Osteopenia NCLEX Review Care Plans
Nursing Study Guide for Osteopenia
Osteopenia is a medical condition wherein the bone density is lower than normal, but not so low that it can be diagnosed as osteoporosis.
The term osteopenia is derived from two words; “Osteo” meaning bone and “penia” meaning lacking. Normally, bone density peaks at around 35 years old. However, some people how lower than normal bone densities, causing their bones to be fragile and prone to breakage.
A bone mineral density test (BMD) is one way of quantifying the bone mineral present in the bones. BMD is a good parameter in determining how prone from breakage the bones are. BMD is one of the criteria routinely used to determine a person’s susceptibility in developing osteoporosis or brittleness of the bones.
Signs and Symptoms of Osteopenia
There are usually no expressive signs and symptoms of osteopenia. Diminishing bone mineral density does not cause pain and may go undetected unless tested. Some cases of osteopenia have the following signs and symptoms:
- Height loss
- Localized bone pain
- Bone breakage or fracture
Causes and Risk Factors of Osteopenia
The more risk factors a person have, the more susceptible they are in developing osteopenia. The causes and risk factors of Osteopenia are as follows:
- Aging. It is the most common reason for osteopenia. As a person reaches the peak age of optimum bone mass, so is how fast the body breaks down old bone from rebuilding new ones as we age. Being older than 50 qualifies a person for osteopenia.
- Women. In addition to aging, women are more susceptible in developing osteopenia in relationship with the diminishing estrogen levels available in the blood brought about by menopause. Likewise, menopausal states before the age of 45 hastens the possibility for the development of Osteopenia.
- Family history of low Bone Mass density (BMD). It has been established that genetics play a role in osteopenia
- Removal of ovaries before menopause. Since estrogen are produced in the ovaries, removal of this early on adds to osteopenia susceptibility.
- Not getting enough exercise. A sedentary lifestyle inhibits bone growth and therefore bone wasting acts much faster when compared to bone repair.
- Poor diet, especially lacking in calcium and vitamin D
- Drinking too much alcohol or caffeine
- Taking prednisone or phenytoin
Certain conditions are also associated with the development of osteopenia:
- Cushing syndrome
- Other inflammatory conditions – Rheumatoid arthritis, lupus, Crohn’s disease.
Complications of Osteopenia
Osteopenia is often coined as the predisposing condition before the development of osteoporosis. Osteopenia is different from osteoporosis because the former is characterized as having the bones weaker than normal but not so much that it breaks easily, which is the defining characteristic of the latter.
Once osteopenia is not addressed clearly, the patient may develop complications, progressing towards osteoporosis. In osteoporosis, the bone has become too brittle that it will cause debilitating conditions to the patient such as stooped posture, increased risk of fractures, which in turn may cause severe pain and stunting and loss of height.
Diagnosis of Osteopenia
- History Taking. Actively diagnosing osteopenia and evaluating for Bone Mass Density is recommended by the National Osteoporosis Foundation if the patient is:
- A woman aged 65 and above
- Younger than 65, post menopause, and have one or more risk factors
- Post menopause
- Incurring bone fractures simply from doing normal activity (i.e. moving a chair)
- Dual Energy X-ray Absorptiometry (DEXA) scan. This scan is the most common way for in measuring a patient’s BMD. It is also known as a bone mineral density test. The test is painless, utilizing X-rays that have a lower radiation dose than an ordinary X-ray. DEXA usually measures bone density of the levels in the hip, spine, wrist, finger, shin, or heel. DEXA shows a comparison of the density of the patient’s bones against someone younger (around 30 years old), of the same sex and race. The result of these scan is called a T-score, which will aid the physician in diagnosing osteopenia. In instances wherein your DEXA indicates osteopenia, another report which is the FRAX score will also be included. The FRAX score is a tool utilized for estimating the risk of breaking of bones of patient within the next 10 years.
Treatment of Osteopenia
The primary goal of treatment is to prevent osteopenia from rapidly developing into osteoporosis. Treating osteopenia involves the following:
- Diet modification. A diet high in dietary calcium and vitamin D would be highly recommended to address osteopenia. Daily calcium intake of 1200 mg and 800 International units (IU) of vitamin D is the recommended daily allowance for patients with osteoporosis, a complication of osteopenia.
- Osteopenia exercises. Physical exercises involving having your feet on the ground (i.e. Weight bearing exercises) like running, walking or jumping for at least 30 minutes a day helps to build bones in the body.
- Medical management. Medications oftentimes prescribed for osteoporosis may also be given for sufferers of osteopenia. Examples of these medications are:
- Selective estrogen receptor modulators (SERMs)
- Prevention. The best treatment for osteopenia is still eliminating preventable risk factors such as smoking, poor diet, and alcohol abuse. Having DEXA scans early on is also beneficial to assess for the general health of the bones and to detect osteopenia as early as possible.
Nursing Care Plans for Osteopenia
Nursing Care Plan 1
Nursing Diagnosis: Deficient Knowledge related new diagnosis of osteopenia, as evidenced by patient’s verbalization of “I want to know more how to manage my illness.”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of his/her acute pain and its management.
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits).||To address the patient’s cognition and mental status towards disease management and to help the patient overcome blocks to learning.|
|Explain what his/her pain management program entails (e.g. medications, relaxation techniques, diet, and related physiotherapy or exercises). Avoid using medical jargons and explain in layman’s terms.||To provide information on his/her pain management program for osteopenia.|
|Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to treat acute pain. Ask the patient to repeat or demonstrate the self-administration details to you.||To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.|
|Educate the patient about non-pharmacological methods for acute pain such as imagery, distraction techniques, recommended exercises, and relaxation techniques.||To reduce stress and to promote optimal pain relief without too much dependence on pharmacological means.|
|Discuss with the patient the need for regular DEXA scans and other preventive measures.||The best treatment for osteopenia is still eliminating preventable risk factors such as smoking, poor diet, and alcohol abuse. Having DEXA scans early on is also beneficial to assess for the general health of the bones and to detect osteopenia as early as possible.|
Nursing Care Plan 2
Nursing Diagnosis: Activity intolerance related to bone pain secondary to osteopenia, as evidenced by bone pain score of 7 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.
|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.|
|Create an exercise/activity plan with the patient, caregiver, and physiotherapy/occupational therapy team.||Sedentary lifestyle is one of the most common risk factors for osteopenia, thus, a crucial part of the treatment is to exercise and have an active lifestyle.|
Nursing Care Plan 3
Nursing Diagnosis: Acute Pain related to the disease process of osteopenia as evidenced by pain score of 7 out of 10, verbalization of sharp 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.
|Administer prescribed pain medications.||To alleviate acute/chronic bone pain. Pain is usually described as sharp and spasmic.|
|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 hot pack on the affected area.||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. Reposition the patient until he/she is comfortable.||To increase the oxygen level by allowing optimal lung expansion. To promote patient comfort and relaxation.|
|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.|
Other possible nursing diagnoses:
- Impaired Physical Mobility
- Risk for Injury
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. (2017). 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. (2018). 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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This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.