N120 HESI Case Study: Medical/Surgical: Osteoporosis
The client sustains a Colles' fracture while on a hiking vacation in the mountains. She received care at a local emergency care center, where asked if she has ever been screened for osteoporosis. When the client replies, "No.", the healthcare provider (HCP) recommends that her primary provider conduct the screening after she returns home.
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The client tells the nurse that she loves to hike and that she walks 2 miles every weekend to stay in shape.
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The client tells the nurse that she started taking a 500 mg calcium supplement daily after she stopped her post-hysterectomy estrogen therapy.
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The nurse also discusses the adverse effects of the medication.
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The nurse observes the client as she demonstrates the procedure for SQ self-injection. The client performs the procedure correctly but states that she feels very nervous about giving herself a daily injection.
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The nurse reviews the client's medical history for other risk factors.
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The supervisor agrees to send additional nursing staff to the unit so that the client can receive one-to-one care.
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Therapeutic Communication The client decides to attempt the self-injections at home, beginning the following day. A week later, she calls the nurse to report that she is able to administer the injections and has also taught her daughter how to perform the injection. The client states, "It is so comforting to be able to stay with my daughter while I recover. I hope I am not a burden to her."
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The client is seen by the HCP, who recommends osteoporosis screening since client is at risk for osteoporosis. The nurse meets with the client to provide teaching. The client tells the nurse that they played a lot of sports as a child and teenager. The client states, "I guess I just put too much stress on my bones over the years."
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The RN charge nurse later overhears the PN conversing with another staff member in the break room. The nurse states that the client is dependent on her pain meds and that her HCP is a "quack" who has caused the client's drug addiction.
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The assigned PN discusses the problem list with the RN team leader. They agree to also includes the problem of possible peripheral neurovascular issues related to the fracture in the plan of care.
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A Complication Occurs Three weeks later, the client goes to the emergency department (ED) of the local medical center, where she reports that she fell off a ladder the previous day and is experiencing increasing pelvic tenderness. The X-ray reveals a pelvic fracture, and the client is transferred to the orthopedic unit for fracture management. While being admitted to the orthopedic unit, the client develops chest pain. Her vital signs are Temperature, 99.8° F (37.6° C), Pulse 122, Respirations 40, Blood Pressure 110/74. While obtaining the client's vital signs, the nurse notes that the client is pale and has petechiae on her anterior chest and neck.
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A repeat DEXA the following year indicates a progression from osteopenia to osteoporosis. The client states adhering to a calcium rich diet and a faithful exercise regimen.
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After taking initial action, the nurse notes that the client is becoming cyanotic and appears restless, anxious, and disoriented with a decreasing SaO2.
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After the appointment for DEXA is scheduled, the client reminds the nurse that she has a number of food allergies, including shellfish, red food color, peanuts, and strawberries.
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Case Outcome The client stays with her daughter until her surgical recovery is complete and continues the PTH injections for a year. During that time her bone density improves and she remains fracture free. She continues to exercise every day and has resumed her frequent hiking trips in the mountains. Click for Image
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Client Teaching The client's HCP recommends a regimen of exercise and diet. The nurse meets with the client to provide osteopenia related teaching. The client and the nurse discuss the need for adequate calcium intake.
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Clinical Manifestations The client returns to the office 1 month later to discuss the results of the DEXA test with the provider and learns that the T-score (- 1.0) indicates osteopenia. The client states, "I guess I am not having any symptoms because I don't have osteoporosis yet."
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Diagnostic Testing The nurse calls to schedule the client's appointment for dual energy x-ray absorptiometry (DEXA) of the hip and spine. An appointment is available in 30 minutes or the next available appointment is in 3 weeks.
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Ethical-Legal Considerations Since the client's respiratory status has stabilized, she undergoes an open reduction and internal fixation of the pelvis. Following surgery, the client receives patient-controlled analgesia (PCA) for 24 hours. When this order is discontinued, a new order is written for morphine, 2 mg IV every 4 hours, as needed (PRN.) The PN caring for the client is concerned about the amount of opioid analgesics that the client has received since her fracture occurred. The nurse administers a dose of sodium chloride (NS) IV the next time the client requests pain medication and reports to the RN charge nurse what she did and that the client indicates that she is pain free.
