Osteomalacia Nursing Care Plans Diagnosis and Interventions
Osteomalacia NCLEX Review and Nursing Care Plans
Osteomalacia is a disorder characterized by weakening and softening of bones, commonly due to low levels of Vitamin D in the body.
Bones are rigid organs in the body that functions to protect other organs and helps with movement and mobility.
Conditions such as osteomalacia can affect the composition of bones can have a debilitating effect on a person’s quality of life.
Vitamin D plays an important role in the absorption of calcium and phosphorus – two important minerals that make up the bones in the body.
If the body is low in any of these minerals, as in osteomalacia, weakness and softening of the bones may occur.
Signs and Symptoms of Osteomalacia
There are usually no apparent signs and symptoms in the early stages of osteomalacia.
As it progresses, the following manifestations will start to become noticeable:
- Bone and joint pain usually in the groin, legs, upper thighs, and knees; pain on the feet can also be noted when standing and walking.
- Muscle pain – commonly affects movements and may make getting out of bed a struggle.
- Weakness after exercising
- Looser’s zones – weight-bearing bones start to break easily (hips, lower back, feet). Breaks related to osteomalacia are referred to as Looser’s zone. They are usually impartial breaks which can lead to complete fractures.
- Waddling gait may be noted due to muscle weakness, pain, and partial fractures.
- Muscle cramps
- Pins and needles sensation in the hands and feet caused by low calcium levels
Causes of Osteomalacia
Like most cells in the human body, bones are made up of cells that require nutrients for their survival.
Calcium and phosphorus are needed to make the outer shell of the bones strong.
Vitamin D makes this happen as it is responsible for the absorption of these minerals to the bones. Any disruption on this process can cause osteomalacia.
- Low levels of Vitamin D. Vitamin D help in the absorption of calcium and phosphorus so they can be used to strengthen the bones. Poor dietary intake of Vitamin D and inadequate sun exposure can both cause Vitamin D deficiency.
- Surgeries. Most of the nutrient absorption happens in the stomach and the intestines. Surgeries that involve removal of parts of these organs can cause inadequate absorption of minerals including calcium.
- Celiac Disease. Celiac disease is a condition where the body reacts to gluten when ingested. The reaction causes the destruction of the intestinal lining called villi, which are finger-like structures responsible for the absorption of nutrients.
- Kidney or liver diseases. Vitamin D is activated by the liver and kidneys when needed. Any conditions that affect the functions of the liver and kidneys can cause inactivation of Vitamin D, therefore causing osteomalacia.
- Medications. Certain medications can cause Vitamin D deficiency, such as anti-seizure drugs.
Complications of Osteomalacia
The following are the known complications of osteomalacia:
- Further broken bones. Incomplete breaks in the bones may end up becoming complete fractures.
- Stunted growth. Bones are also responsible for the body’s stature. Inadequate nutrients cause underdeveloped bone structure.
- Hypocalcemic seizures. Inadequate calcium levels can alter the neuronal activities of the brain.
- Kidney failure. If calcium is not absorbed into the bones, they clump up and stay in the blood stream. The kidneys then try to excrete the excess calcium levels. However, this can cause kidney stones.
- Physical disability. Bones play a vital role in mobility and movements.
Diagnosis of Osteomalacia
The diagnosis of osteomalacia usually occurs in the later stage of the disease as it doesn’t usually present any signs and symptoms in the early stages.
Aside from history taking and physical exam, the following diagnostic tests may be performed:
- Blood tests – a simple blood test to check for the levels of calcium, phosphorus, and vitamin D in the blood. It may also include the levels of alkaline phosphatase and parathyroid hormone to support the diagnosis. Alkaline phosphatase and parathyroid hormone will be raised in a person with osteomalacia.
- Imaging – X-ray images will show the breaks and fractures consistent with osteomalacia.
- Bone biopsy – to give a clinician an accurate diagnosis of osteomalacia, however, it is not usually necessary as blood tests are often helpful and definitive.
Treatment of Osteomalacia
The treatment of osteomalacia relies on addressing the cause of the bone weakness and softening.
