Scenario 1 Alma jones

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• Issues: 60yo, female, visits orthopaedic clinic, lives alone, polypharmacy Underlying osteoporosis Carpal tunnel syndrome Preventing future fractures

1. Social & cultural aspects

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   • Elderly specific
   1. Ecological model of health

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      • Essay question, describing the factors relating to Alma's risk and management of osteoporosis
      1. Australian public health for osteoporosis

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         • Describe the primary secondary and tertiary approaches to osteoporosis related fractures in Australia. For each preventive level, identify any healthcare professionals you would refer the patient to. Answers: https://www.google.com.sg/url?sa=t&rct=j&q=&esrc=s&source=web&cd=9&cad=rja&uact=8&ved=0CDYQFjAIahUKEwjOoeGt6KDIAhXQSo4KHRyxBGI&url=http%3A%2F%2Fwww.aihw.gov.au%2FWorkArea%2FDownloadAsset.aspx%3Fid%3D10737418747&usg=AFQjCNHz5lF2pBO22-gzZII2a_xCOmAZAg&sig2=_LKMhBBbaFKwvrMndEEVUw http://www.aihw.gov.au/publication-detail/?id=6442468121 http://www.osteoporosis.org.au/exercise
         1. Definition of primary secondary and tertiary
         2. Primary: education
         3. Secondary: screening & lifestyle changes
         4. Tertiary: management
         5. Impact
      2. Individual

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         • Genetics, lifestyle (not much exercise), elderly (age,biology of normal ageing), female (post menopausal), polypharmacy (associated chronic conditions)
      3. Social

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         • Husband to help with chores, neighbors that attended to her, availability of seniors centres http://www.nationalseniors.com.au/be-informed/research/productive-ageing-centre http://jos.sagepub.com/content/early/2013/01/24/1440783312474083
      4. Environmental

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         • polypharmacy, stairs
      5. psychological

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         • Senile, anti depressants, proprioception
2. Effective communication

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   • Explores px's views that maybe detrimental to health Develops appropriate health promoting message to appropriate target group Understands good communication principles
   1. examination of the hands and wrists

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      • Link http://www.physio-pedia.com/Wrist_and_Hand_Examination#Functional_Tests
      1. insert video for physical examination
      2. Functionality

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         • Which tests are used to collectively assess the strength of hands and wrists? 1. Pincer test 2. opposition test 3. Flexion and extension of wrist 4. Lifting a cup 5. Turning a door knob
      3. Neurological assessment

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         • Which dermatomes supply the upper limbs?  Which is the best method to assess carpal tunnel syndrome? (Based on sensitivity and specificity) 1.Compression test http://www.thestudentphysicaltherapist.com/phalens-test.html 2.Phalen's test 3.Tinel's test 4.Upper nerve extremity palpation
   2. Health promotion for preventing osteoporosis

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      • What are the principles underlying prevention and treatment of osteoporosis? Give an example of each
      1. Principles of prevention

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         • 1.Maximise peak bone mass 2.Prevent bone and architecture loss 3.Restore bone mass and architecture
      2. Goals of tx

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         • 1.Slow progression 2.Minimise risk of complications 3.Healthy diet and exercise 4.Manage mobility and safety issues