Nursing

write a plan base on the cases see template for planing

Below is the template you are to follow when developing your management plan. It is not a SOAP format as that is not required.

Primary Diagnosis and ICD-10 code: Also include any procedural codes.

3 Differential Diagnoses- Why? What made you select each one as a DDX? How did you rule out? This would be a good area to include references.

Additional laboratory and diagnostic tests: May be necessary to establish or evaluate a condition. Some tests, such as MRI, may require prior authorization from the patient’s insurance carrier.

Consults: referrals to specialists, therapists (physical, occupational), counselors, or other professionals. If you are sending to hospital, what orders would you write for a direct admit?

Therapeutic modalities: pharmacological and nonpharmacological management.

Health Promotion: Address risk factors as appropriate. Consider age-appropriate preventive health screening.

Patient education: Explanations and advice given to patient and family members.

Disposition/follow-up instructions: when the patient is to return sooner, and when to go to another facility such as the emergency department, urgent care center, specialist or therapist.

References (minimum of 3, timely, that prove this plan follows current standard of care).

ANSWER

Treatment Plan

Primary Diagnosis and ICD-10 code: The primary diagnosis is Spinal osteoporosis fractures (ICD-9-CM code 733.01), which is primarily caused by an estrogen hormone deficiency, high rates of bone loss, and bone loss at younger ages. The other three differential diagnoses are Coccydynia, which is mostly caused by trauma and occurs due to variations in shape and pelvis angle in women and injury during childbirth. The patient feels pain at the tail of her spine. The second differential diagnosis is Degenerative spondylolisthesis, which occurs due to the sliding of a spinal vertebra over each other. The condition is usually caused by low estrogen, thereby increasing the respective vertebral disc’s degradation, hence spinal imbalance.

It is typically characterized by lower back pain that radiates towards the legs and a feeling of pain while walking (neurogenic claudication). The third differential diagnosis is Sacroiliac joint dysfunction resulting from a small Si joint surface in women leading to high-stress concentration across the joint. It is typically characterized by lower back pain, radiating pain down the thigh, and an achy pain slightly over the buttock. The outstanding features that qualified them as Differential Diagnoses are their prevalence in women and the joint back pain in all of them. The component used to rule them out was the fact that the primary diagnosis is primarily common in post-menopausal age while the differential diagnoses are might across all ages in women and men (Sözen, Özışık & Başaran 2017).

Additional laboratory and diagnostic tests: The Bone Mineral Density test is the key test in diagnosing Spinal osteoporosis fractures. The test is carried through dual-energy X-ray absorptiometry. Some laboratory tests like alkaline phosphatase, Sprue test, Genetic tests, Protein electrophoresis, and Urine cortisol tests are also recommended to identify the extent of bone damage and other potential diseases.

Consults: Some of the recommended specialists are those dealing with spine disorders and Physiatrists. Orders given for a direct admission would be mandatory comfort and handling with the utmost care due to the fragile patient-bones (Gupta & March 2016).

Therapeutic modalities: Pharmacological managements include administering of Bisphosphonates which help in slowing the rate of bone loss. Approved Bisphosphonates are alendronate, administered daily or weekly, Ibandronate, which is administered preferably once in 3 months, and Zolendronic acid administered once a year. The other pharmacological management is administering Thyroid and Parathyroid hormone therapy, which are used in altering bone growth; the various types include Teriparatide, Abalaparatide, and Calcitonin. Non-pharmacological management involves diet and nutrition monitoring; the patients are recommended to consume substantive calcium and vitamin D. The patients are also advised to engage in frequent exercise and fitness activities like yoga, jogging, dancing, Tennis, and Pilates.

Health Promotion: The risk factors involved in Spinal osteoporosis are advanced age, which lowers the rate of bone growth, sex; women stand high chances of contracting the disease due to their thin bones and relatively low bone mass. Family and personal history of fractures; those with prevalent bone loss and fragility at 45 years and above are more likely to suffer from osteoporosis. Other risk factors involved are menopause, menstrual history in women, and low testosterone in males. Some of the preventive measures include consuming foods rich in calcium and vitamin D nutrients and frequent visits to Physiatrists to monitor the general body-bone condition (Tomé-Bermejo et al., 2017).

Patient education: Patients should strictly follow the prescribed dosages to enhance bone growth and minimize bone loss. They should also consume the recommended nutrition and diet, and finally, the patients should be engaged in non-pharmacological management as recommended by the doctors. Family members should offer emotional and physical support and ensure the patient does not indulge in any activities that would worsen the patient’s health condition.

Disposition/follow-up instructions: In case of endless pains and lack of improvements, the patient is advised to seek further medical guidance and advice from a Physiatrist to prevent other complications. Non-pharmacological management is critical in recovery and, if necessary should be administered from an expert level.

References

Gupta, A., & March, L. (2016). Treating osteoporosis. Australian prescriber, 39(2), 40.

Sözen, T., Özışık, L., & Başaran, N. Ç. (2017). An overview and management of osteoporosis. European journal of rheumatology, 4(1), 46.

Tomé-Bermejo, F., Piñera, A. R., & Alvarez, L. (2017). Osteoporosis and the management of spinal degenerative disease (II). Archives of Bone and Joint Surgery, 5(6), 363.

Varacallo, M., & Pizzutillo, P. (2018). Osteoporosis in spinal cord injuries.