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Further conversation reveals that the client is also worried about experiencing another fracture.
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Further conversation with the client reveals that they have been experiencing lower back pain off and on for the last 2 years. The client takes ibuprofen occasionally for the pain.
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Management Issues The client's condition stabilizes after initial treatment with oxygen and IV fluids. Mechanical ventilation is not needed, but the HCP orders a transfer to the critical care unit (CCU,) where the client can be more closely monitored for the next 24 hours. The house supervisor notifies the orthopedic unit charge nurse that no beds are available in the CCU and there are no clients stable enough to be transferred out of the CCU. The supervisor also notifies the HCP, who agrees that the client can remain on the orthopedic unit if one-to-one care is received. While arrangements are being made for one-to-one care, the nurse currently assigned requests assistance with other client care responsibilities and provides a report about the clients. An RN and two LPNs are working on the unit.
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Parathyroid Hormone (PTH) Injections One week following surgery, the client is discharged and goes to stay with her daughter to complete her surgical recovery. During her next visit to her HCP, she receives a prescription for daily subcutaneous injections (SQ) of teriparatide, parathyroid hormone, to treat her osteoporosis.
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Pelvic Fracture Management The client's respiratory status gradually improves and one-on-one monitoring is no longer required. The client's pelvic fracture involves a weight-bearing aspect of the pelvis, and the client is receiving traction with a pelvic sling.
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Pharmacologic Therapy The client reports having ulcerative colitis and experienced an acute exacerbation during the past year. The client states that they have taken a number of medications over the last year to manage the ulcerative colitis.
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Risk Factors Upon returning home from vacation, the client shedules a follow-up appointment with the healthcare provider (HCP) to ensure adequate healing of the fracture.
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Six weeks after starting the medication, the client leaves a message for the nurse that she is experiencing increasingly frequent and severe heartburn.
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The HCP prescribes alendronate by mouth (PO) once a week. The nurse instructs the client to select a specific day of the week when she can take the medication first thing in the morning. The client states, "Is that really necessary? I'm not much of a morning person."
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To increase the client's dietary intake of calcium, which snack should the nurse recommend? A large apple. A cup of fruit-flavored yogurt. Twenty cheese-flavored crackers. An ounce of low-fat cream cheese on a bagel. Submit
A cup of fruit-flavored yogurt. A large apple. Apples are a poor source of calcium, providing approximately 10 mg of calcium. A cup of fruit-flavored yogurt. A cup of yogurt is a good source of calcium, providing as much as 400 mg of calcium. Nix, S. (2017). Williams' Basic Nutrition and Diet Therapy. (15thedition). St. Louis, Missouri. Elsevier. Pg. 119. Twenty cheese-flavored crackers. The cheese-flavoring in crackers is not a source of calcium. An ounce of low-fat cream cheese on a bagel. An ounce of cream cheese is a poor source of calcium, providing only 25 mg of calcium.
In the planning of the client's care, which problem has the highest priority? Fatigue. Acute pain. Sleep pattern disturbance. Impaired physical mobility.
Acute pain. Fatigue. This problem is important, but it is not of the highest priority. Acute pain. Pelvic fractures can be extremely painful, impacting all aspects of the client's well-being and contributing to fatigue, sleep pattern disturbance, and impaired physical mobility. Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 896. Sleep pattern disturbance. This problem is important, but it is not of the highest priority. Impaired physical mobility. This problem is important, but it is not of the highest priority.
Arrangements should be made for which nurse to provide care for the client? An experienced critical care RN who is scheduled off for the day. An experienced orthopedic unit RN who is scheduled off for the day. A graduate nurse serving a critical care internship who is at work but does not have a client care assignment. An experienced orthopedic LPN who is already at work and has requested to work overtime whenever possible. Submit Previous Section
An experienced critical care RN who is scheduled off for the day. An experienced critical care RN who is scheduled off for the day. 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. Cooper, K., Gosnell, K. (2019). Adult Health Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 148. An experienced orthopedic unit RN who is scheduled off for the day. The orthopedic unit RN does not have the best expertise to manage the care of a critically ill client. A graduate nurse serving a critical care internship who is at work but does not have a client care assignment. A graduate nurse serving an internship does not have the expertise to be assigned independently in a situation where no other critical care nurses are available. An experienced orthopedic LPN who is already at work and has requested to work overtime whenever possible. The orthopedic unit LPN does not have the best expertise to manage the care of a critically ill client, despite the request to work additional hours.
