Marika's Case Study: Nursing Care Plan

The assignment focuses on a case study of Marika, who suffers from osteoarthritis, leading to joint pain, mobility issues, and a risk of falls. The document also addresses her co-existing condition of osteoporosis. It presents a detailed nursing care plan encompassing assessments, goals, interventions, rationales, and evaluations aimed at managing Marika's pain, improving mobility, preventing falls, and addressing osteoporosis concerns.

Running head: EVIDENCE BASED NURSING RESEARCH
HEALTHY AGEING AND CHALLENGES TO HEALTH FOR OLDER PERSONS
Name of the Student
Name of the University
Author note

1EVIDENCE BASED NURSING RESEARCH
Table of Contents
Introduction..........................................................................................................................2
Pathophysiology..................................................................................................................2
Investigation and tests..........................................................................................................4
Clinical manifestation..........................................................................................................5
Clinical course of condition.................................................................................................6
Most common treatment......................................................................................................6
Conclusion...........................................................................................................................7
References............................................................................................................................9
Bibliography......................................................................................................................11

2EVIDENCE BASED NURSING RESEARCH
Introduction
The rate of aging in global population is increasing day by day. This phenomenon is
occurring in a time when the scale and rate of man made changes in the environment is
exceeding the highest levels of ecological limitations. According to World Health Organization
(2017), about 15% of adults aged 60 and over suffer from a mental disorder.
The biophysical issues related to aging is not much discussed in the society however, the
effects of such issues are life threatening in the elderly population of the society (Berryman et al
2012). The psychosocial approach as well, looks at these elderly people in relation with the
combined influence of social factors surrounding environment, and psychosocial factors (Keefe
et al 2013). These approach talks about these above-mentioned factors on the mental and
physical wellness.
To discuss these issues, the critical analysis will discuss the case of Marika, who is in her
80’s and is suffering from several disorders such as osteoporosis, osteoarthritis, hypertension,
falls, overweight and delirium as well. She is currently living in an old age care home and
suffering from these biophysical and psychosocial issues. This critical analysis is going to
discuss her issues about osteoporosis and osteoarthritis with a proper clinical intervention and
care plan to help her age in a healthy way.
Pathophysiology
As Marika is suffering from osteoarthritis, osteoporosis, hypertension, falls, and delirium,
the pathophysiology of osteoarthritis and osteoporosis has been discussed.
Pathophysiology of osteoarthritis- the cartridge is a unique tissue that has several
compressive and viscoelastic properties that is imparted by its extracellular matrix. This cartridge

3EVIDENCE BASED NURSING RESEARCH
is made up of type two collagen and proteoglycans (Sankar et al. 2013). In normal condition, this
matrix undergoes a remodeling process in which, lower level of synthetic and degradative
enzymes are formed, that balances the overall activities and the volume of the cartridge is
maintained. However, in the case of Osteoarthritis, expression of those degradative enzymes
becomes higher than that of the synthesizer enzymes, leading to the shift the balance in the favor
of overall degradation of the bones. This leads to loss of collagen and proteoglycans from the
matrix. Hence, the bones becomes weaker (Olivotto et al. 2015). Due to the loss of those two
building blocks of cartridge, chondrocytes produces elevated amounts of proteoglycans and
collagens, however as the disease continues, the synthesize outmatched the degradation and leads
to fibrillations, cracklings and erosions in the superficial layer of cartilage. These cracklings
progresses to the deeper layers over time leading to clinically observable cracklings and erosions
(Pesesse et al. 2014).
Pathophysiology of Osteoporosis -
The condition of osteoporosis is mainly the reduction in skeletal mass that has been caused by
the imbalance between bone reabsorption and bone formation. In normal physiological
conditions, the reabsorption and the bone formation are present in balance however; increase or
decrease in either factor can lead to the condition of osteoporosis (Armas and Recker 2012). The
cause of osteoporosis can be failure in the formation of bones and reaching the peak bone mass,
during the young age, that causes loss of bones in the later period of life. Hormonal status can be
another factor to cause osteoporosis. Aging and the loss in the gonadal functions are also the
reasons behind the occurrence of the osteoporosis. As the menopause occurs, the rate of bone
loss accelerates in women. Estrogen deficiency is a prime reason of the factors that influences
the process of bone loss in elderly women (Drake, Clarke and Lewiecki 2015).

