Question

Provide two characteristics of osteomalacia. Also provide an appropriate nursing diagnosis, intervention and patient education you would provide.

Answer 1

Osteoporosis is a metabolic bone disorder in which the rate of bone resorption accelerates while the rate of bone formation slows down, causing a loss of bone mass. Bones affected by this disease lose calcium and phosphate salts and thus become porous, brittle, and abnormally vulnerable to fractures. Osteoporosis may be primary or secondary to an underlying disease. Primary osteoporosis is commonly called postmenopausal osteoporosis because it typically develops in postmenopausal women.

Nursing Care Plans

Medical management of osteoporosis aims at slowing down or preventing further bone loss, controlling pain and avoiding additional fractures. A nurse’s care plan should focus on the patient’s fragility, stressing careful positioning, ambulation, and prescribed exercises.

Here are four (4) nursing care plans (NCP) and nursing diagnosis for patients with osteoporosis:

Impaired Physical Mobility
Imbalanced Nutrition: Less Than Body Requirements
Risk for Poisoning
Deficient Knowledge

Impaired Physical Mobility

Impaired Physical Mobility: Limitation in independent, purposeful physical movement of the body or of one or more extremities.

May be related to

Bone loss
Pain
Fracture
Inability to bear weight
Possibly evidenced by

Spontaneous fracture
Desired Outcomes

Patient will maintain functional mobility as long as possible within limitations of disease process.
Patient will have a few, if any, complications related to immobility as disease condition progresses
Nursing Interventions   Rationale
Assess the patient’s functional ability for mobility and note changes.   Identifies problems and helps to establish a plan of care.
Provide range of motion exercises every shift. Encourage active range of motion exercises.   Helps to prevent joint contractures and muscle atrophy.
Reposition patient every 2 hours and prn.   Turning at regular intervals prevents skin breakdown from pressure injury.
Apply trochanter rolls and/or pillows to maintain joint alignment.   Prevents musculoskeletal deformities.
Assist patient with walking if at all possible, utilizing sufficient help. A one or two-person pivot transfer utilizing a transfer belt can be used if the patient has a weight-bearing ability.   Preserves the patient’s muscle tone and helps prevent complications of immobility.
Use mechanical lift for patients who cannot bear weight, and help them out of bed at least daily.   Provides a change of scenery, movement, and encourages participation in activities.
Avoid restraints as possible.   Inactivity created by the use of restraints may increase muscle weakness and poor balance.
Instruct family regarding ROM exercises, methods of transferring patients from bed to wheelchair, and turning at routine intervals.   Prevents complications of immobility and knowledge assists family members to be better prepared for home care.
Assess the degree of immobility produced by injury or treatment and note patient’s perception of immobility.   Patient may be restricted by self-view or self-perception out of proportion with actual physical limitations, requiring information or interventions to promote progress toward wellness.
Encourage participation in diversional or recreational activities. Maintain a stimulating environment (radio, TV, newspapers, personal possessions, pictures, clock, calendar, visits from family and friends).   Provides an opportunity for release of energy, refocuses attention, enhances patient’s sense of self-control and self-worth, and aids in reducing social isolation.
Instruct patient or assist with active and passive ROM exercises of affected and unaffected extremities.   Increases blood flow to muscles and bone to improve muscle tone, maintain joint mobility; prevent contractures or atrophy and calcium resorption from disuse
Encourage use of isometric exercises starting with the unaffected limb.   Isometrics contract muscles without bending joints or moving limbs and help maintain muscle strength and mass. Note: These exercises are contraindicated while acute bleeding and edema are present.
Provide footboard, wrist splints, trochanter or hand rolls as appropriate.   Useful in maintaining a functional position of extremities, hands, and feet, and preventing complications (contractures, foot drop).
Place in supine position periodically if possible, when traction is used to stabilize lower limb fractures.   Reduces risk of flexion contracture of the hip.
Instruct and encourage the use of trapeze and “post position” for lower limb fractures.   Facilitates movement during hygiene or skin care and linen changes; reduces the discomfort of remaining flat in bed. “Post position” involves placing the uninjured foot flat on the bed with the knee bent while grasping the trapeze and lifting the body off the bed.
Assist with self-care activities (bathing, shaving).   Improves muscle strength and circulation, enhances patient control in the situation, and promotes self-directed wellness.
Provide and assist with mobility by means of wheelchair, walker,

Imbalanced Nutrition: Less Than Body Requirements

Imbalanced Nutrition: Less Than Body Requirements: Intake of nutrients insufficient to meet metabolic needs.

