CEBU INSTITUTE OF TECHNOLOGY

U N I V E R S I T Y

COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES

N. Bacalso Avenue, Cebu City 6000, Philippines

CASE PRESENTATION
GERONTOLOGY

Submitted by:

Quijano, Joule Peirre

Rezaba, Angel IV
Tan, Andrian Michael
Antipolo, Alyssa
Añana, Jenevieve
Aguado, Mark Anthony
Alcantara, Dolly Shane
Ayoma, Elaizza Claire
BSN 3 – G8

Submitted to:

Dr. Sitti Shierwina Al-Jumayile, RN, MAN

Clinical Instructor

November 2021
 I. INTRODUCTION

According to NHS 2019, osteoporosis is a condition that weakens bones, making them more
fragile and prone to breaking. It takes years to develop and is frequently only discovered after a
fall or a violent impact breaks a bone (fracture). Broken wrists, hips, and vertebrae are the
most prevalent injuries associated with this health problem, which is more common in the
elderly. The majority of older adults, however, have osteoporosis in their lower extremities. As
stated in the National Center for Biotechnology Information 2004, Fractures, which may be the
earliest apparent evidence of condition in patients, are the most serious problem caused by
bone disease, particularly osteoporosis. An estimated 1.5 million people are fractured each year
as a result of bone disease. On the other hand, The National Health and Nutrition Examination
Survey (NHANES) revealed that only 1 percent of men and 11 percent of women age 65 and
older reported that they had osteoporosis; testing at the hip showed that four times as many
men (4 percent) and 2.5 times as many women (26 percent) actually had the disease (NCBI,
2004).

Despite the fact that a broken bone is often the first sign of osteoporosis, some older
persons develop the stooped (bent forward) posture. It occurs when the spine's bones have
cracked, making it harder to sustain the body's weight. According to NHS 2019, Osteopenia is
the condition that precedes osteoporosis. When a bone density scan reveals that your bone
density is lower than the average for your age, but not low enough to be classified as
osteoporosis, you have osteopenia. Osteopenia isn't always followed by osteoporosis. It is
dependent on a number of factors. Based on the study of 2019 in the UK, osteoporosis affects
about 3 million people, and over 500,000 people are treated in hospitals each year for fragility
fractures (bones that break after falling from a standing height or less) (NHS, 2019). From the
data presented on the precedent paragraph, it shows that the cases is increasingly approaching
to a substantial number of population. Bone loss is a natural aspect of growing older, although
some people lose bone far more quickly than others. This can result in osteoporosis and a
higher risk of breaking a bone. Although seen in most studies that older women are more prone
to osteoporosis, men, younger women, and children can all be affected by it too. There are
ways that osteoporosis can be diagnosed. If your physician believes you develop osteoporosis,
they can use an internet software like FRAX or Q-Fracture to calculate your future risk of
breaking a bone. They might also recommend a bone density scan to assess your bone
strength. It's a quick, painless treatment that takes 10 to 20 minutes, depending on which body
region is scanned. Osteoporosis is treated through preventing and healing broken bones, as
well as taking medicine to strengthen your bones. Your risk of breaking a bone in the future will
determine whether or not you need treatment. This will be determined by a variety of factors,
including your age, gender, and the findings of your bone density scan. If you require
treatment, your doctor can advise you on the safest and most effective course of action. If
you're at risk for osteoporosis, you should take precautions to protect your bones such as taking
exercises, eating healthy especially foods rich in calcium and vitamin D, and of course, making
lifestyle changes.

If you've been diagnosed with osteoporosis, you can take steps to lower your risk of falling
by removing risks from your house and getting regular vision and hearing examinations.
Osteoporosis can sometimes become painful, but according to NHS 2019, you can use hot and
cold therapies, such as warm baths and cold packs, as well as relaxation techniques, to help
you recover from a fracture. If the pain becomes unmanageable, Bisphosphonates are usually
the first line of treatment for osteoporosis if the discomfort becomes unbearable. Alendronate
(Fosamax), a weekly tablet, is one of them. Risedronate (Actonel) is a tablet that is taken once
a week or once a month (Mayo Clinic, 2021).
 II. NURSING HEALTH HISTORY

Biographic Data

Patient MFT is a 76-year-old female, a Roman Catholic and was a teacher but now a
housewife. She weighs 61 kg with a height of 5’2. Her chief complaints include cracking sounds
and pain upon moving in the knee and hips area and stooped posture. The result of her vital
signs are within normal ranges with a BP of 130/80mmHg. She is having a hard time to do
chores due to limited mobility. She does not have any past medical history but according to her,
both her mother and father have had osteoporosis when they were alive. The patient does not
know as well the food and drug allergies thus far.

