A nurse in a provider’s office is caring for a client.
Medical History
Initial visit:
Client reports a sedentary lifestyle.
Client is lactose intolerant and denies taking vitamin supplements. Client is a nonsmoker.
Client does not drink alcohol. Diagnostic Results
Initial visit:
Calcium 8.9 mg/dL (9 to 10.5 mg/dL)
Phosphorus 3.4 mg/dL (3 to 4.5 mg/dL)
Total 25-hydroxy D (vitamin D2+ D3) 24 ng/dL (25 to 80 ng/dL) 6-month follow-up:
Calcium 8.8 mg/dL (9 to 10.5 mg/dL)
Phosphorus 3.2 mg/dL (3 to 4.5 mg/dL)
Total 25-hydroxy D (vitamin D2+D) 15 ng/dL (25 to 80 ng/dL) Nurses’ Notes
Initial visit:
Client instructed to take a calcium and vitamin D supplement and begin an exercise program, such as walking 3 times per week. 6-month follow-up:
Client states they frequently forget to take their calcium and vitamin D supplements and has been unable to exercise due to time constraints.
The nurse is reviewing the client’s medical record. Which of the following findings places the client at risk for osteoporosis? (Select all that apply.)
A.
Lactose intolerant
B.
Smoking history
C.
Vitamin D level
D.
Phosphorous level
E.
Alcohol use
F.
Activity level
The Correct answer and Explanation is:
The findings from the client’s medical record that place them at risk for osteoporosis are:
A. Lactose intolerant
C. Vitamin D level
F. Activity level
Explanation:
Lactose Intolerant (A):
Being lactose intolerant can put a person at risk for osteoporosis primarily because it can limit their intake of dairy products, which are significant sources of calcium. Adequate calcium intake is crucial for maintaining bone density and overall bone health. While lactose intolerance itself does not directly cause osteoporosis, it can lead to a lower calcium intake if alternative sources or supplements are not adequately utilized.
Vitamin D Level (C):
Vitamin D is essential for the absorption of calcium in the gut. The client’s initial vitamin D level is 24 ng/dL, which is below the recommended range of 25 to 80 ng/dL. After 6 months, the vitamin D level further decreased to 15 ng/dL. Low levels of vitamin D can impair calcium absorption, leading to insufficient calcium levels in the body. Over time, this deficiency can contribute to bone weakening and increase the risk of osteoporosis.
Activity Level (F):
A sedentary lifestyle is a well-known risk factor for osteoporosis. Regular weight-bearing exercise, such as walking or resistance training, is important for maintaining bone density. The client’s reported difficulty in starting an exercise program and their sedentary lifestyle contribute to a higher risk of developing osteoporosis. Exercise helps stimulate bone formation and maintain bone strength; therefore, a lack of physical activity can negatively impact bone health.
Other Findings:
- B. Smoking history: The client is a nonsmoker, so smoking is not a risk factor in this case.
- D. Phosphorous level: The client’s phosphorus levels are within the normal range, so this is not a contributing factor.
- E. Alcohol use: The client does not drink alcohol, so alcohol use is not a risk factor in this case.
In summary, the client’s lactose intolerance, low vitamin D levels, and sedentary lifestyle are significant factors that place them at risk for osteoporosis. Addressing these issues through dietary adjustments, increased vitamin D supplementation, and incorporating regular physical activity could help mitigate their risk.