Case Study 9.6 & 11.5
Gregory Cahill
Lakeview College of Nursing
March 2, 2012

1.  Weight bearing exercise, a well balanced diet with plenty of calcium and vitamin D, no smoking and no excessive alcohol intake are recommended in early life to prevent osteoporosis in later life (Mauk, 2010).  Violet worked on a dairy farm and maintained her own vegetable garden that could feed 6 people.  It appears that she was active and got plenty of exercise.  She probably ate a well balanced diet from the vegetables and consumed plenty of calcium and vitamin D from the diary farm.  She also mentioned that she never smoked or drank alcohol.
2.  Risk factors for osteoporosis include white or Asian race, low body mass index, and being female (Mauk, 2010).
3.  DEXA (dual energy x-ray Absorptiometry) uses 2 low powered x-rays which are absorbed by bone to calculate the mineral content of the bone ("Dexa-dual energy x-ray," 2008).  
4.  During a hysterectomy the ovaries are removed leading to a decrease in estrogen production.  This would lead to an increase risk for osteoporosis.
5.  Os-cal- mineral and electrolyte replacements/supplements- PO (Adults): Prevention of hypocalcemia, treatment of depletion, osteoporosis--1-2 g/day
      vitamin D- vitamin-helps the body absorb calcium-600-800IU daily 
     zoledronic acid (Reclast) - used to treat hypercalcemia and osteoporosis- causes the body to absorb calcium from the blood- given is an injection once or twice a year
     bisphosphate-causes bones to retain calcium and minerals
     raloxifene (Evista)- Therapeutic: bone resorption inhibitors Pharmacologic: selective estrogen receptor modulators- Binds to estrogen receptors, producing estrogen-like effects on bone, resulting in reduced resorption of bone and decreased bone turnover- PO (Adults ): 60 mg once daily                                                                    (Roth, 2012)

6.  b.  It is recommended to take this medication in the morning 30 minutes before taking any other drugs or eating. (Roth, 2012)

7.  Fall prevention is very important to the elderly.  To reduce falls you should get rid of rugs that can be tripped over, have adequate lighting; leave a light on at night in the bathroom, put up hand rails in the bathroom and shower.
8.  The elderly is one of the fastest growing demographics in the U.S. and osteoporosis primarily affects the elderly.

11.5
1.  Serum glucose, and hemoglobin A1c, BUN, and creatinine levels are high.  This could indicate a kidney problem for Mr. Nightwolf.
2.  Definition: Isolated systolic hypertension: systolic BP >140 mmHg and diastolic BP <90 mmHg. Etiology
1. Arterial wall thickening and stiffening, decreased compliance.
2. Left ventricular and atrial hypertrophy.
3. Sclerosis of atrial and mitral valves.
Age-Associated Changes in the Pulmonary System
A. Etiology
1. Decreased respiratory muscle strength; stiffer chest wall with reduced compliance.
2. Diminished ciliary & macrophage activity, drier mucus membranes. Decreased cough reflex.
3. Decreased response to hypoxia and hypercapnia.
B. Implications
1. Reduced pulmonary functional reserve.
a. At rest: No change.
b. With exertion: Dyspnea, decreased exercise tolerance.
2. Decreased respiratory excursion and chest/lung expansion with less effective exhalation. Respiratory rate 12 to 24 bpm.
3. Decreased cough and mucus/foreign matter clearance.
4. Increased risk of infection and bronchospasm with airway obstruction.
Age-Associated Changes in the Renal and Genitourinary Systems
A. Definitions: Cockroft-Gault Equation: Calculation of creatinine clearance in older adults:
For Men

For Women, the calculated value is multiplied by 85% (0.85).
B. Etiology
1. Decreases in kidney mass, blood flow, glomerular filtration rate (10% decrement/decade after age 30). Decreased drug clearance.
2. Reduced bladder elasticity, muscle tone, capacity.
3. Increased post-void residual, nocturnal urine production.
4. In males, prostate enlargement with risk of benign prostatic hyperplasia (BPH).
C. Implications
1. Reduced renal functional reserve; risk of renal complications in illness.
2. Risk of nephrotoxic injury and adverse reactions from drugs.
3. Risk of volume overload (in heart failure), dehydration, hyponatremia (with thiazide diuretics), hypernatremia (associated with fever), hyperkalemia (with potassium-sparing diuretics). Reduced excretion of acid load.
4. Increased risk of urinary urgency, incontinence (not a normal finding), UTI, nocturnal polyuria. Potential for falls.
Age related changes include isolated systolic hypertension, decreased pulmonary function and a decrease in kidney function.

4.  Increasing age, American Indian, smoking, and being male are all risk factors for Mr. Nightwolf.
5.  I would recommend these changes taken from "American heart association," 2012  “Choose nutrient-rich foods — which have vitamins, minerals, fiber and other nutrients but are lower in calories — over nutrient-poor foods. A diet rich in vegetables, fruits, whole-grain and high-fiber foods, fish, lean protein and fat-free or low-fat dairy products is the key”
6.  I would tell Mr. Nightwolf to start with stretching exercises and walking and to build up his exercising slowly.
7.  Almost all of Mr. Nightwolf’s labs look improved.  His diabetes is more in control and his kidney function has improved.  Mr. Nightwolf’s HDL could be high but has also improved.
8.  Life's Simple 7 taken from (Paddock, 2010)
1.	Never smoked, or quit more than a year ago.
2.	Having a BMI (body mass index) of less than 25 kg/m2.
3.	Exercising at a moderate level for at least 150 minutes, or at an intense level for 75 minutes per week
4.	Meeting four to five of the key components of a healthy diet in line with current AHA guidelines.
5.	Having a total cholesterol of less than 200 mg/dL.
6.	Blood pressure below 120/80 mm Hg.
7.	Fasting blood glucose below 100 mg/dL
Lifestyle changes of not smoking, eating a healthy diet and exercise are very important to a healthy heart.  The other criteria are measurements that will be affected by the lifestyle choices.

Citation
American heart association. (2012, Febuary 10). Retrieved from      http://www.heart.org/HEARTORG/Conditions/HeartAttack/UnderstandYourRiskofHeart  
     Attack/Understand-Your-Risk-of-Heart-Attack_UCM_002040_Article.jsp
Dexa-dual energy x-ray absorptiometry. (2008, July 28). Retrieved from   
     http://www.youtube.com/watch?v=7EkK1oMK5A8
Mauk, K. L. (2010). Gerontological nursing: Competencies for care (2nd ed.). Boston: 
     Jones & Bartlett..
Paddock, C. P. (2010, january 21). Life. Retrieved from  
     http://www.medicalnewstoday.com/articles/176651.php
Roth, L. (2012). Mosby\. (25th ed.). St. Louis, Mo: Mosby, Inc