Selective estrogen receptor modifiers are other alternatives which preserve
bone density but do not affect the endometrium or the breast tissue. These
medications two years show a modest increase in bone mineral density but
there has been evidence of an increased incidence of thromoembolic disease.
Bisphosphonates inhibit bone resporption and generally have minimal
side effects, and can be used for treatment and prevention of osteoporosis.
There is a rather high incidence of gastro esophageal side effects in
these medications. They can cause esophagitis and ulcers, and may
sometimes be associated with esophageal stricture. The pharmacist should
instruct the patient to stay upright for 30 minutes after she takes the
pill, and also not to eat anything which could impair absorption of the
drug or cause reflux of the medication back into the esophagus. Some of
the medications can be taken monthly which some must be taken once per
week. Some combination therapies of these drugs have been shown to be
effective as well. Most recently there has been intranasal calcitonin
which can treat steroid induced osteoporosis nicely, and has replaced the
previously used injected medication. Calcitonin may also be more helpful
in the patient who experiences severe bone pain, although the mechanism of
action is not clear (Sambrook and Birmingham, .1993)
At the time of admission, Mrs. Woods' fund of knowledge regarding the
disease process must be assessed. Should she appear to be relatively
unclear regarding the disease, then a significant amount of education
should be given, to include the provision of pamphlets. She should be
given a good amount of time to formulate her questions and be able to have
them answered before discharge and not on the way out the door. Also, at
admission it will be necessary to assess what kind of intervention she
desires. She may be entirely happy with simply taking analgesia for her
fracture and not desire any treatment to reverse the process. Conversely,
she may desire every intervention and assessment possible. Only by
sitting down and discussing her wishes will any of this information be
known.
It will also be important to know what kind of help she has at home,
and who will be willing to help her get to exercise or therapy
appointments, or ongoing medical appointments. Her full medical history
will also be enlightening, so that any medical co morbidities (Osterweil,
Brummeis-Smith & Beck, 2000) or contraindications to treatment will be
known. Does she have any kind of personal or religious belief which would
prevent her from having treatment or evaluation? Is she allergic to any
medications, or any type of contrast media? All of these issues will make
it necessary to modify her treatment plan.
Where does the patient live? If she lives in a flat with no high
stairs or areas which put her at risk of falls this may be best for her.
If she lives in an older house which requires her to walk up many flights
of stairs, or puts her at higher risk of falls, then perhaps she may want
to consider moving, or even going to a nursing home for a period of time to
feel more stable before she must care for herself. Are there other issues
in her life which may make her more likely to fall, such as a cat that gets
under her feet? Does she have poor eyesight? When was the last time she
had her glasses checked? All of these elements must be evaluated and
addressed before she leaves the hospital (Miller, 2000).
On discharge, it must be clear that she understands the medication she
is taking, why she is taking it, when she must take it and what kind of
side effects she would look for. It is also important that she...
Free trade also has contributed to the economic exploitation of women, as the textile industry for example, which is predominantly women has seen jobs lost and wages cut. Women are often forced to be teachers or work in day- care centres, but not on equal footing with men. Women are victims as are ethnic minorities, and they are forced into hourly jobs with low salaries, high unemployment, and little unionization or official organization. Furthermore, women are
Although the speaker means his words to be comforting to Tom, the reader is likely to find it grotesque. The speaker tells the reader that Tom had a dream, where the young sweepers were set free of their "coffins of black" by an angel and were allowed to play as young children should in heaven (14). This shows how the priorities of society have gone awry -- instead of hoping
suffers from a number of strengths and weaknesses. The first sentence, uses the phrase "really great" which is both imprecise and uninformative. The following sentences show some good grammatical use in the proper use of contractions (it's), but are again hampered by poor word choice ("neat"). In addition, plurals are used improperly (bookseller's instead of booksellers'). The word "I" is overused, appearing in the beginning of at least five
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