What action should the nurse implement first? Apply oxygen via mask. Observe for hematuria. Measure abdominal girth. Administer an analgesic.
Apply oxygen via mask. Apply oxygen via mask. The client'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. Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 881. Observe for hematuria. A pelvic fracture can damage other organs, so assessment of urinary function is important. However, another action is of greater priority. Measure abdominal girth. Pelvic fractures can cause intraabdominal injury, so assessment of bowel function and intraabdominal bleeding are important. However, another action is of greater priority. Administer an analgesic. Kat is experiencing pain and should receive an analgesic. However, another action is of greater priority.
What action should the nurse implement first upon learning of this problem? Reassure the client that her lower back pain is the result of her osteopenia. Teach the client exercises that will strengthen her abdominal muscles. Determine if the client's PRN (as needed) use of ibuprofen provides adequate pain relief. Ask the client if she has discussed this symptom with her healthcare provider. Submit
Ask the client if she has discussed this symptom with her healthcare provider. Reassure the client that her lower back pain is the result of her osteopenia. Remember that lower back pain can have many causes. Teach the client exercises that will strengthen her abdominal muscles. Strengthening the abdominal muscles often helps reduce lower back pain, but another intervention should be taken first. Determine if the client's PRN (as needed) use of ibuprofen provides adequate pain relief. This is an important intervention, but another intervention should be taken first. Ask the client if she has discussed this symptom with her healthcare provider. 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. Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 868.
What action should the nurse take? Advise the client to go to the emergency department immediately. Ask the client to describe her method of alendronate administration. Instruct the client to use an antacid PRN 2 hours after her alendronate dose. Reassure the client that heartburn is a common side effect of alendronate. Submit Previous Section
Ask the client to describe her method of alendronate administration. Advise the client to go to the emergency department immediately. These symptoms do not require emergency care. Ask the client to describe her method of alendronate administration. After taking a dose of alendronate the client must remain in an upright position for 30 minutes to prevent esophageal irritation and erosion. Skidmore-Roth, L. (2021). Mosby's 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 37. Instruct the client to use an antacid PRN 2 hours after her alendronate dose. This instruction will not resolve her problem. Reassure the client that heartburn is a common side effect of alendronate. The client's symptoms require further intervention.
Which nursing action should be implemented to address this potential problem? Assign a PN to take the client's vital signs every 2 hours. Observe the client's pupillary response to light every 8 hours. Measure and compare calf circumferences every 12 hours. Assess for sensation and movement of the feet every 4 hours.
Assess for sensation and movement of the feet every 4 hours. Assign a PN to take the client's vital signs every 2 hours. Vital sign assessment provides data regarding over-all homeostasis but does not provide data specific to peripheral neurovascular function. Observe the client's pupillary response to light every 8 hours. Assessment of the pupillary response to light provides data regarding neurologic function but does not provide data regarding peripheral neurovascular function. Measure and compare calf circumferences every 12 hours. This action provides data related to the development of deep vein thrombosis but does not provide data regarding peripheral neurovascular function. Assess for sensation and movement of the feet every 4 hours. Diminished sensation and movement of the feet, along with diminished pedal pulses, pallor, and pain indicate impaired peripheral neurovascular function. Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 892.
The nurse stresses the importance of reporting which problem? Headache. Dyspepsia. Rhinitis. Bone pain.
Bone pain. Headache. Headache is an adverse effect that can occur with PTH administration, but it is of less significance than another manifestation. Dyspepsia. Dyspepsia is an adverse effect that can occur with PTH administration, but it is of less significance than another manifestation. Rhinitis. Rhinitis is an adverse effect that can occur with PTH administration, but it is of less significance than another manifestation. Bone pain. The client should be instructed to report bone pain and unexplained leg cramps, which may be indications of altered serum calcium levels.