III. GORDON’S FUNCTIONAL HEALTH PATTERN and REVIEW OF SYSTEMS

Gordon’s Criteria Before Admission During Admission

I. HEALTH PERCEPTION -
HEALTH MANAGEMENT
PATTERN
1. How was general
description of the client’s
health prior to hospitalization
or consultation?
2. Any childhood or past year
illnesses (both physiologic
and psychiatric alterations)?
Any absences from work if
client or patient is working?
3. The most important things
the client/patient does to keep
healthy? Use of cigarettes,
alcohol, drugs?
4. Accidents or injuries (home,
work, driving)? Any
operations, treatments and
medications received?
5. In past, are there any
health suggestions that were
easy for the patient to
comply? what do you think
causes this complaint?
Actions taken when symptoms
perceived? Results of action?
According to the patient, she
did not have a history of
hospitalization, but she had a
consultation about her
condition when she felt pain
upon moving. She also
verbalizes that she doesn’t
have any childhood illnesses
but sometimes she would be
absent to her work due to her
fever. She does not have any
vices like drinking alcohol or
using cigarettes.
The patient stated that her
Blood Pressure is quite high
before but she didn’t take any Verbalized feelings of hip and
medications and instead will
do some light exercises such
as walking for 20 minutes
everyday and eating
vegetables.
Patient MFT doesn’t have any easy for the patient to comply
record of hospitalization but
she went to a consultation
about her pain felt in hips. She medications. Patient keeps
doesn’t have any childhood
illnesses and sometimes has
absences in her work due to
fever.
The patient eats a complete
set of meals every day and
doesn’t have any vices like
drinking alcohol and using
cigarettes to stay healthy. The and aware that her family
patient has not experienced
accidents or injuries. The
patient has no health
suggestions to comply.
Patient’s parents have
osteoporosis.
The patient feels that it is
most important that her needs health care setting and by the
will be met and maintains her
healthy state of mind and
body in health care.
During admission, the patient
verbalized that she needs to
take care of health by being
careful of her food and drinks
especially now that she is
having an osteoarthritis. She
stated that she doesn’t take
any vices but her father is a
first hand smoker in her
family. According to the
patient, she still experiences
pain in her hips and knees.
She mentioned that the doctor
prescribed her a medication
which is a Fosamax drug to
relieve pain.
Patient was in pain and
displayed minimal discomfort.
knee pain and needs to take
care of health by being careful
of her food and drinks
especially now that she was
diagnosed with osteoporosis.
Health suggestions that are
is avoiding alcohol and vices
and drinking prescribed
herself busy by talking to her
family, SO and friends. When
symptoms are perceived, the
patient changes her position
and continues bed rest. The
actions resulted in minimal
pain.
Patient is health conscious
history of illness is dominated
by osteoporosis and is
controlling her diet and
lifestyle. Patient feels that
immediate care should be
given, and proper health
management should be
observed and given in a
healthcare provider.
III. NUTRITIONAL-
METABOLIC PATTERN
1. Describe the typical daily
food intake? Supplements
(vitamins, type of snacks)?
2. State the weight of the
patient in relation to the
height. What is the
significance of his weight to
his height?
3. Can the patient consume
his food during meal or snack
time? If not, why?
4. If the patient has a wound,
does it heal well or poorly?
Any skin problems like
lesions, dryness and dental
problems?
IV. ELIMINATION PATTERN
1. Describe the urine and
bowel elimination pattern?
Frequency? Character?
Discomfort? Problem in
control? Use of laxatives as
over the counter drug or
prescribed? Odor problems?
2. Any body cavity drainage,
suction, and so on that aids
the patient in elimination?
IV. ACTIVITY-EXERCISE
PATTERN
1. Is there sufficient energy for
desired or required activities?
2. Does the patient exercise
regularly? What type of
exercise?
3. What are the patient’s
activities in This spare-time /
leisure time? If the patient is a
child, what play activities does
he indulging in?
4. Perceived ability (code for
level) for:
Criteria Before During
Admission Admission
Feeding 0 0
Bathing 1 2
Toileting 0 2
Home 1 4
Maintain
Dressing 0 0
Prior to being diagnosed with
osteoporosis, the patient’s
typical daily food intake
consists mostly of
carbohydrates such as a large
portion of rice every meal.
She takes vitamins for her
immunity and consumes any
kind of snack available, mostly
are biscuits and breads. She
would also satisfy her
cravings such as “manga nga
gi-tuslob sa patis". She said
that she drinks about 1.5L,
about 8-9, glasses of water
everyday and she stated that
she does not drink coffee. The
patient’s weight is not
proportional to her height; she
weighs 61kgs and has a
height of 5’2” and the result of
the BMI is 26.1 which is
overweight. The patient has
no problem consuming her
food. The patient has no
wounds, lesions, dryness, and
dental problems experienced.
Patient MFT defecates twice a
week usually every 6 am and
8pm with a yellow-colored
semi - solid stool. She also
urinates 5x daily with yellow
and odorless urine. Patient
estimated her urine output of
about 1.5L every day. She
does not feel any pain when
eliminating and urinating.
Patient states that she has
sufficient energy for spending
time with her family by
shopping or going to spa
treatments for her back pains.
Patient performs certain
exercises like walking around
her neighborhood for 20
minutes, doing light yoga
exercises, and does baking in
her leisure time. She is
somehow but not completely
dependent on another person
when performing certain
activities except for bending
down.
Criteria Before During
Admission Admission
Gait 1 1
ROM 1 2
Groom 0 0
Gen 1 3
Mobility
The patient’s typical daily food
intake is complete with
carbohydrates 1 cup of rice in
every meal, proteins ¼ of
meat in every meal,
vegetables, fruits, and milk.
Her water intake is about 7-8
glasses of water every day or
1L per day. She is taking
vitamins every day. The
weight of the patient is relative
to her height. Now she weighs
61kgs. She has no problem
consuming her food and has a
mild pain in the hips and
knees, but no presence of
dryness, and dental problems
experienced.
Patient MFT defecates once a
day with yellow colored watery
stool usually around 3 pm.
She urinates 3x daily with
yellow odorless urine. Patient
is on FBC, 400mL per urobag
change, that aids her in
urinating and reports no
discomfort when urinating or
defecating.
Patient said she is no longer
as energetic as she was
before when performing
certain activities like her daily
exercises and baking. She
also sweats and feels tired
when walking after 5 minutes.
The patient requires
assistance form another
person in doing self-care
activities. The doctor advised
her to limit activities until pain
is no longer perceived. The
patient watches television on
her spare time instead
Criteria Before During
Admission Admission
Cooking 0 1
Shopping 1 2
Bed 0 1
Mobility
Posture 0 0
Hand 0 0
Grip

