Posted: January 24th, 2023

Case study: M.S., a 72-year-old white woman

Create a concept map using information from this case study:
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:
1.What is the priority concept of this scenario?
2.Write a summary of the pathophysiology if appropriate.
3.What assessment findings led you to identify this priority problem? Are there other concerns based on your assessment of M.S.?
4.What is your priority problem?
5.Based on your knowledge of the nursing process so far, what goals would you recommend in the plan of care for M.S?
6.What interventions will help M.S. meet these goals?
7.How would you evaluate your plan of care to determine the next steps?

The priority concept of this scenario is the pain in M.S.’s upper back.
The pathophysiology of M.S.’s pain is not specified in the case study, but it could be related to musculoskeletal issues such as arthritis or osteoporosis.
The assessment findings that led to identifying the pain in M.S.’s upper back as the priority problem include her complaint of sharp, knifelike pain that began three weeks ago and is not related to recent falls or trauma, as well as moderate tenderness to deep palpation over the spinous process at T7 on physical examination. Other concerns based on the assessment include M.S.’s smoking history and lack of exercise, as well as the possibility of osteoporosis due to her family history.
The priority problem is the pain in M.S.’s upper back.
Goals for M.S.’s plan of care could include:
Reducing the pain in her upper back to a manageable level
Quitting smoking and improving her overall health
Increasing physical activity and strength
Screening for and addressing any underlying conditions such as osteoporosis
Interventions that may help M.S. meet these goals include:
Referral to a specialist (orthopedic or rheumatologist) for further evaluation and treatment of the pain in her upper back
Smoking cessation support and education
Physical therapy to improve strength and mobility
Bone density screening and any appropriate follow-up care
Evaluation of the plan of care could include monitoring M.S.’s pain levels, progress with quitting smoking, and participation in physical therapy and other interventions, as well as monitoring any lab results or imaging studies. Based on this evaluation, the next steps could include adjusting or continuing current interventions, referring M.S. to additional specialists, or developing a new plan of care as needed.