Case

Study
Presentati
NCM 16: RLE Medicine

on
 OBJECTIVES
This study aims to provide nursing competencies in
managing patients with osteoporosis and celiac disease
through developing understanding of clinical scenarios
and applying its concept in formulating plan of
treatment and interventions. This study also aims to
build and enhance the student’s understanding and
skills in the care of patients with this type of condition.
Specifically, this study aims:

01 02 03
To provide brief To provide related To discuss the
review of the literatures regarding pathophysiology of
anatomy and celiac disease and celiac disease and
physiology of osteoporosis for better osteoporosis.
involved system. understanding

04
To determine the
05
To document thorough
medications used to treat and comprehensive
the condition and the physical assessment
nursing responsibilities and medical history of
associated with each the patient.
prescription.
 06 07
To analyze the To formulate nursing care
patient's laboratory plans according to the
findings and to prioritization of the
provide adequate patient’s condition
nursing care.

08 09
Provide an evaluation To formulate health
of the expected teaching guide that will
outcome and learnings help improve the
from the case study. condition of the
patient.
Introducti
on
Osteoporosis has become a global problem as the growth in
lifespan brings conditions to view which were originally not
clinically detectable. The disorder is characterized by a lack of
bone density, which causes the bones to become less compact,
brittle, and vulnerable to fracture. Osteoporosis has a poorly
understood pathology since it is influenced by endocrine and
environmental causes, with the genetic aspect responsible for 70%
of individual differences in bone mass density (BMD), the
primary determinant of fracture risk with age. Since pathological
disorders like celiac disease (CD) worsen the mechanism of bone
degradation, osteoporosis in celiac patients is of specific interest.
…
When the skeletal and digestive system, which is the body's core
framework, is harmed by disease or disorders such as osteoporosis
a bone condition that induces bone destruction, the bones become
fragile and susceptible to fractures and damage. Celiac disease an
immune disease in which people can't eat gluten because it will
damage their small intestine, movement, organ defense, fat and
mineral storage, and blood cell formation all decrease. A patient's
diet, as well as adequate health education, will aid in the
prevention or reduction of certain diseases. Nonetheless, as these
disorders present, nurses should provide appropriate interventions,
health education to prevent the disease from worsening or
developing other symptoms, and encourage wellbeing and
healing.
…
This case study aims to familiarize student nurses with clinical
scenarios addressing patients with celiac disease and osteoporosis,
it also aims to gain knowledge about the digestive and skeletal
system. This will help develop skills needed in improving patient
outcomes, prevent complications, and providing knowledge
towards health education to patients or other health care providers.
Anatomy and
Physiology
of Skeletal
System
 The skeleton is the framework that provides
structure to the rest of the body and facilitates
movement. This system is comprised of the bones,
joints, muscles, tendons, ligaments, and bursae of the
body. The major functions of this system are to
support and protect the body and foster movement of
the extremities. The components of this system are
highly integrated; therefore, disease in or injury to
one component adversely affects the others.

skeletal
 There are 206 bones in the human body,
divided into four categories classified by their
shape: long, short, flat, and irregular.
1. Long: legs, arms.
2. Short: wrists, ankles.
3. Flat: skull, sternum, ribs.
4. Irregular: vertebrae, face, scapulae, pelvic

skeletal
girdle.
 LONG BONES SUPPORT WEIGHT AND
FACILITATE MOVEMENT

The long bones, longer than they are wide, include:

The femur (the longest bone in the body) and
humerus in the arm.

Long bones are mostly located in the appendicular

skeleton and include the lower limbs and bones in the
upper limbs.
 SHORT BONES ARE
CUBESHAPED

Short bones are about as long as they are wide.

Located in the wrist and ankle joints, short bones

provide stability and some movement.

Examples of short bones are: the carpals in the

wrist and the tarsals in the ankles.
 FLAT BONES PROTECT
INTERNAL ORGANS

There are flat bones in the skull (occipital, parietal, frontal,

nasal, lacrimal, and vomer),the thoracic cage (sternum and ribs)
the pelvis (ilium, ischium, and pubis).

The function of flat bones is to protect internal organs

such as the brain, heart, and pelvic organs.

Flat bones can provide protection, like a shield and

can also provide large areas of attachment for
muscles.
 IRREGULAR BONES HAVE
COMPLEX SHAPES

They often have a fairly complex shape, which helps protect

internal organs.

For example, the vertebrae, irregular bones of the

vertebral column, protect the spinal cord.

The irregular bones of the pelvis protect organs in the

pelvic cavity.
 Bones are grouped into the axial skeleton and
the appendicular skeleton
Bones of the APPENDICULAR SKELETON
facilitate movement - girdles and limbs

Bones of the AXIAL SKELETON protect

internal organs – skull, vertebral column and
thoracic cage

Of the 206 bones, 80 are in the axial

skeleton, with 64 in the upper
appendicular and 62 in the lower

skeletal appendicular skeleton

 Bone is composed of cells, protein matrix, and mineral deposits. The cells are of
three basic types—osteoblasts, osteocytes, and osteoclasts.

 Osteoblasts function in bone formation by secreting bone matrix. The matrix

consists of collagen and ground substances (glycoproteins and proteoglycans)
that provide a framework in which inorganic mineral salts are deposited. These
minerals are primarily composed of calcium and phosphorus.
 Osteocytes are mature bone cells involved in bone maintenance; they are
located in lacunae (bone matrix units).
 Osteoclasts, located in shallow Howship’s lacunae (small pits in bones), are
multinuclear cells involved in dissolving and resorbing bone.

skeletal
 Bone Formation
 Osteogenesis (bone formation) begins before birth.
 Ossification is the process by which the bone matrix is formed and hard mineral
crystals composed of calcium and phosphorus (e.g., hydroxyapatite) are bound to
the collagen fibers. These mineral components give bone its characteristic strength,
whereas the proteinaceous collagen gives bone its resilience.

Bone Maintenance
Bone is a dynamic tissue in a constant state of
turnover. Throughout the lifespan, a process known as
bone remodeling occurs, in which old bone is removed
(resorption) and new bone is added to the skeleton

skeletal (formation).
 Bone function
 Support. Bones, the “steel girders” and “reinforced concrete” of
the body, form the internal framework that supports the body
and cradle its soft organs; the bones of the legs act as pillars to
support the body trunk when we stand, and the rib cage supports
the thoracic wall.
 Protection. Bones protect soft body organs; for example, the
fused bones of the skull provide a snug enclosure for the brain,
the vertebrae surround the spinal cord, and the rib cage helps
protect the vital organs of the thorax.

skeletal
 Bone function
 Movement. Skeletal muscles, attached to bones by tendons, use
the bones as levers to move the body and its parts.
 Storage. Fat is stored in the internal cavities of bones; bone itself
serves as a storehouse for minerals, the most important of which
are calcium and phosphorus; because most of the body’s calcium
is deposited in the bones as calcium salts, the bones are a
convenient place to get more calcium ions for the blood as they
are used up.

skeletal
Bone function
Central cavity of some bones contains hematopoietic tissue (connective tissue). This is referred to as
red bone marrow – a soft tissue located in networks of spongy bone tissue inside some bones.

