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OSTEOPOROSIS
BY
Aseem.B, MBA, MSc N, PGDHA,Assistant Professor,
Department of Medical Surgical Nursing
SP Fort College of Nursing,Trivandrum.
DEFINITION OSTEOPOROSIS IS A DISEASE OF
BONES THAT LEADS TO AN INCREASED RISK OF FRACTURE.
OSTEOPOROSIS IS A CONDITION IN WHICH THERE WILL BE ABNORMAL RAREFACTION OF BONE WHICH MAY BE IDIOPATHIC OR SECONDARY TO OTHER CONDITIONS.
INCIDENCE
MOST COMMON IN WOMEN AFTER MENOPAUSE
WHO CONSIDERED IT AS A CHRONIC DISEASE
28 MILLION PEOPLE IN USA IS HAVING OSTEOPOROSIS.
INDIA ALSO SEVERAL MILLION PEOPLE ARE AFFECTED
GENETICS
SMALL FRAMED CAUCASIAN WOMEN ARE MORE RISK
FAMILY HISTORY HERITABILITY RANGING FROM 25 TO 80
% ASIAN WOMEN OF SLIGHTBUILD IS ALSO
HAVING RISK
AGE IN WOMEN AND MEN THERE IS
HORMONAL IMBALANCES AS AGE INCREASES
ESTROGEN LEVEL WILL BE ALTERED IN POSTMENOPAUSAL WOMEN
TESTOSTERONE LEVEL IS ALTERED IN OLD AGE.
DISEASES / DISORDERS HYPOGONADAL STATES LIKE TURNER’S
SYNDROME,KLINEFELTER’S SYNDROME GASTOINTESTINAL DISEASES LIKE
CROHNS DISEASE, COELIAC DISEASE, SURGERY LIKE GASTRECTOMY, SEVERE LIVER DISEASES, RENAL
INSUFFICIENCY CAN LEAD TO OSTEO DYSTROPHY DUE TO EXCESSIVE CALCIUM DEPLETION
MEDICATION
CORTICOSTEROIDS ANTI SEIZURE DRUGS ANTI COAGULANTS PROTON PUMP INHIBITORS ANTI DIABETIC DRUGS
LABORATORY STUDIES
SERUM CALCIUM SERUM PHOSPHATE SERUM ALKALINEPHOSPHATASE URINE CALCIUM SEDIMENTATION HEMATOCRIT VALUES ERYTHROCYTE SEDIMENTATION RATE
MEDICAL MANAGEMENT HORMONE REPLACEMENT THERAPY -ESTROGEN -PROGESTERONE BISPHOSPHONATE THERAPY HELP BY INHIBITING THE
OSTEOCLAST FUNCTION - ALENDRONATE (FOSAMAX)
10MG/DAY - RISEDRONATE (ACTONEL) 5MG/DAY
MED MNGT CONTD SELECTIVE ESTROGEN RECEPTOR
MODULATORS -it act on the estrogen receptiors
through out the body in a selective manner.
-normally bmd is regulated by a balance between osteoblast and osteoclastactivity in the trabecular bone.
-Eg : Raloxifene ( it also reducethe risk of breast cancer.
CALCITONIN: PRIMARILY SUPRESSES BONE LOSS THROUGH DIRECT ACTION ON OSTEOCLASTS AND REDUCED BONE TURNOVER.ADMINISTERED THROUGH NASAL SPRAY/IM.
BONE ANABOLIC AGENTS INCLUDE TERIPARIDE, SODIUN FLUORIDE, CALCIUM SALTS
FRACTURE MANAGEMENT
MANAGED SURGICALLY BY JOINT REPLACEMENT OR BY CLOSED OR OPEN REDUCTION WITH INTERNAL FIXATION.
Eg : HIP PINNING, SURGERY, INTENSIVE PHYSICAL THERAPY AND ADEQUATE NUTRITION
KYPHOPLASTY
VERTEBRAL FRACTURES AND KYPHOSIS IS NOW PHARMACOLOGICALLY TREATED BY
PERCUTANEOUS VERTEBROPLASTY/KYPHOPLASTY
-( IN THIS AN INJECTION OF POLY METHYL METHACRYLATE BONE CEMENT INSTILLED IN TO THE FRACTURED VERTEBRA.
NURSING MANAGEMENT
HEALTH HISTORY : -IDENTIFICATION OF PEOPLE AT RISK FOR
OSTEOPOROSIS, -FOCUS ON FAMILY HISTORY, -RECOGNITION OF PROBLEMS
PHYSICAL EXAMINATION-DISCLOSE A FRACTURE-KYPHOSIS OR -SHORTENED STATURE
NURSING DIAGNOSIS ACUTE PAIN RELATED TO FRACTURE &
MUSCLE SPASM.
INEFFECTIVE COPING RELATED TO FEAR OF THE UNKNOWN, PERCEPTION OF THE DISEASE PROCESS.
DEFICIENT KNOWLEDGE ABOUT THE DISEASE PROCESS AND TREATMENT REGIMEN.
IMPAIRED PHYSICAL MOBILITY RELATED TO FRACTURED RIBS
NURSING DIAGNOSIS CONTD
RISK FOR CONSTIPATION RELATED TO IMMOBILITY OR DEVELOPMENT OF ILEUS.
RISK FOR INJURY : ADDITIONAL FRACTURES RELATED TO DISEASE PROCESS’
RISK FOR IMPAIRED THOUGHT PROCESS RELATED TO AGE ,STRESS, UNFAMILIAR SURROUNDINGS AND MEDICATION THERAPY.
NURSING INTERVENTIONS RELIEVING PAIN IPROVING BOWEL ELIMINATION PREVENTING INJURY PROMOTING UNDERSTANDING OF
OSTEOPOROSIS AND THE TREATMENT REGIMEN.
ENCOURAGE WALKING AND GOOD BODY MECHANICS.
MODIFICATION OF LIFE STYLE.