Osteoporosis DSM
Dietary interventions for osteoporosis include:
Calcium-rich foods. Foods rich in vitamin D. Vitamin supplements.
Pointers for preventing injury include:
Implementing safety precautions. Avoiding the use of restraints. Encouraging the use of assistive devices to maintain independence. Instructing the patient on safety and fall precautions.
Lifestyle alterations for osteoporosis include:
Increasing dietary intake of calcium. Adequate dietary intake of vitamin D. Smoking cessation. Doing weight-bearing exercises Moderation of alcohol use.
The nurse is providing care to a patient diagnosed with osteoporosis. Dual-energy x-ray absorptiometry (DEXA) has been ordered for the patient. Which explanation of this diagnostic procedure is appropriate for the nurse to give the patient?
"The test measures bone density in the lumbar spine or hip." The DEXA measures bone density in the lumbar spine or hip. An ultrasound is administered to the heel of the foot to measure bone density. X-rays detect osteopenia and identify fractures. A quantitative ultrasound (QUS) is used to evaluate bone mineral density and the degree of osteoporosis.
A 65-year-old female patient has been recently diagnosed with osteoporosis. Which information should the nurse include in the teaching related to the patient's diagnosis?
"Walk 30-40 minutes per day." Walking is a weight-bearing exercise. The patient should be encouraged to walk 30-40 minutes per day, at least four times a week, to promote bone growth. It is not necessary to decrease dietary iron intake, increase dietary protein, or completely abstain from caffeine.
The nurse is preparing to provide dietary teaching for the patient who is diagnosed with osteoporosis. Which food should the nurse recommend to provide dietary calcium?
Canned sardines
Osteoporosis affects the diaphysis and metaphysis of the bone. Other pointers include:
The diameter of the bone increases, thinning the outer supporting cortex. As osteoporosis progresses, trabeculae are lost from cancellous bone, and the outer cortex thins to the point where even minimal stress will fracture the bone.
The nurse who is caring for an older adult at risk for osteoporosis discusses the importance of weight-bearing activity. Which statement made by the patient requires further teaching?
"I enjoy swimming, so I will try and swim at least 3 times a week." The patient statement, "I enjoy swimming, so I will try and swim at least 3 times a week," requires further teaching. Swimming is not a weight-bearing exercise. Weight-bearing exercises, such as tai chi, weight lifting, and walking on a golf course, influence bone metabolism in several ways. The stress of this type of exercise causes an increase in blood flow to bones, which brings growth-producing nutrients to the cells, resulting in increased osteoblast growth and activity.
The nurse is obtaining a health history on a patient diagnosed with osteoporosis. Which patient statement has the strongest association with osteoporosis?
"I try to walk twice a week."
The nurse is providing nutritional teaching for a newly diagnosed pregnant patient. Which dietary intervention should the nurse suggest in order for the growing fetus to obtain enough maternal dietary calcium without having to pull calcium from the maternal bones?
"Increase your dietary intake of beans." The newly diagnosed patient should be encouraged to increase their intake of beans. Beans not only contain fiber that will help with constipation that occurs during pregnancy, but more important, contain high levels of calcium necessary for the growing fetal skeleton. Other calcium-rich foods include dairy and vegetables. Beef, chicken, and wheat do not contain high amounts of calcium.
A pregnant woman asks, "Can you tell me about breastfeeding and bone loss? I read an article stating that I am at risk for bone loss if I breastfeed." Which response by the nurse demonstrates an understanding of breastfeeding and its effects on loss of maternal bone mass?
"Loss of maternal bone mass does occur with breastfeeding but is restored after weaning."
A patient asks the nurse, "How does exercise prevent osteoporosis?" Which statement accurately describes the nurse's understanding of how weight-bearing exercise can help prevent osteoporosis?
"Weight-bearing exercise promotes osteoblast growth and activity." Weight-bearing exercises, such as walking, influence bone metabolism in several ways. The stress of this type of exercise causes an increase in blood flow to the bones, which brings growth-producing nutrients to the cells. Walking causes an increase in osteoblast growth and activity. Osteoclast activity is the breaking down of the bone cells. Weight-bearing exercise keeps the calcium in the bones. Muscle strength is important to maintain activity, but it is not the primary reason that weight-bearing exercise is recommended to prevent osteoporosis.
