OSTEOPOROSIS A 52-year-old white 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 complaim that any weight-bearing activity causes hier severe discomfort She is not taking hormone replacement other medication. She has been using a soy herbal s lement and vitamin E 400 IU daily. She knows the importance of is up to date on all her gynecological exams, and past mammograms have been sormal as have health maintenance exams. She does not smoke or une alcohol. system reviews are uncremarkable excluding today’s complaint. 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 otherwhe good health. There is no history of breast dhorders or arthritis, thyroid or any other metabolic disorder. preventive healthcare. preventiv She lives alone e in in a a one- one-story house and od works at a car plant. 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 det Make a nursing care plan Moke a nursing care plan 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. Physical Examinatio Upon physical exam, she is afebrile with urvemarkable findings with exception to the musculoskeletal system. She weighs 132 pounds and is 5 feet 5 inches. At her last exam months ago, she was 5 feet & inches. Upon palpation, quarding 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 and upper back areas There is also noticeable guarding with some limitation of movement at the cervical rea. She is able to endure the exam with noticeable painful expressions on e when asked to do range of motion with back, guarding and tenderness noted cervical spine ares. 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. Differential Diagnosis Her symptoms indicate post-menopausal osteoporosis. In addition to physical findings, has risk factors of increased age, heredity, small body size, thin stature and being white. To confirm the diagnosis and rule out other medical conditions, lab tests obtained to aness 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 arid 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. AT score gester than-2.5 5 confirms a diagnosis of osteoporosis and indicates hormonal treatment should be initiarest Treatment Plan Treatment Plan Treatment includes a caicium supplement 1200 mg wit with vitamin D dally, Fosamax salendronate sodium) 10 mg daily and Premarin (conjugated estrogem) 0.625 mg daily. This routine treatment should provide adequate relief and help prevent future bone loss. The Women’s Health Initiative study is the first thal with definitive data supporting the ability of postmenopausal hormones to prevent fractures at the hip, vertebrae and other sites. Patient Education After tolerance of medications and symptom relief have been achieved, a walking routine, weight bearing exercise and education on a well-balanced diet are introduced. The goal of walking and weighe bearing exercises is to increase bone mass and muscle endurance. In addition to the nutritional education, T.S. is given reinforce orcement on continuing to avoid alcohol ant cigarette smoking. Education also includes the side effects of taking estrogen and Fosamax and the importance of following this treatment plan to achieve a good outcome for her, as osteoporosis is a debilitating condition.
The Correct Answer and Explanation is :
Nursing Care Plan for Postmenopausal Osteoporosis
Assessment:
- Subjective Data:
- A 52-year-old postmenopausal white female reports diffuse bone pain over several years, worsening with weight-bearing activities.
- History of left hip and wrist fractures.
- Complaints of “hot spells” and vaginal dryness over the past 3 months.
- No current use of hormone replacement therapy; uses soy herbal supplement and vitamin E 400 IU daily.
- Sedentary lifestyle with no regular exercise routine.
- Diet low in vitamins and minerals.
- Objective Data:
- Physical examination reveals guarding and tenderness in the cervical, thoracic, and lumbar spine with limited range of motion.
- No spasticity, rigidity, or flaccidity noted.
- Active range of motion in all joints without edema, redness, or heat.
- No evidence of dowager’s hump, herniation, disc displacement, scoliosis, or lordosis.
- Preliminary urinalysis and CBC unremarkable.
Diagnosis:
- Impaired physical mobility related to bone pain and fractures.
- Risk for injury related to decreased bone density and previous fractures.
- Deficient knowledge regarding osteoporosis management and prevention.
Planning:
- Enhance mobility and reduce pain through appropriate interventions.
- Implement safety measures to prevent further fractures.
- Provide education on osteoporosis management, including medication adherence, dietary modifications, and exercise.
Interventions:
- Pain Management:
- Administer prescribed analgesics as ordered.
- Encourage the use of heat or cold therapy to alleviate muscle tension.
- Teach relaxation techniques to manage pain.
- Mobility Enhancement:
- Collaborate with physical therapy to develop an individualized exercise program focusing on weight-bearing and resistance exercises.
- Encourage daily walking to improve bone density and muscle strength.
- Instruct on proper body mechanics to prevent injury.
- Safety Measures:
- Assess the home environment for fall hazards and recommend modifications.
- Provide assistive devices as needed to support mobility.
- Educate on the importance of wearing supportive footwear.
- Education:
- Explain the role of calcium and vitamin D in bone health and discuss dietary sources and supplementation.
- Discuss the benefits and potential side effects of prescribed medications, including Fosamax (alendronate sodium) and Premarin (conjugated estrogen).
- Provide information on the importance of weight-bearing exercises and a balanced diet rich in nutrients.
- Encourage smoking cessation and moderation of alcohol intake.
Evaluation:
- Patient reports decreased pain and increased mobility.
- Demonstrates understanding of osteoporosis management strategies.
- Adheres to prescribed medication regimen and lifestyle modifications.
This care plan aims to address the multifaceted needs of a postmenopausal woman with osteoporosis, focusing on pain management, mobility enhancement, safety, and education to improve quality of life and prevent further complications.