Osteoporosis Nursing Care Plans Diagnosis and Interventions
Osteoporosis NCLEX Review and Nursing Care Plans
Osteoporosis is a medical condition wherein the bones become brittle and weak. Normally, bone tissues break down and get replaced constantly.
However, osteoporosis involves the inability of the new bone tissues to keep up with the loss of the old bone tissues.
Osteoporosis makes the person at a high risk for fractures. The most common sites of osteoporosis-related fractures include the wrist, spine, and hips.
Asian and white women are more at risk of osteoporosis than men, but it can affect both men and women of any race and ethnicity. The treatment for osteoporosis involves shifting to a healthy diet, proper weight-bearing exercise, and medications to promote bone strength and reduce bone loss.
Signs and Symptoms of Osteoporosis
- Back pain
- A stooped posture
- Loss of height over time
- Fractures, especially recurrent ones
Causes and Risk Factors of Osteoporosis
By age 30, most people attain their peak bone mass. Aging results to a faster rate of bone mass loss compared to the rate of bone tissue creation. Women are more prone to develop osteoporosis than men.
White or Asian people are at a higher risk than Black or Caribbean people. Having a small body frame tends to put a person at a higher risk as well. Genetics can also play a role in osteoporosis, as having a parent or a sibling with osteoporosis may mean that the person is at a greater risk.
Low sex hormones (especially estrogen in menopausal women), and excessive thyroid, adrenal, and parathyroid hormones may contribute to accelerated bone loss.
Dietary factors include a long-term low calcium intake, eating disorders, and history of gastrointestinal disorders or surgery. Having a sedentary lifestyle, smoking tobacco, and/or consuming too much alcohol contribute to the development of osteoporosis later in life.
Chronic use of corticosteroids may lead to poor bone tissue creation.
Patients with cancer, kidney or liver disease, rheumatoid arthritis, lupus, or Celiac disease are more prone to develop osteoporosis.
Complications of Osteoporosis
- Bone fractures, particularly involving the hip bones, are the most common complications of osteoporosis. Elderly people who suffer from a fall may have hip fractures and eventually become physically disabled, or can be at higher risk of death within a year after the fall.
- Poor posture. The patient’s comfort and quality of life may be affected by poor posture due to osteoporosis.
Diagnosis of Osteoporosis
- Physical examination – to check for any bone fractures, bone pain, or stooped posture
- Blood test – to check for serum calcium levels
- Bone density test – using a low-level X-ray machine to measure the mineral proportion of the bones
Treatment for Osteoporosis
- Bisphosphonates. These medications are used to treat bone loss and can help reduce the risk of bone fractures. Examples of bisphosphonates include: alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), and zoledronic acid (Reclast, Zometa).
- Monoclonal antibody medications. An alternative to bisphosphonates, denosumab ( (Prolia, Xgeva) also lowers the risk for fractures and helps improve bone density. Denosumab is given subcutaneously, while bisphosphonates are usually given intravenously. Both denosumab and bisphosphonates may rarely lead to osteonecrosis of the jaw, so it is important to ensure that the dentist of the patient knows that he/she will be started on these medications.
- Hormone-related therapy. Estrogen replacement therapy such as the use of raloxifene (Evista) in menopausal women is useful in the maintenance of bone density, but its risks (possible blood clots, increased risk of heart disease, endometrial cancer, and breast cancer) should be considered. Testosterone replacement therapy in men may also help to reduce the risk of osteoporosis.
- Bone-building medications. New bone-building medications can help treat osteporosis. These include teriparatide (Forteo), abaloparatide (Tymlos), and romosozumab (Evenity).
- Calcium and Vitamin D supplements. People age 18 to 15 requires at least 1000 mg of calcium per day, while women age 50 and above and men age 70 and above should have 1200 mg of calcium intake per day. This can be achieved by eating calcium-rich foods, or taking calcium supplements as recommended by the physician. Vitamin D rich foods or supplements help in the optimal absorption of calcium. Vitamin D can also be obtained from sunlight.
