Lawes, C.M. and Scragg, R. 2019. Adverse events from large dose vitamin D supplementation taken for one year or longer. The Journal of Steroid Biochemistry and Molecular Biology188, pp.29-37. DOI https://doi.org/10.1016/j.jsbmb.2018.12.002

Meinberg, E.G., Clark, D., Miclau, K.R., Marcucio, R. and Miclau, T. 2019. Fracture repair in the elderly: Clinical and experimental considerations. Injury50, pp.62-65. DOI https://doi.org/10.1016/j.injury.2019.05.005

Sarkar, A., Ye, A. and Singh, H. 2016. On the role of bile salts in the digestion of emulsified lipids. Food Hydrocolloids60, pp.77-84. DOI https://doi.org/10.1016/j.foodhyd.2016.03.018

Seijo-Martinez, M., Cancela, J.M., Ayán, C., Varela, S. and Vila, H. 2016. Influence of cognitive impairment on fall risk among elderly nursing home residents. International Psychogeriatrics28(12), pp.1975-1987. DOI https://doi.org/10.1017/S1041610216001113

Stanhewicz, A.E., Greaney, J.L., Alexander, L.M. and Kenney, W.L. 2016. Blunted increases in skin sympathetic nerve activity are related to attenuated reflex vasodilation in aged human skin. Journal of Applied Physiology121(6), pp.1354-1362. DOI https://doi.org/10.1152/japplphysiol.00730.2016

Waldock, K.A.M., Hayes, M., Watt, P.W. and Maxwell, N.S. 2018. Physiological and perceptual responses in the elderly to simulated daily living activities in UK summer climatic conditions. Public health161, pp.163-170. DOI https://doi.org/10.1016/j.puhe.2018.04.012

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