Osteoporosis HESI case study
– Excessive alcohol use.
A thin body build, evidenced by a body was index of 19, is a risk factor for osteoporosis. Additional risk factors include being female and of Caucasian or Asian ethnicity. Consuming greater than 2 alcoholic beverages daily is a risk factor for osteoporosis.
Building maximal bone mass as a child and adolescent is very important to reduce the risk of osteoporosis as an adult. Physical activity, along with adequate nutrient intake, is essential to strengthen bone density.
Estrogen deficiency contributes to the onset of osteoporosis by causing an increase in osteoclastic activity, resulting in bone breakdown which occurs faster than bone formation (osteoblastic activity).
The nurse should promote client autonomy by offering the client safe, reasonable choices. Since no special preparation is needed prior to the test, the client may choose to have the test completed immediately. Even though the client has recently experienced a fracture this is not an emergency situation, so the client may prefer to wait for the appointment in three weeks.
DXA is a non-invasive procedure that does not involve the use of any dyes or cleansing agents that might contain allergens such as iodine.
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Osteoporosis is often first detected following a fracture, since there are frequently no symptoms associated with osteoporosis.
Lower back pain can be the result of many problems. The healthcare provider should first evaluate the cause of the pain before the nurse provides client teaching regarding exercises or pain management.
Persons with osteoporosis often loose height over time as the vertebrae are compressed.
A cup of yogurt is a good source of calcium, providing as much as 400 mg of calcium.
-By taking 3 of your calcium tablets each day you will receive adequate amounts of calcium for your needs.
Calcium is absorbed most efficiently if taken in amounts of 500 mg or less at a time. Calcium carbonate should be taken with food, and calcium citrate can be taken with or without food. The RDA for calcium for postmenopausal women is 1200 – 1500 mg. Three 500 mg tablets provide 1500 mg of calcium every day. Vitamin D supplementation may also be recommended by the healthcare provider.
Regular exercise, 5 times per week for 30 to 60 minutes, provides the best protection against further loss of bone mass. In addition, regular exercise improves muscle strength and coordination, reducing the client’s risk for falls.
Medications can contribute to the loss of bone density.
Glucocorticoids, such as prednisone, taken over a prolonged time period, are the most common class of medications associated with osteoporosis.
– Make sure you remain upright for at least 1/2 hour after taking the medication.
Fosamax should be taken on an empty stomach with a full glass of water to promote the best absorption. Because the patient may go back to bed, she should be informed that remaining upright helps to avoid irritation of the esophagus.
After taking a dose of Fosamax, the client must remain in an upright position for 30 minutes to prevent esophageal irritation and erosion.
Kat’s vital signs and manifestations indicate that fat embolization syndrome has occurred. Typical symptoms include chest pain, tachycardia, tachypnea, dyspnea, pallor, and petechiae on the anterior chest, neck and axilla. Symptoms are the result of poor oxygenation, so the nurse’s first interventions should include measures to improve oxygenation, such as the application of oxygen.
The fat globules transported to the lungs can result in acute respiratory distress syndrome (ARDS). Acute deterioration of respiratory function may result in the need for endotracheal intubation and mechanical ventilation, so the nurse should ensure that this emergency equipment is readily available.
This client is experiencing a large amount of postoperative drainage and may require a transfusion, as well as close monitoring. This client requires the expertise of the RN for assessment and transfusion management.
Fat embolism syndrome can quickly deteriorate and requires a high level of critical care expertise to effectively assess for subtle changes in the client’s status.
Pelvic fractures can be extremely painful, impacting all aspects of the client’s well-being, contributing to fatigue, sleep pattern disturbance, and impaired physical mobility.
Diminished sensation and movement of the feet, along with diminished pedal pulses, pallor, and pain indicate impaired peripheral neurovascular function. Remember the five Ps!
Placebo use is ethically questionable, and may be construed as fraud. The use of placebos is considered unacceptable in the management of pain by the American Pain Society. Additionally, the nurse administering the placebo does not have a prescription for this treatment.
The nurse is engaging in slander of the healthcare provider. The charge nurse must end the break room conversation and discuss the nurse’s behavior. This should be conducted in a private setting to maintain the nurse’s right to privacy.
PTH is the primary regulator of calcium and phosphate metabolism in bone and kidney, and can result in increased serum calcium levels. Serum calcium levels, alkaline phosphatase, and uric acid should be monitored periodically during treatment.
The client should be instructed to report bone pain and unexplained leg cramps, which may be indications of altered serum calcium levels.
An opportunity to repeat a practice injection under the nurse’s supervision will increase the learner’s confidence.
This open-ended response encourages the client to continue to discuss her relationship with her daughter.
Using this broad question to respond to the client’s concern can help her identify her goals, and the actions needed to meet her goals and reduce her risks.