*Level 0: full self-care
*Level I: requires use of equipment or device
*Level II: requires assistance supervision from *Level IV: is dependent and does not
another person.
Gordon’s Criteria
V. SLEEP-REST PATTERN
1. Can the patient rest/sleep?
What are the usual daily
activities of the patient to
induce him to sleep?
2. Are there sleep onset
problems? Aids? Dreams
(nightmares)? Early
awakening?
VI. COGNITIVE-
PERCEPTUAL PATTERN
1. Any hearing difficulty?
Presence of hearing aid?
Location: Left or right or both?
2. Is there a problem in
vision? Wear glasses? Last
checked? When Last
changed?
3. Any change in memory
lately?
4. Does the patient
experience difficulty in
deciding during problems,
family issues, etc.?
5. What are the patient’s
strategies to make decisions
easier?
6. Any discomfort? Pain?
When appropriate: How do
you manage it?
VII. SELF-PERCEPTION—
SELF-CONCEPT PATTERN
1. How will the patient
describe self?
2. Changes in way the patient
feel about self or body (since
illness started)?
3. Things frequently make the
patient angry? Annoyed?
Fearful? Anxious?
4. Ever feel that the patient
lose hope?
Gordon’s Criteria
VIII. ROLES-
RELATIONSHIPS PATTERN
1. Is the patient living alone?
With family?
Functional Level Codes
*Level III: requires assistance or supervision
from another person and equipment or device.
participate
Before Admission
Patient can sleep well for 6 - 7
hours per day. She sleeps
around 10 pm and wakes up
at 5 in the morning to prepare
for her work. She listens to
music in order for her to sleep.
Patient is not taking any pills
for sleeping and is not
experiencing nightmares as
well.
Patient MFT's hearing is
working well. Patient reported
slight blurry vision, dry eyes
and puffy eyelids so her
doctor prescribed an over-the-
counter eye lubricant for her
dry eyes and advised her to
reduce her sodium intake.
She does not experience any
changes with her memory
lately. She is able to respond
well to her stressors in an
appropriate manner by
making a list of her priorities
and does them one at a time
with personal breaks in
between to prevent her from
having breakdowns. The
patient feels some pains and
manages it by bed rest.
The patient described herself
as a well person since she
has no past medical history.
Since the symptoms started,
she felt like a burden for
leaving her work and thinking
about her medical bills. The
patient would get angry at
people who are not nice to
workers. She also fears
getting an illness if anyone
argues with her and she gets
too angry because of it. The
patient does not feel
hopeless, she is very hopeful
and does her best to think
positive all the time.
Before Admission
The patient is not living with
her husband anymore
because it is deceased. But
she is living with her extended
families.
During Admission
The patient reported trouble of
sleeping due to hip and knee
pains. The patient still listens
to music to help her sleep.
She sleeps at most 4 hours
daily and is often interrupted
because of body pains. She
usually sleep around 2 pm
and wakes up every hour to
check on her hip and knee
pain.
Patient reported that she is
experiencing slight ringing in
her ears. Patient reported
blurry vision along with
sensitivity to light which
sometimes lead to vision loss.
The patient experienced slight
altered memory loss due to
her age. Patient states that
sometimes she feels easily
stressed out lately but she
manages her stress through
maintaining a quiet and calm
environment. The patient still
experiences some pains and
manages it by bed rest and
drinking the medications
prescribed by the physician.
The patient starts to describe
herself as an unwell person
for experiencing a headache,
vision changes and hip and
knee pains. She felt weak for
experiencing pain due to her
condition. She gets annoyed
every time she can’t take care
of herself due to her pains.
The patient still feels hopeful
that she will get better and her
pains will go away after
following the physician’s order
and nursing interventions.
During Admission
The patient is being taken
care of her family and her
grandchildren sometimes visit
her.
 Draw the family structure of genogram with emphasis
on the specific heredofamilial disease.
Family History of Illness
Father’s Side
Deceased
Deceased
Deceased
Male
female
Gordon’s Criteria
2. Any family problems you
have difficulty handling
(nuclear or extended)?
3. Are the family or others
depend on the patient for
things? How is the patient
managing?
4. How do the family or others
feel about illness or
hospitalization?
5. Are problems with children
also the concern of the
patient? Does the patient
have difficulty in handling the
problems?
6. Is the patient belongs to
social groups? Close friends?
Is the patient lonely?
7. Are things generally go well
at work or school?
Deceased
Deceased
Deceased
Patient MFT
Osteoporosis -
Male
Osteoporosis -
Female
Deceased
Married
Before Admission
The patient has an extended
family and has no difficulty
handling her family problems.
The children and
grandchildren are not
dependent on the patient for
their electricity bills and the
patient is not having a hard
time managing it since her
children has enough to pay for
their own bills and grocery.
The patient is close with her
college friends and goes out
every Sunday’s day to
celebrate and so does not feel
lonely. Things are going well
for her.
Mother’s Side
Deceased
Deceased
Deceased Deceased
L
E
G
E
N
D
S
Deceased
During Admission
The patient remains to have
no difficulty handling her
family problems because her
family is considerate of her
condition. The patient’s family
does not say anything to
stress the patient and so the
patient is managing her
condition just fine. The family
of the patient is worried and
would like to take care of the
patient. The patient is close
with her college friends which
visits her when they have
time. Her work gave her
maternity leave with pay and
the income is still sufficient for
their needs
IX. SEXUALITY-
REPRODUCTIVE PATTERN
1. When appropriate to age
and situations: Does the
patient’s sexual relationships
satisfying? Any changes? or
problems? Use of
contraceptives? Problems?
2. If client is female and of
age: When menstruation
started (menarche)?
Duration? Menstrual cycle?
3. Last menstrual period, if
with relation? Menstrual
problems?
G___ T___ P _ A L___ M___
X. COPING-STRESS
TOLERANCE PATTERN
1. Are there any big changes
in the patient’s life in the last
year or two? Any crisis?
2. Who is the most helpful in
talking things over? Is this
person available to you at
present?
3. Is the environment tense or
relaxed most of the time?
When tense, what coping
strategy helps?
4. How do the person handle
stress? Use any medicines,
drugs, alcohol?
5. Is the coping strategy
successful?
XI. VALUES-BELIEFS
PATTERN
1. Important health plans for
the future?
2. Is religion important in life?
When appropriate: Does this
help when difficulties arise?
Does religion interfere with
health practices?
3. Any other values or beliefs
that affect the health care
delivery system.
XII. Other concerns: Any other
things we haven’t talked about
that you would like to
mention? Any questions?
The patient have not had
sexual intercourse for a long
time since her husband died.
She used to not use any
contraceptives because they
are very religious. The
patient’s menarche started at
age 11 and the duration of her
menstruation is 7 days. The
menstrual cycle is 28 days
and she is now at her
menopausal stage.
GTPALM: 8-6-1-1-7-0
There is a little change in the
patient's life in the previous
years of her life. There is no
crisis that she faced in the
previous years. The most
helpful in talking the things
over and available to her
anytime still her SO. The
patients handle her stress by
talking to her friends and
some quality time. No history
of any medication,drugs and
alcohol intake. According to
the patient the coping
strategies are usually
successful.
Patient has no important
health plan in the future. The
patient religion is Roman
Catholic and her religion is
important in her life because
she has faith in GOD. Her
religion doesn’t interfere with
her health practices. There
are no other values or beliefs
that affect the health care
delivery system.
The patient asked, “ok ra
akong health? Wala ray
problema?
The patient is not sexually active.
The osteoporosis diagnosis
was a big change in the life of
the patient. However, there
were no crisis experienced,
still. The most helpful in
talking the things over and
available to her anytime still
her SO. The environment is
most of the time tense since
the patient is quite nervous.
Reading books, watching
videos on osteoporosis
interventions and searching
on the internet helps cope up
her stress. The patient was
prescribed medications to
help relieve her pains and
does not drink alcohol. The
coping strategies were
successful and lessening the
stress of the patient.
Patient has decided to have
important health plans for her
future, she already inquired to
the agency that she applied
for her future health plan. The
patient is GOD fearing and
she never blames GOD for
her condition. Her faithfulness
remained unchanged.
Patient has already
understood the causes of her
condition about the hip and
knee pain, vision changes and
her stooped position. She is
already aware of her
conditions.

Summary:

The patient has an overall healthy lifestyle. The patient feels well before admission and
does not practice any vices and drinks alcohol. Prior to osteoporosis diagnosis, the patient
would intake carbohydrates daily and in every meal like rice. The patient had a height of 5’2”
and a weight of 61kg and the BMI result is overweight. The patient had enough energy to do
desired activities and can do some self-care by her own. The patient has a good sleeping
schedule and does not experience unplanned early awakenings. The patient’s hearing was
working well but the patient reported slight blurry vision, dry eyes and puffy eyelids. Despite
that, the patient did not wear glasses and did not go for a checkup. The patient’s memory is
intact. The patient responds well to stressors, makes a list of her problems and solves it one at
a time which helps her manage her stress. The patient would describe herself as a well and
positive person. The patient is widowed.