At birth, red marrow In adults the red marrow in bones

produce blood cells of the:
It produce all three is present in all Cranium (skull)
main kinds of bones, but with Vertebrae
blood cell: red; increasing age, in the Scapulae (shoulder bones)
white; and long bones it Sternum
gradually becomes Ribs
platelets. Pelvis
yellow marrow and The epiphyseal ends of the
loses its blood- large long bones
making capacity.
Anatomy and
Physiology of
Gastrointestinal
System
gastrointestinal system
The main organs of the gastrointestinal (GI) system
include the mouth, pharynx, esophagus, stomach,
small intestine, and large intestine

Functions
 Normally, the GI system is the only source of intake
for the body.
 Provides the body with fluids, nutrients, and
electrolytes.
 Provides means of disposal for waste residues.
gastrointestinal system
Activities
 Secretion of enzymes and electrolytes are used to break down
the raw materials ingested.
 Movement of ingested products through the system.
 Complete digestion of ingested nutrients.
 Absorption of the end products of digestion into the blood.
Coats of Tissue Walls
A. Mucous lining.
 Rugae and microscopic gastric and hydrochloric acid glands in the stomach.
 Villi, intestinal gland Peyer’s patches, and lymph nodes.
 Intestinal glands.
B. Submucous coat of connective tissue, in which the main blood vessels are located.
C. Muscular coat.
 Digestive organs have circular and longitudinal muscle fibers.
 The stomach has oblique fibers in addition to circular and longitudinal fibers.
D. Fibroserous coat, the outer coat.
 In the stomach, the omentum hangs from the lower edge of the stomach, over the intestines.
 In the intestines, it forms the visceral peritoneum.
The Mouth, Pharynx, and
Esophagus B. The pharynx.
 Tubelike structure that extends from the base of the skull to the
A. The buccal cavity. esophagus.
 Compound of muscle lined with mucous membrane, composed
 Cheeks. of the nasopharynx, the oropharynx, and the laryngopharynx.
 Hard and soft palates.  Functions include serving as a pathway for the respiratory and
 Muscles. digestive tracts, and playing an important role in phonation.
 Maxillary bones. C. The esophagus begins at the lower end of the pharynx and is
 Tongue. a collapsible muscular tube about 10 inches (25 cm) long.
 It leads to the abdominal portion of the digestive tract.
 The main portion is lined with many simple mucous glands;
complex mucous glands are located at the esophagogastric
juncture.
The Stomach
A. Elongated pouch lying in the epigastric and left hypochondriac portions of the abdominal cavity
(approximately 10 inches [25 cm]).
B. Divisions are the fundus, the body, and the pylorus (the constricted lower portion).
C. Curvatures are the lesser curvature and the greater curvature.
D. Sphincters.
1. Cardiac sphincter—at the opening of the esophagus into the stomach.
2. Pyloric sphincter—guards the opening of the pylorus into the duodenum.
E. Regions.
3. Cardiac.
4. Fundus.
5. Body.
6. Pylorus.
The Stomach
F. Coats.
1. The mucous coat allows for distention and contains microscopic glands: gastric, hydrochloric acid, and
mucous.
2. The muscle coat contains three layers.
a. Circular—forms the two sphincters.
b. Longitudinal.
c. Oblique.
3. The fibroserous coat forms the visceral peritoneum; the omentum hangs in a double fold over the intestines.
G. Glands.
4. Mucous glands—secrete mucus to provide protection from gastric juice.
5. Goblet cells—secrete viscid mucus.
6. Gastric glands.
a. Parietal—secrete hydrochloric acid and intrinsic factor.
b. Chief cells—secrete pepsin, lipase, amylase, and renin.
The Stomach
H. Function: mechanical and chemical digestion.
1. Mechanical.
a. A storage reservoir for food.
b. Churning provides for forward and backward movement.
c. Peristalsis moves material through the stomach and, at intervals with relaxation of the
pyloric sphincter, squirts chyme into the duodenum.
2. Chemical.
a. Hydrochloric acid provides the proper medium for action of pepsin and aids in the
coagulation of milk in adults.
b. Pepsin splits protein into proteoses and peptones.
c. Lipase is a fat-splitting enzyme with limited action.
d. Renin coagulates or curdles the protein of milk.
e. Intrinsic factor acts on certain components of food to form the antianemic factor.
f. Mixes food with gastric juices into a thick fluid called chyme.
The Small Intestine
A. Approximately 21 feet (6 m).
B. Divisions.
1. The duodenum (about 10 inches [25 cm]) includes the
Brunner’s glands (the duodenal mucous digestive glands) and
the openings for the bile and pancreatic ducts.
2. The jejunum is approximately 8 feet (2.4 m) long; the ileum is
approximately 12 feet (3.6 m) long. Both have deep circular
folds that increase their absorptive surfaces.
a. The mucous lining has numerous villi, each of which has
an arteriole, venule and lymph vessel that serve as
structures for the absorption of digested food.
b. The small intestine terminates by opening into the cecum
(the opening is guarded by the ileocecal valve).
The Small Intestine
C. Intestinal digestion.
1. Intestinal juice has an alkaline reaction and contains a large number of enzymes.
2. Enzymes.
a. Peptidase.
b. Amylase.
c. Maltase.
d. Lactase.
e. Sucrase.
f. Nuclease.
g. Enterokinase.
The Large Intestine (Colon )
A. Approximately 5 feet (1.5 m) long, with a relatively smooth
mucous membrane surface. The only secretion is mucus.
B. Muscle coats pucker the wall of the colon into a series of
pouches (haustra) and contain the internal and the external anal
sphincters.
C. Divisions.
 The cecum (the first part of the large intestine) is guarded by
the ileocecal valve.
a. Prevents regurgitation of the cecal contents into the
ileum.
b. 3 L of fluid passes through the small bowel but only 500
mL passes through the ileocecal valve.
 The appendix is attached to its surface as an extension. The
appendix is a twisted structure that may accumulate bacteria
and become inflamed.
The Large Intestine (Colon)
 Colon.
a. Ascending.
b. Transverse.
c. Descending.
d. Sigmoid.
e. Rectum.
f. Anus—a hairless, darker-skinned area at the end of the digestive tract. It has an
internal involuntary sphincter and an external voluntary sphincter.
D. Functions.
 Absorption and elimination of wastes.
 Formation of vitamins: K, B12, riboflavin, and thiamine.
 Mechanical digestion: churning, peristalsis, and defecation.
 Absorption of water from fecal mass.
Accessory Organs
Tongue
A. A skeletal muscle covered with a mucous membrane that aids in chewing, swallowing, and speaking.
B. Papillae on the surface of the tongue contain taste buds.
C. The frenulum is a fold of mucous membrane that helps to anchor the tongue to the floor of the mouth.
D. The tongue mixes food with saliva to form a mass called a bolus.
Salivary Glands
E. Three pairs—the submaxillary, the sublingual, and the parotid glands.
F. Secretion.
1. Saliva is secreted by the glands when sensory nerve endings are stimulated mechanically, thermally, or
chemically.
2. pH ranges: 6.0–7.9.
3. Contains amylase, an enzyme that hydrolyzes starch.
Teeth
A. Deciduous teeth (20 in the set) and permanent teeth (32 in the set).
B. The functions are mastication and mixing saliva with food.
 Discussions

