Nursing Care Plan (NCP) for Osteoporosis

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Outline

Pathophysiology

Bone is a living tissue that is constantly breaking down and being replaced. Osteoporosis happens when the growth of new bone does not keep up with the breaking down of old bone. This makes the bones very brittle and fragile. Primary osteoporosis is a result of the normal aging process, while secondary osteoporosis is a result of another disease process.  

Etiology

Bone regeneration normally takes place much faster than the deterioration process and the bones grow in mass reaching a peak in a person’s 20s. As people age, the breaking down process becomes faster than the regeneration process. The amount of bone mass at the peak can partly determine the likelihood of developing osteoporosis. There are many risk factors. It is most common in older women, due to a decrease in estrogen, as well as people taking corticosteroids or with a decreased dietary intake of calcium.

Desired Outcome

The goal of treatment is to address the underlying causes and prevent fractures.

Osteoporosis Nursing Care Plan

Subjective Data:

  • Bone Pain

There are typically no symptoms in the early stages of bone loss

Objective Data:

  • Loss of height over time
  • Stooped posture
    • Kyphosis of the spine
  • Bone fractures, especially hip/pelvis
  • Pathologic fractures
    • Occur without trauma

Nursing Interventions and Rationales

  • Assess and manage pain
  Patients often complain of back pain as the vertebra collapse or pain from a fracture. Pain control is essential for the patient to participate in rehab.
  • Initiate fall precautions to prevent injury
  Falls and injuries are more difficult to heal with osteoporosis as the bone takes longer to regenerate. Provide assistance with ambulation, remove rugs or fall hazards and maintain a clear and well-lit path.
  • Support fracture stabilization
  If patient is in cast or splint, make sure the device fits properly and assess for skin integrity and circulation.
  • Administer medications appropriately
    • Bisphosphonates (alendronate, ibandronate)
    • Hormone therapy
    • Biologic drugs (denosumab)
  Medications to slow bone loss may be given as an oral medication daily, weekly or monthly. Some medications require weekly, monthly or quarterly injections.
  • Monitor respiratory status and signs of fat embolism
  Fat embolism is a complication of fractures and can lead to respiratory insufficiency.
  • Assist with repositioning
  Pain and injury make positioning difficult for some patients. Assist in repositioning every 2 hours as needed to prevent skin breakdown and assist with mobility.
  • Assist with ROM activities
  Immobility can cause atrophy of muscles. Assist as necessary with ROM activities to prevent injury.
  • Consult physical and occupational therapy as appropriate
  Consult with PT/OT for evaluation and rehab to maintain functionality and mobility.
  • Nutrition and lifestyle education
    • A healthy diet, increase calcium intake
    • Exercise as tolerable in a safe environment
    • Quit smoking
    • Limit or avoid alcohol
  • A healthy diet high in calcium and vitamin D can help prevent skin breakdown and exercise promotes circulation and healing.
  • Weight-bearing exercises can improve the strength of muscles around weak bones/joints as well as increase bone density to reduce the risk of fractures.
  • Smoking increases the rate of bone loss.
  • Limit alcohol to two drinks per day as it can decrease bone formation and increase the risk of falls.

Writing a Nursing Care Plan (NCP) for Osteoporosis

A Nursing Care Plan (NCP) for Osteoporosis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey guys, in this care plan, we will explore osteoporosis. So in this osteoporosis care plan, we will cover the desired outcome, the subjective and objective data along with the nursing interventions and rationales. 

 

Bone is a living tissue that is constantly being broken down and replaced. Osteoporosis happens when the growth of new bone does not keep up with the breaking down of the old bone, making the bones very brittle and fragile. Primary osteoporosis is the result of the normal aging process, while secondary osteoporosis is the result of another disease process. Osteoporosis is the most common in older women due to the decreased estrogen levels. It’s also very likely to occur in people taking corticosteroids or with decreased calcium intake. The goal of treatment is to address the underlying causes and prevent fractures. The patient with osteoporosis might experience bone pain, but it’s really important to notice that many patients don’t have any symptoms at all. 

 

Let’s look at the possible objective data. The patient might experience some loss of height over time, and that’s because of the loss of bone mass. Their posture might be really stooped like this woman in this picture here, and they could have that kyphosis of the spine due to the bone breakdown. Bone fractures are really common, especially in the hip and pelvis area and the elderly because they fall with those weakened bones. Pathologic fractures might even occur without any trauma at all. 

 

Let’s discuss the nursing interventions for osteoporosis. You will assess and manage the patient’s pain. Patients often complain of back pain because the vertebrae collapse, or from pain from fractures. Pain control is essential for this person to participate in any rehab activities that you have planned for them. You should make sure you initiate fall precautions because you want to prevent any injuries from occurring falls, and injuries are the most difficult to heal with osteoporosis because their bone takes longer to regenerate. Provide assistance with ambulation, remove any hazards and maintain a clear open path. Support fracture stabilization to allow for healing. If the patient isn’t a cast or a splint, just make sure the device fits properly and assess the skin for good skin integrity and circulation. 

 

Administer medications appropriately, such as by phosphonates hormone therapy or biologic drugs. These drugs are going to help slow bone loss and promote new bone growth. Some indications require weekly, monthly or quarterly injections. You should monitor the patient’s respiratory status for a fat embolism. So, let’s draw our lungs here. What a fat embolism is, is when a fracture occurs in a bone, it’s possible for some of that fat from the inside of the bone to travel out into the circulation and end up in the vessels that are supplying the lungs, which creates an embolism. So, just make sure you monitor for shortness of breath, rapid breathing, and just make sure that everything is okay with the respiratory status, and initiate any precautions as necessary. Assist with repositioning the patient. Pain and injury can make it kind of hard for them to move around, so just help them make sure they’re turning every two hours at least, and just as needed to prevent any skin breakdown, and just assist with any mobility, like getting up to the chair or getting up for a small walk. Make sure you consult physical therapy and occupational therapy as appropriate to work with them because you want them to maintain their functionality and mobility. You should assist with range of motion activities. Immobility can cause atrophy of the muscles, so you need to help them to prevent any injury and keep them moving. 

 

Our last intervention is to educate the patient on lifestyle and nutrition practices. You want to encourage a high intake of calcium and vitamin D because those are going to help with bone growth. Light exercises are great like walking and swimming. Those are just really great ways to stay active and strengthen the muscles around the bones. Smoking cessation should definitely be encouraged if they do smoke because smoking has been shown to affect bone density. Alcohol should be limited because drinking alcohol puts a person more at risk for falls and injuries, and it affects the hormone and vitamin levels in the body. 

 

We love you guys. Now, go out and be your best self today and as always, happy nursing!

 

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