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Thursday, February 26, 2009

Nursing care Plans For Osteoporosis

Osteoporosis is often called the 'silent disease' is often also called porous bone at the time porous bone often occur without significant complaints. Osteoporosis is a disease with a marked reduction in bone mass, so that the bones become fragile and the risk of a fracture increases. In normal conditions, we also experienced bone porous followed by the formation of bone cells in the bone is porous. On osteoporosis, bone porous happen excessive and not followed the process enough so that the formation of the bones thin and become more fragile.Osteoporosis (porous bone) is often called the 'silent disease' or the bone thief. This is because at the time bone porous often occur without any real complaints. To know new people with osteoporosis after the condition is quite severe by the body that crookback or broken bones. It is very important for us to know the risk factors of osteporosis, so that we can be vigilant and make efforts to prevention.

Primary osteoporosis can be classified as idiopathic, type I, or type II. Idiopathic osteoporosis affects children and adults. Type I (or postmenopausal) osteoporosis usually affects females ages 51 to 75. Related to the loss of estrogen's protective effect on bone, type I osteoporosis results in trabecular bone loss and some cortical bone loss. Vertebral and wrist fractures are common. Type II (or senile) osteoporosis occurs most commonly between ages 70 and 85. Trabecular and cortical bone loss and consequent fractures of the proximal humerus, proximal tibia, femoral neck, and pelvis characterize type II osteoporosis.

Osteoporosis risk factors:
  1. Women. Risk of osteoporosis in women more than men because, generally smaller bone mass and the menopause.
  2. Age. Risk of osteoporosis increases each time the addition of 1,4-1,8 age 10 years.
  3. Asian and Caucasus higher risk for osteoporosis than the African race.
  4. Genetic factors. There is a history osteoporosis or fracture in the age less than  50 years in the family is also the occurrence of osteoporosis risk factors.
  5. Some chronic diseases such as diabetes (diabetes), liver disease, kidney, chronic diarrhea and increase the risk of osteoporosis.
  6. Smoking habits and consumption of alcoholic beverages increase the risk of osteoporosis.
  7. Feed calcium and vitamin D that is less important risk factor in osteoporosis.
  8. Weigh less and less exercise (sports) higher risk of osteoporosis.
  9. The use of drugs such as steroid, anti-convulsive drugs (Phenobarbital and; Phenytoin), antasida containing aluminum, metotreksat, siklosporin A risk factor is the cause of osteoporosis because of extraction of calcium from the bones in the number of lots.

Assessment Nursing care Plans For Osteoporosis
The history may typically disclose a postmenopausal patient or one with a condition known to cause secondary osteoporosis. The patient (usually an elderly woman) may report that she bent down to lift something, heard a snapping sound, and felt a sudden pain in her lower back. Or she may say that the pain developed slowly over several years. If the patient has vertebral collapse, she may describe a backache and pain radiating around the trunk. Inspection may reveal that the patient has a humped back and a markedly aged appearance. She may report a loss of height. Palpation may reveal muscle spasm. The patient may also have decreased spinal movement with flexion more limited than extension

Diagnostic tests Nursing care Plans For Osteoporosis
To see the level of bone density and to detect Osteoporosis, can be done in a way to measure bone density using a tool called a Densitometer X-ray Absorptiometry. These two types, namely SXA (Single X-ray Absorptiomety) and DEXA (Dual Energy X-ray Absorptiometry).
In addition to bone density examination, currently available laboratory examination to determine bone activity Remodelling the examination or CTx C-Telopeptide and N-Mid Osteocalcin. CTx or C-Telopeptide is the result of the disintegration of the bones is released into the blood so that it can be used to assess the process of crushing bones. While the N-Mid Osteocalcin is a protein which faction was formed by Osteoblas and a role in the process of bone formation.
By doing inspections or CTx C-Telopeptide and N-Mid Osteocalcin the activity can be Remodelling bone, and when the results of the examination showed abnormal results or imbalance occurs Remodelling the bones need to caution risk the occurrence of Osteoporosis or other bone disease possibility. In addition, the examination can also be used to monitor osteoporosis treatment, especially CTx treatment is used to monitor oral anti resorpsi treatment.

Diagnoses Nursing care Plans For Osteoporosis
Key outcomes Nursing care Plans For Osteoporosis
  • The patient will experience increased comfort and decreased pain.
  • The patient will express positive feelings about herself.
  • The patient will perform activities of daily living (ADLs) within the confines of the disease.
  • The patient will maintain adequate dietary intake.
  • The patient will maintain joint mobility and range of motion (ROM).
  • The patient will exhibit intact skin integrity.
  • The patient will demonstrate measures to prevent injury.

Patient teaching Nursing care Plans For Osteoporosis
  • Explain all treatments, tests, and procedures. For example, if the patient is undergoing surgery, explain all preoperative and postoperative procedures and treatments to the patient and her family.
  • Make sure the patient and her family clearly understand the prescribed drug regimen. Tell them how to recognize significant adverse reactions. Instruct them to report them immediately.
  • Teach the patient taking estrogen to perform breast self-examination. Tell her to perform this examination at least once a month and to report lumps right away. Emphasize the need for regular gynecologic examinations. Also instruct her to report abnormal vaginal bleeding promptly.
  • If the patient takes a calcium supplement, encourage liberal fluid intake to help maintain adequate urine output and thereby avoid renal calculi, hypercalcemia, and hypercalciuria.
  • Tell the patient to report new pain sites immediately, especially after trauma.
  • Advise the patient to sleep on a firm mattress and to avoid excessive bed rest.
  • Teach the patient how to use a back brace properly, if appropriate.
  • Thoroughly explain osteoporosis to the patient and her family. If they don't understand the disease process, they may feel needless guilt, thinking that they could have acted to prevent bone fractures.
  • Demonstrate proper body mechanics. Show the patient how to stoop before lifting anything and how to avoid twisting movements and prolonged bending.
  • Encourage the patient to install safety devices, such as grab bars and railings, at home.
  • Advise the patient to eat a diet rich in calcium. Give her a list of calcium-rich foods. Explain that type II osteoporosis may be prevented by adequate dietary calcium intake and regular exercise. Hormonal and fluoride treatments also may help prevent osteoporosis.
  • Explain that secondary osteoporosis may be prevented by effectively treating underlying disease, early mobilization after surgery or trauma, decreased alcohol consumption, careful observation for signs of malabsorption, and prompt treatment of hyperthyroidism.
  • Reinforce the patient's efforts to adapt, and show her how her condition is improving or stabilizing. As necessary, refer her to an occupational therapist or a home health nurse to help her cope with ADLs.



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