What are the functions of

the skeletal system?
Overview of the
Disease
Osteoporosis
 Osteoporosis
Osteoporosis causes bones to become weak and
brittle — so brittle that a fall or even mild stresses
such as bending over or coughing can cause a
fracture. Osteoporosis-related fractures most
commonly occur in the hip, wrist or spine. Bone is
living tissue that is constantly being broken down
and replaced. Osteoporosis occurs when the creation
of new bone doesn't keep up with the loss of old
bone. Osteoporosis affects men and women of all
races. But white and Asian women — especially
older women who are past menopause — are at
highest risk. Medications, healthy diet and weight-
bearing exercise can help prevent bone loss or
strengthen already weak bones.
 Signs and
Symptoms
There typically are no symptoms in the early stages of bone loss. But once your
bones have been weakened by osteoporosis, you might have signs and symptoms that
include:
 Loss of height (getting shorter by an inch or more).
 Change in posture (stooping or bending forward).
 Shortness of breath (smaller lung capacity due to compressed disks).
 Bone fractures.
 Pain in the lower back.
 Receding gums
 Weakened grip strength
 Weak and brittle nails
 Bones are in a constant state of renewal — new bone is made and

Caus
old bone is broken down. When you're young, your body makes
new bone faster than it breaks down old bone and your bone mass
increases. After the early 20s this process slows, and most people
es reach their peak bone mass by age 30. As people age, bone mass is
lost faster than it's created.

Risk
Factors
A number of factors can increase the likelihood that you'll develop
osteoporosis — including your age, race, lifestyle choices, and
medical conditions and treatments.
Risk
Factors
Non-modifiable Risks
Some risk factors for osteoporosis are out of your control, including:
 Your sex. Women are much more likely to develop osteoporosis than are men.
 Age. The older you get, the greater your risk of osteoporosis.
 Race. You're at greatest risk of osteoporosis if you're white or of Asian descent.
 Family history. Having a parent or sibling with osteoporosis puts you at greater
risk, especially if your mother or father fractured a hip.
 Body frame size. Men and women who have small body frames tend to have a
higher risk because they might have less bone mass to draw from as they age.
Complicati
onsSpinal fractures from osteoporosis can lead to a range of complications, such as:
 Back pain at the level of the fracture. Back pain may start gradually or suddenly, and may be
severe. Nerve root pain from osteoporosis is less common.1
 A hunch in the upper back where vertebrae have fractured and partially collapsed in several places,
causing the curve of the spine to change.
 Loss of height due to multiple fractures in the vertebral bodies.
 Loss of mobility and instability during daily activity due to weakening of the bones.
 Respiratory and cardiovascular complications when multiple fractures shorten the torso and
compress the abdomen
 Loss of self-esteem, loss of independence, mood changes
 Rarely, neurologic injury
Diagno
Postmenopausal women with known risk factors
sis should have an osteoporosis evaluation that includes a
comprehensive medical and family history, as well as a
physical examination that includes vital signs and height
measurement. Laboratory tests should be performed on a
regular basis and should include the following:
 Complete blood count
 Serum chemistry panel, including calcium, phosphate,
liver-associated enzyme, total alkaline phosphatase,
creatinine, and electrolyte levels
 Thyroid function testing
 Urinalysis
 X-ray
 Treatment
Patients with postmenopausal osteoporosis are treated with a combination of pharmacologic
and non-pharmacologic therapies. A program that incorporates comprehensive patient
education is particularly effective in non-pharmacologic management. Patients who have
been diagnosed with osteoporosis are commonly unsure of the condition's short- and long-
term prognosis and implications.

Non-pharmacologic modes of therapy

include: 
 Nutritional supplementations rich in calcium carbonate or
calcium citrate
 Supplemental vitamin D
 Exercise, especially weight-bearing and weight-training
exercise to maintain current bone mass
 Avoidance of tobacco, ethanol, caffeine, and high-protein
foods.
 Treatment
Pharmacologic modes of therapy
include: 
 Hormone Replacement Therapy (Estrogen)
 Selective Estrogen Receptor Modulator Therapy
 Bisphosphonates
 Anabolic Agents (Parathyroid Hormone)

Surgical Treatment
 Vertebroplasty – The surgeon will inject the bone cement directly into the weakened
vertebrae via a thin tube. The cement dries very quickly to secure the fracture.
 Kyphoplasty - a tube is inserted into the vertebra but unlike vertebroplasty, the tube
is connected to a small balloon that creates space when inflated. It is then filled with
the orthopedic bone cement. The extra space restores vertebral height, which is often
lost if the patient experienced a spinal fracture
Prevention
Osteoporosis may be prevented through taking steps in keeping the bones
healthy. This includes activities such as:
 Healthy and varied diet with plenty of fresh fruit, vegetables and whole grains.
 Eat calcium-rich foods.
 Absorb enough vitamin d.
 Avoid smoking.
 Limit alcohol consumption.
 Limit caffeine.
 Do regular weight-bearing and strength-training activities.
Overview of the
Disease
Celiac Disease
 Celiac
Disease
Celiac disease is an immune disease in which people can't eat gluten because it
will damage their small intestine. If you have celiac disease and eat foods with gluten,
your immune system responds by damaging the small intestine. Gluten is a protein
found in wheat, rye, and barley. It may also be in other products like vitamins and
supplements, hair and skin products, toothpastes, and lip balm.
Celiac disease affects each person differently. Symptoms may occur in the
digestive system, or in other parts of the body. One person might have diarrhea and
abdominal pain, while another person may be irritable or depressed. Irritability is one
of the most common symptoms in children. Some people have no symptoms.
 Signs and
 abdominal pain
Symptoms
 weight loss
 bloating  fatigue
 gas  depression or anxiety
 chronic diarrhea or constipation  joint pain
 nausea  mouth sores
 vomiting  dermatitis herpetiformis
 pale stool with a foul smell  peripheral neuropathy
 fatty stool that floats
Caus Celiac disease is caused by an abnormal immune system
reaction to protein gluten. This may be triggered by foods

es such as pasta, bread, oats, cereals, and biscuits.

