Pathophysiology

Introduction

The diagnosis starts with visual observation of the patient as one tries to establish communication for further enquiry. This is important as it makes sure that one is able to detect any irregular signs or symptoms. Once you establish that the patient can communicate well, there is need for further enquiries from the patient, particularly on known illnesses, allergies and whether they are currently on any medication (Vaphiades, Bhatti & Lesser, 2012). This is important information as it helps set up a base line of what could be the problem with the patient. In gathering health information, it is also helpful to ask one of the family members or whoever has accompanied the patient. This is particularly necessary as it adds more information on the patien’s health status (Benatar, Sanders, Burns, Cutter, Guptill, Baggi, & Wolfe 2012).

The patient should be prepared to undergo a physical check-up that involves measuring their vitals. This are recorded on a medical chart in their appropriate sections. The recorded notes on vitals are important as they give an indication of possible signs that are consistent with certain health failures (Beyer, Bergmann, & Mets, 2012). Their functionality often affects more than one of the other major organs.[bookmark: _Toc482883953]

The vitals of the patient having being noted, along with the medical history, the symptoms and signs recorded are compared through elimination until the field narrows to a specific diagnosis (Andr’s, Serraj, Federici, Vogel, & Kaltenbach, 2013). Consequently, there is a chance of quite a few diseases that the patient may be suffering from. This also puts into consideration the age and the medical background or history of the patient. The three possible conditions that the patient could be suffering from are 1. Arrhythmia2. Anaemia3. Muscle weakness The rationale for including these three conditions as the possible diagnosis for the woman’s given condition is that all three of them are mainly associated with a shortness of breath.

Example, arrhythmia cannot be ruled out as the woman has a high blood pressure and a high heart rate which has been recorded to be irregular (Seene & Kaasik, 2012). This suggests that the patient is suffering from arrhythmia. Although the patient does not have chest pain but the presence of an irregular heart rate and a high respiratory rate suggests that the patient might be suffering from arrhythmia. Shortness of breath and confusion is also indicative of the possibility of arrhythmia (Wong, Huda, Vincent, & Plant, 2014). The sore tongue and heavy breathing can additionally be linked with the intake of calcium.

The inclusion of anaemia is dependent on the irregular heart rate and inability of breathing properly. There is a chance that since the patient is suffering from confusion and paleness  it is likely that there is a lack of oxygen in the patient due to her anaemic condition (Seene & Kaasik, 2012). Since the patient is taking supplements for vitamins and calcium, there is a chance that there is an increased calcium concentration in the patient’s blood. This leads towards the possibility of anaemia and a chance of kidney failure in the later stages. This condition cannot be ruled out as most of the symptoms do somehow relate to the possibility of anaemia. The lack of oxygen can directly be related to the increased heart rate as low levels of oxygen are known to cause the heart to pump more blood in order to overcome the lack of oxygen.

This in turn can also link to the present state of confusion and dizziness in the patient (Peterson, Johannsen & Ravussin, 2012). Muscle weakness has been listed due to the age of the patient and the complaint of fatigue and breathlessness. Also, the patient’s medical history suggests that she has been taking vitamin D supplements. This most probably suggests that the vitamin levels may have been falling and therefore the muscle fatigue is experienced.Muscle weakness may occur in a single muscle, groups of muscles, or all muscles but it depends on the cause of the condition. Muscle weakness can be later be followed up by other types of muscular symptoms including severe pain (Gryparis, Kloog, & Schwartz, 2013). In cases of severe sudden weakness of some types of muscles, particularly on one side of the body, may be an indication of a stroke.

However it is important to note that if the muscle weaknesses are accompanied by severe abdominal pain, it may be diagnosed as botulism. Some serious symptoms include sudden change in vision, severe abdominal pains, severe headaches and loss of consciousness. This may be followed up by paralysis either on a specific place or entirely (Carie Ann Braun, 2007). [bookmark: _Toc482883954]Epidemiology Myasthenia, or muscle weakness is a condition that is characterized by either gradual or sudden decrease in strength in a patient’s muscles. This condition is a pointer and thus a symptom of muscular, neurological, or metabolic disorders (Blichfeld’ lauridsen, & Hansen, 2012). With that established, it is also important to note that these symptoms are similar other muscular diseases. One such condition is dermatomyositis which is characterized by muscle inflammation while the other is muscular dystrophy. These two conditions are categorized as common causes of muscle weakness.

