Reference no: EM133565338

Introduction:

E.M is a 54-year-old Caucasian woman who has been suffering from widespread bone pain for several years, particularly since she went through menopause (Simmermacher, 2004). She has a background of having suffered fractures in both her right hip and wrist, which has made it difficult to perform tasks without pain. Weight-bearing activity has been causing her extreme discomfort. She is not taking medications, and lacking vitamin D. She is proactive about her healthcare. Staying up to date on all her gynecological exams and general health exams (Simmermacher, 2004).

Her medical assessments show no noteworthy abnormalities except for the concern she has raised today. Her family history reveals that her mother had a history of alcoholism, osteoporosis, type two diabetes, and high blood pressure (Simmermacher, 2004). Her father has hypertension and a history of smoking for thirty plus years, E.M. herself does smoke approximately a pack and a half a day and drinks a six pack with her mom weekly. There is no history of arthritis or hyperthyroidism. E.M. lives alone in an apartment complex and works as a teacher. She has one child and one grandchild. Her son lives a couple blocks away from her so she is able to visit her 4-year-old- grandson occasionally. She states that she does walk around her neighborhood for exercise but admits to a somewhat inactive lifestyle and a consuming diet that lacks essential vitamins. E.M started experiencing menopausal symptoms at around age 47 including "hot flashes", sleep disturbances, and vaginal dryness, which have been bothering her. E.M. 's prior doctor advised against hormone replacement therapy (HRT) because she was not displaying any noticeable signs or symptoms typically associated with menopause. Her main complaint, however, is severe back pain, making it challenging for her to perform everyday tasks, like walking up the stairs and bending over.

Pathophysiology

Osteoporosis is a condition characterized by weakening of bones, making them fragile and more prone to fractures. It affects women that are in the postmenstrual phase of their lives. The pathophysiology in this metabolic disorder is bone in the body getting absorbed faster than it is forming which causes less density within the bone. Another etiology can be estrogen in a woman, if it is not being produced efficiently especially when a woman is in menopause it can cause the bone to decrease in mass and deteriorate bone tissue. Osteoporosis occurs when there is an imbalance in the normal bone remodeling process, resulting in a situation where the rate of bone resorption (breakdown) by osteoclasts exceeds the rate of bone formation by osteoblasts. This imbalance leads to a net loss of bone mass. Additionally, during this process, there is a decrease in the levels of mineral components (such as calcium and phosphate) and the protein matrix (primarily collagen) that provides strength and density to bones. This reduction in mineral and protein matrix components further weakens the bones, making them porous, brittle, and more prone to fractures. The primary signs that would be present are "kyosis (hunchback), fractured bones, protruding abdomen, deformity, and loss of height" (Willis, 2019b).

History

Based on the information in E.M.'s information, she could be dealing with several health problems and risk factors. E.M. is a fifty-four year old female and has been in menopause for the past seven years ((Simmermacher, 2004). When she was in the beginning stages of menopause a couple of years ago, she wasn't experiencing symptoms, but she is now experiencing symptoms such as "hot spells" and vaginal dryness, which are characteristics of menopause. Her mother has a history of osteoporosis as well which is a non-modifiable risk factor. She reported that she had severe back pain, particularly when performing activities like climbing stairs and bending over. The cause of this back pain would need further evaluation. She also admits to having a vitamin-poor diet, which could contribute to various health issues, including bone health problems. E.M. does walk around her neighborhood, but not having a regular exercise routine, can contribute to muscle and bone weakness. As stated before, E.M. is not taking hormone replacement therapy (HRT), but since she is starting to experience symptoms, she could potentially start taking HRT.

Related Treatments

The treatment for osteoporosis is aiming to increase the bone density, reduce the risk of fractures, and manage the associated symptoms and complications. Lifestyle modifications are very important, since our patient lacks Vitamin D, smokes, is not active and drinks alcohol she needs to make healthier decisions. Some healthier lifestyle decisions can be weight bearing exercises to strengthen her bones, get a supportive device like a back brace, surgery if indicated, have an adequate intake of Vitamin D and calcium through diet supplements, quitting smoking and limiting alcohol intake. Doing all these lifestyle modifications can slow down bone loss and possibly reverse demineralization. Medical advice from the book "Professional Guide to Pathophysiology" suggest to patients to take medications like "bisphosphonates (such as alendronate [Fosamax] and risedronate [Actonel] to increase bone density and restore lost bone, calcium and Vitamin D supplements to support normal bone metabolism, Calcitonin (Calcimar) to reduce bone resorption and slow the decline in bone mass, and lastly hormone replacement therapy with estrogen and progesterone to slow bone loss and prevent occurrence of fractures, raloxifene (Evista) to mimic the beneficial effects of hormone replacement therapy without increasing the associated risks, and lastly Teriparatide (Forteo) a form of PTH to stimulate bone formation this is approved for post-menopausal women" (Willis, 2019b). While taking all these measures it is good to keep an eye on the patient by doing bone density testing and following up with her primary doctor, the goal of these treatments is to enhance bone strength, maintain quality of life, and minimize the impact of this condition on overall health.

Osteoporosis Nursing Diagnosis & Patient Goal

Nursing Physical Assesment: List all the patient's health stats in sentences with
specific numbers/levels (Blood pressure, bowel sounds, ambulation, etc. that

Would be in correspondence with her condition, given her medical background.

Nursing Interventions: Explain how you will accomplish your nursing goals, and
Support this with citations (reference medical journal)

Evaluation: Thoroughly explain how effective the nursing intervention was (What happened after your nursing intervention? Would the patient get better?) Information should be scientifically sound, supported, and sufficient in detail.

Recommendations: Explain what the patient or nurse should do in the future to continue recovery/improvement. Thoroughly explain what the patient or nurse should do in the future to continue recovery/improvement. Provide an overall thorough explanation of patient recommendations. Clinical findings should be supported with evidence, compared, and rationalized thoroughly. Recommendations for continued recovery/improvement should be explained and supported.