29/30 very good with a few APA errors

Case Study 6 (9.6)
Nina Fainter
Lakeview College of Nursing
N309
March 2, 2012

Case Study 6 (9.6)
1.	Preventative measures for osteoporosis should be taken before the age of 20 and when bones are fully developed. Preventative measures include a diet with plenty of calcium, intake of vitamin D, no smoking or alcohol consumption, and regular exercise. Most calcium intake comes from milk, yogurt, broccoli, and some cereals. It’s important to discuss any further needed treatments to minimize the risk of developing osteoporosis with a physician. Also, nurses may provide education on osteoporosis and the prevention of it to children (Mauk, 2010).

2.	Being female is an uncontrollable risk factor of osteoporosis. If female, an estrogen deficiency can also be a contributing risk factor. Abnormal absence of menstrual periods is a risk factor for osteoporosis in females. Also, being thin or having a small body frame is a risk factor of osteoporosis. Caucasians and Asians have the risk factor of osteoporosis although African Americans and Hispanics are still at significant risk (Mauk, 2010).

3.	Anyone at the age of 50 should have a DEXA scan. It’s a simple procedure that measures the amount of calcium in the bones or if osteoporosis is present. It’s a low energy x-ray that measures muscle, bone, and fat. This scan shows body composition such as bone density, fat mass, and muscle mass (YouTube, 2011). 

4.	A hysterectomy can cause a deficiency in estrogen which is a risk factor for osteoporosis. Sometimes estrogen/hormone replacement therapy may be implemented to promote calcium in the bones or to replace estrogen that’s not being produced. This helps create a balance in hormones that help bone reabsorption and demineralization (Mauk, 2010).

5.	Os-Cal is also known as calcium carbonate. It is a calcium supplement and an antacid. It’s neutralizes gastric acidity in order to work. This medication should be taken in 1200mg doses orally every day. Vitamin D is a fat soluble vitamin. It is a parathyroid agent used as a calcium regulator. It increases intestinal absorption of calcium, provides calcium for bones, and increases renal tubular resorption of phosphate. This medication should be taken orally daily in 0.5-1 mcg doses. It should be taken orally with food for better absorption. Zoledronic acid is a bone resorption inhibitor. It inhibits osteoclastic bone resorption and activity. It also inhibits skeletal calcium release caused by stimulating factors released by tumors. This medication should be given as a 5mg IV infusion over 15 minutes or more every 12 months. Raloxifene is a hormone modifier and selective estrogen receptor modulator. It is a tissue selective estrogen agonist and antagonist. It causes agonist activity in the bone and lipid metabolism and antagonist activity on the breast and uterus. It reduces the resorption of bone and decreases bone turnover. This medication should be taken in 60mg doses orally every day (Mosby’s, 2011).

6.	B. Taking this med right before bedtime is recommended.
It is recommended that this medication be taking in the morning on an empty stomach, before eating and taking other medications. Take it with 6-8 ounces of water (Mosby’s, 2011). 

7.	To prevent falls and injuries in the home environment several safety measures can be taken. Throw rugs should be removed and carpet edges should be secured to reduce the risk of tripping. Reduce clutter and remove low furniture and objects on the floor that may be around the house. Clear any cords and wires that may be on the floor. Make sure there is adequate lighting at night, especially the pathway to the bathroom. If there is a staircase, install handrails and secure carpet on the stairs. Get rid of any chairs that may be too low to sit in and be difficult to get out of. Avoid the use of wax on floors unless it is a nonskid wax. Make sure that the telephone may be reached from the floor in case of a fall. Grab bars should be installed in the bathroom and shower. Rubber mats should be used in the shower and bathtub. When the shower is not in use, floor mats in the bathroom should be removed. Raised toilet seats may be helpful. Cracked sidewalks should be repaired outside. Handrails should be installed on stairs and steps outside the home. Shrubs outside the home should be kept trimmed and neat and adequate lighting should be kept by the doorways and path walks leading to the doors (Mauk, 2010). 