- Lifestyle changes. Smoking cessation, limited alcohol intake (no more than 2 units per day), and weight-bearing exercises can help reduce the risk of osteoporosis.
Nursing Care Plans for Osteoporosis
Nursing Care Plan for Osteoporosis 1
Nursing Diagnosis: Impaired Physical Mobility related to bone fracture secondary to osteoporosis as evidenced by presence of hip fracture, severe hip pain rated10/10, failure to perform ADLs, and low bone density score
Desired Outcome: Patient will maintain functional mobility despite presence of fracture.
|Nursing Interventions for Osteoporosis||Rationale|
|Assess the patient’s function ability to perform activities of daily living (ADLs) such as eating, bathing, oral and perineal care.||To identify patient’s current strengths and problems related to performing ADLs while dealing with hip fracture and osteoporosis.|
|Identify the patient’s need for assistance from significant others. Educate the significant others on how to assist the patient in performing ADLs and improving physical mobility through exercise.||To identify patient’s support in terms of his/her physical, social, mental, and emotional health. To support the significant others on how they can assist the patient achieve optimal physical mobility.|
|Encourage physical mobility and demonstrate range of motion exercises.||To prevent muscle atrophy and joint contractures.|
|Refer the patient to the physiotherapist.||To provide specialized care and individualized exercise program.|
Nursing Care Plan for Osteoporosis 2
Nursing Diagnosis: Imbalanced Nutrition Less than Body Requirements related to
inadequate calcium and vitamin D secondary to osteoporosis as evidenced by low serum calcium and vitamin D levels, stopped posture, loss of height, presence of spine fracture.
Desired Outcome: Patient will establish normal serum calcium and vitamin D levels.
|Nursing Interventions for Osteoporosis||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.||People age 18 to 15 requires at least 1000 mg of calcium per day, while women age 50 and above and men age 70 and above should have 1200 mg of calcium intake per day. This can be achieved by eating calcium-rich foods, or taking calcium supplements as recommended by the physician. Vitamin D rich foods or supplements 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 Osteoporosis 3
Nursing Diagnosis: Deficient Knowledge related to lack of access to medication-related information, dietary alterations, or programs that promote safe physical activity secondary to new diagnosis of osteoporosis as evidenced by expressing the problem and requesting additional information, anxiety of further fractures and bone loss, and complications that may have been avoided.
- The patient will gain more knowledge and adhere to the medical regimen to reduce bone demineralization and injury.
- The patient will adhere to the medication and dietary requirements.
- the patient will be able to perform daily exercises, within set limitations, and prevent further bone loss or deterioration.
- The patient will not exhibit signs of injury, fall, or trauma that could lead to a fracture.
- the patient will be able to perform ADLs independently, with modifications.
- The patient and/or family will be able to accurately verbalize medication and administration methods.
