NSG/501 Week 5: The Full Treatment Plan, sample paper

One Plan, Six Disciplines and a Yearly Infusion: A Complete Treatment and Monitoring Plan for a 68-Year-Old After Her First Fragility Fracture

[Student Name]

University of Phoenix

NSG/501: Pathophysiology, Assessment Variables and Pharmacology I

Week 5 Assignment

[Instructor Name]

[Date]

The patient, the clinic and its services are a composite written for a model paper.

Over four weeks, this course has followed Mrs. D., the 68-year-old librarian whose garden-hose fall broke her wrist, from the pathophysiology of her osteoporosis to her assessment, a concept map and a drug choice. This paper assembles one complete plan of care, names who is responsible for each part and explains how the plan will be monitored. A good plan for osteoporosis fails most often not in its content but in the handoffs between the people who are supposed to carry it out.

Goals

The plan has four goals, each measurable: prevent a new fracture over the next five years; raise her 25-hydroxyvitamin D above 30 ng/mL within three months; start and continue osteoporosis drug therapy, with the first infusion within three months and each yearly dose given on schedule; and reduce her fall risk, with home hazards removed and balance training begun within two months.

Part 1: Complete the Diagnosis

Her height loss and kyphosis suggest silent vertebral fractures, which would change her risk category. The plan orders a lateral spine X-ray or a vertebral fracture assessment during her next bone density scan. Secondary causes of bone loss are screened with laboratory tests already done, calcium, kidney function, thyroid function and blood count, and a serum parathyroid hormone level if calcium is abnormal. Responsible: the orthopedic nurse practitioner orders; the radiology team performs; the fracture liaison nurse tracks the result.

Part 2: Nutrition

Vitamin D is repleted with a prescribed daily supplement and rechecked in three months. Calcium intake is raised to about 1,200 mg a day from all sources, mainly food, with lactose-free dairy, fortified alternatives, canned fish with bones and leafy greens, adding a supplement only to make up the difference (LeBoff et al., 2022). Responsible: the registered dietitian teaches and plans meals; the fracture liaison nurse reinforces.

Part 3: Drug Therapy

Based on the Week 4 evaluation, the plan is yearly intravenous zoledronic acid, beginning once her vitamin D is adequate and her spine imaging is reviewed. If imaging shows multiple vertebral fractures, the plan changes to an anabolic agent first. Before each infusion, creatinine and calcium are checked and hydration is ensured; she is asked about planned dental work. Her omeprazole is reviewed by her primary care provider, who decides whether it can be reduced or stopped. Responsible: the nurse practitioner prescribes; the infusion nurse administers and teaches about the acute-phase reaction; the pharmacist reviews interactions and the proton pump inhibitor; the primary care provider manages reflux.

Part 4: Fall Prevention

Her Timed Up and Go and the sway on turning point to a balance problem, and her home has hazards. The plan includes a physical therapy evaluation with a home exercise program emphasizing balance and strength, a home safety review, removal of the two throw rugs, installation of grab bars and a yearly vision check. Responsible: the physical therapist evaluates and teaches; an occupational therapist or home safety program reviews the home; Mrs. D. and her daughter make the changes.

Part 5: Education

Education follows the priorities set in Week 2: the meaning of the fracture, the benefit of treatment, nutrition, fall prevention and medication review. Education is given in short sessions over several visits rather than all at once, with teach-back to confirm understanding. Week 6 will design this education as an intervention for the whole population. Responsible: the fracture liaison nurse leads, with each discipline teaching its own part.

Part 6: Coordination Through a Fracture Liaison Service

The weakness of any plan with this many parts is that each discipline assumes another is responsible for follow-up. In many settings, osteoporosis treatment after a fracture is never started because the orthopedic team treats the fracture and assumes primary care will treat the bone, while primary care does not know the fracture occurred. That pattern shows up at scale: in the national claims study described in Week 1, fewer than one in three patients received osteoporosis medication within a year of a hip fracture (Solomon et al., 2014). A fracture liaison service assigns one person, usually a nurse, to identify every fragility fracture, make sure assessment and treatment happen and follow the patient over time.

The evidence supports this model. A systematic review and meta-analysis of 74 controlled studies found that patients cared for by a fracture liaison service had higher rates of bone density testing, 48.0% compared with 23.5% with usual care, higher rates of treatment initiation, 38.0% compared with 17.2%, and better adherence, 57.0% compared with 34.1%. Unweighted average refracture rates were 6.4% with a fracture liaison service and 13.4% in control groups (Wu et al., 2018). For Mrs. D., the fracture liaison nurse is the person who holds the plan together.

Anticipating Barriers

Three barriers could stop this plan, and each has a planned response. Transportation: Mrs. D. no longer drives on highways, and the infusion center is 25 miles away; the plan schedules her infusion on the same day as a routine appointment and asks her daughter to attend. Cost: coverage for the infusion is checked before scheduling, and the pharmacist identifies the lowest-cost vitamin D product. Belief: Mrs. D. may decide that because she feels well she does not need treatment; the fracture liaison nurse addresses this at each contact by returning to the meaning of the fracture, the first education priority set in Week 2. Naming barriers in advance turns them into tasks with owners.

Monitoring Schedule

At three months: vitamin D level, spine imaging result reviewed, first infusion given, home changes confirmed. At twelve months: second infusion scheduled, adherence and side effects reviewed, falls and new fractures asked about, height measured. At two years: repeat bone density scan. At three to five years: the prescriber reassesses whether to continue or pause bisphosphonate therapy based on fracture risk. At every contact: the fracture liaison nurse confirms the next step is booked.

Shared Decisions With Mrs. D.

The plan is written with Mrs. D., not for her. At the visit where it is agreed, the fracture liaison nurse explains the options in plain language, including what would happen without treatment, and asks what matters most to her. She says she wants to keep gardening and walking her dog and to avoid another cast. Those goals become the reasons the plan uses when it asks her to take each step, which makes the plan hers to carry out.

Interprofessional Summary

The plan involves six disciplines, the nurse practitioner, fracture liaison nurse, infusion nurse, pharmacist, dietitian and physical therapist, along with the primary care provider and Mrs. D.'s family. Each owns a part, and the fracture liaison nurse owns the whole.

Conclusion

Mrs. D.'s plan completes her diagnosis, corrects her vitamin D and calcium, starts effective drug therapy, reduces her fall risk and teaches her why each step matters. Its success depends on coordination, which a fracture liaison service provides and which evidence shows improves testing, treatment, adherence and refracture rates. Week 6 will design the education intervention for the whole population.

References

LeBoff, M. S., Greenspan, S. L., Insogna, K. L., Lewiecki, E. M., Saag, K. G., Singer, A. J., & Siris, E. S. (2022). The clinician's guide to prevention and treatment of osteoporosis. Osteoporosis International, 33(10), 2049-2102. https://doi.org/10.1007/s00198-021-05900-y

Solomon, D. H., Johnston, S. S., Boytsov, N. N., McMorrow, D., Lane, J. M., & Krohn, K. D. (2014). Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. Journal of Bone and Mineral Research, 29(9), 1929-1937. https://doi.org/10.1002/jbmr.2202

Wu, C.-H., Tu, S.-T., Chang, Y.-F., Chan, D.-C., Chien, J.-T., Lin, C.-H., Singh, S., Dasari, M., Chen, J.-F., & Tsai, K.-S. (2018). Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: A systematic literature review and meta-analysis. Bone, 111, 92-100. https://doi.org/10.1016/j.bone.2018.03.018