On the other hand, during admission, the patient felt the need to be more careful of her
health by managing her food and fluid intakes. The patient would feel pains all over her body
every now and then due to the aftereffects of osteoporosis. The patient, however, manages her
pains by following the physician’s order and nursing interventions. The patient has a healthier
daily food intake. Her meals consisted of carbohydrates, proteins, vegetables, fruits, and milk.
Her weight increased to 63kg. The patient defecates once a day and with normal
characteristics. The patient used FBC to aid in urinating. Functional Level Codes were Level II
for all the criteria due to the patient’s inability to do full self-care. The patient has disrupted
sleeping schedule due to her hip and knee pains. The patient experienced slight ringing in her
ears. The patient’s blurry vision worsened because it was accompanied by sensitivity to light
and sometimes vision loss. The patient is taken care of her children and sometimes would be
visited by her grandchildren.

IV. PHYSICAL ASSESSMENT (HEAD TO TOE) AND REVIEW OF SYSTEMS

GENERAL SURVEY:

A patient of 76-year-old female, a Roman Catholic and was a teacher but now a
housewife, appears stated age complains of hip pain, knee pain, and stooping position. The
patient was flushed looking with a grimace expression and guarding behavior on the hip near
abdomen. The patient cannot talk properly and is mumbling in a fast pace. Patient appears
confused and distracted. The patient physically looks clean and neat with no foul odors noted.

PHYSICAL FINDINGS REVIEW OF SYSTEMS

ASSESSMENT (filled only when unusuality noted)
SKIN. Inspect the color *Normal skin noted. Subjective:
and presence of *Visible Wrinkles "Nindot jud kaayo kog panit niadto. Hamis
lesions. Palpate *No lesions niya medyo pution. Karun nga nagkatigulang
temperature, turgor *Skin soft to pinch na, medyo kunot kunot na akong panit"
and texture. *No foul odor
*Skin is warm to touch Objective:
*Skin is intact with no - Wrinkled Skin
signs of irritation
*Less sweating Scientific Analysis:
As you get older, your skin naturally becomes
less elastic and more fragile. Decreased
production of natural oils dries your skin and
makes it appear more wrinkled

Reference:
Wrinkles - Symptoms and causes. Mayo Clinic.
(2021). Retrieved 5 December 2021, from
https://www.mayoclinic.org/diseases-
conditions/wrinkles/symptoms-causes/syc-
20354927#:~:text=Age.,makes%20it%20app
ear%20more%20wrinkled.

Head. Inspect size, INSPECTION

shape, symmetry, *Skull is round with
position, hair prominence in the
distribution presence frontal and occipital
of parasites, lice, area (Normocephalic)
dandruff and lesions *Hair is black and
brittle
*Hair is thick
*No scars noted
PALPATION:
*Sweaty scalp
 *No lesions
*Hair is evenly
distributed
*Scalp is free from the
presence of parasites,
lice, dandruff
*Head needs not to be
held still
*Head is hard when
palpated
*No tenderness or
masses on palpation
Face. Inspect *Face is oval-shaped
symmetry of nasolabial *Face is symmetrical
folds and palpebral *No involuntary
fissures. Palpate muscle movements
muscle of mastication *Can move facial
and test sensory muscles at will
function (CN V). Note *No grimace face
facial mobility (CN VII). noted
*Intact cranial nerve V
*Temporal artery is
pulsating when
palpated
Neck. Inspect, palpate *Neck is symmetric Subjective:
and auscultate thyroid. with head centered When doing ROM Patient complains of
Palpate lymph nodes *No visible mass or discomfort when moving
and tracheal position. lumps
Note ROM of neck. *The neck is flexed Objective:
Test neck muscle due to the patient's - The neck is flexed due to the patient's
strength (CN XI) headache. headache
*No mass or lumps
*The thyroid cartilage, Scientific Analysis:
cricoid cartilage and Muscle contraction headache is associated
thyroid gland moves with bilateral mild to moderate aching pain in
symmetrically upward. the head and is linked to tightening of the
*No thyroid swelling neck muscles.
*C7 is palpable
*No cervical lymph Reference:
nodes palpated
Smith, Y. B. (2018, August 23). What is
*ROM: patient
complains discomfort Muscle Contraction Headache? News-
when moving. Medical.Net. https://www.news-
medical.net/health/What-is Muscle-
Contraction-Headache.aspx

