Preliminary report osteoporosis I. Definition.

Osteoporosis is a condition of decreased density / matrix / bone mass, increased boneporosity, and a decrease in the mineralization process is accompanied by damage tothe micro architecture of bone tissue resulting in decreased robustness of the bones so that bones become brittle (textbook nursing care clients musculoskeletal systemdisorders) Osteoporosis is a progressive decrease in bone density, so that bones become brittleand break easily. Bone composed of minerals such as calcium and phosphate, so thatthe bone becomes hard and dense. If the body is unable to regulate the mineral contentin bones, the bones become less dense and more fragile, so there was osteoporosis.
II. Etiology Causes of osteoporosis There are two main causes of osteoporosis, namely: Establishment of peak bone mass during the period of poor growth and increased reduction of bone mass after menopause. Bone mass increases constantly and reaches a peak until the age of 40 years, in women about 30-35 years younger. Yet the living bones never rest and will always hold a remodeling and updating of mineral reserves along the lines of mechanical loads. Factors regulating bone formation and resorption carried out through two processes are always in a state of balance and is called coupling. This process allows the coupling of bone formation activity comparable to the activity of bone resorption. This process lasted 12 weeks in young people and 16-20 weeks in middle or advanced age. Remodeling rate is 2-10% skeletal mass per year.This remodeling process is influenced by several factors, namely the local factors that led to a series of events on the concept of Activation - resorption - Formation (ARF).This process is influenced by mitogenic proteins derived from the bone to stimulate preosteoblas splitting splitting into osteoblasts due to the activity of resorption by osteoclasts. Another factor that affects the remodeling process is a hormonal factor.Remodeling process will be enhanced by parathyroid hormone, growth hormone and 1,25 (OH) 2 vitamin D. Was that inhibit the process of remodeling is calcitonin, estrogen and glucocorticoids. The processes that interfere with bone remodeling is what causes osteoporosis. Impaired regulation of calcium and phosphate metabolism. Impaired metabolism of calcium and phosphate may occur due to inadequate calcium intake, whereas according to the RDA of calcium for teenagers young adults 1200mg, 800mg adult, post-menopausal women from 1000 to 1500 mgmg, sdangkan the elderly are not limited to the elderly, although normally it takes 300-500mg . therefore less calcium intake in the elderly and the more rapid excretion of calcium from the kidneys into the urine, causing impaired calcium absorption. In addition, there is also a risk factor that can trigger the onset of osteoporosis are: Risk factors that can not be changed: - Age, more common in elderly - Gender, three times more often in women than in men. This difference may be caused by hormonal factors and the skeleton of a smaller

- Race, whites had the highest risk - Family history / ancestry, the family had a history of osteoporosis, children who are born are also likely to have the same disease - The shape of the body, the body frame is weak and scoliosis vertebramenyebabkan this disease. This situation trejadi chiefly in women between the ages of 50-60tahundengan low bone density and age above 70tahun with a low BMI. Modifiable risk factors: - Smoking - Defisisensi vitamins and nutrients (including protein), salt content in food, alcohol and coffee drinkers are heavy. Nicotine in cigarettes causes the weakening of the absorption cell to kalsiumdari blood to the bone so that bone formation by osteoblasts is waning. Consume more than 3 cups of coffee per day causes the body always wants to urinate. The situation is causing a lot of wasted with urine calcium. - Lifestyle, less physical activity and immobilization with a buffer reduction of body weight is an important stimulus for bone resorspi. Integrated physical load is a key determinant of peak bone mass - Eating disorders (anorexia nervosa) - Early menopause, declining estrogen levels lead to more rapid bone resorption and causes a decrease in bone mass that many. - Use of certain drugs such as diuretics, glucocorticoids, anticonvulsants, excessive thyroid hormone, and corticosteroids.

III. Pathophysiology Osteoforosis occurs because of a chronic interaction between genetic factors and environmental factors. Genetic factors include: - Age sex, race, family, body shape, never given birth. Environmental factors include: - Smoking, Alcohol, Coffee, vitamin and nutritional deficiencies, lifestyle, mobility, anorexia nervosa and drug use. - Both the above factors will lead to weakening of the absorption of calcium from the blood cells to tulag, together with urine calcium increased spending, not the achievement of the maximum bone mass with bone resobsi faster which in turn cause more bone resorption than formation of new bone resulting in a decrease total bone mass called osteoporosis. IV. Signs and Symptoms Bone pain akut.Nyeri particularly felt in the spine, pain can be with or without fracture of the real and the pain begins suddenly. reduced pain at rest in bed mild pain when I wake up and will increase when the activity bone deformities. Traumatic fractures can occur in the vertebrae and cause angular kyphosis of the spinal cord causes pressure that can occur paraparesis. Clinical prior fracture, clients (especially older women) usually present with spinal pain, stooped and had menopause whereas the clinical picture after a fracture occurs, the client usually comes with a very painful back complaint (acute back pain), pain at the base thigh, or swelling in the wrist after a fall. The tendency of decrease in height