4EVIDENCE BASED NURSING RESEARCH
Due to these health problems, Marika is suffering from falls, delirium and hypertension.
Investigation and tests
Investigation of these diseases in Marika can be done using different pathophysiological
tests. The diagnosis processes that can be used to investigate the level of osteoporosis are-
 Complete blood count test should be done to investigate the occurrence of anemia
in Marika. In bone marrow, the level of cartridge determines the activities of bone
reabsorption and bone formation. Hence, anemic patients can acquire this disease
condition (Pisani et al. 2013).
 Serum chemistry tests to determine the levels of it in blood serum. However, if
the patient is suffering from primary osteoporosis, the level will be normal in their
serum.
 Hypercalciuria is another factor that can lead to the osteoporotic condition.
Furthermore, the investigation, to determine the presence of intact para-thyroids
and urine pH may indicate to these conditions. Hence, a 24-hour urine calcium or
creatinine level is diagnosed to understand the reason for osteoporosis (Cosman et
al. 2014).
 Serum protein electrophoresis can be done to determine the presence of multiple
myeloma. Moreover, 25-hydroxyvitamin D level can be determined as the
deficiency in this kind of protein can lead to the occurrence of the disorder.
Diagnosis procedures for the osteoarthritis can be-
 Magnetic resonance imagination or MRI and X-rays can be done to get a clear
idea and image of the affected joints. However, cartilage cannot be seen through

5EVIDENCE BASED NURSING RESEARCH
X-rays but the loss of cartilage can be observed by seeing the narrowing of the
space between joint bones. MRI used radio waves and a magnetic fields to
generate a detailed image of the bone and the tissues that are been affected by the
presence of osteoarthritis (Aicher and Rolauffs 2014).
 Other than these imaging tests, different lab tests should be performed to
understand the co-morbid situations of the presence of this disease. Joint fluid
analysis is such a test that determines the fluid present in joints. The diagnosis
includes extraction of fluid from the joints to determine the cause of inflammation
is due to either infection or some other physiological condition (Loeser et al.
2012).
Clinical manifestation
The primary signs and symptoms for Marika’s osteoarthritis included-
 Pain, the joint s of Marika used to hurt during and after movements. The pain
became adverse with every day passing.
 Tenderness and stiffness in the joints. She used to feel tenderness in her joints
while applying minimal pressure to it. She also felt stiffness after inactivity and
waking up in the morning.
 Loss of flexibility and bone spurs were her secondary signs and symptoms for
osteoarthritis (Aaseth, Boivin and Andersen 2012).
Symptoms of osteoporosis includes –

6EVIDENCE BASED NURSING RESEARCH
 Acute pain in the joints occurs after her fall. After this, she became prone to falls.
The history of falls has caused the incidences of deliriums (Braun and Gold
2012).
 She was suffering from sharp pain in her joints and paravertebral muscle spasms
that decreased when was lying and increases during activities. Hence,
osteoporosis was detected.
 The pain was localized in the vertebral level and in lower thoracic (Castañeda et
al. 2013).
Clinical course of condition
The clinical course of osteoporosis and osteoarthritis can be better understood by
Marika’s history of diseases. There are three levels for the etiopathogenesis of osteoarthritis.
Marika is currently suffering from acute phase of arthritis hence; her pain is of the sharp level
and cannot be controlled by physiotherapies of medication. In early stages the joint were
appearing normal and was little tender and stiff while inactive. However, due to several course of
falls. The pain become inevitable and joints become weaker (Pisters et al. 2012).
As per her symptoms. Marika is suffering from acute phase of osteoporosis as well. The
MRI and X-ray reports has cleared the fact that her bone has become narrower due to the loss of
calcium and several pores are present in it. Initially her pain used to be controlled by some
analgesics; however, nowadays it has become intolerable.
Most common treatment
Osteoporosis

