An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen
Scenario: An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has a history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition.
Write an explanation of the disease highlighted in the scenario provided above. Include the following in your explanation:
- The role genetics plays in the disease.
- Why the patient is presenting with the specific symptoms described.
- The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
- The cells that are involved in this process.
- How another characteristic (e.g., gender, genetics) would change your response.
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
- Chapter 1: Cellular Biology; Summary Review
- Chapter 2: Altered Cellular and Tissue Biology: Environmental Agents (pp. 46-61; begin again with Manifestations of Cellular Injury pp. 83-97); Summary Review
- Chapter 3: The Cellular Environment: Fluids and Electrolytes, Acids, and Bases
- Chapter 4: Genes and Genetic Diseases (stop at Elements of formal genetics); Summary Review
- Chapter 5: Genes, Environment-Lifestyle, and Common Diseases (stop at Genetics of common diseases); Summary Review
- Chapter 7: Innate Immunity: Inflammation and Wound Healing
- Chapter 8: Adaptive Immunity (stop at Generation of clonal diversity); Summary Review
- Chapter 9: Alterations in Immunity and Inflammation (stop at Deficiencies in immunity); Summary Review
- Chapter 10: Infection (pp. 289–303; stop at Infectious parasites and protozoans); (start at HIV); Summary Review
- Chapter 11: Stress and Disease (stop at Stress, illness & coping); Summary Review
- Chapter 12: Cancer Biology (stop at Resistance to destruction);Summary Review
- Chapter 13: Cancer Epidemiology (stop at Environmental-Lifestyle factors); Summary Review
Expert Answer and Explanation
Alteration in Cellular Processes
The assessment of the patient is important when it comes to understanding the underlying patient’s health issues. When assessing patients for diseases, the nurse or caregiver would look at the presenting clinical symptoms including the patient’s health history. This is necessary to help the caregiver make appropriate inferences concerning the patient’s health, and come up with an intervention that can address the needs of the patient (Coulthard, 2015). It is imperative to explore the case of an 83-year old Kwashiorkor patient in terms of the reason behind their symptoms, and the genetics’ role in the development of this condition.
Role of Genetics in Disease
Genetics play a role in the development of the various diseases including the protein malnutrition. Genetics affects people’s preference for certain foods, and because of one’s genetic orientation, one may dislike some foods. Accordingly, this may contribute to a situation where one gets much of only certain types of nutrients, causing a decline in some forms of nutrients in their body (Coulthard, 2015). Thus, a person who dislikes food rich in protein would develop protein malnutrition.
Reason for Presenting Symptoms
Reflecting on the scenario, the 83-year old patient presents with some key symptoms including the generalized edema. This is a condition that one would link to the kwashiorkor. The blood vessels have proteins which perform the function of holding water and salts. The inadequate availability of the albumin protein leads to leaking of the fluid into tissues, and this explains the reason for swelling of the patient’s abdomen and extremities (Kismul, Van den Broeck, & Lunde, 2014).
The presenting clinical manifestations also seem to contribute to the patient’s nutritional deficiencies. For instance, the mal-absorption could point to this problem. The poor dentures, still, appears to cause this problem.
Physiological Response to the Stimuli
The patient experiences physiological responses which seem to stem from specific stimulus. The occurrence of the edema is as a result of the loss in the protein in the blood vessels. This makes it difficult for the absorption of the blood and water to take place. The loss of the muscle mass coupled by the fatigue constitutes some other responses linked to the presenting stimuli. Proteins play critical roles in the growth of the muscles, and the lack of it can cause the decline in the growth of these muscles. This would cause a decline in the energy level because these muscles store energy (Benjamin & Lappin, 2020).
Cells involved in the Physiological Response
Certain cells play a role in the physiological responses linked to the formation of the edema in a patient with malnutrition. The endothelial cells play a crucial role in the absorption of the water as well as the salts. These cells are responsible for regulating the exchange of the fluids from the blood to the nearby tissues, and for this reason, they play a key role in the formation of the edema.
Impact of another Characteristics
An individual’s genetic orientation is not the only factor that can cause the development of the protein deficiency. The age of an individual can significantly influence their risk of developing this medical condition (Ellis, 2016). Children are in stage where they are still developing, and their demand for proteins is high at this stage in their lives.
In conclusion, the presenting clinical manifestations in the case of the 83-year old patient points to the underlying protein absorption syndrome. Besides this syndrome, the patient’s protein deficiency seems to result from the lack of dentures and the issues with the patient’s absorption. However, the age is a factor that can also contribute to the development of the disease.
Benjamin, O., & Lappin, S. L. (2020). Kwashiorkor. StatPearls. StatPearls Publishing. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29939653/.
Coulthard M. G. (2015). Oedema in kwashiorkor is caused by hypoalbuminaemia. Paediatrics and international child health, 35(2), 83–89.Doi: https://doi.org/10.1179/2046905514Y.0000000154.
Ellis D. (2016). Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome. Frontiers in pediatrics, 3, 111. https://doi.org/10.3389/fped.2015.00111.
Kismul, H., Van den Broeck, J., & Lunde, T. M. (2014). Diet and kwashiorkor: a prospective study from rural DR Congo. PeerJ, 2, e350.Doi: https://doi.org/10.7717/peerj.350.
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