 Posture seemed shortened V. Nursing Diagnosis - Acute pain associated with vertebral fractures secondary impacts of - Barriers to physical mobility related to the dysfunction secondary to skeletal changes (kyphosis), secondary pain, or new fracture - The risk of injury associated with the secondary effects of changes in skeletal and body imbalance - Kurangperawatan themselves associated with fatigue or movement disorders. VI. Interventions and Rational A. Nursing Diagnosis. Acute pain associated with vertebral fractures secondary to the impact. Objectives: Having given nursing actions are expected to decrease pain. KriteriaHasil: - The client may express feelings of pain, the client can be quiet and rest. - Clients can be self-sufficient in handling and simple maintenance. Intervention: - Evaluation of pain / discomfort, note the location and characteristics, including intensity (scale 1-10). Notice nonverbal clues pain (changes in vital signs and emotional / behavior). - Teach the client about other alternatives to address and reduce the pain. - Encourage the use of stress management techniques are examples of progressive relaxation, nafasa exercise in imagination, visualization, touch teraupetik. - Collaboration in the administration of drugs as indicated. Rational: - R / Affect selection / monitoring the effectiveness of interventions. - Another Alternative for pain such as moist heat, adjust the position to prevent errors in the position of the bone / tissue injury. - Focusing attention again, increase the sense of control and can enhance coping skills in pain management that may persist for longer periods. - Awarded to reduce pain.

2. Nursing Diagnosis Physical Hambatanmobilitas associated with dysfunction secondary to skeletal changes (kyphosis), secondary pain, or a new fracture. Objectives: After nursing actions are expected to clients are able to do physical mobility. Results Criteria: - The client can improve physical mobility, participation in the activity desired / required. - Client is able to perform activities of daily living independently. Intervention: - Assess the client's ability level is still there. - Plan on the provision of training programs, teach clients about the activities of daily living that can be done. - Give encouragement to perform the activity / self-care gradually if tolerated. Provide assistance as needed. Rational: - As a basis to provide alternative and movement exercises according to his ability.

- The exercise will improve muscle movement and stimulation of blood circulation. - Prevent the progress of the activity gradually increased sudden cardiac work, providing only limited need for encouraging independence in activities 3. Nursing Diagnosis Risk of injury associated with the secondary effects of changes in skeletal and body imbalance. Objectives: injury did not occur. KriteriaHasil: - The client does not fall and did not experience a fracture. - The client can avoid activities that result in fractures.

Intervention: - Create an environment free from hazards eg: place the client on a low bed, provide adequate lighting, place the client in a room that is easy to observe. - Teach the client to stop slowly, do not go up the stairs and lifting heavy loads. - Observation of the side effects of drugs used. Rational: - Create a safe environment to reduce the risk of accidents. - Will facilitate the rapid movement of vertebral compression fractures in osteoporosis client. - Drugs such as diuretics, phenothiazines may cause dizziness, drowsiness and weakness that predisposes the client to fall. 4. Nursing Diagnosis Lack of self care related to fatigue or movement disorders. Objectives: After nursing actions are expected to be given self-care clients are met. KriteriaHasil: - The client is able to reveal feeling comfortable and satisfied about personal hygiene. - Able to demonstrate optimal hygiene in the care provided. Intervention: - Assess the ability to participate in any care activity. - Rate adaptive equipment if necessary eg under the shower chair, place the handle on the bathroom wall, footwear or a non-slip mat, shaving equipment, spray shower with handle holder. - Plan for individuals to learn and demonstrate the activity of one part before moving on to more advanced levels. Rational: - To determine the extent to which the client is able to perform self-care independently. - For older clients, the bias is very tiring part of the activities that need adequate time to demonstrate a part of self care.

