Term Paper: Gerontology and Gerontic Nursing Practice

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1. As she suffers from osteoporosis, several mechanisms are at play in

Mrs. Wood's condition. The basic elements result from poor bone mass

accumulation during childhood combined with an acceleration of bone loss

adulthood, when peak bone mass has been achieved. One half of bone mass is

made during pre-puberty, with only minimal accumulation of minerals in the

teens and peak bone mass in the 20s. Mrs. Wood's rate of bone loss is

based more upon her lifestyle than her genes. Dietary calcium, vitamin D,

protein and calories impact on her development of osteoporosis. If she had

poor calcium intake in her childhood, this directly impacts her likelihood

of fracture in adulthood (Heaney, 1998). Mrs. Wood's calcium intake is

directly associated with bone mineral mass at any age. Supplementation

reduces the rate of bone loss and will reduce her risk of fracture.

Vitamin D intake is necessary for bone mineral metabolism and the rate of

osteoclastic resorption. The addition of Vitamin D to calcium

supplementation reduces fracture rates. Other elements in Mrs. Wood's diet

impact on her osteoporosis. The degree of protein and caloric intake in

her daily diet will support fat and muscle that is covering bony areas.

There are several medications which may be associated with the

development in osteoporosis for Mrs. Woods. Chronic steroid use may have

contributed to her condition, resulting in the loss of trabecular bone

mass. It is estimated that 20-40% of bone loss occurs within the first

year of steroid use, especially in patients using doses greater than 7.5 mg

per day (Libinat and Baylinki, 1997).

The most common sign of osteoporosis is a skeletal fracture, and the

most common fracture will be seen in the vertebral column. Mrs. Woods may

remain completely asymptomatic even after compression fracture has

occurred. These usually happen in the course of the day with normal

activity. A cough or working in the garden is enough to cause a vertebral

compression fracture in the lumbar spine of a patient with osteoporosis.

Mrs. Woods may be asymptomatic, as noted, or she may note an acute episode

of back pain which resolves or becomes more chronic and dull in nature.

Should Mrs. Wood experience multiple vertebral compression fractures, she

may note a loss in height and eventual development of a Dowager's hump, as

is called the thoracic kyphosis resulting from the fracture. She may find

that her clothes no longer fit as they did before, she may notice a

thickening in the area of her waist, primarily because the vertical

dimension of the abdominal cavity disappears secondary to the vertebral

collapse and the abdominal contents shift toward the anterior region

(Kanis, 1994; Wasnich, 1993). Mrs. Woods may notice this causes a new and

very slow onset of shortness of breath because of the reduction in thoracic

volumes and poor lung volumes due to thoracic restriction.

Hip fracture after falls is also very common in patients who have

osteoporosis. Mrs. Wood may also note leg cramps, bone pain and tenderness

(not necessarily in the joints), abdominal pain, rib pain, tooth loss and

periodontal disease, fatigue and brittle fingernails. Pain and fractures

in joints are not always secondary to falls, but may occur due to

subchondral insufficiency in femoral head fractures. Another common injury

in patients who have osteoporosis is a Colles' fracture, in which there is

a fracture of the distal radius after the most minimal trauma. This often

occurs when the patient falls or trips and catches oneself against an

outstretched hand.

2. Mrs. Woods, I am sure you are concerned about the symptoms you

have been experiencing. It appears from your x-rays that you have

developed a condition which is called osteoporosis. Have you ever heard of

this condition before, or do any of your friends have this condition?

Well, osteo means related to the bone, and porosis is just as it sounds,

your bones are a little bit more porous and brittle appearing on the x-rays

than would perhaps be seen in a younger patient, or in a patient who does

not have osteoporosis. The cells which break down your bones are working a

little harder than the cells which build up your bones. While this can be

seen in some degree in all patients over age 50, in your case we are seeing

a little bit more of it than we would like, and as a result you are having

these symptoms. Osteoporosis can cause your bones to be brittle and break

more easily, so perhaps if you were to have a fall that would not have

caused more than a bruise in the past, you will now have to take care that

you observe that you have not caused a break in your bones. This can

sometimes cause quite a bit of pain, but in other patients only cause a bit

of a dull ache. In any case, when you have a fall or pain, we would want

you to come in so an x-ray could be done to make sure you have not done any

damage. The doctor and the medical team want you in the hospital right now

so we can take a look at your bones, see what degree of osteoporosis is

there, and perhaps even begin treatment. Luckily, there are some things

that we can do to make you feel better and improve the health of your

bones. We will also be talking about some things in your past, such as

medicines you have taken, which may have contributed to this condition

(Nolan, Davies, & Grant, 2001).

3. Education will be key to Mrs. Wood's recovery, since we cannot

reverse the osteoporosis which has already occurred. We may, however, be

able to preserve the healthy bone mineral mass she still has and for that

reason it would be good to have the pharmacist come in to speak to Mrs.

Woods about some medications which may be helpful in treating her disease.

The pharmacist will discuss some nutritional supplements which will be

helpful in preserving bone mass as well as medications which may help build

the bone she has already (Gray, et.al, 2000) .

Additionally, Mrs. Woods would do well to see the nutritionist. While

medication and nutritional supplementation will be helpful to her

condition, there are certain dietary choices she could make which would be

healthier for her, like dairy foods which are higher in calcium as well as

green vegetables which have calcium, especially if she has developed an

element of lactose intolerance as do many older patients. The nutritionist

will also be able to identify elements in her diet which are not good for

bone health, like high caffeine intake or alcohol.

Finally, it would be good for Mrs. Woods to see a physiotherapist.

Her pain from previous fractures may cause her to limit her range of motion

and activity, which will in turn complicate her osteoporosis. It would be

helpful were she to be instructed on physical exercise which will help her

maintaining range of motion to keep her joints flexible and maintain her

vertebral height as much as possible. Weight bearing exercise would also

modify the degree to which she experiences ongoing bone loss. A

physiotherapist would instruct her to be careful to follow an exercise

regimen which will be good for her and not cause a greater degree of

trabecular bone loss or deformation of her articular cartilage.

4. The physician would help in arranging for coordination of care for

Mrs. Woods. He or she will order bone mineral density testing to evaluate

the degree of bone loss, as well as metabolic testing to ensure 1) there is

not another physical condition which is causing her bone loss and 2) there

is no physical condition which would prevent her from taking some of the

medications she would need to treat her osteoporosis. I am thinking

specifically of issues such as hyperparathyroidism, history of renal

calculi and liver disease, a history of dysphagia or esophageal erosions.

The nursing staff will ensure that Mrs. Woods is clear regarding all

the testing and the results, and that she has a clear idea of the treatment

plan. It is also important that Mrs. Woods feels comfortable with the

treatment plan and understands what and why things are being done.

A pharmacist will evaluate the testing ordered by the physician and

give opinion on which medications, if any, would be helpful for treating

Mrs. Woods' condition. Additionally, the pharmacist can give Mrs. Woods

advice regarding the timing of the medication administration and side

effects she should be aware of.

A physiotherapist can set up an exercise plan for Mrs. Woods to ensure

she gets the appropriate type and amount of exercise to treat her

condition. The physiotherapist would be aware of possible co morbid

factors which would limit Mrs. Woods' exercise ability.

A social worker could evaluate Mrs. Woods' home situation to see if

any assistance would be needed regarding activities of daily living or

transportation needs. Additionally, the social worker may… [END OF PREVIEW]

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Gerontology and Gerontic Nursing Practice.  (2007, July 29).  Retrieved December 7, 2019, from https://www.essaytown.com/subjects/paper/gerontology-gerontic-nursing-practice/5923211

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