NURSING PROCESS:THE PATIENT WITH A SPONTANEOUSVERTEBRAL FRACTURE RELATEDTO OSTEOPOROSIS

Ns. Heri Kristianto, MKep.,Sp.Kep.MBNursing SchoolFaculty of Medicine

Assessment

Health promotion Identification of people at risk for

osteoporosis and recognition of problems associated with osteoporosis form the basis for nursing assessment

Health history: osteopenia and osteoporosis, family history, previous fractures, dietary consumption of calcium, exercise patterns, onset of menopause, and use of corticosteroids as well as alcohol, smoking, and caffeine intake

Any symptoms the patient is experiencing, such as back pain, constipation, or altered body image, are explored

Physical examination : disclose a fracture, kyphosis of the thoracic spine, or shortened stature.

Problems in mobility and breathing may exist as a result of changes in posture and weakened muscles

Nursing Diagnoses

The major nursing diagnoses for the patient who experiences a spontaneous vertebral fracture related to osteoporosis may include the following:

Deficient knowledge about the osteoporotic process and treatment regimen

Acute pain related to fracture and muscle spasm

Risk for constipation related to immobility or development of illeus (intestinal obstruction)

Risk for injury: additional fractures related to osteoporosis

Planning and Goals

Knowledge about osteoporosis and the treatment regimen

Relief of pain Improved bowel elimination Absence of additional fractures

Nursing Interventions

PROMOTING UNDERSTANDING OF OSTEOPOROSIS AND THE TREATMENT REGIMEN

1. Patient teaching focuses on factors influencing the development of osteoporosis, interventions to arrest or slow the process, and measures to relieve symptoms

Adequate dietary or supplemental calcium and vitamin D, regular weight-bearing exercise, and modification of lifestyle, if necessary (eg, cessation of smoking, reduced use of caffeine and alcohol), help to maintain bone mass

Diet, exercise, and physical activity are the primary keys to developing high-density bones that are resistant to osteoporosis

It is emphasized that all people continue to need sufficient calcium, vitamin D, sunshine, and weight-bearing exercise to slow the progression of osteoporosis

Patient teaching related to medication therapy is important

Because gastrointestinal symptoms and abdominal distention are frequent side effects of calcium supplements, the nurse instructs the patient to take the calcium supplements with meals

Drink adequate fluids to reduce the risk of renal calculi

Medication If HRT (hormone replacement therapy) is

prescribed, the nurse teaches the patient about the importance of compliance and periodic screening for breast and endometrial cancer.

Alendronate requires compliance: it must be taken on an empty stomach with water, and then the patient must not consume foods or liquids or assume a reclining position for 30 to 60 minutes.

Nasal calcitonin is administered daily, alternating the nares. An adequate daily intake of dietary calcium and vitamin D is needed along with these prescribed medications.

RELIEVING PAIN Istirahat dalam posisi supine atau

miring Matras tempat tidur harus kaku dan

tidak kendur. Fleksi lutut relaxing back muscles. Penghangat lokal dan masase ringan

muscle relaxation. Hindari gerakan memutar tubuh,

pindahkan badan secara lurus/ sejajar.

Ajarkan gerakan mekanika tubuh dan postur yang benar

Lumbosacral corset membantu aktivitas

Pasien melanjutkan aktivitasnya sehingga nyeri berkurang.

Vertebroplasty alternatif pilihan

IMPROVING BOWEL ELIMINATION Constipation is a problem related to

immobility and medications. Early institution of a high-fiber diet,

increased fluids, and the use of prescribed stool softeners help to prevent or minimize constipation.

If the vertebral collapse involves the T10–L2 vertebrae, the patient may develop an ileus.

The nurse therefore monitors the patient’s intake, bowel sounds, and bowel activity.

PREVENTING INJURY

Aktivitas fisik memperkuat otot, menjaga keseimbangan, mencegah atropy, mencegah retardasi demineraliasi tulang yg berlebihan

Isometric exercises memperkuat otot Ners meningkatkan kemampuan perawat

dalam berjalan, bodi mekanik dan postur tubuh.

Daily weight-bearing activity dan berjemur sinar matahari meningkatkan kemampuan tubuh untuk memproduksi vitamin D

Hindari aktivitas berat.

Evaluation1. Acquires knowledge about

osteoporosis and the treatment regimen

States relationship of calcium and vitamin D intake and exercise to bone mass

Consumes adequate dietary calcium and vitamin D

Increases level of exercise Takes prescribed hormonal or non

hormonal therapy Complies with prescribed screening and

monitoring procedures

Achieves pain relief Experiences pain relief at rest Experiences minimal discomfort

during ADLs Demonstrates diminished tenderness

at fracture site

Demonstrates normal bowel elimination

Has active bowel sounds Reports regular bowel movements

Experiences no new fractures Maintains good posture Uses good body mechanics Consumes a diet high in calcium and

vitamin D Engages in weight-bearing exercises

(walks daily) Rests by lying down several times a day Participates in outdoor activities Creates a safe home environment Accepts assistance and supervision as

needed

………Selesai………