In providing client teaching, the nurse discusses the need for periodic monitoring of which diagnostic serum lab value? Calcium. Potassium. Platelet count. Hemoglobin.
Calcium. Calcium. PTH is the primary regulator of calcium and phosphate metabolism in bone and kidney, and the administration of PTH can result in increased serum calcium levels. Serum calcium levels, alkaline phosphatase, and uric acid should be monitored periodically during treatment. Skidmore-Roth, L. (2021). Mosby's 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 1209. Cooper, K., Gosnell, K. (2019). Adult Health Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 481. Potassium. PTH does not impact serum potassium levels. Platelet count. PTH does not impact platelets. Hemoglobin. PTH does not impact hemoglobin levels.
Which aspect of the client's medication history is most likely to impact the client's risk for osteoporosis? Chronically low calcium and/or Vitamin D intake Took an antidepressant for 6 months immediately following spouse's death. Began treatment for hyperlipidemia with simvistatin 6 months ago. Has occasionally taken ibuprofen for lower back pain for the last 2 years.
Chronically low calcium and/or Vitamin D intake Chronically low calcium and/or Vitamin D intake Appropriate intake of calcium and Vitamin D rich foods, along with vitamin D3 supplements decreases the risk for osteoporosis Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 868. Took an antidepressant for 6 months immediately following spouse's death. Antidepressant use is not associated with osteoporosis. Began treatment for hyperlipidemia with simvistatin 6 months ago. The use of statins for hyperlipidemia is not associated with osteoporosis. Has occasionally taken ibuprofen for lower back pain for the last 2 years. The use of NSAIDs, such as ibuprofen, is not associated with osteoporosis.
What action should the RN charge nurse implement? Request that a social worker meet with the client to arrange drug abuse counseling. Discuss the implications of placebo use with the PN nurse who administered the saline and initiate an incident report. Notify the surgeon that this technique has reduced the client's need for morphine. Encourage the nurse to continue the placebo use, alternating with the morphine.
Discuss the implications of placebo use with the PN nurse who administered the saline and initiate an incident report. Request that a social worker meet with the client to arrange drug abuse counseling. There is no evidence of drug abuse by the client. Therefore, this action is not indicated. Discuss the implications of placebo use with the PN nurse who administered the saline and initiate an incident report. The use of placebos has both ethical and legal implications, violates the nurse-patient relationship, and deprives patients of more appropriate methods of assessment or treatment. The charge nurse should also have the administering nurse fill out an incident report and follow hospital policy in reference to medication errors. Giving a medication without an order is not only a facility policy issue, but is a legal issue. Cooper, K., Gosnell, K. (2019). Foundations of Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 32, 49, 87, 437. Notify the surgeon that this technique has reduced the client's need for morphine. Another action by the charge nurse is indicated. Encourage the nurse to continue the placebo use, alternating with the morphine. There is no order for placebo use, so the nurse should not be encouraged to continue its administration.
What action should the nurse take? Consult with the HCP about a prescription for a different route of medication administration. Encourage the client to practice the injection technique again under the supervision of the nurse. Suggest that the client come to the provider's office to receive the injections for the duration of the treatment. Perform another demonstration of the injection procedure so the client can carefully observe the steps.
Encourage the client to practice the injection technique again under the supervision of the nurse. Consult with the HCP about a prescription for a different route of medication administration. PTH is only available for subcutaneous administration. Encourage the client to practice the injection technique again under the supervision of the nurse. An opportunity to repeat a practice injection under the nurse's supervision will increase the learner's confidence. Potter, P., Perry, A., Stockert, P., Hall, A. (2019). Essentials for Nursing Practice. (9th edition). St. Louis, Missouri. Elsevier. Pg. 92. Suggest that the client come to the provider's office to receive the injections for the duration of the treatment. Treatment of osteoporosis with PTH typically lasts 1 to 2 years, and the PTH is administered every day. Perform another demonstration of the injection procedure so the client can carefully observe the steps. This is not the most effective teaching strategy to promote learner confidence.
