Vitamin D deficiency

Diagnostic Test Results-Laboratory

A serum 25-hydroxyvitamin D level less than 32 ng/mL indicates deficiency. Plasma calcium and phosphorus levels may be low. Alkaline phosphatase levels are elevated late in the disease. Urinary calcium levels are low.

Nursing Considerations-Monitoring

Activity tolerance Energy level Nutritional status Safety Response to treatment

Nursing Considerations-Nursing Diagnoses

Acute pain Disturbed body image Imbalanced nutrition: Less than body requirements Impaired physical mobility Ineffective health maintenance Risk for injury

Assessment-Physical Findings

Bowlegs Knock-knees Rachitic rosary (beading of ends of ribs) Enlargement of wrists and ankles Pigeon breast Bulging of the forehead

Overview-Pathophysiology

Deficiency of vitamin D causes failure of normal bone calcification, which results in osteomalacia in adults. With treatment, the prognosis is good; in osteomalacia, bone deformities may disappear.

Overview

Deficiency of vitamin D in the body Also known as osteomalacia in adults

Treatment-Medications

Ergocalciferol Vitamin D3 (cholecalciferol) Elemental calcium

Treatment-Diet

Fatty fish, such as tuna and salmon Fortified milk, cereal, and other foods

Nursing Considerations-Associated Nursing Procedures

Health history interview and physical assessment Intramuscular injection Neurologic assessment Oral drug administration Pain management Venipuncture

Overview-Causes

Hepatic or renal disease Inadequate dietary intake of preformed vitamin D Macrobiotic diet Malabsorption of vitamin D Malfunctioning parathyroid gland (decreased secretion of parathyroid hormone), which contributes to calcium deficiency (normally, absorption of calcium and phosphorus through the intestine controlled by vitamin D) and interferes with activation of vitamin D in the kidneys Too little exposure to sunlight Medications, such as phenytoin, phenobarbital, and rifampin (which increase catabolism of vitamin D)

Patient Teaching-Discharge Planning

If deficiency is due to socioeconomic conditions, refer the patient to an appropriate community agency.

Nursing Considerations-Nursing Interventions

Obtain a dietary history to assess the patient's current vitamin D intake and sunlight exposure. Administer vitamin D supplementation as ordered; give ergocalciferol orally or I.M. for 8 to 12 weeks and then give vitamin D3 and elemental calcium. Enlist the aid of a nutritional therapist or dietitian to assist with meal planning and appropriate food choices. Encourage the patient and family to verbalize feelings related to body changes. Provide support and guidance as necessary. Assist with energy conservation techniques. Provide frequent rest periods, but encourage the patient to participate in care and activities within the limits of the condition. Institute safety measures to prevent injury. For example, assist with ambulation as necessary to prevent falls.

Overview-Complications

Spontaneous fractures Abnormal gait Short stature

Assessment-History

Spontaneous multiple fractures Pain in the legs and lower back Muscle cramps Numbness

Treatment-General

Sunlight exposure

Overview-Incidence

Vitamin D deficiency now is rare in the United States. This condition may also occur in overcrowded, urban areas where smog limits sunlight penetration. The highest incidence of this deficiency occurs in dark-skinned individuals who, because of their skin color, absorb less sunlight. Incidence is highest among elderly people and those who are institutionalized or hospitalized.

Diagnostic Test Results-Imaging

X-rays show characteristic bone deformities and abnormalities such as Looser's zones (pseudofractures).

Patient Teaching-General

disorder, diagnosis, and treatment, including the use of vitamin D supplementation prescribed vitamin D therapy, including drug names, dosages, frequency and schedule of administration, and duration of therapy need to adhere to the prescribed drug therapy regimen signs of vitamin D toxicity (headache, nausea, constipation and, after prolonged use, renal calculi) and the need to notify a health care provider if any occur importance of exposure to sunlight in obtaining vitamin D nutritional therapy, including dietary sources of vitamin D, such as fish (tuna and salmon) and fortified milk, cereal, and other foods signs and symptoms of hypercalcemia, such as decreased muscle tone, muscle weakness, vomiting, constipation, bone pain, drowsiness, lethargy, and irritability, and the need to notify a health care provider if any occur (if the patient is receiving supplemental calcium) importance of adhering to recommended follow-up, including monitoring blood levels to evaluate the effectiveness of therapy.

Nursing Considerations-Expected Outcomes

express feelings of increased comfort express positive feelings about self express an understanding of a diet high in vitamin D and improving vitamin levels maintain optimal mobility within the confines of the disorder express an understanding of dietary adjustments needed to improve nutritional status avoid injury and complications.