1. What treatment/s might you expect to help address the loss of bone mineral density of Mrs.

Pringle and reduce the risk

of hip fracture?

Diet
The National Osteoporosis Foundation and the Institute of Medicine make the following dietary recommendations to
prevent bone loss (Note that these recommendations apply to everyone.):

• Get enough calcium. The Recommended Dietary Allowance (RDA) for adults younger than 51 is 1,000 mg/day. For
adults aged 51 and older, the RDA is 1,000 to 1,200 mg/day. People need to take a supplement if their dietary calcium
level is inadequate.2 No specific recommendations have been made for low bone mass.

• Get ample vitamin D. The RDA for adults is 600 IU/day. This recommendation assumes minimal sun exposure. If
dietary intake is low, a supplement is recommended. No specific recommendations are made for low bone mass.

• Limit intake of salt, caffeine, and soft drinks, as they can weaken bones when consumed in excess.

• Avoid consuming too much alcohol. Drinking more than two or three alcoholic drinks per day can harm bones.

Physical Activity
While exercise is routinely recommended for bone health, research findings as to the effect of regular exercise on bone
have been inconsistent, depending on the bone site examined, the age of the study group, the degree and type of bone loss,
and the intensity and frequency of the activity involved. The findings are further complicated when weight loss occurs as
a result of an increase in physical activity since weight loss could have a negative effect on bone in women who are

Weight-bearing exercises such as walking and dancing are all good choices for the lower body, and adding exercise with
light weights or elastic bands or straps can help the bones in the upper body

• Incorporate balance work such as yoga at the beginning of a workout to help prevent falls.

• In the absence of joint or muscular problems, jumping activities such as jumping rope, jumping up on a bench, and
simply jumping up and down on the floor are recommended. The impact helps build bone.

• To help the spine, include exercise that strengthens the back muscles, such as back extensions, bridges, and planks.

• To avoid injury, people should work with an exercise physiologist or a personal trainer with a degree and certification to
work with specialized population

Medication
Like all medications, drugs designed to maintain or improve bone density, such as Fosamax, Boniva, Actonel, and
Reclast, carry potential side effects, including heartburn, ulcers, weakened jawbones, and, ironically, an increased risk of
certain types of fractures. There is no consensus as to who might benefit the most from these drugs (ie, when the benefits
outweigh any potential risks). Currently, physicians and patients make these determinations on an individual basis .

2. How will you set your treatment goals to comply with the Mrs. Pringle stated goal of ‘bothering vaginal dryness’?
There are many over-the-counter lubricants that can be applied to the vaginal area to reduce dryness and discomfort.
These lubricants and moisturizing creams can also change the vagina’s pH, reducing the likelihood of getting a UTI.
Women should choose a lubricant specifically intended for vaginal use. The lubricant should be water-based. They
shouldn’t contain perfumes, herbal extracts, or artificial colors. These can cause irritation.
Lubricants such as petroleum jelly and mineral oil can damage latex condoms and diaphragms used for birth control.
In some instances, a healthcare provider will prescribe estrogen therapy in the form of a pill, cream, or ring, which release
estrogen.
Creams and rings release estrogen directly to the tissues. Pills are more likely to be used when you have other
uncomfortable menopause symptoms, such as hot flashes.
Because many products can irritate delicate vaginal skin, it’s important to seek evaluation and treatment advice with a
physician if the condition persists.
3. Develop a nursing care plan according to your identified priority plan of care