What is the priority nursing action? Prepare the client for a blood transfusion. Initiate cardiopulmonary resuscitation. Ensure that intubation equipment is readily available. Position the client on her right side with her head down. Submit Previous Section
Ensure that intubation equipment is readily available. Prepare the client for a blood transfusion. The client with fat embolus and pelvic fracture may experience sufficient hemorrhage to require a blood transfusion; however, client's symptoms indicate a higher priority problem. Initiate cardiopulmonary resuscitation. CPR is not indicated since there has not yet been a loss of pulse or respiration. Ensure that intubation equipment is readily available. The fat globules transported to the lungs can result in acute respiratory distress syndrome (ARDS). Acute deterioration of respiratory function may require intubation or intermittent positive pressure ventilation if satisfactory PaO2 cannot be obtained with supplemental O2 alone. The nurse should ensure that this emergency equipment is readily available. Cooper, K., Gosnell, K. (2019). Adult Health Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 147. Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 881. Position the client on her right side with her head down. This position is useful for the client experiencing an air embolus, but it is not useful during management of a fat embolus.
How should the nurse respond? Your daughter is nearby in case you need help in the future. How do you envision your lifestyle in the years ahead? Try not to worry about that right now while you are still healing. Most people your age have some health problem to cope with.
How do you envision your lifestyle in the years ahead? Your daughter is nearby in case you need help in the future. This response is not the most helpful in guiding the client to a resolution of her concern about experiencing another fracture. How do you envision your lifestyle in the years ahead? 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. Cooper, K., Gosnell, K. (2019). Foundations of Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 68. Try not to worry about that right now while you are still healing. Responding by telling people what they "should" do (stated or implied) is generally not helpful in resolving problems. Most people your age have some health problem to cope with. This response does not encourage further communication and problem-solving.
What action should the charge nurse take? Encourage the nurse to visit with the client's daughter to share these concerns. Immediately meet privately with the nurse to discuss the conversation that was overheard. Quietly leave the area and allow the nurse to ventilate these concerns in the break room. Immediately confront the nurse in the break room about the negative remarks.
Immediately meet privately with the nurse to discuss the conversation that was overheard. Encourage the nurse to visit with the client's daughter to share these concerns. This is an invasion of the client's privacy and supports further slander of the healthcare provider. Immediately meet privately with the nurse to discuss the conversation that was overheard. The nurse is engaging in slander of the HCP. 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. Through teamwork and collaboration the nurse should value the expertise of each interprofessional member. Cooper, K., Gosnell, K. (2019). Foundations of Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 25, 33, 1227. Quietly leave the area and allow the nurse to ventilate these concerns in the break room. This supports unethical and illegal behavior by the nurse. Immediately confront the nurse in the break room about the negative remarks. This action does not provide sufficient protection of the rights of the nurse.
How should the nurse respond? It sounds as if your long walks provide plenty of weight-bearing exercise. It is important to increase the frequency of your walks to at least three to five times per week. Walking more than a mile at one time is likely to increase your risk for another fracture. The best way to increase your bone strength is by lengthening your weekly walk by another mile.
It is important to increase the frequency of your walks to at least three to five times per week. It sounds as if your long walks provide plenty of weight-bearing exercise. The nurse should encourage the client to alter her exercise regimen for maximal benefit. It is important to increase the frequency of your walks to at least three to five times per week. Regular exercise, walking for 30 minutes three to five times a week is the single most effective exercise for osteoporosis prevention. In addition, regular exercise improves muscle strength and coordination, reducing the client's risk for falls. Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 868. Walking more than a mile at one time is likely to increase your risk for another fracture. Increased weight-bearing exercise will not increase the risk for fracture. The best way to increase your bone strength is by lengthening your weekly walk by another mile. Increasing the length of a once-a-week walk is not the best approach to increase bone strength.
How should the nurse respond? What other responsibilities does your daughter have? Why would your daughter find you to be a burden? I am sure your daughter is glad to be able to help you. It sounds as if your daughter has been really helpful.
