Question

Scenario #2- The Patient with Osteoporosis

A 76-year-old postmenopausal woman has come to the clinic for moderate to severe backache; pain interferes with all activities of daily living, bathing, going out with friends and recently sleeping. She admits to being tearful as things are changing and “I am getting old and unable to do what I like to do.”

• She works 2 days/week as a secretary. Ordinarily, she has an active social life and enjoys walking and going out with her friends, but lately she hasn’t felt good and canceling social activities. Pain has gotten in the way and she feels that she will injure herself of fall.
• Pain is rated 8/10.
• Nutritionally, she eats two meals a day, but does not like milk or cheeses. She admits to drinking alcohol socially three to four times a week.
• She reports recently she changed her shoes to slip on due to bending and trying to tie the shoes. Her daily routine does not involve much exercise other than walking with friends.
• Medical history includes hypertension; the patient reports taking lisinopril 10 mg orally daily. She has no known drug allergies. She has smoked 1ppd for 15 years and does not plan on quitting.
• Vital signs are temperature 98.9 HR 92/min; Respirations 18/min; and blood pressure 148/80 mm Hg.
• The patient needs diagnostic tests of her spine and pain management.

1. Identify four questions that the nurse would ask the patient while performing the assessment.
2. The patient says that she does not like milk and rarely drinks it. How could she increase her calcium intake?
3. The health care provider suspects osteoporosis. What test is most likely to be ordered, and what should the nurse tell the patient about the test?
4. Fill in the typical diagnostic test and laboratory results for patients who have osteoporosis.

Diagnostic test	Typical finding given the history
X-ray
Calcium level
Phosphate level

5. The patient is given a prescription for alendronate. What patient teaching is needed for this medication?
6. Determine appropriate measures to relieve this patient’s back pain include three nonpharmacological interventions.

Answer 1

1) The question during the assessment of the patient will be:

How often were you in bed or chair most of the day?

How often you are able to walk as much as u need?

How often you will have the trouble in bending or lifting?

How often you need to use walker or crutches?

2) There are so many calcium rich foods other than milk. The patient can take Chia seeds, dried figs, white beans, sunflower seed, broccoli rabe etc.

calcium supplements can also be recommended to the osteoporosis patients.

3) Non laboratory tests and laboratory tests can be done.

Non laboratory tests include bone mineral density test (BMD) which is the primary test for diagnosis of osteoporosis. X-ray to evaluate bone density.

Laboratory tests include blood calcium levels, vitamin D, thyroid test and parathyroid test, protein electrophoresis to identify abnormal protein produced, alkaline phosphatase test.

The patient is informed about the test that are performing inorder to give right treatment for her. By doing above tests it will be easy for physicians to give appropriate medications in correct doses.

4)laboratory test values of osteoporosis patients may have calcium in mg/dl below 8.6. The vitamin D range below the range of 10-55 ng/ml is indication of osteoporosis. For treating osteoporosis requires positive phosphorus balance upto 90mg/dl.

osteoporesis may be visible on Xray. X ray measures the bone density of patient. In bone density tests how many grams of calcium and minerals are packaged in bone is calculated.