Kalyn you need to fix you header. It is Running head: CASE STUDY WEEK 6 and the last half will be all capitals on the following pages.
Need some improvement on reference sheet and it needs to be in alphabetical order.

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Gerontology Case Study Week 6
Kalyn Madej
Lakeview College of Nursing
N309 Nursing of the Gerontological Client
March 2, 2012

Case Study 11.5: Hyperlipidemia

1.	Mr. Nightwolf has had a variety of laboratory work done on admission. Upon looking at the results it showed that his triglyceride level was 330 mg/dl. This is abnormally high and the normal lab values are normally 10-150 mg/dl with the optimal goal for the number to be lower. This can be a concern since it may represent problems with the liver. Since he has diabetes this may be what is leading him to have a higher level of triglycerides. Also from the history it says that he was diagnosed with coronary artery disease which may be a result from the high levels of cholesterol. (A.D.A.M, 2011).What about the rest of the labs? LDL, HDL, HA1C, glucose, BUN, creatinine?

2.	Some changes that may be due to common age related changing of Mr. Nightwolf would possibly be a gain in weight increasing his BMI since he is less active due to his shortness of breath and lack of exercise. His radial pulse is considered normal but his doralis pedis pulse was +1. This may be done because of poor perfusion since he is having changes with his heart. Some age associated cardiovascular changes would be isolated systolic hypertension with the systolic being greater than 140mmHg and diastolic less than 90 mmHg. There will be some signs of thickening of the arterial wall. There can be some left ventricular and atrial hypertrophy and sclerosis of atrial and mitral valves. (Smith, 2008).

3.	More blood work may be requested and make sure that the patient was actually fasting before the initial labs were taken. The patient may also have a thyroid function test to check for an underactive thyroid gland. (A.D.A.M., 2011).  The nurse should make sure that she takes a daily weight. The nurse should assess the skin to check for coolness and the pulses. The nurse should do take the vitals every four hours. The nurse should make sure that they are listening to the lungs since he is now complaining of shortness of breath.

4.	Since Mr. Nightwolf is an American Indian according to the American Heart association (2010) he is at a higher risk for cardiovascular events. This includes coronary heart disease, stroke, high blood pressure, and acute myocardial infarction. Mr. Nightwolf is also considered obese which is has been causing an increase in mortality rates. After doing some research his lifestyle is more of the issue than his race.

5.	Since Mr. Nightwolf’s normal diet is high in fat and salts so there are many things that can be done to change that. By limiting the intake of canned foods. Also limiting the amount of frozen meals that he eats since they are high in salts to preserve the food.  He should try eating fresh foods and vegetables. When it comes to meats he should try to choose lean meats and stay away from fried foods. Avoiding fast food restaurants will help decrease the amount of fats and salts consumed. If Mr. Nightwolf will stick to these diet changes it will help avoid the possibilities of stroke or heart attacks. A great way to start this and keep track of the diet is to keep a journal to record his entire food intake. Cite source

6.	Now that Mr. Nightwolf realizes he has been making poor choices and wants to make proactive changes to begin exercising there are some things that he can try. He should make sure that when he is starting off that he takes it easy and does not over do it. He should have someone there to assist him with his workouts to make sure that everything is okay. He should not feel discouraged if he is not able to do lengthy workouts since he has been out of shape for so long. He can start out by doing short distances of walking. He can walk around the neighborhood a couple times a week to build up his endurance. He should start of slow and build his strength up. He should walk about 20-30 minutes. 
Cite source
7.	After the 3 months his lab reports showed some changes. His triglyceride levels have lowered quite a bit since he has started changing his lifestyle habits. He has also seen a change in his LDL cholesterol level. This means that he is lowering his bad cholesterol to within the normal limits. His creatinine level along with his BUN level has decreased making them not as big of a concern. 

