The physiology of how the body maintains normal bone density.

1. Generalized Anxiety disorder (including Postpartum anxiety) is a mental health condition encountered by midwives. Discuss the etiology, components of assessing for this condition (including screening for them), when to refer, and patient health education points.

2. Case Study 1- Musculoskeletal Conditions

Irene is a 65 year old white woman who presents to you today to review her recent DEXA results, which you ordered as routine screening at her last annual exam.

PMH:

Menopause 52, never on hormone therapy

Seizure disorder since age 22

Asthma since childhood

FH:

Sister, paternal aunt- osteoporosis

Mother- breast cancer 58, HTN, borderline DM, died of lung cancer 69

Father- HTN, cholesterol, died MI 76

Social hx:

1 glass wine daily

4 cigs/d down from ½ ppd 8 yrs ago

Widowed for 1 year, one healthy son

Meds:

Phenytoin 100 mg pot id

Albuterol MDI 2 puffs bid prn

Triamcinolone MDI 2 puffs qid

Prednisolone 5 mg po bid prn

Vital Signs

BP 129/83

RR 20

Ht 5’3″

P 88

T 98.7

Wt 102

DEXA Scan Results

Site

T score

Lumbar spine L2-4

-2.8

R femoral neck

-2.1

Discuss, using the midwifery management process, answer the following:

Describe the physiology of how the body maintains normal bone density.

What are the authoritative bodies’ criteria for osteoporosis and osteopenia?

What components of the PE will you emphasize?