- Vitamin D supplementation. Oral vitamin D is commonly prescribed for months to correct osteomalacia if the cause if low levels of it.
- Calcium and phosphorus supplementation may also be required, however, increasing oral intake from food sources is the first step.
- Treatment of underlying conditions causing osteomalacia.
- Pain killers. When the vitamin D supplement is started, the breaks in the bones usually heals on their own. However, pain can persist while healing is taking place.
Nursing Diagnosis for Osteomalacia
Nursing Care Plan for Osteomalacia 1
Nursing Diagnosis: Acute Pain related to the disease process of osteomalacia as evidenced by pain score of 10 out of 10, verbalization of sharp bone pain, guarding sign on the affected area, facial grimace, crying, and restlessness
Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.
|Nursing Interventions for Osteomalacia||Rationale|
|Administer prescribed pain medications.||To alleviate acute/chronic bone pain. Pain is usually described as sharp. It can be aggravated by activity, especially full-weight bearing activities.|
|Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.||To monitor effectiveness of medical treatment for the relief of bone pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.|
|Apply cold and hot pack on the affected area.||Use the cold pack for 10 to 15 minutes to reduce pain impulses. Then, use the heat pack for pain relief and for the restoration of range of motion (ROM). Elevate the head of the bed if the patient is short of breath.||To increase the oxygen level by allowing optimal lung expansion.|
|Place the patient in complete bed rest during severe episodes of pain. Perform relaxation techniques such as deep breathing exercises, guided imagery, and provision of distractions such as TV or radio.||To enable to patient to rest and to provide comfort.|
Nursing Care Plan for Osteomalacia 2
Nursing Diagnosis: Imbalanced Nutrition Less than Body Requirements related to inadequate vitamin D secondary to osteomalacia as evidenced by low serum vitamin D levels, muscle cramps, bone and joint pain, and muscle weakness.
Desired Outcome: Patient will establish normal serum vitamin D levels.
|Nursing Interventions for Osteomalacia||Rationale|
|Educate the patient on the relationship between osteoporosis and calcium and vitamin D levels, as well as the target dietary amounts for calcium and vitamin D.||The recommended vitamin D levels for an adult is between 20 to 50 ng/mL or 400 IU. A level of less than 12 ng/mL is considered vitamin D deficiency. Vitamin D rich foods such as oily fish, red meat, liver, vitamin D-fortified cereals, and egg yolks help in the optimal absorption of calcium.|
|Inform the patient on the sources of calcium and vitamin D.||Aside from supplements, calcium can be obtained from milk, cheese, yogurt, seafood, legumes, dried fruit, and green leafy vegetables. Vitamin D can be obtained from fatty fish such as salmon, tuna, and mackerel. Vitamin D can also be obtained from sunlight (15 minutes per day).|
|Encourage the patient to stop smoking, limit alcohol intake to maximum of 2 units per day, and to improve exercise and physical activity.||To reduce bone loss and to improve the absorption of calcium in the bones.|
|Refer the patient to the dietitian.||To provide specialized care and individualized dietary program geared towards improving bone health.|
Nursing Care Plan for Osteomalacia 3
Nursing Diagnosis: Activity intolerance related to joint and bone pain secondary to osteomalacia, as evidenced by pain score of 10 out of 10, fatigue, disinterest in ADLs due to pain, verbalization of tiredness and generalized weakness
Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.
|Nursing Interventions for Osteomalacia||Rationales|
|Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.||To create a baseline of activity levels and mental status related to chronic pain, fatigue and activity intolerance.|
|Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.||To gradually increase the patient’s tolerance to physical activity. To prevent triggering pain by allowing the patient to pace activity versus rest.|
|Administer analgesics as prescribed prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.|
|Refer the patient to physiotherapy / occupational therapy team as required.||To provide a more specialized care for the patient in terms of helping him/ her build confidence in increasing daily physical activity.|
|If the patient is overweight or obese, create a weight loss plan with the patient, caregiver, physiotherapy/occupational therapy, doctors, and dietitian.||Obesity may aggravate bone and joint pain, thus, a crucial part of the treatment is to lose weight through diet and exercise.|
More Nursing Diagnosis Nursing for Osteomalacia
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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