Question

The nurse in the outpatient orthopedic clinic is reviewing the medical records of several patients being seen in the clinic today. In the most recent note by the provider, the nurse reads the following:

“67-year-old, moderately obese woman examined today for increasing back and left shoulder pain. Limited circumduction of left arm noted in comparison with right arm. Strength of left arm is less than right, with less muscle definition in the left arm. Examination of back indicates significant kyphosis, and the patient states that she is ‘shrinking.’ Bone density testing of the hip is ordered.”

1. How does the nurse interpret “limited circumduction”?
2. When the patient arrives, the nurse correlates the “kyphosis” with what physical finding? What causes kyphosis in the older adult?
3. How should the nurse explain the patient’s decreasing height?
4. What is the rationale for ordering bone density testing of the hip in this patient?

Answer 1

1.The patient is unable to fully move the arm in a circle around the shoulder.

2 Kyphosis is the extreme curvature of the upper back.This condition is found in elderly patients with osteoporosis and can also be related to neuromuscular disorders.

3 Due to loss of vertebral cartilage and osteoporosis-related vertebral fractures older adults experience a loss of height.

4 Inorder to evaluate bone mineral density bone densitometry is used.it is used to estimate the extent of osteoporosis and monitor a patients response to treatment for osteoporosis.Hip bone mineral density testing is considered the most accurate test for osteoporosis and for predicting hip fractures.So evidence-based guidelines recommend hip BMD as first -line test for osteoporosis.