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Case Study Six
Amanda L. Miller
N309 Nursing of the Gerontological Client
February 18, 2012

		Case Study Six: Osteoporosis
	What Violet is saying is that along with a diet rich in calcium, she also worked outside in the garden, so she maintained a regular exercise. She also refrained from smoking and alcohol. This lifestyle she maintained actually lessened her risk for osteoporosis. 
	Risk factors for osteoporosis include; being female, age, race, family history, and frame size (Mayo-Clinic. 2011). Females are much more likely to get osteoporosis than males. As we age the older we get is increasing the risk of bone loss. White and Asians are at higher risk of osteoporosis than other races. If you have a family history of osteoporosis, you are at great risk of getting it. And smaller frames are at risk of osteoporosis because there is less bone mass to draw from as you age (Mayo-Clinic. 2011)
	http://www.youtube.com/watch?v=BP0JxkRTOPU&feature=related   The video explaining a DEXA test. 
	A hysterectomy removes your sex organs and you should be on estrogen replacement therapy. Low estrogen levels is a huge risk factor for developing osteoporosis, because it leads to weakening of the bones (Mayo-clinic. 2011). 
	Zoledronic acid (reclast) Drug category- Bisphosphonate . Route/frequency- injection as ready to infuse solution. 5mg/100ml. IV infusion over no less than 15 minutes once a year. Action- inhibits bone reabsorption, probably by inhibiting osteoclast activity and osteoclastic resoprtion of mineralized bone and cartilage. Decreases calcium release induced by the stimulatory factors produced by tumors (Drug Handbook. 2011. Pg 1416).
	Raloxifene (Evista). Drug category-Aniosteroporatic. Route/frequency-Tablet 60mg. PO once daily. Action-Reduce resorption of bone and decreases overall bone turnover. These effects on bone are manifested as reductions in serums and urine levels of bone turnover markers and increases in bone mineral density (Drug Handbook. 2011. Pg. 1163)
	Taking fosamax right before bedtime would be the statement that indicates further teaching. According to the Drug Handbook, it is recommended to take the drug with the first drink you have in the morning, and waiting 30 minutes till consuming any food to ensure absorption. 
	Safety measures, would be ensuring that there aren’t any loose rugs about the house so tripping and falling is avoided. Another safety measure would be provide good lighting in hallways especially around to the bathroom. Eliminating clutter will reduce falls. Making sure proper footwear is provided and worn in the home. Loose clothing is avoided to limit getting tangled up or caught on something that could cause a fall. Having  a low lying bed will ensure safety. 
	According to the Surgeon General, osteoporosis is the leading most common bone disease and there is a significan’t increase in the disease for future generations of the elderly. There is also a look at the rising costs of osteoporosis in healthcare, and how it influences a downward spiral of physical and mental health (Bone Health. 2004) What about the fact that the Baby aboomers are aging and that there are more of us than you?

References
Deglin, J., & Vallerand, A. (2011). Davis’s drug guide for nurses (ed.).  Philadelphia, PA: F.A. Davis.             I changed this so look at it

Mayo Clinic. Osteoporosis .(2010, August 14). Retrieved from 

	http://www.mayoclinic.com/health/osteoporosis/DS00477/DSECTION=lifestyle-
	
	and-home-remedies

Bone health and osteoporosis: A report of the surgeon general part two. (2004, October 14). 
Retrieved from http://www.surgeongeneral.gov/library/bonehealth/part_two.html

Case Study Six: Hyperlipidemia
	Labs and patient history to be concerned include his smoking history and his waist circumference.  Blood pressure and pedis pulses are both concerning. His triglycerides are high as well as his serum glucose level. His BUN is also high. 
	His blood pressure of 142/88 is actually considered normal, according to Consultgeririn.org. They state that  it is because of arterial wall thickening and ventricular atrial hypertrophy. Decreased respiratory muscle strength is considered normal in aging, as well as decreased muscle mass. Which explains why he is unable to run 5 miles when he was younger (2008). 
	Nursing care for pulmonary assessments will be to ascultate the lungs, check nasal airway. Also check the positioning of the patient, and maintain hydration and mobility. Inspect chest expansion, and respiratory rate, check abg’s, and pulse oximetry (Want to know more. 2008). For musculoskeletal system checks, you will want to check ROM.
	According to Americanheart.org, risk factors that contribute to both stroke and myocardial infarction are the following, high LDL, Low HDL, high blood pressure, smoking, diabetes, physical inactivity, and being overweight or obese (2011).
	Something he could consider for nourishment is avoid frozen meals and and canned soups. I would suggest it’s available in his area that he should consider meals on wheels for meals. Another suggestion would be to consider the DASH diet, and perhaps work it out with his daughter to make pre made meals for the week that are following the dash diet. 
	A good exercise routine for him would be to try to focus on being just more physically active in day to day activities. Instead of focusing on doing only 30 minutes per day, splitting it up throughout the day. Walking is a great activity, but it is important to check over his ROM, and discuss the importance of proper footwear, also to steer clear of clutter so he doesn’t trip. Another thing to discuss is that he feels well before starting any physical activity. It is important to have energy when engaging in physical activity, so fitting in a snack before activity is advised.  Cite source 
	His triglycerides are down, as well as blood glucose.  The BUN level is lowered as well. So this indicates that his nutrition is getting better. What about his other labs?
	Life’s simple 7’s include the following; Never smoked, or quit more than a year ago. Having a BMI (body mass index) of less than 25 kg/m2. Exercising at a moderate level for at least 150 minutes, or at an intense level for 75 minutes per week. Meeting four to five of the key components of a healthy diet in line with current AHA guidelines. Having a total cholesterol of less than 200 mg/dL. Blood pressure below 120/80 mm Hg. Fasting blood glucose below 100 mg/dL. Cite source

References
Paddock, C. P. (2010, January 21). Life's simple 7 measures for healthy heart. Retrieved from 
http://www.medicalnewstoday.com/articles/176651.php 
Smith, C. M., & Cotter, V. T. (2008, March). Normal aging changes nursing standard of 
practice protocol: Age-related changes in health. Retrieved from 
http://consultgerirn.org/topics/normal_aging_changes/want_to_know_more
How cardiovascular & stroke risks relate . (2011, April 21). Retrieved from 
http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/HealthyLivingAfterStr
oke/UnderstandingRiskyConditions/How-Cardiovascular-Stroke-Risks-
Relate_UCM_310369_Article.jsp