OSTEOPOROSIS

Use the Osteoporosis case study to complete the assignment. Review the client profile, subjective date, objective data and diagnostic studies to complete the case study in Sherpath. After completing the case study, use the information to answer the following discussion questions.

The health care provider suspects the client has osteoporosis. What are her risk factors for osteoporosis?
What studies could be done to support the diagnosis of osteoporosis?
What clinical manifestations of osteoporosis does the client present with?
The client is prescribed alendronate. What instructions will you provide the client in regards to taking this medication?
What nutritional teaching is important of the client with her new diagnosis of osteoporosis?
What other teaching is appropriate for this client?
Answer the questions and format in an essay style paper. Introduce the client prior to answering the questions. Your conclusion is the evaluation of the teaching plan. It is required that you use APA format for your essay and references.Case Study
Musculoskeletal Problems
Case Study: Osteoporosis
approx 30 min
Patient Profile

Mrs. Pelletier is a 75-year-old female who presents to the health care provider’s office for back pain. She has a history of hypertension, Crohn’s disease, and hypothyroidism. She is currently taking the following medications:

Metoprolol 50 mg PO twice daily
Sulfasalazine 500 mg PO twice daily
Prednisolone 5 mg PO twice daily
Levothyroxine 75 mcg PO daily,/li>
Subjective Data

Has had some mid-back pain for the past week, which is worse when standing or walking and is relieved a little by lying down
Her back pain at the moment is a level 4, on a 1 to 10 scale
Denies any recent injury to her back
Broke her wrist a few months ago, but doesn’t know how
Her Crohn’s disease just ‘flared up’ a couple of weeks ago
Lactose intolerant
Objective Data

Temperature 98.2° F, pulse 74, respirations 16, blood pressure 130/78
Height 5 feet 3 inches, Weight 100 lb, BMI 17.7 kg/m2
Kyphosis of the spine

Question 1
The health care provider suspects Mrs. Pelletier has osteoporosis. What are her risk factors for osteoporosis?

Mrs. Pelletier’s risk factors for developing osteoporosis are her gender (female), age (>65 yr), low body weight, Crohn’s disease (due to malabsorption problems), nontraumatic fracture of her wrist, and use of corticosteroids for her Crohn’s disease and levothyroxine for her hypothyroidism.

Question 2
What studies could be done to support the diagnosis of osteoporosis?

Bone mineral density (BMD) measurements are typically used to assess the mass of bone or how tightly the bone is packed. Types of BMD studies include quantitative ultrasound (QUS) and dual-energy x-ray absorptiometry (DEXA).

Question 3
Mrs. Pelletier’s diagnostic testing yielded a bone density T-score of -3. What does this mean?

A T-score of -3 means that Mrs. Pelletier’s BMD is 3 standard deviations below the mean BMD of young adult. Any score greater than 2.5 standard deviations is defined as osteoporosis.

Question 4
Mrs. Pelletier is prescribed alendronate. What instructions should Mrs. Pelletier receive regarding taking this medication?

There are gastrointestinal side effects associated with taking bisphosphonates such as alendronate including dyspepsia, abdominal pain, and the most common one, esophageal irritation or esophagitis. To decrease these side effects, teach Mrs. Pelletier to take her alendronate with a full glass of plain water 30 minutes before food or other medications, and to remain upright for at least 30 minutes after taking it.

Question 5
What nutritional teaching is important for Mrs. Pelletier with her new diagnosis of osteoporosis?

Treatment of osteoporosis focuses on adequate calcium intake. Teach Mrs. Pelletier to take calcium 1500 mg/day. Due to Mrs. Pelletier’s lactose intolerance, she is not able to consume dairy products to get her daily calcium intake. Foods that are high in calcium that do not have lactose include almonds, sardines, salmon, turnip greens, and spinach. Supplemental calcium is likely if dietary intake of calcium is inadequate. Vitamin D is also necessary for calcium absorption and function and may have a role in bone formation. The recommended dosage for postmenopausal women is 800-1000 IU/day.

Question 6
What other teaching is appropriate for Mrs. Pelletier?

Moderate amounts of exercise are important to build up and maintain bone mass. The best exercises are weight-bearing exercises that force the individual to work against gravity. Exercises that are low impact, such as walking, hiking, weight training, and dancing, are recommended to avoid stress fractures associated with high-impact activities. Review with her general measures to reduce her risk of falling, including getting up slowly, wearing well-fitting shoes, removing any loose rugs in the house, making sure all of the walkways are kept clear, using grab bars and nonskid mats in the bathroom, and having appropriate lighting, particularly at nighttime.