Risk Complicat
Factors
 Genetics

ions
Malabsorption may cause:
o
Infection in the digestive system Iron deficiency anemia
 Type 1 diabetes o Osteoporosis
 Thyroid conditions o Vitamin B12 deficiency
 Ulcerative colitis  Malnutrition
 Neurological disorders  Lactose intolerance
 Down syndrome  Cancer
 Turner syndrome
Diagno
sis
 Blood test
 Biopsy
 DEXA scan
 X-ray
 Treatment
The patient will be advised to have gluten-free diet. This includes avoiding food that contain
barley, rye, wheat, farina, graham flour, semolina, durum, and spelt. The following foods are
advised as well:
 most dairy products, such as cheese, butter and milk
 fruit and vegetables
 meat and fish (although not breaded or battered)
 potatoes
 rice and rice noodles
 gluten-free flours, including rice, corn, soy and potato

Other treatments include:

 Vaccination
 Supplements
 Medications (corticosteroids) to block the harmful effects of the
immune system
 Discussions
Give two signs and symptoms
of Osteoporosis?
Pathophysi
ology
Risk Factors:
Abbreviations:
ROS: Reactive oxygen species
OC: Osteoclast
OB: Osteoblast
RANKL: Receptor activator of nuclear factor
kappa-B ligand pathway
IGF1: insulin-like glucose factor 1
GI: Gastrointestinal
 
 Case
Scenario
Background:
A 62-year-old postmenopausal woman with a family history of breast cancer, mild
gastroesophageal reflux disease, iron-deficient anemia and declining BMD was seen in a specialist center
for the evaluation and management of osteoporosis.
Investigations:
Analysis of tissue transglutaminase IgA, endoscopic biopsy, serial BMD scans, FRAX®
calculation of osteoporotic fracture risk, Gail model calculation of breast cancer risk, assessment of blood
vitamin D concentration and secondary evaluation for osteoporosis.
Diagnosis:
Osteoporosis, persistent after 12 years of hormone replacement therapy, and celiac disease.
Management:
The patient was initially treated for bone loss with postmenopausal hormone replacement therapy.
Dual energy X-ray (DXA) analyses showed a continued decline in Bone mass density (BMD) despite
adequate replacement of calcium and vitamin D levels and withdrawal of gluten from the patient's diet.
An oral bisphosphonate was recommended with plans to reassess BMD after 1 year. Iron replacement.
 Patient Medical History
General Information
❏Name: Carmen Angeles
❏Address: Lucena City
❏Gender: Female
❏Age: 62-year-old
Diagnosis
Osteoporosis, persistent
after 12 years of hormone
replacement therapy, and
celiac disease.
General Assessment
Awake on bed; intact skin; appropriately
dressed for season; muscle tone and mass
decrease with aging, loss of subcutaneous fat
noted; with prominent bones and muscles.
Vital Signs:
T- 36.4 C
PR – 76 bpm
RR – 18 bpm
BP – 110/70 mmHg
Mental Status
Conscious but rarely follows verbal cues; oriented to time,
place and person; able to move all extremities, has a
problem with balance; fatigue noted.
Past Medical History Present Medical History

The patient has chronic bone loss, moderate The 62-year-old postmenopausal patient

gastroesophageal reflux disease (GERD) that visited the hospital to see a specialist for the

is treated with omeprazole for 4-8 weeks, and routine check-up, evaluation, and management

iron deficiency anemia that is treated with of chronic bone loss because of her
osteoporosis. At the hospital, the patient has
ferrous sulfate. She had screening tests for
undergone different diagnostic tests such as
osteoporosis, including osteoporotic fracture
analysis of tissue transglutaminase IgA and
risk assessment and blood vitamin D
endoscopic biopsy to determine if there are
concentration assessment. In addition, the
changes or complications that is needed to be
patient underwent a DXA scan due to a
addressed.
decrease in BMD caused by the
discontinuation of hormone replacement
therapy.
 Review of Systems
Skin, hair
nails  Skin
Skin is very dry, warm to touch, matches whole skin coloration; has blistering skin
rash that intermittently appeared on her elbows and knees in the form of eruptions
of tense vesicles and papules with 3-4 mm in width; no presence of any foul odor,
skin is mobile and returns to original shape within 3-5 seconds; sagging presented
in facial and breast area.
 Hair
Black thin colored hair, scalp is clean and dry.
 Nails
Well-groomed nails in whitish color; hard and immobile; capillary refill at 3
seconds.
 Review of Systems
Head and
Neck  Head:
Normocephalic and atraumatic, head can be held still and upright; hard and smooth
without lesions noted; round in appearance and no abnormal movements noted,
decreased pulsation in temporal artery; temporomandibular joint palpated with full
range of motion without tenderness
 Neck:
Neck supple, symmetric with head; centered and without bulging masses, thyroid
cartilage and cricoid cartilage move upward symmetrically as the client swallows;
cervical curvature is noted, decreased flexion, extension, lateral bending and
rotation of the neck; trachea and landmarks in midline, irregular thyroid, lobes are
smooth and rubbery; no bruits auscultated, no swelling or enlargement noted.
 Review of Systems
 Conjunctiva and EOM are normal; pupils are equal, round, and reactive to
Eye
light; no scleral icterus, bilateral periorbital edema presented; no redness,
swelling or lesions on both eyelids, iris round and evenly colored.

 With elongated earlobes and linear wrinkles; skin is smooth with no lesions,
Ears lumps or nodules; color is consistent with facial color; auricle, tragus and
mastoid process are not tender; small amount of odorless cerumen is noted.
 Review of Systems
Mouth,
throat,  Mouth and Throat
nose, Lips and gums are smooth and moist without lesions; jaws are aligned
sinuses with no deviation seen when biting down; color and consistency of tissues
along cheeks and gums are even; teeth appear longer; oral mucosa in
slightly pink in color and dry; stensen ducts are visible with flow of saliva
and no redness, swelling, pain or moistness in area; tongue is slightly pink
with presence of macroglossia and varicose veins on the ventral surface;
frenulum is in midline; no lesions, ulcers or nodules are apparent; tongue
offers strong resistance; no usual foul noted; tonsils are pink, symmetric
and no swelling; throat is patent and moist
 Review of Systems
Mouth,
throat,
nose,  Nose
sinuses Color is the same with the rest of the face; nasal structure is smooth and
symmetric; client report no tenderness; able to sniff through each nostril
while other is occluded; nasal mucosa is slight pink, moist and free of
exudate; nasal septum is intact and free of ulcers;
 Sinuses
Frontal and maxillary sinuses are non-tender to palpation and no crepitus is
evident.
 Review of Systems
Thorax
and lungs
 Nasal flaring is not observed; client has evenly colored skin tone in the face, lips and
chest; scapulae are symmetric and non-protruding; Pulmonary/Chest shows no
respiratory status distress; bradypnea present; decreased air movement bilaterally;
patient barely able to finish a full sentence due to shortness of breath; Skin and
subcutaneous tissue are free of lesions and masses
 Breast
Swelling noted on right breast; asymmetry; breast skin pale, with brown areola; Nipples everted bilaterally;
Difficult to move upon position changes of arms and hands; No dimpling, retraction, lesions, or inflammation
noted; Axillae free of rashes or inflammation; No masses or tenderness noted on palpation; Bilateral mammary
ridge present; No discharge noted from nipples; Axillary (central, posterior, or anterior) and lateral arm lymph
nodes non-palpable.
 Review of Systems
Head and With a rate slightly below the normal; regular rhythm, and normal heart sound
Neck with no murmur noted upon auscultation; external chest is normal in
vessels appearance without lifts, heaves, or thrills; No murmurs, gallops, or rubs are
auscultated; S1 and S2 are heard and are of normal intensity.