It sounds as if your daughter has been really helpful. What other responsibilities does your daughter have? This is not the best response to address the client's concerns about feeling like a burden to her daughter. Why would your daughter find you to be a burden? This response may be perceived as challenging by the client rather than helpful. I am sure your daughter is glad to be able to help you. This response is patronizing and is unlikely to help the client deal with her concerns about feeling like a burden. It sounds as if your daughter has been really helpful. This open-ended response encourages the client to continue to discuss her relationship with her daughter. Cooper, K., Gosnell, K. (2019). Foundations of Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 68.
During the focused assessment and interview, what information indicates that the client has an increased risk for osteoporosis? (Select all that apply. One, some, or all options may be correct.) Select all that apply Recent death of her husband of 30 years. Gave birth to her first and only child at age 30. Low body weight, thin build Parent with history of osteoporosis High alcohol intake
Low body weight, thin build Parent with history of osteoporosis High alcohol intake Recent death of her husband of 30 years. Stressful events, such as the death of a spouse, do not increase the risk for osteoporosis. Gave birth to her first and only child at age 30. Osteoporosis is not associated with the timing or number of pregnancies. Low body weight, thin build A low body weight, thin build is a nonmodifiable risk factor for osteoporosis.Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 868. Parent with history of osteoporosis Parental history of osteoporosis, especially mother associated with increased risk for osteoporosis.Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 868. High alcohol intake Consuming greater than 3 alcoholic beverages daily is a risk factor for osteoporosis.Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 868.
How should the nurse respond? Both terms mean the same thing, so you do have osteoporosis. Many persons with osteoporosis do not have any symptoms. Weakness and fatigue often increase as the condition worsens. You are fortunate that you are not having any symptoms yet.
Many persons with osteoporosis do not have any symptoms. Both terms mean the same thing, so you do have osteoporosis. The term osteopenia indicates decreased bone mass without the clinically increased risk of fracture that defines osteoporosis. However, osteopenia often leads to osteoporosis. Many persons with osteoporosis do not have any symptoms. Osteoporosis is often referred to as a silent disease or silent thief because the first sign of osteoporosis in most people follows some kind of a fracture Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 868. Weakness and fatigue often increase as the condition worsens. Weakness and fatigue are not symptoms of osteoporosis. You are fortunate that you are not having any symptoms yet. This statement does not accurately reflect the symptoms of osteoporosis and is also patronizing.
In addition to evaluating for the presence of subjective symptoms, what focused assessment technique should the nurse include in the ongoing assessment of the client's bone density? Record her grip strengths. Perform an Allen's test. Observe her feet and toes. Measure her height. Submit Previous Section
Measure her height. Record her grip strengths. Grip strength is not typically affected by the client's degree of osteoporosis. Perform an Allen's test. An Allen's test is performed to determine adequacy of ulnar artery perfusion. Observe her feet and toes. Osteoporosis does not impact the size or appearance of the feet and toes. Measure her height. Persons with osteoporosis often loose height over time as the vertebrae are compressed. Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 868.
How should the nurse respond? Excessive wear and tear during the growth years can weaken your bones as an adult. Being active in sports only increases the risk for osteoporosis if your bones break a lot. Brittle bones are primarily inherited and are not often affected by your level of activity. Participating in sports activities often helps the bones become stronger and denser.
Participating in sports activities often helps the bones become stronger and denser. Excessive wear and tear during the growth years can weaken your bones as an adult. Physical activity helps build bone mass, strengthening the bones. Being active in sports only increases the risk for osteoporosis if your bones break a lot. Multiple fractures do not increase the risk for osteoporosis. Brittle bones are primarily inherited and are not often affected by your level of activity. A positive family history is considered a risk factor for osteoporosis. However, osteoporosis is not primarily inherited and can be affected by activity. Participating in sports activities often helps the bones become stronger and denser. 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. Cooper, K., Gosnell, K. (2019). Foundations of Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 1080.