8.	After talking with Mr. Nightwolf he reminded him of the “Life’s Simple 7”.  According to the American Heart Association and American Stroke Association (2012), this includes getting active, controlling cholesterol, better dietary habits, managing your blood pressure, losing weight, reducing your blood sugar, and to stop smoking. At least 30 minutes of physical activity five times a week can help lower the risk for heart disease, stroke, and diabetes. By controlling cholesterol levels by exercise or dietary habits with foods lower in saturated fats, trans fats, cholesterol, sodium and added sugars can be beneficial to the patient. Replacing those foods with foods high in fiber, lean meats, and fruits and vegetables is an easy step. Since high blood pressure is a main factor in heart disease. This can be managed by diet as well, exercise, management of stress, and limiting the use of things like alcohol and tobacco products. Losing weight or managing your weight is another healthy life style choice. According to the American Heart Association and American Stroke Association (2012), a BMI of 30.0 and above puts people at a higher risk for heart disease. In patients with high blood sugar it can quicken the onset of diabetes by having a healthy blood sugar of below 100 is the goal. Eliminating smoking can help improve your health tremendously. Smoking has been related to many disease especially ones related to the heart. People who smoke are at greater risk for cardiovascular disease. If Mr. Nightwolf sticks to the “Life’s Simple 7” he will be on his way to becoming healthier and living a longer life. 

Case Study 9.6: Osteoporosis
1.	According to Mauk, “Preventing osteoporosis in adolescent years would include eating a well-balanced diet with plenty of calcium and vitamin D, no smoking or excessive alcohol intake, plenty of weight-bearing exercise, and discussing any needed treatments with the physician to minimize the risk of the disease” (Mauk, 2010, p. 427). Violet has done a variety of activities that are now currently recommended to prevent osteoporosis. She stated that she once worked on a dairy farm and consumed all their products along with working in a vegetable garden which was used to feed her family. She also did not smoke or drink throughout her lifetime. Mauk talked about eating a well balanced diet with calcium is a great prevention tool. It was also explained that not excessively smoking or drinking is a great prevention measure. Without prior knowledge of this Violet was already doing things in her younger years to prevent her from developing osteoporosis. 
2.	Osteoporosis is seen more often in women, this accounts for 80% of cases. It is also possible for an ethnicity to be more at risk for development of this. It is seen more often among whites and Asians. A thing or small frame is at greater risk for the development of osteoporosis. (Mauk, 2010, p. 426-427). Violet was able to control her lifestyle choices she was not able to control her biological factors that put her at risk for osteoporosis. Because of this she is considered at a higher risk.
3.	The DEXA test is done where a radioisotope is injected into a vein in your arm.  The patient is not able to smell or taste the radiation. The blood then carries the radiation to the bones. Pictures are than taken immediately after the injection. The gamma camera is used to visualize the substance in the bones. This takes about 30 minutes to take all of the pictures. A second set of pictures is then taken. Once the test is analyzed the results will show your bone density (KMH Labs USA, 2010). 
4.	When a hysterectomy is done the body goes into menopause and stops producing estrogen. Estrogen is made and can help prevent osteoporosis. The estrogen is produced in the ovaries so once they are removed there may be a lack of estrogen in the body that may affect the bones.  After a hysterectomy a bone scan may be done to make sure that the lack of estrogen does not affect the bone mass. (AHFS Consumer Medication Information, 2010). 
5.	Medications:
-Zoledronic acid (reclast):
	- Drug Category: bone resorption inhibitor
	-Route/Frequency: IV INF 5mg> 15 min or q12months
-Action: Potent inhibitor of osteoclastic bone resorption; inhibits osteoclastic activity, inhibits skeletal calcium release caused by stimulating factors released by tumors; reduction of abnormal bone resorption is responsible for therapeutic effect in hypercalcemia; may directly block dissolution of hydroxyapitate bone crystals
	- Raloxifene (Evista):
		- Drug Category: bone resorption inhibitor
		-Route/Frequency: PO 60mg/day, max 60mg/day
-Action:Tissue selective estrogen antagonist; agonist activity in bone and lipid metabolism; antagonist activity on breast and uterus; reduces resorption of bone and decreases bone turnover
	-OS- Cal:
		-Drug Category: calcium supplement, antacid
		-Route/Frequency: 1000-1500 mg/day
		-Action: neutralizes gastric acid
Cite source
6.	If the patient states B. “taking this med right before bedtime is recommended” they need more teaching on the medication. Aldendronate (Fosamax) should be taken in the morning after you get out of bed before eating or drinking anything.
7.	There are a variety of safety measures that can be done to help eliminate potential home hazards that may result in a fall or an injury. First off you can clear your home of clutter. It is important to make sure there are not things in the way of the first step.  This would include things like eliminating rugs from the house and making sure there are no long cords that are not secured down. The stairs in the home need to be well lit and have some time of secured railings. A fall that involves stairs can be fatal. Grab bars should be installed in the bathroom area for toileting and showering. When walking throughout the house wearing rubber soled shoes or slippers to help with traction. This helps prevent falls.  (Vann 2012, p. 1). These simple things can help the elderly adults in their home to prevent or lessen fall risks. 