 Bloated abdomen, hard, asymmetric; and tender with distention, bowel sounds are
normal; No distension and no tenderness noted, no visible lesions or scars; Aorta is
Abdomen
in midline without bruit or visible pulsation; Umbilicus in midline without
herniation; Bowel sounds are present and normative in all four quadrants; No
masses, hepatomegaly, or splenomegaly are noted.
 Review of Systems
Musculo-
skeletal
 Abnormal gait; Limited ROM with pain, tenderness, clicking and crepitus
noted; sternoclavicular joint midline with swelling or redness. Cervical;
thoracic and lumbar spine slightly curve; Paravertebral non-tender; with
limited movement of cervical and lumbar spine; upper and lower extremities
asymmetric with lesions; and swelling in the left extremities; Limited ROM
against gravity and resistance.
Laboratory
Analysis
 Diagnostic Test Normal Values Abnormal Values Interpretation Nursing Responsibilities

Tissue 3 U/mL or less 4-10 U/mL Weak Positive: Presence of  Ensure that the patient has
Transglutaminase (ttg) the tissue transglutaminase had the appropriate
 
Antibody, IgA (tTG) IgA antibody is preparation. For example:
  associated with gluten a special diet or fasting.
  sensitive enteropathies
such as celiac disease and  Be aware of the normal
 
dermatitis herpetiformis. and abnormal ranges of
blood tests, in order to
Positive: tTG IgA antibody
understand the
11 U/mL or greater concentrations greater than
significance of the test
40 U/mL usually correlate
results.
with results of duodenal
 
biopsies consistent with a
diagnosis of celiac disease.
 Diagnostic Test Normal Values Abnormal Values Interpretation Nursing Responsibilities

25- Between 50 Less than 30 Deficiency  Advise patient to take vit. D

hydroxyvitamin D nmol/L (20 nmol/L (12 ng/ml): supplements as indicated.
 
ng/mL) and Deficiency
 Advise patient to consume more
Potential
125 nmol/L
Between 30 vitamin-D-rich foods, such as fatty
deficiency
(50 ng/mL)
nmol/L and 50 fish or fortified dairy products
nmol/L: Potential
 Advise patient to increase sun
deficiency High levels
exposure. 5–30 minutes of sun
Higher than 125 exposure daily or taking a
nmol/L: High supplement to meet the
levels recommended daily amount of
600 IU (15 mcg).
 Diagnostic Test Normal Values Abnormal Values Interpretation Nursing Responsibilities

1.25 dihydroxy 1.25 (OH) 2 D Less than 30 Deficiency  Advise patient to increase sun
vitamin D either pg/mL nmol/L (12 exposure. 5–30 minutes of sun
 
or pmol/L ng/ml) exposure daily or taking a
Potential
(approximatel supplement to meet the
Between 30
deficiency
y 416- recommended daily amount of
nmol/L and 50
molecular High levels 600 IU (15 mcg)
nmol/L
weight)
Higher than 125
nmol/L
 Diagnostic Test Normal Values Abnormal Values Interpretation Nursing Responsibilities

Endoscopic biopsy No signs of: Signs of:   Pre-Procedural Nursing Implications.

 Endoscopic procedures are invasive, and
 Infection  H. Pylori
therefore require a formal, signed consent
 Damage to bacterial form.
cells infection  The patient must be educated about the
 H. pylori procedure, the significance of any
 Gastric cancer
bacteria preparation, and any post-procedural
 Cancer  Swollen and sequelae.
 other inflamed  Upper GI endoscopy (esophagoscopy,

abnormalitie stomach lining, gastroscopy) requires that the patient be

known as fasting. Sedatives are administered prior to
s, such as
gastritis the procedure to relax the patient and
ulcers or
facilitate passage of the scope.
gastritis
 If the patient wears dentures, have a denture
cup available. The physician may require
the removal of the dentures prior to oral
insertion of the scope.
Diagnostic Test Normal Values Abnormal Values Interpretation Nursing Responsibilities

   Colon endoscopy (proctoscopy,

sigmoidoscopy, and colonoscopy) requires
that the bowel be free of stool to enhance
visualization. This is normally
accomplished with laxatives and cleansing
enemas..

Post-Procedural Nursing Implications.

 
Accidental perforation of the esophagus or
colon may occur during endoscopy. If pain or
bleeding occur following the procedure, notify
the professional nurse. Note the following:
o Mouth or throat pain.
o Rectal pain.
o Abdominal pain.
o Bleeding from rectum.
o Bleeding from mouth or throat.
Diagnostic Test Normal Values Abnormal Values Interpretation Nursing Responsibilities

   Withhold foods, fluids, and oral

medications until the patient is
fully alert and gag reflex has
returned.
 Take vital signs per ward SOP.
 Diagnostic Test Normal Values Abnormal Values Interpretation Nursing Responsibilities

Dual energy +0.50 to -1.0 -1.1 to -2.4 Low Bone Density  Promoting understanding of osteoporosis
(Osteopenia): and the treatment regimen. Patient
 
X-ray (DXA) teaching focuses on factors influencing
Bones are weak but
  the development of osteoporosis,
Bone mineral are still strong.
  interventions to arrest or slow the process,
density (BMD) The lower the and measures to relieve symptoms.
  score, the more
 Relieving pain. Advise the patient to rest
porous your bone.
in bed in a supine or side-lying position
several times a day; the mattress should
be firm and non-sagging; knee flexion
increases comfort; intermittent
local heat and back rubs promote muscle
relaxation, and the nurse should
encourage good posture and teach body
mechanics. 
Diagnostic Test Normal Values Abnormal Values Interpretation Nursing Responsibilities