Nose and Sinuses. *Nose in the midline

Inspect nasal mucosa, *Nose color is the
septum and turbinates. same as the rest of
Palpate sinuses and the face.
nasal patency. Test *No flushed nose
sense of smell (CN I) noted.
*No nasal flaring
noted
*Opening of the left
side of the nose is
slightly smaller than
the right side
*Nasal mucosa is
pinkish in color and
free of exudate
*Septum is intact and
free of lesions
*Turbinates are pink
*No bone or cartilage
deviation
*No tenderness
*Nasal septum is in
 the midline and not
perforated
*No discharges noted
on paranasal sinuses
and nontender
Mouth. *Patient bites lips due Subjective:
Inspect lips, oral to hip and knee pain. “Mapaakan gyud nako akong dila tungod sa
mucosa, teeth, gums *Client can distinguish kasakit usahay sa tuhod ig tindog”
and tongue. Test taste
sense of taste (CN VII, *Lips: smooth and Objective:
IX). Test mobility of moist without lesions - Patient bites lips due to hip and knee
tongue (CN XII) and or swelling pains
gag reflex (CN IX, X) *Gums: Pinkish in - Slight crepitus noted
color, no gum
bleeding, no receding
Scientific Analysis:
gums
Physical conditions can cause a person to
*Teeth: one missing
bite their lips when they use their mouth for
teeth (upper left);
talking or chewing. In other cases, the cause
history of braces is
can be psychological. People may bite their
noted; history of tooth
lip as a physical response to an emotional
repair is noted. Total
state, such as pain, stress, fear, or anxiety.
of 30 teeth. Slightly
yellow in color. No
Reference:
halitosis.
*Buccal mucosa: Lip biting: Causes, treatment, and other
pinkish and moisty. anxious habits. Medicalnewstoday.com.
No swelling or lesions (2021). Retrieved 5 December 2021, from
*Parotid ducts are
https://www.medicalnewstoday.com/article
visible with flow of
saliva with no s/322093#:~:text=What%20causes%20lip
redness, swelling and %20biting%3F,stress%2C%20fear%2C%2
pain 0or%20anxiety.
*Tongue: pink in
color, moist, moderate
in size with papillae
present.
*Able to move the
tongue freely but
weak.
*Uvula: pinkish and
positioned in the
midline
*Palates: hard palate
is whitish with firm
transverse rugae.
*Gag reflex is present
*Temporomandibula
r: slight pain in
movement
*No lesions
*No varicosities on
ventral surface
*Frenulum is thin
attaches to the
posterior 1/3 of the
ventral aspect of the
tongue
*Surface of the
tongue is rough
>Temporomandibular
*Slight crepitus noted
Eyes. *Eyes evenly placed
Test visual acuity with in line with each other
Snellen Chart or *Eyelashes: evenly
allowing the client to distributed, turned
read a magazine (CN outward
II), Peripheral vision by *Eyebrows: dark
confrontation, EOM in brown; symmetrical to
6 cardinal fields (CN each other; evenly
III, IV, VI), Corneal distributed
light reflex, *Eyelids:
Cover/uncover test. symmetrical, No
Inspect external PTOSIS; Patient
structures of the eye, shuts eyes hard in
test pupillary reaction,response to pain.
and palpate lacrimal *Conjunctiva: moist;
glands / ducts no ulcers; no foreign
objects; both are
pinkish in color; with
presence of minutes
capillaries
*Sclera is white in
color, no discoloration
*Cornea: no
irregularities, looks
smooth, clear.
Positive corneal reflex
*Iris: color is black,
slightly bulging,
transparent
*Patient reported
visual changes;
sensitivity to light and
blurry vision reported.
*Lacrimal gland is
non palpable
*No tenderness on
palpation
*No regurgitation from
the nasolacrimal duct
Ears. *Earlobes are bean
Inspect/palpate shaped, equal in size
external ear, perform bilaterally,
whisper tests (CN VIII) symmetrical
*The upper
connection of the ear
lobe is parallel with
the outer canthus of
the eye
*No lesions noted on
inspection
*Flushed in color.
*Odorless
*No discharges
*The auricle aligns
with the corner of
each eye
*Auricles has firm
cartilage
*No lesions noted
*Pinna recoils when
folded
*Slight pain on
palpation noted
*Weber and Rinne
Tests: vibrations are
often misheard in
either one of the ears.
LUNGS INSPECTION
Inspection. Respiratory *Trachea is centrally
effort or rate, located
anteroposterior-lateral *The diaphragm and
ratio and condition of external diaphragm
the skin in the intercostal muscles do
thoracic. Palpation. most of the breathing.
Symmetric chest *Nasal flaring noted
expansion, presence *Client has evenly
of tenderness, colored skin tone but
masses,crepitus and flushed in color of skin
tactile Fremitus *Patient sitting,
Percussion. leaning forward with
Anterior/posterior/later shoulders arched
al and diaphragmatic forward to assist
excursion. accessory muscle of
Auscultation. Note for respiration.
breath and *Uses scapula to
adventitious sounds assist in breathing.
PALPATION
*No tenderness during
palpation
*No masses noted
*No chest expansion:
both thumbs move
apart symmetrically
and normally.
PERCUSSION
*Normal
diaphragmatic
excursion
*Tympanic tones
AUSCULTATION
*Normal breath
sounds
*Respirations are
mormal
*No respiratory
distress noted
Breast. *Not completely Objective:
Inspect the color and symmetrical at rest - Breast not completely symmetrical at
presence of lesions. *The aeorola is rest.
Palpate temperature, rounded with the
turgor same color (dark Scientific Analysis:
brown) Breast tissue is made up of milk ducts, lobes,
*Nipples are rounded, fatty tissue, and other matter and it's
same size and equal extremely common for breasts (and nipples)
in color to be uneven in appearance. Breast tissue is
*No “orange peel” is constantly changing due to hormones, weight
noted gain (or loss) and even age, so your breasts
*No obvious mass may appear more asymmetrical at some
noted times than others.
*Not fixated and
moves bilaterally Reference:
when hands are
abducted over the What Can You Do About Uneven
head, or is leaning Breasts?. Ronald C. Bary. (2018).
forward Retrieved 5 December 2021, from
*No retractions or https://www.rcbarrymd.com/what-can-
dimpling
you-do-about-uneven-
*No lumps or masses
are palpable breasts#:~:text=Breast%20tissue%20is
*No tenderness upon %20made%20up,at%20some%20times
palpation %20than%20others.
*No discharges from
the nipple
ABDOMEN *Skin color is uniform
Inspection, (flushed), no lesions
Auscultation, *Umbilical is centrally
Percussion, Palpation located and protrudes
*Slight venous
engorgement noted
*Abdominal
tenderness noted
*Pain in the hip near
abdomen
 *No abnormal
tympany noted
*Diminished bowel
sounds noted
UPPER *Both upper
EXTREMITIES Test extremities are equal
for ROM Upper in size
extremities, (arms and *No involuntary
hands), shoulders movements
Perform the following *Color is flushed
tests (If the present *Cannot counteract
condition allows) gravity and resistance
Phalen’s on ROM *Weak upper
extremities
*Temperature is warm
and even *Pitting
edema of grade 2+
noted on left arm
*Joints hard to move
LOWER *No involuntary Subjective:
EXTREMITIES Test movements “Sakit akong tuhod ug hawak dapit”
for ROM Head, spinal *Both lower
cord, lower extremities are equal Objective:
extremities, (feet, in size - Limited mobility especially when
ankles and knees) *Have the same standing
Perform the following contour with
tests (If the present prominences of joints Scientific Analysis:
condition allows) *Cannot counteract A person with osteoporosis has weakened
Nudge gravity and resistance bones that are prone to fracturing. Many
on ROM; is weak individuals who suffer fractures as a result of
*Temperature is warm osteoporosis suffer significant pain, height
and even loss, and may lose the ability to dress
*No crepitus noted on themselves, stand up, and walk.
joints
References:
(US), O. (2021). The Burden of Bone
Disease. Ncbi.nlm.nih.gov. Retrieved 5
December 2021, from
https://www.ncbi.nlm.nih.gov/books/NBK4550
2/.
GENITALS. *Pubic hairs are
Inspection. Note evenly distributed
distribution of pubic *No presence of
hairs and presence nits/lice
nits/lice. For female: *Labia minora are
Observe perineum, equal in size and
labia, clitoris, urethral small lesions noted;
meatus, vaginal *Client vagina is tilted
opening, Bartholin’s 45-degree angle
glands for lesions, posteriorly.
swelling and *Vaginal opening is
excoriation as well as slightly wide
enlarged nodes. *Redness noted •
Palpate hypogastrium Bartholin’s glands are
gently for urine soft, nontender and
retention and drainage free.
presence of abnormal *No foul odor
mass or growth *Fundus is large in the
Auscultate labia or the upper end of the
scrotal area for uterus and is round
presence of bowel and smooth.
sounds. *Enlarged uterus and
irregular in shape.
*No presence of
bowel sounds
ANAL AREA *The anal opening
Inspect the perianal appears hairless,
area for lumps, ulcers, moist and tightly
lesions, rashes, closed.
redness fissures and *Anus skin is coarse
thickening of the and darkly pigmented
epithelium. Ask the *No redness fissured
client to perform *No presence of
Valsalva’s maneuver lumps, ulcers, and
(bearing down) to note rashes
any bulges. *No bulges with
strong anal sphincter

