M.S., a 72-year-old white woman, comes to your clinic for a complete physical examination. She has not been to a provider for 11 years because “I don’t like doctors.” Her only complaint today is “pain in my upper back.”

She describes the pain as sharp and knifelike. The pain began approximately three weeks ago when she was getting out of bed in the morning and hasn’t changed. M.S. rates her pain as 6 on a 0- to 10-point pain scale and says the pain decreases to 3 or 4 after taking “a couple of ibuprofen.” She denies recent falls or trauma.

M.S. admits she needs to quit smoking and start exercising but states, “I don’t have the energy to exercise, and besides, I’ve always been thin.” She has smoked one to two packs of cigarettes per day since she was 17 years old. Her last blood work was 11 years ago, and she can’t remember the results. She went through menopause at the age of 47 and has never taken hormone replacement therapy. The physical exam was unremarkable other than moderate tenderness to deep palpation over the spinous process at T7. No masses or tenderness to the tissue surrounded the tender spot. No visible masses, skin changes, or erythema were noted. Her neurologic exam is intact, and no muscle wasting is noted.

M.S. has never had an osteoporosis screening. She confides that her mother and grandmother were diagnosed with osteoporosis when they were in their early 50s.

Include answers to the following questions in your concept map:

• What is the priority concept of this scenario?
  • Write a summary of the pathophysiology if appropriate.
• What assessment findings led you to identify this priority problem? Are there other concerns based on your assessment of M.S.?
• What is your three-part nursing diagnosis?
• Based on your knowledge of the nursing process so far, what goals would you recommend in the plan of care for M.S?
• What interventions will help M.S. meet these goals?
• How would you evaluate your plan of care to determine the next steps?