 Improving bowel movement. Early

-2.5 to -3.0 Osteoporosis is a
institution of high fiber diet, increased
bone disease that fluids, and the use of prescribed stool
softeners help prevent or minimize
occurs when the
constipation.
body  Preventing injury. The nurse encourages
walking, good body mechanics, and good
posture plus daily weight-bearing activity
loses too much outdoors to enhance production of
vitamin D.
bone, makes too
little bone, or both.
As a result, bones
become weak and
may break from a
fall or, in serious
cases, from
sneezing or minor
bumps.
Nursing Care
Plan
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Impaired physical After the nursing  Established  To build After the nursing
“Nahihirapan po mobility related to intervention, the rapport foundation of intervention, the
ako na kumilos bone fracture patient will be able trust patient
gawang di ko po secondary to to demonstrate  Assessed vital  To have a demonstrated
masyadong osteoporosis as techniques signs baseline of data techniques and
naiigalaw,” evidenced decreased behaviors that  Assessed the  To identify behaviors that
as verbalized. range of motion and enable resumption patient’s patient’s current enable resumption
  weakness in of activity. functional ability strength and of activity, such as
Objective: appearance. to perform problems related participating in
Stooped posture activities of daily to performing ROM exercises, and
Decreased range living. ADLs while seen doing activities
of motion dealing with that require little to
osteoporosis.
Weak in moderate mobility
 Provided range of  Helps to prevent
appearance such as walking to
motion exercises joint contractures
V/S as follows: every shift. and muscle the toilet, with
T- 36.4 C Encouraged atrophy. assistance.
PR – 76 bpm active range of
RR – 18 bpm motion exercises.
BP – 110/70  Reposition patient  Turning at regular
mmHg every 2 hours and intervals prevents
prn. skin breakdown
from pressure
injury.
Assessment Diagnosis Planning Intervention Rationale Evaluation

 Assist patient with  Preserves the patient’s

walking if at all muscle tone and helps
possible, utilizing prevent complications of
sufficient help. A one immobility.
or two-person pivot  
transfer utilizing a  
transfer belt can be
used if the patient has a
weight-bearing ability.
 Instruct family
regarding ROM  Prevents complications of
exercises, methods of immobility and
transferring patients knowledge assists family
from bed to members to be better
wheelchair, and prepared for home care.
turning at routine
intervals.
Assessment Diagnosis Planning Intervention
 Encourage participation in
diversional or recreational
activities.
 
 
 
 Instruct patient or assist
with active and passive
ROM exercises of affected
and unaffected extremities.
 Provide and assist with
mobility by means of
wheelchair, walker,
crutches, canes as soon as
possible. Instruct in the safe
use of mobility aids.
 Refer patient to
physiotherapist as
indicated.
Rationale Evaluation
 Provides an opportunity for
release of energy, refocuses
attention, enhances patient’s
sense of self-control and self-
worth, and aids in reducing
social isolation.
 Increases blood flow to
muscles and bone to improve
muscle tone, maintain joint
mobility; prevent contractures
or atrophy and calcium
resorption from disuse
 Early mobility reduces
complications of bed rest
(phlebitis) and promotes
healing and normalization of
organ function. Learning the
correct way to use aids is
important to maintain optimal
mobility and patient safety.
 To provide specialized care
and individualized exercise
program.
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Imbalanced nutrition: After the nursing  Established  To build After the nursing
“Nakakaapekto less than body intervention, the rapport foundation of trust intervention, the
po ba yung isa requirements related patient will be able  Assessed vital  To have a baseline patient expressed
kong sakit sa to related to reduced to verbalize signs of data understanding of the
pagrupok ng buto absorption of nutrients understanding of the  Patients who importance of
 Complete a fluid experience celiac
ko?” secondary to Celiac required dietary required dietary
and nutritional disease often have
as verbalized. disease as evidenced recommendations. assessment, decreased recommendation, as
  by decreased weight. restrictions, and the including nutritional status evidence by
Objective: importance of assessing for due to verbalization of,
Weak in adequate nutrition. nausea, vomiting, malabsorption of “Uugaliin na
appearance poor skin turgor, nutrients in the GI naming ang pagkain
Pale skin dry, pale mucous tract, the loss of ng masustansyang
Moist mucous membranes, electrolytes and pagkain lalo na
membranes. diarrhea, dietary fluids through ‘yung mataas sa
Have loss of intake and output, diarrhea, and a vitain D at
appetite. weight loss, loss of feeling of malaise calcium.”
appetite, decreased that decreases
Decreased
muscle tone, appetite
weight, from hemoglobin, iron,
50kg to 47 kg in and electrolytes.
3 days
Present Weight:
47 kg
 
Assessment Diagnosis Planning Intervention
V/S as  Take daily weight and create
follows: daily weight, food, and fluid
T- 36.4 C chart. Discuss with the
PR – 76 bpm patient the short- and long-
RR – 18 bpm term nutrition by advising
the patient to eat a well-
BP – 110/70
balanced diet such as meat,
mmHg eggs, vegetables along with
gluten free foods, and weight
goals related to Celiac
disease.
 Help the patient to select
appropriate dietary choices
to avoid gluten-containing
foods such as bread, pasta,
cereals, and oats. Encourage
her to reduce or avoid intake
of milk products.
 Instruct recommended daily
intake for calcium.
Rationale Evaluation
 Helps to establish baseline for
comparison and to detect
significant weight loss early to
allow for prompt treatment.
 
 
 
  
 To relieve abdominal pain and
cramping, alleviate diarrhea,
and to promote healthy food
habits. To avoid flare ups of
Celiac disease. Many patients
with Celiac disease are also
lactose intolerant.
 After menopause, the
requirement is 1,200 mg daily.
Getting enough vitamin D is
equally important as getting
enough calcium because
vitamin D aids in the
absorption of calcium and
improves muscle strength.
Assessment Diagnosis Planning Intervention
 Instruct on the importance
of adequate exposure to
sunlight to prevent vitamin
D deficiency.
 If the patient has limited
exposure to sunlight,
encourage vitamin D
supplementation.
 Instruct patient to perform
gentle exercises.
 Encourage the patient to
stop smoking, limit alcohol
intake to maximum 2 units
per day.
 Refer patient to the
dietitian to provide a
balanced diet.
Rationale Evaluation
 The patient should be outside
15 minutes daily.
 
 
 Supplementation will ensure
adequate vitamin D intake.
 
