Sign and Symptoms
Physical assessment finding
Poor mass of bone acquisition during growth and development and after that accelerated loss of bone after the achievement of peak bone mass (Milas-Ahi?, Prus, Kardum & Kova?evi?, 2014).
Post menopause is the main risk factor where fracture occurs determined by the pre-menopausal peak mass of bone. Calcium deficit diet, low body weight and family history of osteoporosis.
Acute onset of pain, may progress into chronic dull pain, hip fracture occur after falls and subchondrial-insufficiency fractures.
The fractures of distal radius are the most common physical assessment that occurs in osteoporosis after falls or trauma. Skeletal fracture, vertebral fracture (most common)
Senile or amyloid plaques called neuritic plaques called the extracellular lesions that are found in brain and vasculature of cerebrum. Extracellular amyloidal protein and intracellular neurofibrillary tangles deposits that lead to senile plaques.
Age, Family history, gender (rare) and modifiable risk factors like alcohol, smoking, diabetes, high cholesterol, obesity.
Memory loss, challenges in solving problems, difficulty in carrying out tasks, confusion with time or space, trouble in understanding the visual images, problems in words, spelling. Poor judgment, withdrawal from social work, mood and personality changes (Geda et al., 2013).
Neurological examination along with mental status examination for language, recent memory, concentration, attention, executive function, praxis and visuospatial function.
The enzymatic increased breakdown of the proteoglycans in the cartilage superficial layers and fractures of the collagen fibers. This proteoglycan loss results in the increased diminution of weight-bearing capacity and elasticity of the cartilage (Gibofsky, 2014).
Non-modifiable risk factors like age, gender and genetics. Modifiable risk factors are overweight, obesity, joint injuries, infection and occupation where it demands, repetitive squatting or bending of the knee.
Pain in the affected joint, stiffness after waking up or long periods of inactivity, joint sound at the affected area, hardness where it causes bone spurs or abnormal lumps.
Assess the stiffness, tenderness, swelling, pain, deformity, rheumatoid nodules or limitations in motion of the affected joints.
Norephinephrine, dopamine, serotonin and GABA are the main mediators in the autonomic nervous system in the sympathetic nervous system. Increased flow in the parahippocampal region on the right side and reduced type 1A serotonin receptor binding (Fox & Kalin, 2014).
Trauma, buildup of stress, stress as a result of illness, personality disorder, mental health disorders, alcohol or drug consumption and family history of anxiety disorders.
Nervousness, anxiety, sense of impending panic, danger or doom, increased heart rate, rapid breathing, trembling, sweating, feeling of tiredness or weakness, trouble in thinking or concentration, disturbed sleep, difficulty in controlling worry and things that trigger anxiety.
Mental Status examination (MSE) that provide information about anxiety symptoms, behavior, level of activity, mood, effect, speech and physical signs like restlessness, sweat, distractibility and restlessness.
Morphological changes witnessed in the grey matter reduction volume, glial density in the hippocampus and prefrontal cortex, decline in hippocampal functioning that have an inhibitory effect on the hypothalamic-pituitary- adrenal (HPA) axis that may be seen in depression. Also, hyperactivity or chronic stress in HPA axis and hormonal imbalance like thyroid hormone, vasopression or estrogen involvement.
Low esteem, self-critical or too dependent personality traits, stressful or traumatic events, family history of mental health disorders, alcohol or substance abuse, chronic illness like cancer or heart disease.
Feelings of emptiness, sadness, sleep disturbances, loss of interest in activities, agitation, anxiety, trouble thinking, recurrent thoughts of death, unexplained symptoms like headache.
Physical examination including mental status examination to assess the appearance, effect, speech, neurological and hormonal tests for hypothyroidism, Cushing syndrome, Vitamin D and calcium levels, MRI or CT scan, ECG, EEG and screening tests that diagnose depression.
Sequelae of fracture of femur
It is caused due to significant force when it is transmitted from direct or indirect blow at the knee. It can also be caused by bone weakness resulting from lytic lesions or osteoporosis (Belzung, Willner & Philippot, 2015).
Age is the main risk factor after the age of 50 years with osteoporosis, gender, smoking, defective vision, physical inactivity, low body mass index, arthritis and dementia.
Inability to move, severe hip pain, bruising, stiffness, swelling, shortening of leg on the side of the injured hip, turning outward of the leg on the injured hip side.
Medical examination that assess the deformity in the leg or thigh, skin break, bruises or bony pieces that pushes the skin. Imaging tests like CT scan and X ray.
Assess the functional ability, provision of motion exercises, repositioning of the patient, assistance with walking, mechanical lift, access degree of immobility and assistance with self-activities (Ha et al., 2014).
Bone mineral density test (BMD) through Dexa-Scan, CT scan, X-rays, body composition analysis, bone scan, blood calcium levels and hormonal levels.
Exercise like weight-bearing exercises, jogging, weightlifting and calcium and Vitamin D medications to prevent fractures.
Appearance of symptoms, family history, extent of pain and fractures associated with ongoing condition. Severity of the fractures.
Provide additional support, effective communication for adjustment to the altered cognitive functioning (Howard et al., 2015).
Testing of mental abilities, brain scans and blood tests. Neurological examination is done to assess the muscle tone and strength, reflexes, coordination, balance, sense of hearing and sight.
They should be taught about the following of routines, help them in taking frequent breaks in between tasks. They should also be taught about self-care and independence in carrying out their daily activities.
First symptoms, family history, severity of the symptoms and progressing condition.
