Musculoskeletal Case Study 2017 20 PDF

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NRSG 102: Musculoskeletal Case Study :(This assignment meets the following course learning objectives (CLO .1

CLO #2: Describe the etiology, pathophysiology and clinical manifestations of (common alterations in health. (SLO 2

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CLO #4: Describe current techniques and strategies for assessing and providing evidenced based nursing care to adults with alterations in health within the (context of identified concepts. (SLO 4 CLO #5: Apply basic principles of the nursing process to select patient care (scenarios. (SLO 4 CLO #6: Describe the ordered plan of treatment of adults experiencing non(complex alterations in health. (SLO 2, 4 CLO #7: Discuss the basic health teaching needs of adults and their significant others while providing care in a collaborative, safe, culturally competent, and (holistic patient-centered environment. (SLO 1, 2, 5

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Scenario MS, a 72-year-old white woman, comes to your clinic for a complete physical examiniation. She has not been to a provider for 11 years because “I don’t like doctors.” Her only complaint today is “pain in my upper back.” She describes the pain as sharp and knifelike. The pain began approximately 3 weeks ago when she was getting out of bed in the morning, and hasn’t changed at all. MS rates her pain as 6 on a 0-10 point scale and says the pain decreases to a 3 or .4 after taking “a couple of ibuprofen.” She denies recent falls or trauma MS admits that she needs to quit smoking, lose some weight, and start exercising but states, “I don’t have the energy to exercise.” She has smoked 1 to 2 packs of cigarettes per day since she was 17 years old. Her last blood work was 11 years ago, and she can’t remember the results. She went through menopause at the age of 47 and has never taken hormone replacement .therapy The physical exam was unremarkable other than moderate tenderness to deep palpation over the spine at T7. No visible masses, skin changes, erythema, or tenderness to the surrounding .area were noted. Her neurologic exam is intact, and no muscle wasting is noted 1. An x-ray examination of the thoracic spine reveals osteopenic changes at T7. What does this mean? (3 points) a. The patient is experiencing bone loss (osteoporosis), which is detected by x-rays only once the bone loss is between 25%-45%.

2. The physician suspects osteoporosis. List seven risk factors associated with osteoporosis. (7 points) a. Lifelong Insufficient calcium & vit D b. Cigarette smoking c. Alcoholism d. Longterm affects of medications that lead to bone density loss e. Age >65 years f. Estrogen deficiency g. Low body weight

3. Underline the risk factors specific to MS. (3 points) a. genetics: having immediate relatives with MS greatly increases a persons risk of developing it b. Smoking: 1.5 times more likely to develop MS than nonsmokers c. Advanced age Case Study Progress MS has never had osteoporosis screening. She confides that her mother and grandmother were .diagnosed with osteoporosis when they were in their early 50’s 4. What tests could be done to determine whether MS has osteoporosis? Which test is recommended and why? (3 points) a. DEXA - a precise test that is considered the best at this time; it emits less radiation than chest x-ray

5. MS’s DEXA scan revealed a bone density of -2.6SD (standard deviations). What does this mean? (3 points) a. Normal results (-1); osteoporosis is greater than 2.5 standard deviations below normal, meaning M.S.’s score is defined as osteoporosis and there is also an increased risk of skeletal fracture 6. The physician orders alendronate (Fosamax) 70mg/week. What instructions should you

give MS regarding alendronate? (4 points) a. Take first thing in the morning with a full glass of 8 ounces of water; take the medication on the same day each week if only taken once per week; take medication at least 30 minutes before you eat, drink, or take any other medications. Be aware of any side affects such as abdominal pain, N/V which could be possible severe side effects.

7. What nonpharmacologic interventions should you teach MS to prevent further bone loss? (4 points) a. Smoking cessation - smoking speeds up bone loss

Case Study Progress MS seems overwhelmed and says, “I cannot possibly stop smoking and lose weight and exercise ”.all at the same time 8. You encourage MS to start working on one problem at a time. Which problem should MS attempt first? (3 points)...