response Guidelines: Review other students posts and respond to one. Address the following information:
Were there any differences in what you each identified as necessary additional questioning? Discuss your findings and provide appropriate rationale/ evidence to support your response (this applies to question #2 from above).
What differences, if any were there in what you each identified as nursing diagnoses, possible medical diagnoses, and data that required a physicians or other interdisciplinary team members referral? Provide appropriate rationale/evidence to support your response (this applies to question #3 from above).
my post:
Special Populations
Understanding the physiological changes related to aging is vital for appropriate assessment and intervention in caring for older adults. This case study explains Bertie Thomas, an 88-year-old client with left hip pain after a fall.
Typical Physiological Signs of Aging in the Musculoskeletal System
When individuals become older, many physiological changes happen throughout the musculoskeletal system. These alterations may lead to mobility, balance, and general activity difficulties. In this example, some of these indications are clear. In other words, the client walks with a broad-based gait and exhibits an exaggerated thoracic curve, low muscle strength, and unsteady balance, especially when standing on toes or heels (Grimmer et al., 2019). Furthermore, genu varum, which can be considered as mild bowing knees, is observed. Such changes are manifestations of age impacting bone structure, muscle mass, joint flexibility, and proprioception.
Further Questions for Eliciting Necessary Information
More questions would have to be asked to understand the clients condition completely (Soames, 2023). These may involve questions relating to any recent falls or unexplained injuries, prevalence of osteoporosis or other bone disorders, deterioration in functional abilities or mobility over time, medications (particularly those impacting balance or bone health), history of physical rehabilitation or therapy as well as recent changes in living or daily activities that might increase fall risk.
Possible Medical and Nursing Diagnoses
Based on the assessment findings, two possible medical diagnoses could be: Based on the assessment findings, two possible medical diagnoses could be:
Osteoarthritis of the hip: As an outcome of comprehensive clinical examinations, including histogram and CT, the diagnosis level complied with the clients complaint of lower hip pain after falling (Katz et al., 2021). Osteoarthritis is prevalent in older adults and results in pain, stiffness, and movement problems (for example).
Cervical spondylosis: The clients problem with neck and back stiffness is a possible symptom of cervical spondylosis, a degenerative disease that slowly affects the cervical spine.
Two nursing diagnoses using the PES format
Risk for falls related to impaired balance and gait instability as evidenced by wide-based gait, inability to stand on toes or heels without losing balance, and history of falling backward quickly (Soames, 2023).
Impaired physical mobility is related to musculoskeletal impairment, as evidenced by difficulty with toe touch, decreased muscle strength, and an exaggerated thoracic curve.
Data Requiring Referral
If neurological symptoms like numbness, tingling, weakness, or changes in bowel or bladder function occur, a physician or neurologist must be referred, who will perform further evaluation. Furthermore, if imaging (for example, X-ray, MRI, etc.) is needed to confirm diagnoses such as osteoarthritis and spondylosis, a referral to an orthopedics or radiology specialist would be appropriate (Soames, 2023). Such an interdisciplinary approach provides for comprehensive needs assessment and patient-appropriate management.
CLASSMATES POST TO RESPOND TO:
As people age, there are several normal physiological changes that occur in the musculoskeletal system. When performing an assessment of an older adult, it is essential to be aware of these changes to differentiate between normal aging and potential pathology. Weber (2021) mentions some of the common signs of aging associated with the musculoskeletal system, including a decrease in muscle mass (sarcopenia), slower gait, accentuated dorsal spine curve (kyphosis), loss of muscle bulk and tone, decrease range of motion of spine, neck, and extremities; a decrease in height (1.2 cm lost every 20 years); shoulder width decreases; chest and pelvis widths increase (p. 451).
The nurse may ask the further questions to elicit necessary information related to the musculoskeletal system. For example, regarding to pain and discomfort, the nurse can ask the patient to describe any pain or discomfort they are experiencing in their muscles or joints, where specifically they feel the pain, when does the pain occurs, and if it is worse with certain activities or times of the day. Regarding the mobility function, the following questions can be addressed: how has your mobility been recently? Are you able to perform daily activities without difficulty? have you noticed any changes in your ability to perform specific movements? do you experience any stiffness or limited range of motion in your joints? Lastly, the nurse could expand on the patients health and family history by asking about any experienced falls, fractures, or injuries, previous musculoskeletal conditions such as osteoarthritis, rheumatoid arthritis, or osteoporosis. And the type of physical activity that the patient engages in regularly. These questions can provide valuable insight into the clients musculoskeletal health, history of musculoskeletal problems, and potential risk factors for musculoskeletal disorders. Additionally, they can help guide the examination and develop an appropriate management plan to address any identified issues.
In the case of the patient from the case study, Bertie Thomas, two possible medical diagnoses could be a hip bruise since she had equal leg lengths, and a gait deviation since the patient is unable to stand on her heels without losing her balance. Additionally, two nursing diagnosis for Bertie can be hip pain related to a recent fall, as evidenced by the patient reporting hip pain, and impaired physical mobility related to neck and back stiffness secondary to aging process.
Bertie could benefit from interdisciplinary team members referrals such as physical medicine since she falls backward easily on the nudge test. Also, the hip pain could be a serious concern which requires a physician opinion. Mohammadi & Sedlak (2024) mentions that physical medicine and rehabilitation is needed more than ever for the promotion of population health as individuals age and need to preserve musculoskeletal health for maintaining independence and building functional abilities (p. 28). Therefore, it is important to recognize that while changes are typical aspects of aging, they can vary significantly among individuals. Regular physical activity, proper nutrition, and preventive healthcare measures can help mitigate some of the effects of aging on the musculoskeletal system and promote healthy aging. Additionally, healthcare professionals should carefully assess older adults for signs of musculoskeletal disorders and provide appropriate interventions to maintain function and quality of life.