NURSING CARE PLAN

INTERVENTION
ASSESSMENT DIAGNOSIS PLANNING & EVALUATION
RATIONALE
Subjective Data: Chronic pain After 30 mins 1. Maintain immobilization of After 30 mins of
- Mrs. Pringle is a related to of nursing affected part by means of nursing
62-year-old female movement of interventions, bedrest, cast, splint, and interventions, the
experiencing bone fragments the client will traction. Relieves pain and client was able to
diffuse bone pain and injury to be able to prevents bone display relaxed
over the past the soft tissue display relaxed displacement/extension of manner and able
several years after as manifested manner and tissue injury to participate in
menopause. by severe back able to activities
- Patient states, pain and participate in 2. Elevate and support injured
“The pain is inability to do activities extremity. Promotes venous After 2 days of
becoming simple chores return, and may reduce pain. nursing
worse and it is After 2 days of interventions, the
keeping me from nursing patient was able
doing my daily interventions, 3. Elevate bed covers and keep to verbalize
activities.” the patient will linens off toes. Maintains relief of pain.
- She currently be able to body warmth without
complains that any verbalize relief discomfort due to pressure of
weightbearing of pain. bedclothes on affected parts.
activity causes her
severe discomfort. 4. Evaluate and document
reports of pain or discomfort,
Objective Data: noting
- History of location and characteristics,
fractures to her left including intensity (scale of
hip and wrist. 0–10), relieving, and
- severe back pain aggravating factors. Note
- inability to do nonverbal pain cues, such as
simple chores such changes in vital signs and
as lifting grocery emotions or behavior. Listen
bags and her to reports of family
grandchild without member/significant other (SO)
pain regarding client’s pain.
- with noticeable Influences choice of, and
painful expressions monitors effectiveness of,
on her face when interventions. Many factors,
asked to do range including level of anxiety, may
of motion with affect perception of and
back, guarding and reaction to pain. Note:
tenderness noted at Absence of pain expression
cervical spine area does not necessarily mean
lack of pain.

5. Explain procedures before

beginning them. Allows client
to prepare mentally for
activity and to participate
in controlling level of
discomfort.

6. Medicate before care

activities. Let client know it is
important to request
medication before pain
becomes severe. Promotes
muscle relaxation and
enhances participation.

7. Perform and supervise

passive or active ROM
exercises. Maintains strength
and mobility of unaffected
muscles and facilitates
resolution of inflammation in
injured tissues.

8. Provide alternative comfort

measures, for example,
massage, back rub, or position
changes. Improves general
circulation; reduces areas of
local pressure
and muscle fatigue.

9. Provide emotional support

and encourage use of stress
management techniques—
progressive relaxation,
deepbreathing exercises, and
visualization or guided
imagery; provide therapeutic
touch. Refocuses attention,
promotes sense of control, and
may enhance coping abilities
in the management of the
stress of traumatic injury and
pain, which is likely to persist
for an extended period.

10. Identify diversional

activities appropriate for
client’s age, physical abilities,
and personal preferences.
Prevents boredom, reduces
muscle tension, and can
increase muscle strength; may
also enhance coping abilities.

11. Investigate any reports of

unusual or sudden pain or
deep, progressive, and poorly
localized pain unrelieved by
analgesics. May signal
developing complications,
such as infection, tissue
ischemia, or compartment
syndrome.

Dependent:
1. Administer medications, as
indicated: opioid and
nonopioid analgesics, such as
morphine, meperidine
(Demerol), or hydrocodone
(Vicodin); injectable and oral
nonsteroidal anti-
inflammatory drugs
(NSAIDs), such as ketorolac
(Toradol) or ibuprofen
(Motrin); and/or muscle
relaxants, such as
cyclobenzaprine (Flexeril) or
carisoprodol (Soma). Given to
reduce pain and/or muscle
spasms. Studies of
Toradol have shown it to be
effective in alleviating bone
pain, with longer action and
fewer side effects than opioid
agents

2. Maintain continuous
intravenous (IV) or patient-
controlled analgesia (PCA)
using peripheral, epidural, or
intrathecal routes of
administration. Maintain safe
and effective infusions and
equipment. Optimal pain
management is essential to
permit early mobilization and
physical therapy and to
maintain adequate blood level
of analgesia, preventing
fluctuations in pain relief with
associated muscle tension or
spasms.