|Nursing Interventions for Osteoporosis||Rationale|
|Assess the patient’s knowledge about the disease, nutrition, treatment, and exercise regimen in order to halt bone deterioration.||Provides a foundation for teaching and compliance strategies. The disease is frequently not identified until 24-40% of the calcium in the bones has been lost.|
|Evaluate the patient’s knowledge of osteoporosis.||The majority of people with osteoporosis are not diagnosed until they suffer an acute fracture.|
|Encourage positive body image and lifestyle modifications.||Assists the patient in dealing with the chronic nature of the condition as well as the possibility of fractures causing pain and immobility.|
|Assist in developing an exercise program based on the client’s ability; minimize flexion of the spine and, if necessary, wear a corset (walking is preferred to jogging).||Bones are strengthened through exercise. The use of a corset to stabilize vertebral collapse is common.|
|Educate the client about calcium intake and nutrition.||In women with a small body frame, advanced age, Asians, and Caucasians, enough calcium helps to prevent osteoporosis.|
|Educate the client that the most effective type of calcium is calcium carbonate.||In an acidic stomach, calcium carbonate is best absorbed. Adults aged 19 to 50 should consume 1000 mg of elemental calcium per day, while those aged 51 and up should get 1,200 mg.|
|Instruct the patient that vitamin D supplementation is recommended for people who don’t get enough sun.||Vitamin D supplements are required for persons who live in the far north or far south, where sunlight is scarce. Vitamin D levels should be 200 IU till age 50, 400 IU between 51 and 70, and 600 IU after 70.|
|Instruct the patient on how to accomplish everyday activities while avoiding lifting, bending, or carrying large objects.||It prevents osteoporosis-related harm that is present with minimal trauma.|
|Instruct the patient and/or family on how to take calcium, vitamin D, estrogens, and other osteoporosis medications.||Substitutes calcium in the body and helps to prevent bone loss.|
|Instruct the patient about osteoporosis medicine, side effects, administration, and the necessity for follow-up testing.||A well-informed patient is more likely to stick to the drug schedule and report side effects.|
|As needed, inform the patient and/or family about possible therapeutic referrals.||Exercise and the implementation of an activity program may aid in maintaining bone health and encouraging independence in ADLs.|
|Teach the patient and/or family about available assistive devices and safety procedures for maintaining mobility.||Prevents further injury or fractures as a result of falls caused by a lack of support.|
Nursing Care Plan for Osteoporosis 4
Risk for Falls
Nursing Diagnosis: Risk for Falls related to bone weakness secondary to osteoporosis.
- The patient will not suffer from a fall.
- The patient will express the desire to employ safety measures to avoid falling.
- The patient will exhibit that he or she is taking precautions.
- The patient and caregivers will put in place measures to improve home safety and prevent falls.
|Nursing Interventions for Osteoporosis||Rationale|
|Examine the client’s history of fall.||Individuals who have had one or more falls in the previous six months are more likely to fall again. According to a study that identified the characteristics that predict repeat falls-related outcomes, the elderly population is at an increased risk of readmission.|
|Examine any changes in the client’s mental status.||People who are disoriented or have poor awareness may not know where they are or how to aid themselves. They may wander from one location to another, putting their safety at risk. Confusion and impaired judgment further raise the risk of the patient falling.|
|Examine physiological and anatomical changes that occur with aging.||People’s capacity to defend themselves from falls is influenced by characteristics such as age and development. Muscle weakness makes older persons more likely to fall than those who retain muscle strength, flexibility, and endurance. Reduced visual function, impaired color perception, shift in center of gravity, unsteady gait, diminished muscle strength, decreased endurance, changed depth perception, and delayed response and reaction times are all examples of these alterations. Reduced contrast sensitivity was linked to an increased risk of falls and other injuries, whereas decreasing visual acuity was simply linked to an increased risk of falling.|
|Assess the client for any sensory issues.||The ability to perceive environmental stimuli is critical to safety. The patient’s capacity to perceive threats in the environment is limited due to vision and hearing impairment. The elderly were found to be at a significantly higher risk of falling in homes with dimly lit kitchens and debris at entryways or backyards.|
|Assess the client’s balance and walking gait.||Falling is more prevalent in elderly people with poor balance or difficulty in walking. These issues could be linked to a lack of activity, a neurological ailment, arthritis, or other medical illnesses and therapies. Adults with rheumatoid arthritis had a higher risk of falling due to swollen and sore lower extremity joints, exhaustion, and the use of psychiatric medicines, according to a study.|