Which medication is most likely to have contributed to the decrease in the client's bone density? Diphenoxylate, an antidiarrheal, taken prior to the acute exacerbation for occasional episodes of diarrhea. Sulfasalazine, an antiinflammatory sulfonamide, administered during the acute exacerbation. Prednisone, a corticosteroid, taken during the acute exacerbation and for several months following. Propantheline, an anticholinergic, administered during the acute exacerbation. Submit
Prednisone, a corticosteroid, taken during the acute exacerbation and for several months following. Diphenoxylate, an antidiarrheal, taken prior to the acute exacerbation for occasional episodes of diarrhea. Antidiarrheal medications, such as Lomotil, do not typically impact bone density. Sulfasalazine, an antiinflammatory sulfonamide, administered during the acute exacerbation. This medication does not typically impact bone density. Prednisone, a corticosteroid, taken during the acute exacerbation and for several months following. Corticosteroid-induced osteoporosis is an important concern for patients who receive corticosteroid treatment for prolonged periods (longer than 3 months). Cooper, K., Gosnell, K. (2019). Adult Health Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 127. Propantheline, an anticholinergic, administered during the acute exacerbation. Anticholinergic medications do not typically impact bone density.
What action should the nurse implement? Advise the client that an immediate appointment will not allow adequate time to maintain NPO status before the test. Provide the client with the available choices of appointment times and allow the client to select the desired appointment. Schedule the client for the immediate appointment so that emergency treatment can be started, based on the test results. Instruct the client that it may be desirable to have a family member available following the test to drive her home.
Provide the client with the available choices of appointment times and allow the client to select the desired appointment. Advise the client that an immediate appointment will not allow adequate time to maintain NPO status before the test. It is not necessary to be NPO prior to a DEXA study. Provide the client with the available choices of appointment times and allow the client to select the desired appointment. 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 3 weeks. Cooper, K., Gosnell, K. (2019). Foundations of Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 36. Schedule the client for the immediate appointment so that emergency treatment can be started, based on the test results. Osteoporosis management does not require emergency treatment. Instruct the client that it may be desirable to have a family member available following the test to drive her home. There is no sedation involved with the DEXA, so the client can safely drive home following the test.
What information should the nurse provide the client concerning the effects of food allergies on osteoporosis screening? Advise the client that an ultrasound or CT scan may need to be prescribed, rather than the scheduled DEXA. Reassure the client that there are no dyes or products containing iodine used during a DEXA. Advise the client that their allergy to multiple food products increases their risk for hypersensitivity to the medication used during the test. Contact the DEXA technician to ensure that the contrast medium used does not contain any of these allergens.
Reassure the client that there are no dyes or products containing iodine used during a DEXA. Advise the client that an ultrasound or CT scan may need to be prescribed, rather than the scheduled DEXA. Ultrasounds and CT scans can be used to screen for osteoporosis, but DEXA studies are the Gold Standard for Bone Mineral Density (BMD) testing by the World Health Organization (WHO.) Reassure the client that there are no dyes or products containing iodine used during a DEXA. DEXA is a non-invasive procedure that does not involve the use of any dyes or cleansing agents that might contain allergens such as iodine. Cooper, K., Gosnell, K. (2019). Foundations of Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 158. Advise the client that their allergy to multiple food products increases their risk for hypersensitivity to the medication used during the test. No medication is used during this procedure. Contact the DEXA technician to ensure that the contrast medium used does not contain any of these allergens. There is no contrast medium used during this procedure.
Which reported information indicates the need to assign the client to the RN? There is no drainage in the hemovac drain of a client 2 days following an open reduction and internal fixation of the hip. Six hours following a hip arthroplasty, the client's autotransfusion collection device is full of sanguinous drainage. Twenty-four hours following a vertebral khyphoplasty, a client needs the surgical dressing changed. Twelve hours following a knee arthroplasty, a client reports pain when using the prescribed continuous passive motion device.
Six hours following a hip arthroplasty, the client's autotransfusion collection device is full of sanguinous drainage. There is no drainage in the hemovac drain of a client 2 days following an open reduction and internal fixation of the hip. This client is experiencing an expected decrease in postoperative drainage and does not require the expertise of the RN. Six hours following a hip arthroplasty, the client's autotransfusion collection device is full of sanguinous drainage. This client is experiencing a large amount of postoperative drainage and may require a transfusion, as well as close monitoring. The acuity of this client requires the expertise of the RN for assessment and transfusion management. Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 536. Twenty-four hours following a vertebral khyphoplasty, a client needs the surgical dressing changed. This sterile dressing change can be performed by the PN. Twelve hours following a knee arthroplasty, a client reports pain when using the prescribed continuous passive motion device. Pain is expected when moving the joint following arthroplasty and can be treated by the PN.