8.	Osteoporosis may be considered a national public health issue priority considering that over44 million Americans have this disease. Over 55% of adults over the age 50 have this disease and is most common in women. Eighty percent of osteoporosis cases are in women (Mauk, 2010). Many of Americans may have low bone density and do not know it or are not sure how to prevent osteoporosis so it is important to educate people on the preventative measures that can be taken and risk factors of osteoporosis. Just think of what us Baby Boomers are going to do with the stats!

References
Mauk, K. L. (2010). Gerontological nursing: Competencies for care. (2nd ed.) Sudbury, MA: Jones & Bartlett.
Skidmore-Roth, L. (Ed.). (2011). Mosby's nursing drug reference (24th ed.). Philadelphia: Elsevier Mosby.
YouTube. (2011, August 14). MeasureUp- dexa scan. Retrieved from http://www.youtube.com/watch?v=rdPI9bE6SGU&feature=related

Case Study 7 (11.5)
Nina Fainter
Lakeview College of Nursing 
N309
March 2, 2012

Case Study 7 (11.5)
1.	Mr. Nightwolf has a previous history of coronary artery disease and angina. He smokes four cigarettes a day and has type II diabetes. He is slightly hypertensive as his blood pressure is 142/88 and anything over 140 systolic or 90 diastolic is considered hypertensive. All of these are risks for heart disease. He is also short of breath with increased activity which would be of concern. A normal BMI is considered 22-27 and Mr. Nightwolf’s is 28.6 so he is considered overweight. His pedis pulses only being a 1+ is likely attributed to the fact that he is a type II diabetic (Mauk, 2010). His triglycerides are 330 mg/dl which is high because normal level is below 150 mg/dl. He has an HDL level of 38 mg/dl which anything under 40 mg/dl is a positive risk factor for coronary heart disease. An optimal LDL level is below 100 mg/dl and Mr. Nightwolf’s is 130 mg/dl which is considered borderline high. His glucose 180 mg/dl which is high compared to the normal level of 120mg/dl. His hemoglobin A1c is 8.3% and a normal level for diabetic people is typically under 7% (Corbett, 2008). What about his BUN & creatinine?

2.	Age-related changes may have resulted in Mr. Nightwolf’s hypertension. This may be due to the walls of the arterials thickening and hardening. Also, the enlargement of the left ventricle and arterial may have contributed in this. Sclerosis can occur in the atrial and mitral valves. When resting these changes cause no change in heart rate or cardiac output but when active it causes a decreased maximal heart rate and cardiac output. It also causes exhaustion and shortness of breath. It will cause a slower recovery time from increased heart rate also. It causes inflamed varicosities and the risk for arrhythmias and has the potential to cause syncope. It causes strong arterial pulses but diminished peripheral pulses. Extremities may be cool to the touch. He may also have decreased gastric motility and atrophy of GI mucosa. He could have an impaired sensation to defecate. This may cause constipation and risk of incontinence (Cotter & Smith, 2008).

3.	Nurse should expect a blood count to be drawn with bleeding times. Liver tests should also be down such as ALT, ALB, and AST. A chest x-ray will most likely be done to examine the heart and lungs. His oxygen saturation should be checked when resting and with increased activity to determine if he needs oxygen. The nurse should also listen to lung sounds and heart sounds. He should perform a skin examine since the patient is diabetic and has the risk of neuropathy. 

4.	Mr. Nightwolf is at a greater risk for a cardiovascular event for many reasons. He smokes four cigarettes a day and smoking puts him at risk for a myocardial infarction. He also has diabetes which is another risk factor for myocardial infarction. He has high cholesterol levels, both HDL and LDL, which is a risk for a heart attack. He also has high blood pressure and according to his BMI is considered overweight which both put him at risk for a heart attack (American (b), 2012).

