Nursing Care Plan for Osteoporosis and Neck of Femur Fracture Patient

Running head: ASSESSMENT TASK 2 1
NMIH106 2018 Assessment Task 2: Case Study
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ASSESSMENT TASK 2 2
Overview of Pathophysiology
Osteoporosis
In adults, bone maintenance involves resorption where small quantities of bone mineral
are removed and re-deposition of equal amounts for born strength to be maintained (Heaney,
1998; International Osteoporosis Foundation 2018; Milas-Ahić, Prus, Kardum, & Kovačević,
2014). As people age, the bone restructures gradually. The resorption processes involving
removal of mineral from inner cortical layers and the bone cavity increase. This excessive loss of
bone mineral leads to widening of the bone cavity and reduces the trabecular bone. Over time,
the fragile bones become brittle and prone to fracture, causing a disease called osteoporosis, the
state Ms. Marley presents with.
Osteoclasts and osteoblast regulate the balance between resorption of re-deposition
(International Osteoporosis Foundation, 2018; Milas-Ahić et al., 2014). The cell membrane of
osteoclasts has highly active ion channels that lower the pH of their microenvironment. In the
bone, the low pH facilitates resorption. When the function of osteoclasts exceeds that of
osteoblasts, osteoporosis occurs.
Neck of Femur Fracture
Neck femur fracture is common in older adults who have an increased risk of developing
osteoporosis and high fall risks due to neurovascular lesions, medication, cognitive impairment,
and dehydration (Lareau & Sawyer, 2010; Metcalfe, 2008; Whiteing, 2008). Osteoporosis leads
to weakened bones that cannot withstand pressure. When an old person with osteoporosis takes a
direct fall on the hip, such as Ms. Marley, chances of neck fracture are high (Lareau & Sawyer,
2010).
Wound Healing

ASSESSMENT TASK 2 3
As a normal biological process, wound healing is achieved through four highly
programmed stages: Coagulation/hemostasis, inflammation, granular tissue formation
(proliferation), and remodeling/scar formation (Demidova-Rice, Hamblin, & Herman, 2012; Guo
& DiPietro, 2010). These four stages must occur in the mentioned sequence and within a time
frame. Guo and DiPietro (2010) posit that certain local and systematic factors may interfere with
the normal wound healing. For Ms. Marley case, local factors likely to have interfered with her
would require healing process include oxygenation, venous and arterial insufficiency while
systematic factors include age and gender, sex hormones, diseases such hypertension, and pain
medications (Demidova-Rice et al., 2012; Guo & DiPietro, 2010).
First, oxygen is critical in all would healing phases such as inducing angiogenesis,
facilitating keratinocyte differentiation, migration, and re-epithelialization, and promotes the
formation of fibroblasts and collagen (Demidova-Rice et al., 2012; Guo & DiPietro, 2010).
According to Guo and DiPietro (2010), old age and hypertension may affect vascular flow,
inducing poor tissue oxygenation and subsequent healing. In addition, old age affects every
phase of the wound healing process such as delayed angiogenesis and collagen deposition,
decreased secretion of growth factors, and delayed infiltration of lymphocytes in the wounded pit
(Demidova-Rice et al., 2012; Guo & DiPietro, 2010).
Another cause of the delayed wound healing could be estrogen reduction, a common
characteristic of old people (Demidova-Rice et al., 2012; Guo & DiPietro, 2010). Ms. Marley's
hypertensive could also contribute to the delayed healing. Hypertension interferes with venous
and arterial blood supply, thereby affecting the amount of oxygen (Ahmed, Mooar, Kleiner,
Torg, & Miyamoto, 2011).

ASSESSMENT TASK 2 4
Involving the Patient in Her own Care
Assessing the Patient
Medeiros, Nóbrega, Rodrigues, and Fernandes (2013) posit that communication is vital in
healthcare by facilitating patient-provider communication. For people with disabilities such as
Ms. Marley significant hearing deficits, effective communication may be hard. Even so, the
Action on Hearing Loss (2018) establishes there is no need of exaggerating mouth movements
for people with sensory deficits. Rather, a nurse should treat that patient with respect unless sign
language is required, which is not needed in this case. Additionally, the patient can communicate
coherently and seems to understand her current condition.
Fostering a Healing Relationship
The first aspect I would implement and assess is the trust and rapport between Ms.
Marley and me (Levit, Balogh, Nass, & Ganz, 2016). To achieve trust and rapport, I would
exhibit high-emotional awareness, support, guidance, and comprehensive understanding of the
patient. I would show empathy and relate to Ms. Marley at the patient level.
Exchanging information
From Ms. Marley narration, it is evident that she is aware of the risk of falling due her to
osteoporosis. Her multiple comorbidities warrants a caregiver to help her, so I will ask Ms.
Marley to consider involving her daughter in the recovery plan. Upon agreement, I would engage
the patient and caregiver in ask-tell-ask method to equip them with all the information they need
to manage her health (Alston et al., 2012; Corrigan, 2005).
Responding to Emotions
To facilitate effective communication, I will have to respond to Ms. Marley's concerns
(Levit et al., 2016). First, the patient is worried about falling again upon resuming her life.