7EVIDENCE BASED NURSING RESEARCH
 The most common treatment for osteoporosis involves bisphosphonates that
are the most common kind of medication that has been provided to a patient of
osteoporosis. The drugs that are commonly used are Alendronate,
Risedronate, Ibandronate and Zoledronic acid. Hormones also plays an
important role in the occurrence of the osteoporosis, hence ingestion of small
amount of hormones are also prescribed.
 Denosumab are recent invented drugs that are currently used in the
osteoporosis that reduces the risk associated with this disease (Das and Crockett 2013).
Osteoarthritis
 Acetaminophin are drugs that are currently been used to control the pain in the
acute phase of osteoarthritis. These drugs are superior to NSAIDs that are primary
pain relief medication provided.
 NSAIDs or non-steroidal anti-inflammatory agents are drugs that are used to limit
the adverse pain in the osteoarthritis. It inhibits the prostaglandin generating
enzyme COX that leads to decrease in the inflammatory symptoms leading to
decreased pain.
 Another major medication that has been used commonly to reduce the pain in
osteoarthritis are COX-2 inhibitors. It also inhibits the prostaglandin synthase
enzyme leading to the decrease in the inflammatory symptoms (Sinusas 2012).
Conclusion
Aging is the most difficult phase for human being as the dependency on others affect the
elderly people more effectively than any other health condition. Furthermore, presence of

8EVIDENCE BASED NURSING RESEARCH
adverse health conditions increases their dependency, leading to hypertension. Marika lives in an
old age care home and is suffering from several diseases. Due to the level of dependency, she is
suffering from hypertension, which is the prime reason for her overweight body. She has a
history of falls and due to which she used to feel severe pain in her joints. This is later diagnosed
as osteoporosis and osteoarthritis of acute level. In this critical analysis, the sign, symptoms and
the diagnosis process for her disease has been mentioned. Current medication that are being used
to treat these bone disease has been discussed. The pathophysiology has also been discussed. A
detailed care plan, including the interventions, goals and objectives, rationale and evaluation for
these interventions has been mentioned in a tabular format that has been attached in the appendix
section.

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References
Aaseth, J., Boivin, G. and Andersen, O., 2012. Osteoporosis and trace elements–an
overview. Journal of Trace Elements in Medicine and Biology, 26(2), pp.149-152.
Aicher, W.K. and Rolauffs, B., 2014. The spatial organisation of joint surface chondrocytes:
review of its potential roles in tissue functioning, disease and early, preclinical diagnosis of
osteoarthritis. Annals of the rheumatic diseases, 73(4), pp.645-653.
Armas, L.A. and Recker, R.R., 2012. Pathophysiology of osteoporosis: new mechanistic
insights. Endocrinology and metabolism clinics of North America, 41(3), pp.475-486.
Berryman, S.N., Jennings, J., Ragsdale, S., Lofton, T., Huff, D.C. and Rooker, J.S., 2012. Beers
criteria for potentially inappropriate medication use in older adults. Medsurg Nursing, 21(3),
p.129.
Braun, H.J. and Gold, G.E., 2012. Diagnosis of osteoarthritis: imaging. Bone, 51(2), pp.278-288.
Castañeda, S., Roman-Blas, J.A., Largo, R. and Herrero-Beaumont, G., 2013. Osteoarthritis: a
progressive disease with changing phenotypes.
Cosman, F., De Beur, S.J., LeBoff, M.S., Lewiecki, E.M., Tanner, B., Randall, S. and Lindsay,
R., 2014. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis
international, 25(10), pp.2359-2381.
Das, S. and Crockett, J.C., 2013. Osteoporosis–a current view of pharmacological prevention and
treatment. Drug design, development and therapy, 7, p.435.