 
 Exercise can help build
strong bones and slow bone
loss.
 To reduce bone loss and
improve the absorption of
calcium in the bones
 To provide specialized care
and individualized dietary
program geared towards
improving bone health. A
diet high in nutrients that
support skeletal metabolism:
vitamin D, calcium, and
protein.
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Risk for injury related After the nursing  Established  To build After the nursing
”Madalas to effects of change in intervention, the rapport foundation of intervention, the
kaialangan may bone structure patient will be able trust patent is
aakay sa akin secondary to demonstrate  Assessed vital  To have a demonstrated
kais hirap ako osteoporosis. behavior that will signs. baseline of data behaviors that help
lumakad,”as help reduce risk of  Performed  Failure to reduce risk of injury
verbalized. injury and modify thorough accurately assess as evidenced by
  environment as assessments and intervene asking SO to assist
Objective: indicated to enhance regarding safety these issues can her in some
Weak in safety. issues. place the client at activities, and keep
Appearance needless risk and her side rails up.
Decrease in creates
Range of Motion   negligence issues
Muscle strength   for the healthcare
is asymmetric and practitioner.
weak.  Assess client’s  To identify risk
Shows muscle strength, for falls.
discomfort. gross, and fine
motor
coordination.
Assessment Diagnosis Planning Intervention Rationale Evaluation

V/S as  Maintain bed and chair in  To reduce risk for falls.

follows: lowest position with
T- 36.4 C wheels locked.  
PR – 76 bpm  Ensure that pathway to  To reduce risk for falls.
RR – 18 bpm bathroom is unobstructed  
BP – 110/70 and properly lighted.  
mmHg  Check on home  Patients experiencing
environment for threats to impaired mobility are at risk
safety: clutter, improper for injury from common
storage of chemicals, hazards.
slippery floors, scatter  
rugs, unstable stairs and  
stairwells, blocked entries,  
dim lighting, and  
extension cords across  
pathways.
 Coordinate with physical  Gait training in physical
therapist for strengthening therapy has been proven to
exercises and gait training effectively prevent falls.
to increase mobility
Drug Study
MEDICATION MECHANISM INDICATION CONTRA- SIDE EFFECTS NURSING
OF ACTION INDICATION /ADVERSE CONSIDERATIONS
REACTIONS
Generic Impedes bone  Paget’s  Hypersensitivity to Side Effects  Instruct patient to take
Name: resorption by disease of drug or its tablets first thing in the
 diarrhea,
Alendronate inhibiting bone (men components morning on an empty
 painful or difficulty
Sodium osteoclast and women)  Hypocalcemia stomach, with 6 to 8 oz of
urinating,
activity,  Prevention  Esophageal water only. 
Brand Name:  trouble sleeping,
absorbing of abnormalities such
 depression,  Instruct patient to follow
Fosamax calcium osteoporosis as stricture or
 irritability, oral solution with at least
phosphate crystal in post- achalasia, that delay
Pharmacologi  headache, 60 ml (2 oz) of water.
in bone, and menopausal esophageal
c class:  dizziness
directly blocking women emptying  Tell patient not to lie down,
Bisphospho-  weakness,
dissolution of  Glucocortic  Inability to stand or eat, drink, or take other oral
nate  lightheadedness,
hydroxyapatite oid-induced sit upright for 30 medications for 30 minutes
Therapeutic  blisters or ulcers in
osteoporosis minutes after taking dose.
your mouth,
class: Bone- in men and
 red or swollen gums,
resorption women
and trouble
swallowing
MEDICATION MECHANISM INDICATION CONTRA- SIDE EFFECTS /ADVERSE
OF ACTION INDICATION REACTIONS
Adverse Reactions
CNS: headache
CV: hypertension
GI: nausea, vomiting,
diarrhea, constipation,
abdominal pain, acid
regurgitation, esophageal
ulcer, flatulence, dyspepsia,
abdominal distention,
dysphagia
Hematologic: anemia
NURSING
CONSIDERATIONS
 Inform her that some
over-the-counter pain
medications (such as
aspirin and NSAIDs)
may worsen drug’s
adverse effects.
 As appropriate, review
all other significant
and life threatening
adverse reactions and
interactions.
MEDICATION MECHANISM INDICATION CONTRA- SIDE EFFECTS NURSING
OF ACTION INDICATION /ADVERSE CONSIDERATIONS
REACTIONS
Generic Increases serum Hypocalcemic  Hypersensitivity  Loss of appetite  Instruct patient to
Name: calcium level emergency to drug  Constipation consume plenty of
through direct Hypocalcemic  Ventricular  Gas (flatulence) milk and dairy
Calcium
effects on bone, tetany fibrillation  Nausea products during
Brand Name: kidney, and GI Cardiac arrest  Hypercalcemia  Vomiting therapy.

Maalox tract. Decreases Magnesium  Cancer  High calcium levels  Refer patient to
tablet osteoclastic intoxication  Renal calculi  Low phosphate dietitian for help in
osteolysis by Exchange levels meal planning and
Pharmaco-
reducing transfusions  Milk-alkali preparation.
logic class:
mineral release Hyperphospha syndrome
Mineral   As appropriate,
and collagen temia in
  review all other
  breakdown in patients
significant and life
bone. with end-
threatening adverse
stage renal
reactions and
disease
interactions.
MEDICATION MECHANISM INDICATION CONTRA- SIDE EFFECTS NURSING
OF ACTION INDICATION /ADVERSE CONSIDERATIONS
REACTIONS
Generic Promotes Hypoparathyro  Hypersensitivity  Constipation,  Monitor closely patients
Name: intestinal idism to drug receiving therapeutic doses
 Dry mouth of vitamin D must remain
vitamin D absorption of Refractory  Hypercalcemia
 Headache, under close medical
calcium, rickets  Malabsorption
Brand Name: supervision.
maintains normal Familial syndrome
Drisdol  Loss of appetite,  Lab tests: When high
calcium and hypophosphate  Abnormal
therapeutic doses are used,
Drug Class: phosphorous mia sensitivity to the  Metallic taste in your
progress is followed by
Vitamins, levels to enable toxic effects of mouth, and
frequent determinations of
Fat-Soluble normal bone vitamin D serum calcium,
 Stomach upset
mineralization phosphorus, magnesium,

and prevent alkaline phosphatase,

BUN, and determinations
hypocalcemia.
of urine calcium, casts,
albumin, and RBC. Blood
calcium concentration is
generally kept between 9
and 10 mg/dL.
MEDICATION MECHANISM INDICATION CONTRA- SIDE EFFECTS NURSING CONSIDERATIONS
OF ACTION INDICATION /ADVERSE
REACTIONS
Generic Omeprazole is a Duodenal ulcer  Hypersensitivity  Stomach pain,  Monitor improvements in
Name:  proton pump Gastric ulcer to the drug or GI symptoms (gastritis,
 Gas,
inhibitor. It dosage form. heartburn, and so forth) to
Omeprazole Treatment of
inhibits the  Nausea, help determine if drug
gastroesophage  Patients taking
Brand parietal cell H+ / therapy is successful.
al reflux dosage forms  Vomiting,
Name:  K+ ATP pump,
disease containing  Assess dizziness that
the final step of  Diarrhea, and
Prilosec (GERD) rilpivirine. might affect gait, balance,
acid production.  Headache and other functional
Maintenance of
In activities. Report balance
healing of
turn, omeprazole  problems and functional
erosive
suppresses limitations to the
esophagitis 
gastric basal and physician, and caution the
stimulated acid Pathological
patient and
secretion. hypersecretory
family/caregivers to guard
conditions
against falls and trauma.
MEDICATION MECHANISM INDICATION CONTRA- SIDE EFFECTS /ADVERSE NURSING CONSIDERATIONS
OF ACTION INDICATION REACTIONS
Adverse Reactions  Monitor other CNS side
effects (drowsiness,
 Severe stomach pain,
fatigue, weakness,
 Diarrhea that is watery headache), and report
or bloody, severe or prolonged
effects.
 New or unusual pain in
wrist, thigh, hip or back,  Monitor any chest pain and
attempt to determine if
 Seizure (convulsions),
pain is drug induced or
 Little or no urination, caused by cardiovascular
dysfunction (e.g., angina
 Blood in your urine,
that occurs during
 Swelling, exercise).