A patient is prescribed estrogen replacement therapy for treatment of osteoporosis. The patient states to the nurse, "I heard that estrogen is associated with an increased risk of uterine cancer." Which response made by the nurse provides the patient with accurate information?
"You will be prescribed progesterone with the estrogen to protect you from uterine cancer." Estrogen therapy alone is associated with an increased risk of endometrial cancer, so it usually is prescribed in combination with progesterone; this is referred to as hormone replacement therapy. Bisphosphonates are not used to decrease the risk of cancer, they are used to inhibit bone reabsorption. There is no new research that disputes the risk factor of endometrial cancer associated with estrogen replacement therapy. The dose of estrogen is not too low in that there is no increase in the risk of cancer.
A patient diagnosed with osteoporosis states to the nurse, "I don't understand how my bones can be so brittle and break easily." Before responding to the patient, the nurse should understand that which process is involved in the pathophysiology of osteoporosis?
An imbalance between osteoblasts and osteoclasts has occurred. Osteoporosis is a metabolic bone disorder characterized by loss of bone mass, increased bone fragility, and increased risk of fractures. Although the exact pathophysiology of osteoporosis is unclear, it is known to involve an imbalance in the activity of osteoblasts that form new bone and osteoclasts that reabsorb bone. Osteoclasts are responsible for reabsorption of bone and osteoblasts the formation of new bone.
The nurse caring for a patient with osteoporosis notes that the patient's height has significantly decreased each year over the past few years. Which further additional assessment finding should the nurse anticipate?
Dorsal kyphosis Along with loss of height, characteristic dorsal kyphosis and cervical lordosis develop, accounting for the buffalo hump (sometimes referred to as a "dowager's hump") frequently associated with aging. Recumbent is a position, and cervical kyphosis and thoracic lordosis do not occur with osteoporosis.
The nurse is caring for a patient suspected of having osteoporosis. Which diagnostic test should the nurse anticipate to be ordered to specifically diagnose osteoporosis?
Dual-energy x-ray absorptiometry (DEXA)
Laboratory diagnostics for osteoporosis include:
Dual-energy x-ray absorptiometry (DEXA) is used to measure bone density. Ultrasound measures bone density. Alkaline phosphatase is elevated after a fracture. Gla protein is a marker for osteoclastic activity and is used to evaluate the effects of treatment.
The nurse is providing medication teaching to a patient who has been prescribed alendronate sodium (Fosamax) for the treatment of osteoporosis. Which adverse effect should the nurse include?
Dyspepsia Dyspepsia is a common adverse effect that occurs for patients taking alendronate sodium (Fosamax). Sinusitis and hot flashes are expected adverse effects that occur with raloxifene hydrochloride (Evista). Diarrhea, not constipation, is an adverse effect expected with the medication.
The nurse is assessing a patient who is postmenopausal and at risk for osteoporosis. The nurse notes a 3-in decrease in height from last year's assessment. Laboratory and radiological studies confirm osteoporosis. Which collaborative intervention should the nurse anticipate to further prevent decrease in bone loss?
Estrogen replacement therapy Pharmacotherapy is used for prevention and treatment of osteoporosis. Estrogen replacement therapy reduces bone loss, increases bone density in the spine and hip, and reduces the risk of fractures in postmenopausal women. Vitamin D and calcium supplementation, as well as bisphosphonates are beneficial to any patient with osteoporosis, but postmenopausal women can be specifically treated with estrogen replacement therapy.
A 62-year-old female patient presents with a possible wrist fracture and reports no other health problems. This is the third such injury that the patient has had in the past year, and the nurse suspects osteoporosis. Which assessment finding in the patient's health history supports the diagnosis of osteoporosis?
History of alcoholism
A 65-year-old man with a low testosterone and lifetime calcium level has had two bone fractures in the past 2 years. Which intervention should the nurse suggest to prevent or slow the development of osteoporosis?
Increasing calcium intake The nurse will recommend that the patient increase calcium intake as a way to slow the development of osteoporosis. The use of corticosteroids increases the risk factor for osteoporosis. Low estrogen levels are a cause of osteoporosis in women but not in men, so estrogen supplements would not be indicated for an older man. The patient should be advised to increase activity, not to decrease it.