There are other common causes that one has to look out for. Among them is Guillain-Barre syndrome, commonly categorized as a neurological disorder, ALS or Lou Gehrig’s disease and stroke (Wong, Huda, Vincent, & Plant, 2014). In other rare cases like that of the autoimmune neuromuscular disorder, muscle weakness is followed up by drooping eyelids with the patient experiencing double vision.Incidence rates of Myasthenia, or muscle weakness[image: S-5978-pic-2] Patients experiencing muscle weakness may also be experiencing other symptoms. This however is dependent on a number of variables that help identify the underlying disease, disorder or condition. It is also important to note that the symptoms of muscle weakness and the area affected involve other body systems as well. Thus the reason as to why vitals are measured and the results recorded. In this current case, the patient experiences a few similar symptoms that look to indicate that the underlying condition is muscle weakness (Spillane, Hayward, Hirsch, Taylor, Kullmann, & Howard, 2013)).

Among other common symptoms that the patient experienced, included: feeling a burning sensation, severe pain, prickling sensation that she associated with pins and needles (Carneiro, Howard & Bailey, 2011). Muscle weakness as a condition is highly gaining recognition as it is on the rise among different groups of people. However, the prevalence rate is undeterminable as very few cases are correctly diagnosed for what they actually are (Evoli, & Padua, 2013). Many people suffering from this condition often identified fatigue and weakness among the major symptoms that they experienced. In most cases of muscle weakness diagnosis, the patients mostly show muscle atrophy without the accompanying and expected muscle degeneration.

Patients who have myopathy as the sole manifestation have a higher risk of being misdiagnosed, which is a common case (Ciafaloni, Griggs & Chinnery, 2011). Muscle weakness may result in the patient feeling weak accompanied by either pain or both of them. These two symptoms may affect the day to day mobility or ability to function normally. This thus influences the quality of life that the patient lives with the condition. Some of the contributing factors that lead to the diagnosis of the condition as muscle weakness include feeling weak, becoming pale and slight shortness of breath.

However, other factors from her medical history could also contribute to the muscle weakness problem (Clark & Fielding, 2012). They include the fact that she still drinks given her advancing age and also the dietary choice of vegan. This means that the sudden change of diet may have affected the levels of different vitamins that were vital. It could also point to the fact that there may be an over absorption of certain minerals and vitamins to supplement the lack of those provided for in the former diet (Dworkin, 2011). [bookmark: _Toc482883955]

Pathophysiology

Pathophysiology seeks to explain the biological processes that result or bring about a certain condition. This is done through the combination of the physical elements observed from the patient and the changes in the various metabolic changes in their bodies. This helps with further understanding the causes of the condition (Petrosyan, Blaison, Andr’s, & Federici, 2012). In this case, the muscle weakness condition can be attributed to various biological processes that the patient is having. Changes in the equilibrium of these biological processes manifest itself physically as a symptom (Gea, AgustГ­, & Roca 2013). The symptoms that the patient in this case experienced can be attributed to changes in the physiological processes due to a myriad of reasons.

However, results may not be consistent and may not show reproducible abnormalities in every tested case. Consequently, there are various patterns that are recognized and are discussed in the sections below. Adrenal dysfunctionResults in hypoadrenalism whose effects include infections, inflammatory disease and tumor appearance. Important to note is that adrenal failure may be accompanied by pituitary failure. This condition also affects other neurological manifestations like behavior and mental change (Berrih-Aknin, & Le Panse, 2014). The factors that contribute to muscle weakness in adrenal insufficient patients include lower circulatory cycles, bodily fluid and electrolyte imbalances and impaired metabolism.

Thyroid dysfunction

This happens when the level of the Thyroid hormone reduces or is in deficit.

This deficiency of the hormone often results in various neurological syndromes. These syndromes are variant in nature and depend on when the deficiency started happening in the body. In this case, muscle weakness of the patient occurred due to the advancing age and presents itself in the forms of myxedema. According to Gea, AgustГ­, & Roca (2013), the overproduction of the thyroid hormone is also considered a factor that causes muscle weakness. This is believed to be the secondary sign or symptom associated with the effect to muscles. This may be caused by increased respiration, increased protein degradation and lipid oxidation. This is attributed to the overproduction of the thyroid hormone and its presence in the body system.