5.	Mr. Nightwolf should eat more fruits and vegetables. If a 2000 calorie diet is consumed 4-5 servings of fruits and vegetables per day should be taken in. Whole grain foods are lower in saturated fat and cholesterol and he should consume more of these. They are also higher in fiber. Some whole grain items may include whole wheat bread, rye bread, and whole grain cereal. Liquid vegetable oils such as olive, canola, corn, or safflower oil should be used in place of solid fats when cooking. Skinless poultry, fish, and beans are also lower in saturated fat and cholesterol. Mr. Nightwolf should also pay special attention to food labels to watch sodium and fat content. This may help him make better food choices. He may use substitutions such as fat free milk in place of whole milk or soft margarine in place of real butter.   Also instead of using whole eggs, he may use egg whites or egg substitutes (American(a) , 2011).

6.	It is recommended that Mr. Nightwolf exercise for 30 minutes most days of the week. It does not have to be 30 consecutive minutes but can be shorter periods of activity throughout the day. The intensity should be increased just to raise the heart rate and the body temperature.  It’s recommended that he aim to exercise every day to develop a healthy habit of this and build motivation. He may do this by walking for 30 minutes every day (Mauk, 2010). 

7.	His triglycerides are 250 mg/dl and were previously 330mg/dl. They are still elevated but are decreasing. His blood glucose is down to 148 mg/dl fasting as opposed to 180 mg/dl and his hemoglobin A1c is down to 7.2% as opposed to 8.3%. This shows that he is eating a better diet. His BUN and creatinine were not elevated before but were right on the border. They have now also improved. His diet and exercise are improving his labs (Corbett, 2008).

8.	Life’s Simple 7 include getting active, controlling cholesterol, eating better, managing blood pressure, losing weight, reducing blood sugar, and stopping smoking. Exercising 30 minutes a day lowers the risk for heart disease, stroke, and diabetes. By controlling cholesterol, arteries remain clear from blockage and plaque buildup. Eating better includes eating a diet lower in saturated fat, trans fat, cholesterol, sodium and sugar and eating food higher in whole grain, fiber, protein, and fruits and vegetables. This helps reduce the risk of cardiovascular disease. By managing blood pressure, the risk for heart disease is reduced. Normal blood pressure prevents injured blood vessel walls, prevents blockage, and allows adequate blood supply to all tissues. By controlling weight, it also helps control the risk of hypertension, high cholesterol, and diabetes. By controlling blood sugar, it protects the heart, kidneys, eyes, and nerves. High blood sugar causes hydration issues. Smoking is a high risk of cardiovascular disease so by quitting we are helping to eliminate that risk (American Heart & American Stroke, 2012).

References

American Heart Association(a) . (2011, June 22). 5 goals to health eating. Retrieved from http://www.heart.org/HEARTORG/GettingHealthy/WeightManagement/LosingWeight/5-Goals-to-Healthy-Eating_UCM_307257_Article.jsp#.T1F_ZfGPV2C
American Heart Association(b). (2012, January 9). Heart attack risk assessment. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartAttack/HeartAttackToolsResources/Heart-Attack-Risk-Assessment_UCM_303944_Article.jsp#.T1F6tPGPV2B
American Heart Association & American Stroke Association. (2012). The simple 7: Heart health factors. Retrieved from http://mylifecheck.heart.org/Multitab.aspx?NavID=8&CultureCode=en-US
Cotter, V. T., & Smith, C. M. (2008, March). Normal aging changes nursing standard of practice protocol: Age-related changes in health. Hartford Institute of Geriatric Nursing. Retrieved from http://consultgerirn.org/topics/normal_aging_changes/want_to_know_more#item_4
Corbett, J. V. (2008). Laboratory tests and diagnostic procedures with nursing diagnoses (7th ed.). New Jersey: Pearson Prentice Hall.
Mauk, K. L. (2010). Gerontological nursing: Competencies for care. (2nd ed.) Sudbury, MA: Jones & Bartlett.