May be related to

Inadequate calcium and vitamin D
Possibly evidenced by

Deformity
Kyphosis
Loss of height
Fractures
Desired Outcomes

Patient will demonstrate adequate intake of calcium and vitamin D.
Nursing Interventions   Rationale
Instruct recommended daily intake for calcium.   Premenopausal women (19-50 years old) need 1,500 mg of calcium daily. After menopause, the requirement is 1,200 mg daily. Getting enough vitamin D is equally important as getting enough calcium because vitamin D aids in the absorption of calcium and improves muscle strength.
Instruct on the importance of adequate exposure to sunlight to prevent vitamin D deficiency.   The patient should be outside 15 minutes daily.
If the patient has limited exposure to sunlight, encourage vitamin D supplementation.   Supplementation will ensure adequate vitamin D intake.
Instruct patient to perform gentle exercises.   Exercise can help build strong bones and slow bone loss. Strength-training exercises should be combined with weight-bearing exercises. Strength training helps in bone and muscle strength.
Limit alcohol intake   Consuming more than two alcoholic drinks a day may decrease bone formation and reduce the body’s ability to absorb calcium.
Provide a balanced diet.   A diet high in nutrients that support skeletal metabolism: vitamin D, calcium, and protein.
Limit caffeine intake.   Limit the amount of caffeinated beverages to about two to three cups of coffee a day. As long as the diet contains adequate calcium, moderation in caffeine consumption won’t harm the patient. Note also caffeine-containing beverages like colas and some teas.

Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to

Lack of exposure to information regarding medications, dietary modifications, or safe activity program.
Possibly evidenced by

Verbalization of the problem and request for information
Fear of further bone loss and fractures
Presence of preventable complication
Desired Outcomes

Patient will achieve increased knowledge and compliance with medical regimen to minimize bone demineralization and injury.
Patient will be compliant with medication and dietary instructions.
Patient will be able to perform daily exercises within identified limitations and to prevent further bone loss or deterioration.
Patient will exhibit no injury, fall, or trauma that might predispose to a fracture.
Patient will be independent in performing ADLs with modifications.
Patient and/or family will be able to accurately verbalize understanding of medications and methods of administration.
Nursing Interventions   Rationale
Assess patient’s knowledge of disease, diet, medication, and exercise program to arrest the progression of bone deterioration.   Provides a basis for teaching and techniques to promote compliance. Disease is not usually detected until 24-40% of calcium in bone is lost.
Assess the patient’s understanding of osteoporosis.   Most individuals with osteoporosis are not diagnosed until an acute fracture occurs.
Provide support for body image and lifestyle changes.   Assists patient to cope with chronicity of disease and potential fractures causing pain and immobility.
Assist to plan an exercise program according to capabilities; to avoid flexion of the spine and wear a corset if appropriate (walking is preferred to jogging).   Exercise will strengthen bone. Vertebral collapse is common and corset provides support.
Teach patient about nutrition and calcium intake.   Adequate calcium helps to prevent osteoporosis in women with a small frame, increased age, Asians, and Caucasians.
Teach the patient that calcium carbonate is the most effective form of calcium.   Calcium carbonate is best absorbed in an acidic stomach. Adults 19-50 years of age should take 1000mg of elemental calcium daily and individuals 51 years above should take 1,200 mg daily.
Instruct patient that vitamin D supplementation is indicated for patients with limited sun exposure.   Vitamin D supplements are needed for people living in the extreme northern or southern latitudes with limited sun exposure. Recommended vitamin D is 200 IU through age 50; 400 IU for 51-70-year-olds, and 600 IU for >70 yr.
Instruct patient in methods to perform activities of daily living and to avoid lifting, bending, or carrying heavy objects.   Prevents injury that can occur with osteoporosis with minimal trauma.
Instruct patient and/or family in the administration of calcium, vitamin D, estrogens, and other drug therapy for osteoporosis.   Provides replacement of calcium and helps to decrease bone loss.
Instruct patient about medication for osteoporosis, adverse effects, administration, and need for follow-up tests.   An informed patient is likely to adhere to the medication regimen and report adverse effects.
Instruct patient and/or family regarding potential referrals to therapy as warranted.   May help to provide exercise and the development of an activity program to maintain bone condition and encourage independence in ADLs.
Teach patient and/or family regarding the use of assistive devices and safety precautions that are available to maintain mobility.   Prevents further trauma or fractures from falls resulting from lack of support.
Administer and teach the patient about the following drugs:
alendronate (Fosamax)
Bisphosphonates inhibit the activity of osteoclasts. Oral bisphosphonates must be taken on first rising, without eating or drinking for 30 mins.
risedronate (Actonel)
Risedronate may be taken once daily or weekly.
ibandronate (Boniva)
Ibandronate requires only monthly administration.