Answer the questions in details

READ AND ANSWER THE QUESIONT IN DETAILS

STEP 1: READ

Patient History 868952

Mai-jen Chou, is 64 years of age with a history of type 2 diabetes, asthma, hypertension, and degenerative joint disease. She presents to a general medicine clinic with persistent lower back pain. Her sister, Tian (age 68) has accompanied her to the clinic. Mai-jen reports that for the last few months, she has been experiencing aching pain in the lower lumbar area. It is worse with exertion. The pain is fairly localized, without radiation. She does not experience any tingling, numbness, or weakness. There is no history of trauma.

Mai-jen does exhibit some tenderness to palpation in the lower lumbar area. She notes that she tries to remain active, walking about 2 to 3 miles, 3 or 4 days a week; she is also a devoted gardener. She is concerned enough about this pain that she believes she needs an x-ray. She also reluctantly remarks that she is not sure if she is exaggerating, but she feels she might be "shrinking." She recently tried on a pair of pants she purchased several years ago, and now they appear to be too long. She wants to know if this is possible. Tian recently told her that she was diagnosed with "brittle bones."

Mai-jen has numerous risk factors for osteoporosis, including older age, female gender, and low body weight (she weighs 98 pounds and is 5’1” tall). She may also have a family history, and this should be explored further. Upon review of her medications, she has been treated with steroids for exacerbation of asthma, but there have been no such episodes in the past year. In addition, she is not on estrogen replacement therapy. The use of steroids and estrogen deficiency may be additional risk factors. Her level of physical activity is encouraging, but it does not offset her numerous risk factors.

Mai-jen lives alone in a two-story home. Mix of hardwood, carpets, vinyl for flooring. She shoveled snow during the last winter, but only twice. She then had a neighbor, Mike (age 36) and his son, Tom (age 10), shovel her driveway and sidewalk for her.

Mai-jen is a vegetarian, though will eat fish on rare, special occasions (holiday, birthday), along with some red or white wine. She loves fresh salads, tofu, soy alternatives (like soy “chicken” patties), and green tea and water to drink.

STEP 2: ANSWER THE QUESIONT IN DETAILS

The Questions

1. What questions would you ask Mai-jen? You could categorize these questions as follows.

Household environment questions

Do you live alone?

Do you live in a single story or multistory house?

Have you experienced any physical trauma recently?

Does your house hold have any environmental obstacles?

Answer #1 WRONG, STEP #1 already told you she live alone why would you ask if she lives alone

Diet and exercise questions

What quantity of alcohol do you take?

Do you take any tobacco products?

Do you exercise indoors or outdoors? How often?

Do you consume any caffeine? How much?

Family history questions

Does your family have a history of osteoporosis?

Does your family have a history of estrogen deficiency?

Does your family have a history of diabetes?

Does your family have a history of brittle bone disease?

brittle bone SAME AS osteoporosis Why ask same questions twice?

Co-morbidities/health questions

Have you been diagnosed with diabetes?

Do you experience any tenderness or pain on the lower lumbar area?

Have you been diagnosed with asthma?

Do you have degenerative joint disease?

ALL WRONG, STEP #1 ALREADY TOLD YOU SHE HAS ASTHMA, AND LUMBAR AREA PAIN

Medications/supplements questions

Do you use any supplements?

What kind of diet do you take?

What medication are you currently on?

What kind of fruits do you take?

ALREADY STEP #1 TOLD YOU WHAT SUPPLEMENT SHE TAKE

NOTE: List at least 4 questions of each category

2. What specific information about Mai-jen worries you about her risk for osteoporosis and further bone injury?

· She has a history of degenerative joint disease.

· Her gender is also a risk factor.

· Her advanced age is a risk factor

· She has a low body weight.

· Her family history could be a risk factor

THIS IS SO BASIC ANSWER, PLEASE ANSWER IN DETALIS

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3. How could Mai-jen’s home be assessed and perhaps improved safety-wise to prevent risk of falls or other injuries?

· Her home can be assessed and improved to accommodate the struggles associated with aging bodies as well as to reduce her risk of falling.

· The steps in her house can pose a problem for her as she is experiencing pain in her lower lumber area. Her house requires to be installed with a stair lift or home elevator.

· Her house should be installed with grab bars in areas ranging from bathroom, exterior doorway and long hallways.

· If she does not have a bathroom in the ground floor of her house, one can be installed to avoid the need to walk up and down stair each time she needs to use one.

· Remove all environmental obstacles from her house such as rugs.

4. What dietary recommendations would you make for Mai-jen?

Although Mai-jen believes she eats a healthy diet, I would recommend that she takes both calcium and vitamin D supplements.

THIS IS SO BASIC ANSWER, PLEASE ANSWER IN DETALIS

5. What physical activity recommendations would you make for Mai-jen?

While Mai-jen tries to remain active through her involvement in walking and gardening. I would encourage her to continue them and in addition recommend that she should start on a weight-bearing exercises. However, the exercise should be monitored since she has degenerative joint disease.

6. What questions and/or recommendations would you have for Mai-jen? Tian?

Since Mai-jen has numerous risk factors for osteoporosis and has a history of degenerative joint disease, I would recommend that she undergoes a bone mineral density to see if she has osteoporosis. Although this test is not a sole indicator for osteoporosis, I would enquire about Mai-jen’s family history, pain or tenderness in bones to offer a proper diagnosis

WRONG THIS IS SO BASIC ANSWER, ASK TIAN QUESTIONS

7. What physical examinations would perform on Mai-jen and why?

Height should be measured and compared with results from previous measurements. This test is vital because if measurements reveal that she has lost height then that is an indicator of osteoporosis due to collapsing vertebrae.

8. What lab tests would you get from Mai-jen and why?

The lab tests I would get for Mai-jen comprise of a full chemistry panel including calcium and phosphorus, liver function test, thyroid function test and a complete blood count. I would undertake these tests in order to diagnose secondary causes including hyperthyroidism.

SO BASIC ANSWR, PLEASE ANSWER IN DETALIS

9. Briefly, how would you educate a senior population regarding osteoporosis management and prevention?

Although the progression of bone thinning is a natural part of aging and it cannot be stopped completely, I would educate the senior population and recommend to them the following preventive measures.

· To take a balanced nutritious diet rich in calcium and vitamin D

· They should maintain a healthy body weight

· They should engage in exercises for at least 30-60 minutes

· They should not use tobacco products and consume alcohol moderately

· They should improve their homes to be fall proof

HOW WOULD YOU EDUCALTE NOT WHAT WOULD EDUCATE. PLEASE READ THE QUESTION

10. What do you consider the best physical activities (pick your top three) for bone health in senior populations? Briefly, explain why.

The best physical activities for bone health in senior populations include;

· Aerobic exercises such as brisk walking, - they use large muscle groups and is it is rhythmic in nature. It strengthens the myocardium and overall fitness of the body to utilize oxygen.

· Anaerobic exercises such as weightlifting –these exercises relate to muscle strength and muscle endurance.

· Monitored exercise program is recommended for senior citizens with a history of vertebral compression fracture and degenerative joint disease.

WRONG, YOU DID NOT EXPLAING WHY. PLEASE EXPLAIN WHY