Create a concept map using information from this case study:
M.S., a 72-year-old white woman, comes to your clinic for a complete physical examination. She has not been to a provider for 11 years because “I don’t like doctors.” Her only complaint today is “pain in my upper back.”
She describes the pain as sharp and knifelike. The pain began approximately three weeks ago when she was getting out of bed in the morning and hasn’t changed. M.S. rates her pain as 6 on a 0- to 10-point pain scale and says the pain decreases to 3 or 4 after taking “a couple of ibuprofen.” She denies recent falls or trauma.
M.S. admits she needs to quit smoking and start exercising but states, “I don’t have the energy to exercise, and besides, I’ve always been thin.” She has smoked one to two packs of cigarettes per day since she was 17 years old. Her last blood work was 11 years ago, and she can’t remember the results. She went through menopause at the age of 47 and has never taken hormone replacement therapy. The physical exam was unremarkable other than moderate tenderness to deep palpation over the spinous process at T7. No masses or tenderness to the tissue surrounded the tender spot. No visible masses, skin changes, or erythema were noted. Her neurologic exam is intact, and no muscle wasting is noted.
M.S. has never had an osteoporosis screening. She confides that her mother and grandmother were diagnosed with osteoporosis when they were in their early 50s.
Include answers to the following questions in your concept map:
1.What is the priority concept of this scenario?
2.Write a summary of the pathophysiology if appropriate.
3.What assessment findings led you to identify this priority problem? Are there other concerns based on your assessment of M.S.?
4.What is your priority problem?
5.Based on your knowledge of the nursing process so far, what goals would you recommend in the plan of care for M.S?
6.What interventions will help M.S. meet these goals?
7.How would you evaluate your plan of care to determine the next steps?
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Writing Guide
Concept Map
Patient: M.S., a 72-year-old white woman
Chief Complaint: Pain in upper back
History of Present Illness: M.S. has been experiencing sharp, knifelike pain in her upper back for three weeks. The pain is worse when she gets out of bed in the morning and decreases with ibuprofen. She denies recent falls or trauma.
Past Medical History:
Osteoporosis (mother and grandmother)
Smoking (1-2 packs/day for 55 years)
Menopause at age 47
No hormone replacement therapy
Social History:
Lives alone
No family or friends nearby
Retired teacher
Physical Examination:
Moderate tenderness to deep palpation over the spinous process at T7
No masses or tenderness to the tissue surrounding the tender spot
No visible masses, skin changes, or erythema
Neurologic exam is intact
No muscle wasting is noted
Laboratory Tests:
Complete blood count (CBC) within normal limits
Chemistry panel within normal limits
Bone mineral density (BMD) test shows osteopenia
Diagnosis:
Osteoporosis
Priority Concept:
Pain
Pathophysiology:
Osteoporosis is a condition in which the bones become weak and brittle. This can lead to fractures, especially in the spine, hips, and wrists. The exact cause of osteoporosis is unknown, but it is thought to be a combination of genetic and environmental factors. Risk factors for osteoporosis include:
Age
Gender (women are more likely than men to develop osteoporosis)
Family history
Caucasian or Asian race
Small body frame
Late menopause
Low calcium intake
Low vitamin D levels
Smoking
Alcohol abuse
Long-term use of certain medications, such as corticosteroids
Assessment Findings:
Pain in upper back
Tenderness to deep palpation over the spinous process at T7
No masses or tenderness to the tissue surrounding the tender spot
No visible masses, skin changes, or erythema
Neurologic exam is intact
No muscle wasting is noted
Other Concerns:
Smoking
Osteopenia
Lack of social support
Priority Problem:
Pain
Goals of Care:
M.S. will report a decrease in pain.
M.S. will be able to participate in her usual activities without pain.
M.S. will not experience any further fractures.
Interventions:
Administer pain medication as ordered.
Teach M.S. about pain management techniques, such as relaxation exercises and heat therapy.
Encourage M.S. to participate in regular physical activity.
Refer M.S. to a physical therapist for exercises to strengthen her back muscles.
Encourage M.S. to quit smoking.
Refer M.S. to a dietitian for help increasing her calcium and vitamin D intake.
Assessment:
M.S. will report a decrease in pain.
M.S. will be able to participate in her usual activities without pain.
M.S. will not experience any further fractures.