10EVIDENCE BASED NURSING RESEARCH
Drake, M.T., Clarke, B.L. and Lewiecki, E.M., 2015. The pathophysiology and treatment of
osteoporosis. Clinical therapeutics, 37(8), pp.1837-1850.
Keefe, F.J., Porter, L., Somers, T., Shelby, R. and Wren, A.V., 2013. Psychosocial interventions
for managing pain in older adults: outcomes and clinical implications. British journal of
anaesthesia, 111(1), pp.89-94.
Loeser, R.F., Goldring, S.R., Scanzello, C.R. and Goldring, M.B., 2012. Osteoarthritis: a disease
of the joint as an organ. Arthritis & Rheumatology, 64(6), pp.1697-1707.
Olivotto, E., Otero, M., Marcu, K.B. and Goldring, M.B., 2015. Pathophysiology of
osteoarthritis: canonical NF-κB/IKKβ-dependent and kinase-independent effects of IKKα in
cartilage degradation and chondrocyte differentiation. RMD open, 1(Suppl 1), p.e000061.
Pesesse, L., Sanchez, C., Walsh, D.A., Delcour, J.P., Baudouin, C., Msika, P. and Henrotin, Y.,
2014. Bone sialoprotein as a potential key factor implicated in the pathophysiology of
osteoarthritis. Osteoarthritis and cartilage, 22(4), pp.547-556.
Pisani, P., Renna, M.D., Conversano, F., Casciaro, E., Muratore, M., Quarta, E., Di Paola, M.
and Casciaro, S., 2013. Screening and early diagnosis of osteoporosis through X-ray and
ultrasound based techniques. World journal of radiology, 5(11), p.398.
Pisters, M.F., Veenhof, C., Van Dijk, G.M., Heymans, M.W., Twisk, J.W.R. and Dekker, J.,
2012. The course of limitations in activities over 5 years in patients with knee and hip
osteoarthritis with moderate functional limitations: risk factors for future functional
decline. Osteoarthritis and cartilage, 20(6), pp.503-510.

11EVIDENCE BASED NURSING RESEARCH
Sankar, W.N., Nevitt, M., Parvizi, J., Felson, D.T. and Leunig, M., 2013. Femoroacetabular
impingement: defining the condition and its role in the pathophysiology of osteoarthritis. Journal
of the American Academy of Orthopaedic Surgeons, 21, pp.S7-S15.
Sinusas, K., 2012. Osteoarthritis: diagnosis and treatment. American family physician, 85(1).
World Health Organization (2017). Mental health and older adults. [online] World Health
Organization. Available at: http://www.who.int/mediacentre/factsheets/fs381/en/ [Accessed 22
Oct. 2017].
Bibliography
DiCenso, A., Guyatt, G. and Ciliska, D., 2014. Evidence-Based Nursing-E-Book: A Guide to
Clinical Practice. Elsevier Health Sciences.
Dunphy, L.M., Winland-Brown, J., Porter, B. and Thomas, D., 2015. Primary care: Art and
science of advanced practice nursing. FA Davis.
Gordon, M., 2014. Manual of nursing diagnosis. Jones & Bartlett Publishers.
Gulanick, M. and Myers, J.L., 2013. Nursing Care Plans-E-Book: Nursing Diagnosis and
Intervention. Elsevier Health Sciences.

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Appendix
Nursing
diagnosis/
Problem/Issue
identified:
Goal/Aim Interventions/Actions Rationalle/Evidence Evaluation
Marika has
osteoarthritis
due which she
is suffering
from joint pain,
cannot walk
properly and is
prone to fall
and delirium
(DiCenso,
Guyatt and
Ciliska 2014).
After this
treatment
Marika will
be able to
walk properly
without any
help from
others or not
by the
walker.
Assessing the type of
pain the Marika is
suffering from and
taking the appropriate
treatment which will
help Marika (Gordon,
2014).
The pain may start as
an ache then
gradually increases
to a sharp pain if any
pressure is applied to
the area of the pain
(Gordon, 2014).
Marika has
started to
walk by her
the help of
walker and
her pain is
reduced.
Marika is also
suffering from
osteoporosis in
which the bone
gets degraded
and prone to
breakage.
Recovery of
any broken
bone or
undetected
fractures in
the joints,
hips, bones or
the spinal
cord
(Gulanick
and Myers
2013).
Marika must be
prevented from any
injury, as she is prone
to falls. Her pain must
be in control and a
physiotherapist must
assess her.
The skin breakdown
must be prevented so
that it could promote
healing. The intake
of calcium must be
increased, so that the
breakage must be
reduced (Gulanick
and Myers 2013).
Marika was
now become
a bit stable
and does not
fall too
frequently.
Hypertension
is caused due
The pain that
is causd from
To determine the
severity of the pain
By facilitating the
diagnosis and the
After the
treatment,

13EVIDENCE BASED NURSING RESEARCH
to high blood
pressure and it
gradually
increases
(Dunphy et al.
2015).
the
hypertension
will be
reduced.
that Marika is
suffering from, provide
non-pharmacological
treatment (Dunphy et
al, 2015).
appropriate therapy,
it will reduce the
stimulation and helps
in relaxation.
Marika had
showed a
reduction in
her state of
hypertension.