V. LABORATORY RESULTS

LAB EXAM DATE NORMAL RESULT SIGNIFICANCE NSQ

TAKEN VALUES RESPONSIBILITIES
WBC 11/02/21 (4.10-10.9) x 11 A high white BEFORE:
– Date of 10^9/L blood cell count • Check Physician’s
Hospital isn’t a specific order
Visit disease in itself • Observe proper
but it can handwashing.
indicate an • Wear disposable
underlying gloves/sterile gloves
problem such for sterility
as infections, • Check equipments
stress, expirations date.
inflammation, • Ask patient to state
trauma, allergy her name and
or certain birthdate for MAR
diseases. verification.
Neutrophils (47.0-80.0)% 75 Within normal • Ask patient if she
values have any allergies.
Lymphocytes (13.0-40.0)% 25 Within normal • Take vital signs.
value • Explain the
Eosinophils (0.00-5.00)% 4 Within normal procedure.
values • Explain to the
Basophils (0.00-2.00)% 1.5 Within normal patient that slight
values discomfort may be
Hemoglobin (12.0-16.0) 11 Low felt during the
g/dL hemoglobin procedure.
levels may lead
to anemia DURING:
which causes • Calm the patient
symptoms like • Instruct the patient
fatigue and to cooperate fully
trouble and to follow
breathing directions. Direct the
Hematocrit (36.0 - 35 A lower than patient to breathe
46.0)% normal normally and to
hematocrit can avoid unnecessary
indicate: An movements.
insufficient • Observe standard
supply of precautions, and
healthy red follow the general
blood cells guidelines.
(anemia). A Positively identify
large number of the patient, and
white blood label the appropriate
cells due to tubes with the
long -term corresponding
illness, infection patient
or a white blood Demographics, date,
cell disorder and time of
such as collection.
leukemia or • Inform patient that
lymphoma. the procedure is
Vitamin or done.
 mineral
deficiencies. AFTER:
Recent or long - • Promptly transport
term blood loss. the specimen to the
RBC (4.50 -5.90) 4 Low RBC laboratory for
10^12/L signifies low processing and
iron in blood. analysis
Postpartum • After the laboratory
mothers may exam, ask patient
have low RBC for any discomfort or
due to baby’s pain.
establishment • Assess patient’s
of iron from capabilities in
mothers. Low performing activities
RBC may also after the procedure.
indicate that • Monitor the
postpartum puncture site for
mothers are at oozing or hematoma
risk for formation.
postpartum • Evaluate test
depression results in relation to
the patient’s
symptoms.
• Notify the attending
physician if the
laboratory results
are outside of the
normal value/limits.
• Report the result of
CBC test to the
attending physician.
• Monitor patient
closely after the test.
• Write and
document the
results of the client’s
laboratory test.

VI. SUMMARY OF MEDICATIONS/IV, BLOOD TRANSFUSIONS, TREATMENTS

SUMMARY OF MEDICATIONS ADMINISTERED

Day 1 to Day 2
Name of Drugs Route of Frequency When Taken/ Completed
and Dose Administration Administered
Paracetamol Oral PRN q4H November 2,
500mg/tab 2021
Ferrous Sulfate 1 Oral OD November 2,
tab 2021
Alendronate Oral 70mg qw November 2,
Sodium 2021
70mg/week

SUMMARY OF IVF ADMINITERED

Treatment: Date Performed Date Discontinued

N/A N/A N/A

SUMMARY OF BLOOD TRANSFUSIONS

In reference to the patient’s hematology lab results, the hemoglobin and hematocrit
levels of the patient are within normal range. With this, no blood transfusion done to the patient
as there are no signs of excessive bleeding.
SUMMARY OF TREATMENTS

HEADACHE

• Prescription medications including triptans, such as sumatriptan and zolmitriptan

• Heat or cold compresses
• Healthy diet, including green and leafy vegetables with a protein and avoiding processed
foods wherever possible
• Exercising regularly
• Increased fluid intake
• Rest

VISION CHANGES

• Corrective glasses or contact lenses

• Eye drops or ointments
• Obtaining regular eye exams
• Surgical treatments such as laser or refractive surgery\

FRACTURED PAIN

• Healthy diet, include foods sources of fiber and protein

• Having several smaller meals
• Drinking lots of fluids
• Placing a light heating pad on the area

VII. ANATOMY AND PHYSIOLOGY OF OSTEOPOROSIS AND OTHER BODY PARTS

AFFECTED

Osteoporosis is a metabolic bone disease that, on a cellular level, results from osteoclastic bone
resorption not compensated by osteoblastic bone formation. This causes bones to become
weak and fragile, thus increasing the risk of fractures.

Bone Tissue Types

1. Cortical bone - is the hard-outer shell of a bone.

2. Trabecular bone - is the honeycomb-like bone in the center of long bones and in the
middle of the vertebrae.

Bone is not dead tissue. Both types of bone are alive and in a continuous state of being broken
down and regenerated by the body. This cycle of bone build-up and break down keeps bones
strong. But in osteoporosis, the balance between bone build up and break down is lost. Your
body slowly starts to break down bone faster than it can regenerate it.

Trabecular bone is more active and is broken down and regenerated more quickly than cortical
bone. Because of this, trabecular bone is more likely to be affected when the break down and
regeneration of bone are out of balance in osteoporosis.
Bone Growth and Peak Bone Mass

Bone size grows throughout childhood and adolescence. During that time, your body produces
more bone than it loses. At some point, you will be at your peak bone mass density, or BMD;
that's as much bone as you'll ever have. For most people, this comes when you're between the
ages of 18 and 25.

After you reach your peak bone mass, BMD either stays constant (with a balanced break down
and regeneration of bone), or it starts to slowly decline if these two actions are out of balance.
The greater the bone mass a person builds up as they're growing up, the less likely they are to
suffer from osteoporosis. This is why proper nutritional intake of calcium, phosphorus,
magnesium, and other minerals, as well as vitamin D, are so important during childhood and
adolescence. Good nutrition and exercise are what build and help to maintain strong bones.