8.	According to Mauk, “Over 44 million Americans including 55% of adults age 50 or over have this disease” (Mauk 2010, p. 426). Osteoporosis is becoming a more common diagnosis. It should be considered a public health issue. Many people are living with it and there are so many things done to prevent it. This should be publicized and discussed to all patients. The more things people do to prevent osteoporosis when they are younger the better the outcomes will be for the future. The baby boomers are aging and will create a huge increase in osteoporosis cases and the financial burden of treating it

References

Case Study 11.5: Hyperlipidemia

Board, A.D.A.M. Editorial. (2011) Causes, Incidence, and Risk Factors. High Blood Cholesterol Levels. U.S. 

 National Library of Medicine. Retrieved from 

<http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001440/>.
Here is how I would have done this one

National Institute of Health, National Center for Biotechnology Information. (2011).
High cholesterol levels. A.D.A.M. Medical Encyclopedia. Retrieved from PubMed       at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001440/>

Smith, C.M., & Cotter, V.T. (2008). Nursing standard of practice protocol: Age-related changes 	
	in health. Hartford Institute for Geriatric Nursing. Retrieved from 
	
http://consultgerirn.org/topics/normal_aging_changes/want_to_know_more#item_4

American Indians/Alaska natives and cardiovascular diseases-Statistics. (2010). American Heart 
	Association. Retrieved from 	http://www.americanheart.org/presenter.jhtml?identifier=3000929 

Life’s Simple 7. (2010). American Heart Association. Retrieved from 
	http://mylifecheck.heart.org/Multitab.aspx?NavID=14&CultureCode=en-US 

Case Study 9.6: Osteoporosis

Mauk. K. L, (2010). Management of common illnesses, diseased, and health
 
conditions. In K. L. Mauk (Ed.), Gerontological nursing: Competencies for care. (2nd ed., 	pp. 426-427). Sudbury, MA: Jones & Bartlett

KMH Labs USA. (2010, January 23). Bone scan- Mayland, USA- dexa scan- bone

Densitometry. Retrieved from http://www.youtube.com/watch?v=-z3OZCHhlhY

Vann, M., Fall prevention strategies that reduce osteoporosis fracture risk. Health

	Information, Resources, Tools & News Online-EverdayHealth.com. Retrieved from
	
	http://www.everydayhealth.com/women-health/osteoporosis/living/index.aspx

AHFS Consumer Medication Information. Estrogen-PubMed Health. National Center for 

	Biotechnology Information. Retrieved from

 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000806/

National Institute of Health, National Center for Biotechnology Information. (date?). 	Estrogen. AHFS Consumer Medication Information. Retrieved from PubMed at  	http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000806/

		 
Roth, L. (2012). Mosby’s 2012 nursing drug reference (25th ed.). St Louis, MO: Elsevier/Mosby