 Rapid weight gain,

 Dizziness,

 Irregular heartbeats,
MEDICATION MECHANISM OF INDICATION CONTRA- SIDE EFFECTS NURSING CONSIDERATIONS
ACTION INDICATION /ADVERSE
REACTIONS
Generic Iron combines with Iron Haemochromatosis Constipation  Monitor Hgb and
Name:  porphyrin and deficiency Blood disorders Contact irritation reticulocyte values during
globin chains to anemia Active peptic ulcer Diarrhea therapy. Investigate the
Ferrous
form hemoglobin, Regional enteritis Dark stools absence of satisfactory
Sulfate
which is critical for Ulcerative colitis. Gastrointestinal (GI) response after 3 weeks of
Brand oxygen delivery Patient receiving hemorrhage drug treatment.
Name:  from the lungs to frequent blood Gastrointestinal (GI)
 Continue iron therapy for
other tissues. Iron transfusions. irritation 2–3 months after the
Fersulfate –
deficiency causes a GI obstruction hemoglobin level has
Iron
microcytic anemia Nausea returned to normal
due to the Vomiting (roughly twice the period
formation of small Stomach pain required to normalize
erythrocytes with Urine discoloration hemoglobin
insufficient concentration).
hemoglobin.
MEDICATION MECHANISM OF INDICATION CONTRA- SIDE EFFECTS NURSING CONSIDERATIONS
ACTION INDICATION /ADVERSE
REACTIONS
 Monitor bowel
movements as
constipation is a
common adverse effect.

 Be aware that iron

preparations cause dark
green or black stools

 Be aware that milk,

eggs, or caffeine
beverages when taken
with the iron preparation
may inhibit absorption.
MEDICATION MECHANISM OF INDICATION CONTRA- SIDE EFFECTS NURSING
ACTION INDICATION /ADVERSE CONSIDERATIONS
REACTIONS
Generic An estrogen  Vasomotor  Breast cancer  Vaginal bleeding  Instruct patient to use
Name: symptoms with some  Breast pain or this drug cyclically or
medication that associated exceptions tenderness short term; prepare a
Conjugated increases synthesis with  Hepatic  Gynecomastia calendar of drug days,
Estrogens
of DNA, RNA, and menopause, disease  Headache rest days, and drug-
  atrophic  Thrombophle  Hypertension free periods.
various proteins in
vaginitis, bitis  Intolerance to  Instruct patient to use
Brand Name: target tissues; kraurosis contact lenses vaginal cream
Premarin reduces release of vulvae  Anorexia properly.
 Female  Nausea  Potentially serious side
gonadotropin-
hypogonadis  Loss of scalp effects can occur:
releasing hormone m hair Cancers, blood clots,
from the  Female  Depression liver problems; it is
hypothalamus; and castration, very important that
primary you have periodic
reduces follicle- ovarian medical examinations
stimulating failure throughout therapy.
hormone (FSH) and  Osteoporosis
 Breast cancer
luteinizing hormone
 Abnormal
(LH) release from uterine
the pituitary gland. bleeding
MEDICATION MECHANISM INDICATION CONTRA- SIDE EFFECTS NURSING CONSIDERATIONS
OF ACTION INDICATION /ADVERSE
REACTIONS
 The patient may experience these
side effects: Nausea, vomiting,
bloating; headache, dizziness,
mental depression; sensitivity to
sunlight; rash, loss of scalp hair,
darkening of the skin on the face;
changes in menstrual patterns.
 Instruct patient to report pain in the
groin or calves of the legs, chest
pain or sudden shortness of breath,
abnormal vaginal bleeding, lumps
in the breast, sudden severe
headache, dizziness or fainting,
changes in vision or speech,
weakness or numbness in the arm or
leg, severe abdominal pain,
yellowing of the skin or eyes,
severe mental depression, pain at
injection site.
 QMC
Geriatric Ward
Carmen Angeles
Aoa l a d
Calcium (Maalox) 500 mg
ANDREA O. ALAD
BID 1 Tab
BSNIII-SLSU
April 29, 2021

QMC
Carmen Angeles Geriatric Ward
Alendronate Sodium (Fosamax) 10 mg Aoa l a d
OD 1 tab ANDREA O. ALAD
BSNIII-SLSU
April 29, 2021

QMC
Geriatric Ward
Carmen Angeles
Vitamin D (Drisdol) 15 mg Aoa l a d
OD 1 tab ANDREA O. ALAD
BSNIII-SLSU
April 29, 2021

QMC
Geriatric Ward
Carmen Angeles Aoa l a d
Omeprazole (Prilosec) 20 mg ANDREA O. ALAD
OD 1 tab BSNIII-SLSU
April 29, 2021
 QMC
Geriatric Ward
Carmen Angeles
Aoal ad
Ferrous Sulfate (Fersulfate Iron) 325 mg
ANDREA O. ALAD
OD 1 tab
BSNIII-SLSU
April 29, 2021

QMC
Geriatric Ward
Carmen Angles Aoal ad
Conjugated Estrogen (Premarin) 0.3 mg ANDREA O. ALAD
OD 1 tab BSNIII-SLSU
April 29, 2021
 Evaluation
After the nursing interventions, the patient is expected to acquire
knowledge about osteoporosis and the treatment regimen as
evidenced by the following: states relationship of calcium and
vitamin D intake and exercise to bone mass; consumes adequate
dietary calcium and vitamin D; takes prescribed medications,
following instructions for administration; increases level of exercise;
and, adheres to prescribed screening and monitoring procedures.
Additionally, the patient should relief of pain and discomfort as
evidenced by experiences pain relief at rest and experiences minimal
discomfort during activity of daily living. Furthermore, the patient
will be guided in creating a safe home environment to reduce risk of
injuries at home.
 Thank you
for listening!

Andrea Alad Lynchner Dan Hizon

Bihag

BSN III