However, most thyroid disorders result in orbital myositis. This is described as a disorder that impairs the ocular movement. It is for this reason that many people are commonly diagnosed with muscle weakness as it easily passes the clinical eye observation (Jayam Trouth, Dabi, Solieman, Kurukumbi, & Kalyanam, 2012). Parathyroid dysfunctionIn the event of a parathyroid dysfunction, the pathophysiology involves either the deficiency of the parathyroid hormone or the inability of the hormone itself to have an effect (Benatar, Sanders, Burns, Cutter, Guptill, Baggi, & Wolfe, 2012). This is particularly common with the end-receptors because of the lack or dysfunction of the hormone receptors that the parathyroid hormone bonds with.Hyperpara thyroidism is characterized by the fact that it results in muscle wasting. It also results in myopathy which is referred to as proximal muscle weakness. In its diagnosis, the pathophysiology of this condition is observed whenever there is an over secretion of the parathyroid hormone (Berrih-Aknin, & Le Panse, 2014).

Pituitary dysfunction

According to Peterson, Johannsen, & Ravussin (2012), Muscle weakness may results from an underlying pituitary disease. This may be as a result of the adrenal dysfunction. It can also be as a result of failure other important hormonal glands such as the thyroid. The two forms of pituitary dysfunctions are hypopituitarism and hyperpituitarism. This two may be as a result of other causes such as trauma, infections and/or growth of tumors (Petrosyan, Blaison, Andr’s, & Federici, 2012). [bookmark: _Toc482883956]

Pre-hospital care and transport

Pre-hospital care for patients who are suffering from muscle weakness involves careful movement of the patient to the hospital. This includes pre-existing treatment regimens being administered in the course of transportation. However, some cases do not require transportation to hospital and are treatable on site (Jayam Trouth, et, al 2012).

Establishing the nature of muscle weakness is paramount as this influences the patient’s mobility. This is important as some variations or muscle weaknesses can render a patient totally immobile thus requiring help with their movement. In other cases, such as the one discussed in this paper, the patient was on the onset of muscle weakness. Although they could move comfortably, their mobility was affected in that her respiratory system was affected due to shortness of breath. In cases of muscle weakness, the muscle function is affected which in turn affects the mobility of the patient. This condition is characterized by less or zero mobility levels. This is however dependent on the area that has been affected and the duration of the disease (Degens, & Korhonen, 2012).

Although muscle weakness is predominant in old age, there are various factors that can lead to the development of this condition is other age brackets (Peterson, Johannsen, & Ravussin, 2012). In recent studies, it has been observed that the disease has no age bracket limit and affects anyone, including children. In most cases recorded, women are the most affected as their hormonal imbalance influences these factors thus leading to the disease’s development. In most cases when this happens, the patients often require assistance with transportation to hospital. In the event that this occurs, there are wheelchairs available which are utilized. This is because muscle weakness gradually increases and he thus affecting the mobility level of the patient.

As the condition worsens, the patient may require additional assistance in terms of increased amount of support. This is followed by the support of the respiratory muscles which are affected by the disease (Benatar, Sanders, Burns, Cutter, Guptill, Baggi, & Wolfe, 2012). In major cases of muscle weakness, the patients may end up solely depending on the ventilator or even in worse cases resuscitation is required. Respiratory muscle weakness may lead to the patient developing pneumonia. This is a common cause of death with people affected by this condition. Therefore, low amounts of supplemental oxygen should be administered during transport in cases observed for signs of respiratory dysfunction.

Consequently, it is important to closely monitor the patient for signs and symptoms of any other condition related to muscle weakness (Spillane, Hayward, Hirsch, Taylor, Kullmann, & Howard, 2013). With proper diagnosis and treatment, patients are often observed to recover their mobility fully within months. In cases where intubation is required and administered, succinylcholine, is administered to patients with muscular dystrophy or weakness. Contraindication of succinylcholine, a paralytic, which is often used in intubations, is administered for its reverse effects.

According to Vaphiades, Bhatti, & Lesser 2012), the introduction of succinylcholine to the health system acts as a toxin to unstable membranes in patients with muscle weakness. Before the patient is transported to the hospital for additional treatment, obtaining additional information on the patient is required. This is acquired from the family members or caretakers present. These sources of information supplement the health history obtained earlier.

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