Basic Spinal Anatomy

The spine consists of individual bones called vertebrae. There are 24 vertebrae in the spine,
plus the sacrum and tailbone (coccyx). Most adults have seven vertebrae in the neck (the
cervical vertebrae), twelve vertebrae from the shoulders to the waist (the thoracic vertebrae),
and five vertebrae at the lower back (the lumbar vertebrae). The sacrum is made up of five
vertebrae between the hipbones that are fused into one bone. The coccyx is made up of small
fused bones at the tail end of the spine.

Because the vertebrae of the spine are primarily trabecular bone, they are more likely to be
weakened by osteoporosis. Standing erect puts a great deal of pressure on the vertebrae, which
means that weakened ones can fracture and start to compress or collapse. If one vertebra is
fractured, it puts stress on other vertebrae and puts them at greater risk of fracture.

HIP

The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by
the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the
upper end of the femur (thighbone).
In transient osteoporosis of the hip, the femoral head weakens and loses density (bone mass).
During the time that the bone is weakened, it is at greater risk for breaking.

Transient osteoporosis most often occurs in the hip joint, but can also affect other joints in the
leg, such as the knee, ankle and foot.

Transient osteoporosis of the hip most often occurs in young or middle-aged men (between
ages 30 and 60). It is also more common in women who are in the late stages of pregnancy (the
last 3 months) or who have recently given birth.

KNEE

The knee is one of the largest and most complex joints in the body. The knee joins the thigh
bone (femur) to the shin bone (tibia). The smaller bone that runs alongside the tibia (fibula) and
the kneecap (patella) are the other bones that make the knee joint.

Tendons connect the knee bones to the leg muscles that move the knee joint. Ligaments join
the knee bones and provide stability to the knee:

The anterior cruciate ligament prevents the femur from sliding backward on the tibia (or the tibia
sliding forward on the femur).

The posterior cruciate ligament prevents the femur from sliding forward on the tibia (or the tibia
from sliding backward on the femur).

The medial and lateral collateral ligaments prevent the femur from sliding side to side.

Two C-shaped pieces of cartilage called the medial and lateral menisci act as shock absorbers
between the femur and tibia.
 VIII. PATHOPHYSIOLOGY

Women over the Postmenopausal Caucasian and

Bone loss Age
age of 50 women Asian women

Family history of Bone structure and Low calcium Not exercising

osteoporosis body weight intake regularly

Normal homeostatic bone turnover is altered

The rate of bone resorption that osteoclasts maintain is larger

than the rate of bone creation that osteoblasts maintain.

Reduced total bone mass

Deterioration of bone matrix

Diminished bone architectural strength

Loss of height
Bulging
over time
abdomen

Stooped
posture Shortness of
breath
Pain in the
Bone fractures lower back
Neck pain

Legends
Etiology

Predisposing factors

Precipitating factors

Disease Process

Signs and Symptoms

 IX. MEDICAL MANAGEMENT

MEDICAL IDEAL (Book) ACTUAL (Done or Not

Done)
MEDICATIONS 1. Bisphosphonates DONE
Bisphosphonate osteoporosis
treatments are considered
antiresorbtive drugs. They
stop the body from re-
absorbing bone tissue. There
are several formulations with
various dosing schemes
(monthly, daily, weekly and
even yearly) and different
brands:
- Alendronate:
Fosamax®, Fosamax
Plus D®, Binosto®.
- Ibandronate:
Boniva®.
- Risedronate:
Actonel®, Atelvia®.
- Zoledronic acid:
Reclast®.
You may be able to stop
taking bisphosphonates after
three to five years and still get
benefits after you stop. Also,
these drugs are available as
generic drugs. Of these
products, Boniva and Atelvia
are recommended only for
women, while the others can
be used by both women and
men.
2. Anabolic Agents NOT DONE
These products build bone in
people who have
osteoporosis. There are three
of these products currently
approved:
- Romososumab-aqqg
(Evenity®) has been
approved for
postmenopausal
women who are at a
high risk of fracture.
The product both
enables new bone
formation and
decreases the
breakdown of bone.
You will get two
injections, one right
after the other, once
per month. The time
limit is one year of
these injections.
- Teriparatide
(Forteo®) and
Abaloparatide
(Tymlos®) are
injectable drugs given
daily for 2 years. They
are parathyroid
hormones, or products
similar in many ways
 to the hormones.
3. Hormone and NOT DONE
Hormone-related
Therapy
This class includes estrogen,
testosterone, and the
selective estrogen receptor
modulator raloxifene
(Evista®). Because of the
potential for blood clots,
certain cancers and heart
disease, estrogen therapy is
likely to be used in women
who need to treat menopause
symptoms and in younger
women.
- Testosterone might
be prescribed to
increase your bone
density if you are a
man with low levels of
this hormone.
- Raloxifene acts like
estrogen with the
bones. The drug is
available in tablet form
and is taken every
day. In addition to
treating osteoporosis,
raloxifene might be
used to reduce the risk
of breast cancer in
some women. For
osteoporosis,
raloxifene is generally
used for five years.
- Calcitonin-salmon
(Fortical® and
Miacalcin®) is a
synthetic hormone. It
reduces the chance of
spine fractures, but not
necessarily hip
fractures or other
types of breaks. It can
be injected, or it can
be inhaled through the
nose. Side effects
include runny nose or
nosebleed and
headaches for the
inhaled form. Side
effects include rashes
and flushing for the
injected form. It is not
recommended as a
first choice. There are
possible more serious
side effects, including
a weak link to cancer.
LABORATORY Complete blood count DONE
This test measures the
number of red blood cells,
white blood cells and platelets
as well as the amount of
hemoglobin, a protein in red
blood cells.
 Dual-energy x-ray DONE
absorptiometry (DXA)
This is the gold standard test
for diagnosis of osteoporosis.
This is the most common way
to measure bone density.

Bone Density Scan DONE

A bone density test
determines if you have
osteoporosis — a disorder
characterized by bones that
are more fragile and more
likely to break. The test
uses X-rays to measure how
many grams of calcium and
other bone minerals are
packed into a segment of
bone.
DIAGNOSTICS Radiography NOT DONE
It is used to diagnose or treat
patients by recording images
of the internal structure of the
body to assess the presence
or absence of disease, foreign
objects, and structural
damage or anomaly.
DIET 1. Protein DONE
Foods like beans, seafood,
lean meats, eggs, and soy
products are rich in protein,
which help your body recover
from loss of enerfy. Aim for
five servings each day, or
seven if you’re having a hard
time.
2. Iron DONE
This nutrient helps your body
make new blood cells, which
is especially important if you
lost a lot of blood during your
CBC. Red meat and poultry
are high in iron. So are tofu
and beans.
3. Calcium DONE
You’ll need 1,000 milligrams --
about 3 servings of low-fat
fairy -- each day.
TREATMENTS 1. Medications for DONE
Osteoporosis
Bisphosphonates are usually
the first choice for
osteoporosis treatment.
2. Medications to lower NOT DONE
blood pressure
These medications, called
antihypertensives, are used to
lover your blood pressure if
it’s dangerously high. Blood
pressure in the 140/90
millimeters of mercury
(mmHg) range generally isn’t
treated. Although there are
many different types of
antihypertensive medications,
a number of them to use an
antihypertensive medicine in
your situation to control your
 blood pressure.