It includes the assessment for acute pain, impaired physical mobility, self-care deficit, impaired home maintenance to reduce the risk (Primdahl et al., 2014).
X-rays, angiograms like blood vessel studies, MRI, cause of chronic pain, lab tests like antinuclear antibody, anti-cyclic citrullinated peptide, uric acid, HLA tissue typing, ESR, joint fluid tests, muscle biopsy, lyme serology and C-reactive protein.
Pain management by applying cold or heat on the painful joint, regular exercise that provides joint mobility or stretching, encouragement of coordination of pain with medications, assistance of protective devices that helps support to the joints. Encouraged to eat balanced diet and providing a safe environment for the patient.
Symptoms, prevailing conditions, previous and ongoing medications, family history, joint information like swelling, warmth and redness.
To recognize the patient’s awareness for anxiety, use of touch, presence, demeanor and verbalization that remind the patients and encourage clarification or expression, questions, concerns and needs, familiarization of the patient with the environment, use of convenient language, reinforcing of the patient towards pain or discomfort (Chlan et al., 2014).
Physical examination that helps to look for the anxiety signs, urine or blood tests,
Patient and caregivers should be taught to report the anxiety symptoms, impending danger, and doom or panic and other complications. Simple breathing exercises, methods to relieve stress and ease the symptoms of anxiety.
Repeated episodes of anxiety, persistent worry, fear and symptoms of anxiety that interfere with their daily activities.
Identification of suicide precautions, arrangement of counseling through self-help groups, encouragement of the patients to express feelings of guilt, sadness or anger (Cukor et al., 2014).
Physical examination that focus on endocrine or neurological systems, corticosteroid medications that might lead to depression on withdrawal, vitamin D and calcium levels, anemia and thyroid levels.
Patient and their caregivers should be taught about encouragement of verbalization of feelings and degree of control, encourage them to make decisions, instruct them on controlling the suicidal behavior or easy crying and instruct them on the physical complaints and difficulty in concentration.
Family history of mental health disorders or depression episodes, current medications, hormonal levels like thyroid, blood calcium and vitamin D levels, anemia.
Sequelae of fracture of femur
Maintenance of bed or limb rest that provides support to the joints, supporting of the fracture with folded blankets or pillows with neutral position, sufficient personnel for the patient turning, evaluation of splinted extremity, therapy for wrist bending and sitting up (Neuman et al., 2014).
X ray that shows femoral neck and intertrochanteric region fracture, atypical fracture that can occur in rare cases.
Rehabilitation for the patient after the surgery with focus on physical therapy on the range of strengthening and motion exercises, compliance with medications.
Recent falls or injury, weight gain on the injured hip, alcohol or tobacco consumption, current medications, bone density test, family history of osteoporosis or bone fractures.
Belzung, C., Willner, P., & Philippot, P. (2015). Depression: from psychopathology to pathophysiology. Current opinion in neurobiology, 30, 24-30.
Chlan, L. L., Weinert, C. R., Heiderscheit, A., Tracy, M. F., Skaar, D. J., Guttormson, J. L., & Savik, K. (2013). Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial. Jama, 309(22), 2335-2344.
Cukor, D., Ver Halen, N., Asher, D. R., Coplan, J. D., Weedon, J., Wyka, K. E., … & Kimmel, P. L. (2014). Psychosocial intervention improves depression, quality of life, and fluid adherence in hemodialysis. Journal of the American Society of Nephrology, 25(1), 196-206.
Fox, A. S., & Kalin, N. H. (2014). A translational neuroscience approach to understanding the development of social anxiety disorder and its pathophysiology. American Journal of Psychiatry, 171(11), 1162-1173.
Geda, Y. E., Schneider, L. S., Gitlin, L. N., Miller, D. S., Smith, G. S., Bell, J., … & Rosenberg, P. B. (2013). Neuropsychiatric symptoms in Alzheimer’s disease: past progress and anticipation of the future. Alzheimer’s & dementia, 9(5), 602-608.
Gibofsky, A. (2014). Epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis: A Synopsis. The American journal of managed care, 20(7 Suppl), S128-35.
Ha, M., Hu, J., Petrini, M. A., & McCoy, T. P. (2014). The effects of an educational self-efficacy intervention on osteoporosis prevention and diabetes self-management among adults with type 2 diabetes mellitus. Biological research for nursing, 16(4), 357-367.
Howard, R., McShane, R., Lindesay, J., Ritchie, C., Baldwin, A., Barber, R., … & Jones, R. (2015). Nursing home placement in the Donepezil and Memantine in Moderate to Severe Alzheimer’s Disease (DOMINO-AD) trial: secondary and post-hoc analyses. The Lancet Neurology, 14(12), 1171-1181.
Milas-Ahi?, J., Prus, V., Kardum, Ž., & Kova?evi?, I. (2014). Pathophysiology of osteoporosis. Reumatizam, 61(2), 65-69.
Neuman, M. D., Silber, J. H., Magaziner, J. S., Passarella, M. A., Mehta, S., & Werner, R. M. (2014). Survival and functional outcomes after hip fracture among nursing home residents. JAMA internal medicine, 174(8), 1273-1280.
Primdahl, J., Sørensen, J., Horn, H. C., Petersen, R., & Hørslev-Petersen, K. (2014). Shared care or nursing consultations as an alternative to rheumatologist follow-up for rheumatoid arthritis outpatients with low disease activity—patient outcomes from a 2-year, randomised controlled trial. Annals of the Rheumatic Diseases, 73(2), 357-364.