|Examine how the client is using mobility aids.||Mobility devices such as canes, walkers, and wheelchairs can increase energy consumption, uneven stride, overload, and joint damage, increasing the patient’s risk of falling, if used inappropriately. Frail older persons who do not use ambulatory assistive devices are more likely to fall during their daily activities. Education programs for the frail elderly should be established to encourage proper usage of ambulatory-assistive devices.|
|Examine the client’s symptoms for signs of disease.||Orthostatic hypotension, diminished cerebral blood flow, poor urine elimination, edema, dizziness, weakness, weariness, and disorientation have all been linked to an increased risk of falling. Patients with particular diagnoses were more likely to fall. Patients with stroke, for example, were more prone than other patients to fall, extending their stay and increasing medical costs during physical therapy. Patients with orthostatic hypotension suffer light-headedness or dizziness when standing for long periods of time, which can lead to falls.|
|Provide fall-risk patients with signs or secure wristband identification to encourage healthcare staff to pursue fall-prevention strategies.||Patients who are at risk of falling need to be aware of the warning signs. Healthcare practitioners must recognize who has the condition in order to take steps to improve patient safety and prevent falls. Use two patient identifiers while delivering treatment, care, and services. Wristbands in the UK, for example, should carry the patient’s last and first names, date of birth, and NHS number. Details should be printed or written in black on white paper. Only the color red should be used to indicate that a patient is in a particular situation. These suggestions are in line with recent advances in patient identification.|
|Place the patient in a room close to the nursing station.||Identifying which patients are most likely to fall is critical for planning and anticipating adjacent locations, as well as providing more consistent watch and rapid response to emergency demands.|
|Place items that the patient uses frequently, such as the call light, urinal, water, and telephone, within easy reach.||Items that are too far away may force the patient to reach out or ambulate unnecessarily, posing a risk or contributing to falls.|
|As soon as possible, respond to the call light.||It aids in preventing the patient from getting out of bed without assistance. Nurses respond faster to call lights initiated by fallers than to lights initiated by non-fallers. The nurses’ sensitivity to call lights could be a compensatory mechanism in response to the unit’s high fall rate.|
|Explain to the patient the benefits of using glasses and hearing aids.||If the patient uses suitable aids to increase visual and aural orientation to the environment, the risk can be mitigated.|
|Place beds at the lowest position possible. If necessary, place the patient’s sleeping surface as close to the floor as possible.||The risk of falls and serious injury is reduced by keeping the beds closer to the floor. In some hospital settings, putting the mattress on the floor decreases the chance of falling. Low beds are made to reduce the distance a patient must fall when getting out of bed. Although these beds can not eliminate falls, they do minimize the distance a fall travels, lowering the risk of injury and trauma.|
|Raise bed side railings as needed. Leave one of the rails at the foot of the bed down if the bed has split side rails.||According to studies, if one of the four rails is left down, a disoriented or confused patient is less likely to fall.|
|At the foot of the bed, place a non-skid floor mat.||Floor mats can act as a cushion, reducing the impact of a potential fall.|
|Make the patient familiar with the room’s arrangement. Rearranging the furnishings in the room is discouraged.||If an individual is in a surroundings that they are unfamiliar, such as the placement of furniture and equipment in a certain space, he or she is more prone to fall. To avoid tripping over furniture or heavy objects, the patient must become familiar with the room’s layout.|
|Provide adequate lighting, particularly at night.||The visual capacity of patients, particularly elderly ones, is diminished. If the patient needs to get up at night, lighting an unfamiliar location can aid boost visibility. A study found that residences with appropriate illumination have fewer falls. Improvements in home lighting may help older people fall less.|
Nursing Care Plan for Osteoporosis 5
Nursing Diagnosis: Chronic Pain related to bone fragility secondary to osteoporosis
- The patient will display the use of various relaxation techniques and diversional activities as appropriate for the situation.
- The patient will exhibit the use of various relaxation techniques and diversional activities as appropriate for the situation.
- On a scale of 0 to 10, the patient will report discomfort that is less than 3 to 4.
- The patient will employ nonpharmacological pain management techniques.
- The patient will express a satisfactory level of pain alleviation and the ability to participate in desired activities.
