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Case Study 4
Medical Surgical (NUR425)
Arizona College of Nursing
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Martha Smitty and 81-year-old patient is admitted to the medical surgical unit after a recent fall resulting in a fracture of the right hip.
What areas of information need to be gathered by the nurse during the patient’s history?
I would ask the patient about any medical condition such as diabetes, hypertension, lungs, kidney or liver disease. Infections osteoarthritis, osteoporosis, spinal curvature abnormalities such as Kyphosis, any pre- existing disability. I would also ask the patient about her occupation. Any genetic disorder or disease that runs in the family. History of alcohol, tobacco or drugs use, history of problems with balance, posture, flexibility range of motion, numbness or weakness. History of joint pain, stiffness or deformity. History of previous falls, list of all medication (corticosteroids can cause bone loss), including over the counter, herbal and vitamin supplements, and any allergies to food or medications. I would also assess her nutrition.
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 primary 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”.
How does the nurse interpret “limited circumduction”? The patient is unable to move the arm at the shoulder joint in a circular manor through 360 degrees of range of motion. When the patient arrives the nurse correlates the “kyphosis” with what physical finding? What causes Kyphosis in the older adult?
Physical findings of Kyphosis show’s a forward curvature of the back bones (vertebrae) in the upper back area giving an abnormally rounded or humpback appearance. These postural changes can interfere with normal joint mechanisms and movements around the shoulder and hip joints. Kyphosis can be caused by poor posture and dehydration of intervertebral discs, narrowing of intervertebral spaces and osteoporosis, weak bones can cause spinal curvature, weakened vertebrae can develop compression fractures. How should the nurse explain the patients decreasing height? Loss of height is a normal process of aging, the shape of vertebrae can be changed by disk degeneration, with age the disks that act as cushions between spinal vertebrae flatten and shrink and worsen kyphosis.
What is the rationale for prescribing bone density testing of the hip in this patient? Hip bone mineral density testing is considered the most accurate test for osteoporosis and for predicting risk of hip fractures. Evidence based guidelines recommend hip bone mineral density as fist line test for osteoporosis.
Case Study 4
Course: Medical Surgical (NUR425)
University: Arizona College of Nursing