In older adults, risk factors for osteoporosis include:
Menopause resulting in decreased estrogen. Normal aging. Visual impairment. Loss of balance. Neuromuscular dysfunction. Dementia. Immobilization. Use of sleeping pills.
The nurse is providing dietary teaching for a patient newly diagnosed with osteoporosis. Included in the teaching is the importance of dietary intake of calcium and vitamin D. Which foods that are high in vitamin D should the nurse recommend?
Milk Vitamin D is necessary for the body to absorb calcium. The food the nurse will recommend that is high in vitamin D is milk. Milk is also high in calcium, which is recommended in the prevention of further complications of osteoporosis. Beef does not contain high amounts of vitamin D. Orange juice and beans contain high amounts of calcium.
The nurse is caring for a patient diagnosed with osteoporosis. When planning the patient's care, which nursing diagnosis is most appropriate?
Mobility: Physical, Impaired
The nurse is caring for an older adult who has advanced dementia, osteoporosis, and frequently gets out of bed throughout the night. Which nursing intervention is most appropriate for the nurse to include in the plan of care?
Placing the bed in the lowest position
The nurse is caring for an older adult at risk for osteoporosis who frequently experiences a loss of balance. Which activity should the nurse encourage the patient to do to prevent osteoporosis?
Tai chi
Nutritional interventions for osteoporosis include:
Teach adolescents, pregnant or lactating women, and adults through age 35 to eat foods that are high in calcium and to maintain a daily calcium intake of 1200-1500 mg. Encourage postmenopausal women to maintain a calcium intake of 1000-1500 mg daily, through either diet or a calcium supplement. Teach patients who are taking calcium supplements about the importance of taking the medication at the proper time and about the possible side effects. Free hydrochloric acid is needed for calcium absorption. - Calcium carbonate supplements (for exampe, Tums) should be taken 30-60 minutes before meals to allow adequate absorption. - Calcium citrate supplements should be taken with meals to prevent gastrointestinal distress. - Calcium supplements should be taken in divided doses (two to three times daily) for improved distribution, because the body requires calcium 24 hours per day. Inform patients that calcium absorption requires sufficient levels of vitamin D. -Patients who are at risk for insufficient levels of vitamin D may need to take a vitamin D supplement in combination with their calcium supplement. The National Institutes of Health recommends 400-800 IU of vitamin D daily for those under 50 years of age and 800-1000 IU for those age 50 and older.
The nurse working in a clinic is screening female adolescent patients for risk factors of osteoporosis. Which patient has the greatest risk for osteoporosis?
The female adolescent on a cross-country running team The female that is on the cross-country running team has the greatest risk factor for osteoporosis. Adolescent athletes who participate in sports that emphasize leanness, such as gymnastics or cross-country running, are at risk for osteoporosis. Golf does not pose a great risk factor. A sedentary lifestyle over a long period of time or sedentary activity such as chess increases the risk for osteoporosis in adults.
The nurse is providing care for a patient diagnosed with osteoporosis who is recovering from a wrist fracture. Which outcome should the nurse expect the patient to meet?
The patient identifies and eliminates safety hazards.
Expected outcomes for patients with osteoporosis include:
The patient identifies and implements strategies to change or modify lifestyle factors such as smoking cessation, weight-bearing exercise, and moderation in alcohol use. The patient achieves adequate calcium and vitamin D intake. The patient identifies and eliminates safety hazards. The patient experiences relief from acute pain.
During a home visit, the nurse is concerned that a patient recovering from an osteoporosis-related fracture is at risk for future fractures. Which assessment finding supports the nurse's conclusion?
The patient is smoking cigarettes.
The nurse has completed the medication teaching for the patient prescribed a bisphosphonate for osteoporosis. Which patient statement indicates that further teaching is required?
The statement "I will take my medication with my breakfast, so I do not get nauseated" indicates that further teaching is required. Bisphosphonates should be taken on an empty stomach with water first thing in the morning. The patient should remain upright for 30 minutes and should not eat or drink anything else for 30 minutes to avoid esophagitis. A dietary log is helpful to the healthcare provider and the patient to ensure that adequate dietary calcium, vitamin D, and phosphate are consumed. Walking is a weight-bearing exercise that is important in the prevention of further complications of osteoporosis. Calcium and vitamin D supplements should be held 60 minutes or longer after taking the bisphosphonate.