X. SURGICAL MANAGEMENT

SURGICAL (INVASIVE OR IDEAL (BOOK) ACTUAL (Done or Not

NON INVASIVE) Done)
INVASIVE Kyphoplasty NOT DONE

During this procedure, a small

incision is made in the back
then a small tube is placed
through it. The tube is guided
into the correct position which
creates a path through the
back into the fractured area.
The surgeon uses x-rays to
insert a below into the
vertebrae then inflates it. The
inflation of the balloon returns
the fractured pieces to a more
appropriate position, relieving
pain and creating a cavity.
After the balloon is removed,
the doctor fills the cavity with
a material that hardens and
stabilizes the bone.

Vertebroplasty NOT DONE

This minimally invasive

procedure involves inserting
low viscosity cement directly
into the collapsed vertebral
body to stabilize the fracture.
It can also prevent further
deformity, such as spine
curvature or loss of height.
Vertebroplasty is different
from kyphoplasty because it
does not typically involve
manipulation before the
injection.

XI. OUTLINE OF NURSING MANAGEMENT

GOAL FOCUS/PROBLEM NURSING INTERVENTIONS

Health Promotion • Impaired Physical 1. Assess the patient’s

Mobility functional ability for
mobility and note
changes.
2. Provide range of motion
exercises every shift.
Encourage active range
of motion exercises.
3. Reposition patient
every 2 hours and prn.
4. Apply trochanter rolls
and/or pillows to
maintain joint
alignment.
5. Assist patient with
walking if possible,
utilizing sufficient help.
A one or two-person
 pivot transfer utilizing a
transfer belt can be
used if the patient has a
weight-bearing ability.

1. Instruct recommended
• Imbalanced daily intake for calcium.
Nutrition: Less Than 2. Instruct on the
Body Requirements importance of adequate
exposure to sunlight to
prevent vitamin D
deficiency.
3. If the patient has limited
exposure to sunlight,
encourage vitamin D
supplementation.
4. Instruct patient to
perform gentle
exercises.
5. Limit alcohol intake

1. Evaluate the patient’s

• Risk for Poisoning entire collection of
medications, including
over-the-counter drugs,
vitamin and mineral
supplements, herbal
remedies, and dietary
regimen.
2. Encourage patient
and/or family to utilize
one primary doctor to
coordinate care.
3. Administer drugs as
ordered, being
cognizant of any
interactions that might
be possible.
4. Provide instructions for
use of medications,
quantity, frequency,
number of doses and
times, and under what
conditions they are to
be taken.
5. Ensure medication
labels are inscribed in
large print
with dosage instruction
s.

Disease Prevention • Imbalance 1. Assess the patient’s

nutritional: Less than functional ability for
body requirements mobility and note
Intervention changes.
2. Provide range of motion
exercises. Encourage
active range of motion
exercises.
3. Assist patient with
walking if possible,
utilizing sufficient help.
Curative • Bisphosphonates 1. WARNING: Give in AM
(Alendronate sodium) with full glass of water
at least 30 min before
 the first beverage, food,
or medication of the
day. Patient must stay
upright for 30 min.
2. Monitor serum calcium
levels before, during,
and after therapy.
3. Ensure 6-mo rest
period after treatment
for Paget’s disease
if retreatment is
required.
4. Ensure adequate
vitamin D and calcium
intake.
5. Provide comfort
measures if bone pain
returns.

Rehabilitation • Healthy Diet and 1. Encourage intake of

Exercise calcium supplements.
2. Assist the patient to
develop and adhere to
an appropriate exercise
regimen.
3. Emphasize increase
intake of fruits and
vegetables rich in
calcium.
4. Self-monitor.
5. Allow and encourage
patient to adopt an
exercise routine that
involves 45 minutes of
exercise five times per
week.

XII. NURSING CARE PLAN

***See PowerPoint Presentation

XIII. DRUGS STUDIES

***See PowerPoint Presentation

XIV. DISCHARGE PLAN

METHODS INSTRUCTIONS
Advise the patient to take the medications prescribed by the
MEDICATIONS physician following the proper dosage, route, timing, and
frequency.
Be sure the patient understands all medications, including the
dosage, route, action, and side effects.
Re-inform patient about the purpose and indications of each of the
medications prescribed.
Encourage the patient and her SO to always carry an up-to-date
list of medications.
Inform the patient to store the medications in a safe container.
ENVIRONMENT Advise SO and patient to maintain a clean, calm, and quiet
environment with adequate warmth and good ventilation to
facilitate patient’s recovery and promote comfort.
Inform SO and patient to provide a hazard-free environment to
prevent falls. Apply orthotic devices correctly. Remove scatter
rugs, provide good lighting, and install handrails in the bathroom.
 Educate about importance of a smoke-free environment.
Ensure the home is free from drugs and/or violence
Advise patient to consult a physiotherapist to support during
TREATMENT treatment by providing rehabilitation programs that helps improve
the condition such as modified strength-training exercises, weight-
bearing exercises and exercises that focus on posture and
balance.
Instruct patient to do follow-up visits especially if changes in the
condition will occur.
Discuss with the patient about the purpose of treatments to be
done and continued at home.
Educate patient the following:
HEALTH TEACHING Encourage ambulation; assist with ambulation if the client is
unsteady.
Instruct in the use of assistive devices such as a cane or walker.
Demonstrate range of motion exercises.
Instruct the client in the use of good body mechanics.
Instruct the client in exercises to strengthen abdominal and back
muscles to improve posture and provide support for the spine.
Instruct the client to avoid activities that can cause vertebral
compression.
Encourage the use of a firm mattress.
The patient should notify her primary healthcare provider if she
OBSERVABLE S/SX has:
Suffer severe pain.
Increasing pain after fall.
Pain when doing daily activities.
Questions or concerns about the condition or care.
Advise the patient to reduce the intake of processed foods
DIET containing high levels of saturated fat, sugar, and salt.
Encourage the patient to consume foods high in calcium. This
helps keep your bones strong.
Encourage the patient to increase vitamin D and protein intake.
Advise patient to drink liquids as directed. Avoid liquids that have
alcohol or caffeine. They decrease bone density, which can
weaken your bones.
Encourage participation in religious activities.
SEXUALITY / Encourage patient to be always positive and pray.
SPIRITUAL
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