Question

Josephina is a 72-year-old Korean woman presenting to the emergency department with severe shoulder pain following a ground-level fall. On assessment, the patient cannot move the shoulder; there is moderate swelling and marked ecchymoses. The patient reports pain at an 8 on a 0 to 10 scale (with 10 being worst ever). She has a history of right hip fracture 2 years ago, which was fixed with a hip prosthesis. She also has a 42-pack year history of smoking, is relatively inactive, and weighs 90 pounds.

1. What are the priorities at this time with this patient?

2. What are the opportunities for teaching for this patient?

3. What disease process puts her at risk for further fractures?

Answer 1

Ans) 1) Priorities:

- Pain management

- Activity intolerance

- Mobility

2) Manage your symptoms:
Apply ice on your shoulder for 20 to 30 minutes every 2 hours or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel before you apply it to your shoulder. Ice helps prevent tissue damage and decreases swelling and pain.
Apply heat if ice does not help your symptoms. Apply heat on your shoulder for 20 to 30 minutes every 2 hours for as many days as directed. Heat helps decrease pain and muscle spasms.
Limit activities as directed. Try to avoid repeated overhead movements.
Go to physical or occupational therapy as directed. A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain. An occupational therapist teaches you skills to help with your daily activities.
Prevent shoulder pain:
Maintain a good range of motion in your shoulder. Ask your healthcare provider which exercises you should do on a regular basis after you have healed.
Stretch and strengthen your shoulder. Use proper technique during exercises and sports.

3) The most risk factors are advancing age and personal history of fragility fracture. Others include low body mass index (BMI), long-term glucocorticoid therapy, cigarette smoking, excess alcohol intake, high levels of bone turnover markers, and parental history of hip fracture.