Question

Mrs. Pringleis a 62-year-old female experiencing diffuse bone pain over the past several years after menopause. She has a history of fractures to her left hip and wrist. She states, “The pain is becoming worse and it is keeping me from doing my daily activities.” She currently complains that any weight-bearing activity causes her severe discomfort. She is not taking hormone replacement or any other medication. She has been using a soy herbal supplement and vitamin E 400 IU daily. She knows the importance of preventive healthcare. She is up to date on all her gynecological exams, and past mammograms have been normal as have her health maintenance exams. She does not smoke or use alcohol. Her system reviews are unremarkable excluding today’s complaint.

Her family history reveals that her mother had a history of anxiety, osteoporosis, non-insulin dependent diabetes and hypertension. Her father has hypertension but is in otherwise good health. There is no history of breast disorders or arthritis, thyroid or any other metabolic disorder.

She lives alone in a one-story house. She has three children and one grandchild. Her daughter lives in close proximity to her so she is able to enjoy visiting and caring for her 3-year-old grandson occasionally. She has no exercise routine and admits to a somewhat sedentary lifestyle. She admits to eating a vitamin-poor diet.

Mrs. Pringle experienced menopause around the age of 47 when her menstrual periods stopped. Her previous physician recommended no hormone replacement because she was not suffering from any menopausal symptoms. However, she now reports having “hot spells” at different times

throughout the day with some trouble sleeping for the past 3 months. She also complains of some vaginal dryness that she admits is bothersome.

Her chief complaint is severe back pain and the inability to do simple chores such as lifting grocery bags and her grandchild without pain.

Upon physical exam, she is afebrile with unremarkable findings with exception to the musculoskeletal system. She weighs 132 pounds and is 5 feet 5 inches. At her last exam 8 months ago, she was 5 feet 6 inches.

Upon palpation, guarding and tenderness are present in the cervical, thoracic and lumbar spine with limited range of motion. No spasticity, rigidity or flaccidity is present. She has active range of motion in all joints, with no edema, redness or heat present in joint areas. She exhibits notable guarding and rigidity performing range of motion of lower and upper back areas.

There is also noticeable guarding with some limitation of movement at the cervical spine area. She is able to endure the exam with noticeable painful expressions on her face when asked to do range of motion with back, guarding and tenderness noted at cervical spine area. There is no presence of dowager’s hump. She has no evidence of herniation or disc displacement upon inspection. No scoliosis or lordosis is present. Her preliminary urinalysis and CBC are unremarkable. Her symptoms indicate post-menopausal osteoporosis.

To confirm the diagnosis and rule out other medical conditions, lab tests were obtained to assess hormone, calcium, vitamin D, blood cholesterol levels and thyroid function. Also ordered were a sedimentation rate to check for arthritis, an X-ray of her back and a dual energy X-ray absorptiometry (DEXA) scan to rule out injury. DEXA scan is the gold standard in diagnosis of osteoporosis.

Diagnostic tests revealed a lack of estrogen and calcium. The X-ray of her back showed degenerative changes but no disc dislocations or herniations. The DEXA scan showed a T score of -2.9. A T score greater than -2.5 confirms a diagnosis of osteoporosis and indicates hormonal

treatment should be initiated.

Study Questions:

1.What treatment/smight youexpect to help address the lossof bone mineral density of Mrs. Pringle and reduce the risk of hip fracture?

2.How will you set your treatment goals tocomply with the Mrs. Pringlestated goal of ‘bothering vaginal dryness’?

3.Develop a nursing care plan according to your identified priority plan of care.

Answer 1

1.What treatment/smight youexpect to help address the lossof bone mineral density of Mrs. Pringle and reduce the risk of hip fracture?

Never regain the bone density same as we had in our youth but we can help to prevent rappidly thinning bones by

a) drugs

b) diet- with calcium rich and high protiens, carbohydrates, vitamins, minerals vitamin D suppliment, adequate sun light and fiber rich diet.

avoid foods such as high salt foods , vitamin A, beans, legumes,caffeine etc

c) exercise- some exersice each day can help to improve bone density such as Yoga, tai chi, and even walking can help the body to resist gravity and stimulate bones cells to grow. maintain proper body alignment.

e) hormone treatment.

2.How will you set your treatment goals tocomply with the Mrs. Pringlestated goal of ‘bothering vaginal dryness’?

Hormone treatment for women to reduce menoposal symptoms such as hot flashes and vaginal dryness.health education and psycological support needed for post menoposal stage.

3.Develop a nursing care plan according to your identified priority plan of care.

Mrs Pringles cheif complaint is severe back pain and even she cannot bear small weight and her length reduced.

osteo porosis may be primary or secondary to an underlying disease primary osteoporosis is commonly called post menoposal osteoporosis because it typically develop in post menoposal women. in this case correct diagnosis can do after laboratory findings.

here medical management of osteoporosis aims slowing down or preventing further bone loss , controlling pain and avoiding additional fracturs.

A nurse care plan should focus on the patient's fragility, stressing careful positioning,ambulation, and prescribed exercise.

impaired physical mobility- assess the patient's functional ability for mobility and note the changes, provide range of motion exercise .

diet- provide diet in high protien,calcium carbohydrate,vitamins and minerals additional suppliments of vitamin D

imbalanced nutrition lead to inadiquate calcium and vitamin d absorbtion wich lead to deformity , kyphosis , loss of hight, and fracture. instruct to take daily dose of calcium and adequate exposure to sun light.limit caffeine and avoid smoking.

assess patient knowledge of disease diet medication and exercise program to identify the progression of bone detoriaration.

health education for patient and family about disease , drug toxicity, analgesic abuse, exercise, and hormone treatment.