What instruction(s) should the nurse provide? (Select all that apply. One, some, or all options may be correct.) Select all that apply Try to take 1 tablet with each meal. 500 mg is adequate for women taking estrogen, but you now need at least 2 grams of calcium every day. As long as your vitamin supplement also contains Vitamin D, you will be receiving adequate supplementation. By taking 3 of your calcium tablets each day you will receive adequate amounts of calcium for your needs. Any additional calcium supplementation could cause you to have harmful symptoms of calcium toxicity.
Try to take 1 tablet withe each meal By taking 3 of your calcium tablets each day you will receive adequate amount of calcium for your needs Try to take 1 tablet with each meal. 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. Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 868. Skidmore-Roth, L. (2021). Mosby's 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 216. 500 mg is adequate for women taking estrogen, but you now need at least 2 grams of calcium every day. Two grams of calcium every day is more than the recommended amount of calcium for postmenopausal women. As long as your vitamin supplement also contains Vitamin D, you will be receiving adequate supplementation. An intake of 500 mg of calcium is insufficient for postmenopausal women, even with additional Vitamin D supplementation. By taking 3 of your calcium tablets each day you will receive adequate amounts of calcium for your needs. 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 HCP. Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 868. Any additional calcium supplementation could cause you to have harmful symptoms of calcium toxicity. An intake of 500 mg of calcium per day is insufficient for postmenopausal women.
To help determine why osteoporosis has developed, what question should the nurse ask the client? What medications have you taken during the last year? How many hours of sleep do you get per night? Have you experienced any infections recently? Do your hands or feet ever swell when you exercise? Submit Previous Section
What medications have you taken during the last year? What medications have you taken during the last year? Medications can contribute to the loss of bone density. Linton, A., Matteson, M. (2020). Medical-Surgical Nursing. (7th edition). St. Louis, Missouri. Elsevier. Pg. 868. Cooper, K., Gosnell, K. (2019). Adult Health Nursing. (8th edition). St. Louis, Missouri. Elsevier. Pg. 127. How many hours of sleep do you get per night? This question is unlikely to elicit relevant information about the loss of bone density. Have you experienced any infections recently? This question is unlikely to elicit relevant information about the loss of bone density. Do your hands or feet ever swell when you exercise? This question is unlikely to elicit relevant information about the loss of bone density.
Which response(s) are appropriate? (Select all that apply. One, some, or all options may be correct.) Select all that apply The medication is much better absorbed when taken on an empty stomach. Increased nausea often occurs when the medication is taken late in the day. You may prefer to take the medication with a specific meal once a week. It is important to have a weekly routine so you won't forget to take the medication. Make sure you remain upright for at least ½ hour after taking the medication.
the medication is much better adsorbed when take on an empty stomach make sure you remain upright for at least 1/2 hour after taking the medication The medication is much better absorbed when taken on an empty stomach. Bisphosphonates, alendronate should be taken on an empty stomach with a full glass of water to promote the best absorption. Skidmore-Roth, L. (2021). Mosby's 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 37. Increased nausea often occurs when the medication is taken late in the day. This is not the rationale for why the medication should be taken in the morning. You may prefer to take the medication with a specific meal once a week. Bisphosphonates, alendronate should not be taken with a meal. It should be taken 30 minutes before food or other medications. It is important to have a weekly routine so you won't forget to take the medication. A weekly routine is important. However, the nurse needs to explain the rationale for taking the medication in the morning. Make sure you remain upright for at least ½ hour after taking the medication. To avoid esophageal irritation, the client should remain upright for at least 30 minutes. Skidmore-Roth, L. (2021). Mosby's 2021 Nursing Drug Reference. (34thedition). St. Louis, Missouri. Elsevier. Pg. 37.