- The patient will participate in desired activities with visible comfort.
|Nursing Interventions for Osteoporosis||Rationale|
|Evaluate and record the following pain characteristics:|
-Quality (e.g., sharp, burning)
-Severity (scale of 0 [meaning no pain] to 10 [meaning the most severe pain])
-location (anatomical description)
-Onset (gradual or sudden)
-timeframe (e.g., continuous, intermittent)
-Factors that causes the occurence
-Factors that provide relief
|Patient self-report is the most accurate source of information about chronic pain.|
|Check for indications and symptoms of chronic pain, such as weakness, decreased appetite, weight loss, changes in body posture, sleep disturbances, anxiety, irritability, agitation, or sadness.||Patients with chronic pain may not show the physiological changes and behaviors associated with acute pain. A patient with chronic pain may develop a lasting alteration in body posture as a result of their acute pain guarding behavior. Chronic pain might diminish a patient’s ability to engage in other activities.|
|Evaluate the patient’s opinion of the success of previous pain-relieving measures.||Chronic pain patients have a long history of utilizing pharmacological and nonpharmacological treatments to regulate and relieve their symptoms.|
|Consider gender, cultural, socioeconomic, and religious issues that may have an impact on the patient’s pain experience and response to pain alleviation.||Recognizing the factors that influence a patient’s pain experience can help you build a plan of care that the patient will accept.|
|Evaluate the patient’s expectations and beliefs regarding pain relief.||Patients with chronic pain may not expect complete pain relief, but they may be content with a reduction in pain severity and an increase in activity level.|
|Evaluate the patient’s approach to pain treatment, including pharmaceutical and nonpharmacological.||Patients may believe that drugs are the sole effective treatment for pain relief and that nonpharmacological therapies are ineffective.|
|Assess the patient’s capacity to perform and complete activities of daily living (ADLs), instrumental activities of daily living (IADLs), and demands of daily living (DDLs).||Exhaustion, worry, and despair associated with chronic pain might impede a person’s capacity to complete self-care chores and fulfill role obligations.|
|Discuss the benefits of utilizing nonpharmacological pain management options with the patient and family: Acupressure||Acupressure is a pain-relieving technique that involves applying finger pressure to acupressure sites on the body. The technique employs the gate control hypothesis to “close the gate” on pain transmission, which necessitates training and repetition.|
|Cold compress||Cold compress reduces pain, inflammation, and muscle stiffness by constricting blood vessels, restricting the release of pain-inducing chemicals, and modulating pain impulse conduction. This intervention is both cost-effective and does not necessitate the use of any specific equipment. Cold applications should last 20 to 30 minutes/hour, or as long as the patient tolerates.|
|Distraction||Distraction is a pain-relieving technique that works by temporarily raising the pain threshold. It should only be used for a limited period of time, usually less than 2 hours. Long-term use can cause tiredness, which can lead to exhaustion, as well as an increase in discomfort when the distraction is removed.|
|Heat compress||Heat reduces pain by causing vasodilation, which increases blood flow to the area, as well as reducing pain responses. This does not require any additional equipment and is also quite cost effective. Heat applications should last no longer than 20 minutes per hour, depending on the patient’s tolerance. With this method, special attention must be paid to preventing burns.|
|Massage||Massage reduces tissue edema and reduces pain transmission by increasing endorphin release. This intervention may need the massage being performed by someone else.|
|Music therapy, guided imagery, and progressive relaxation technique||These centrally acting pain treatment strategies function by lowering muscle tension and stress. The patient may feel like he or she has more control over their suffering. The patient can use guided imagery to explore images of pain, pain alleviation, and healing. To be effective, these approaches must be practiced.|
|TENS (Transcutaneous Electrical Nerve Stimulation) uses 2 to 4 skin electrodes to stimulate the nerves.||When a small electrical current flows through the electrode and onto the skin, pain is reduced. The patient has control over the degree and frequency of electrical stimulation, which is determined by his or her tolerance.|
More Osteoporosis Nursing Diagnosis
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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