Who Gets a DEXA Scan? (Nursing)

00:01 Answering the question, "Who gets a DEXA scan?", is the same thing as looking at the risk factors for osteoporosis.

00:08 Now, this test, this scan has to be ordered by a healthcare provider.

00:13 That is not within my scope of practice as a registered nurse to order this test.

00:18 But of course, I'll collaborate with the physician.

00:20 I will give he or she the heads up, that this patient meets the risk factor so collaboration is involved.

00:28 But a health care provider has to order the test.

00:31 So let's talk about the risk factors.

00:33 Who are we going to be watching for? Patients of increased age, patients that have a family history of osteoporosis, patients that have had previous fracture injuries, and maybe some that seem unusual or atypical.

00:48 We look at the overall health of the client.

00:51 What medications are they on? These are all factors that we'll be looking for to see what could be the problem with a client needing to be screened for osteoporosis.

01:03 Let's break down that first risk factor we talked about.

01:07 Increased age.

01:09 Now, bone mass declines with age.

01:12 Typically, cisgender women tend to lose bone mass earlier than cisgender men.

01:19 But we're looking here on the screen, you see we have age 70 for men.

01:22 Age 65 for women.

01:25 So why we have women a few years earlier? Because, cisgender women tend to lose bone mass earlier than cisgender men.

01:34 Now those age references, you'll see that we gave you the reference where they came from.

01:38 The National Osteoporosis Foundation recommendations for DEXA scans.

01:43 Now in other presentations and other literature, you'll see different ages suggested.

01:49 That's why we always cite the reference for where we get this age or recommendation.

01:54 So become comfortable with that.

01:57 Know that wherever you're practising, they will tell you which of the recommendations which agency they subscribe to or follow.

02:05 So know that "Oh, you feel sometimes kind of uncomfortable.

02:08 I heard this age and this and this age and that." It's okay.

02:12 That's how medicine works.

02:14 We have lots of different reference points.

02:17 But the health care provider will be determined, which is the best one for your patient population.

02:23 So we talked about increased age.

02:25 Now let's look at family history.

02:27 That's why you see we have our friend here with a broken arm.

02:30 If the client has one or more family members who've been diagnosed with osteoporosis or they themselves have had more than one fracture, this is going to be a sign that they have an increased risk for osteoporosis.

02:43 and they likely need a DEXA scan earlier.

02:46 Now if the patient has had previous fracture injuries, like they've broken a bone after age 50, that's something we definitely want to take a look at.

02:55 Now my brother was playing, he's over 50 and he was playing racquetball and he ran into the back wall of the court at top speed.

03:04 He shattered his humerus, I said humerus.

03:09 He shattered his humerus.

03:12 So, my first thought was once we took care of the injury and it was a definite significant fracture was, "Oh my goodness. Jeff, you need to go have a DEXA scan." So following up, they have that type of injury, they break a bone after 50.

03:27 We definitely want to follow up with a DEXA scan to check for osteoporosis.

03:32 Now certain medications can also be problematic.

03:35 There's about seven of them that we've discussed in this whole video series.

03:40 But you want to watch especially with steroids or immunosuppressants, those are particularly difficult on bones.

03:47 What about chemotherapy? Yep, that's another one of the groups of medications.

03:52 If a client is on chemotherapy, that is one piece to the puzzle, that they may be at increased risk for osteoporosis.

04:00 Now, we talked about the client's overall health.

04:03 If they have certain chronic health conditions, this is a red flag.

04:08 Look at that graphic.

04:10 That hurts my hand to see someone's hand like that.

04:14 That's what it looks like with rheumatoid arthritis.

04:18 So if the client has a history of a chronic health condition, like rheumatoid arthritis or lupus or diabetes, these should be things that we should follow up with extra screening or consideration for the client to have a DEXA scan.

04:34 Now remember lupus.

04:35 We've shown you a picture there with that classic butterfly rash.

04:39 That's one of the signs and symptoms of lupus.

04:42 Diabetes, I know you're probably very familiar with.

04:46 But chronic health conditions can increase the risk for osteoporosis and require to be monitored with a DEXA scan.

04:55 What about liver disease? Yep, that's no good either.

04:59 And kidney disease.

05:01 Okay, we've given you a whole group here, right? Of chronic diseases.

05:06 How many were there? Stop and count them.

05:09 Kidney disease, liver disease, diabetes, lupus, rheumatoid arthritis.

05:16 Okay, we've listed five of these.

05:20 If you can't keep all five in your mind, ones that are most visual to you may be the easiest.

05:27 But I want you to choose how are you going to group these together in a way that makes sense in your mind.

05:33 Well, the easiest one for me is like, "Whoa, rheumatoid arthritis!" That seems to be one that's easy to remember.

05:39 But look at the other four components.

05:41 How can you group them together or chunk them in a way that you'll be able to remember? Most important, think of chronic health conditions, we talked about client's overall health and then think through these five examples in a way that you think will stick in your brain.

05:59 Remember, using our spaced repetition deck to help you study is a brilliant way to keep these five chronic diseases on the top of your mind.