VII. evaluation Diharapkanmeliputi results

 Pain is reduced To fulfill the need for physical mobility There was no injury To fulfill the needs of self-care a balanced psychological status. Demonstrate the normal emptying of the bowel Terpeneuhinya need for knowledge and information

CASE fictitious On Monday morning at 07.00 WIB elderly patient named Mrs. Coming. "P" age of 65years to the ER room with complaints of spinal pain than it's clients have also complained about his movement and stamina rapidly declined and the Client complainsof swelling in his wrist after falling out of bed and clients say defecation difficult and hard.The patient appears anxious, wincing in pain and spine bent than it seems clients seemto use a buffer of the spine (spinal brace). From the results of TD RESULTS:140/110mmHg, Temperature: 37.4 C, Nadi: 140x/menit, Breathing: 26x/menit. Thenperformed a physical examination that indicate the presence of bone deformity in the spine, and the physical deformity of the bones as well as weaknesses in the range ofmotion.

INTERVENTION The goal of nursing diagnosis NO.Dx Kriteri The Rational Intervention 1 Acute pain associated with vertebral fractures secondary to the impact. After nursing actions are expected to be given to the criteria of pain reduced the client can express feelings of pain, the client can be quiet and rest, the client can be self-sufficient in handling and simple maintenance - Evaluation of pain / discomfort, note the location and characteristics, including intensity (scale 1-10) . Notice nonverbal clues pain (changes in vital signs and emotional / behavioral) - Teach the client about other alternatives to address and reduce the pain.

- Encourage the use of stress management techniques are examples of progressive relaxation, nafasa exercise in imagination, visualization, touch teraupetik.

- Collaboration in the administration of drugs as indicated. - R / Affect selection / monitoring the effectiveness of interventions.

- Another alternative for pain such as moist heat, adjust the position to prevent errors in the position of the bone / tissue injury. - Focusing attention again, increase the sense of control and can enhance coping skills in pain management that may persist for longer periods. -Are given to reduce pain. 2 Barriers to physical mobility related to the dysfunction secondary to skeletal changes (kyphosis), secondary pain, or new fracture after nursing actions are expected to be able to perform physical mobility client with the client's criteria can improve physical mobility, participation in the activity of the desired / required, clients are able to perform activities of daily living independently. - Assess the client's ability level is still there.

- Plan on the provision of training programs, teach clients about the activities of daily living that can be done. - Give encouragement to perform the activity / self-care gradually if tolerated. Provide assistance as needed.

- As a basis to provide alternative and movement exercises according to his ability. - / Exercise will improve muscle movement and stimulation of blood circulation. - Prevent the progress of the activity gradually increased sudden cardiac work, providing only limited need for encouraging independence in activities 3

Risk of injury associated with the secondary effects of changes in skeletal injuries and imbalances of the body is not the case with the client's criteria do not fall and did not experience a fracture, the client can avoid activities that result in fracture - Create an environment free from hazards eg: place the client on a low bed, provide adequate lighting, place the client in a room that is easy to observe. - Teach the client to stop slowly, do not go up the stairs and lifting heavy loads. - Observation of the side effects of drugs used. - Create a safe environment to reduce the risk of accidents. - Will facilitate the rapid movement of vertebral compression fractures in osteoporosis client. - Drugs such as diuretics, phenothiazines may cause dizziness, drowsiness and weakness that predisposes the client to fall. 4

Lack of self care related to fatigue or movement disorders after a given act of nursing care expected by the client met the criteria the client is able to express a feeling of comfort and satisfaction of personal hygiene, be able to demonstrate optimal hygiene in the care provided. - Assess the ability to participate in any care activity. - Rate adaptive equipment if necessary eg under the shower chair, place the handle on the bathroom wall, footwear or a non-slip mat, shaving equipment, spray shower with handle holder. - Plan for individuals to learn and demonstrate the activity of one part before moving on to more advanced levels. - To determine the extent to which the client is able to perform selfcare independently. - Adaptive equipment is working to help the client so that it can independently perform selfcare ability and optimal fit. - For the elderly client, one of the activities can be very tiring so it needs enough time to demonstrate a part of self care.

IMPLEMENTATION NO Dx day, date NO hours. DK Signature Implementation Full name 1 Monday, 10 oct '11

10.00 1 - Evaluation of pain / discomfort, note the location and characteristics, including intensity (scale 1-10). Notice nonverbal clues pain (changes in vital signs and emotional / behavioral) - Teach the client about other alternatives to address and reduce the pain. - Encourage the use of stress management techniques are examples of progressive relaxation, nafasa exercise in imagination, visualization, touch teraupetik. - Collaboration in the administration of drugs as indicated. 2 Monday, 10 oct '11 11:00 a

- Assess the client's ability level is still there. - Plan on the provision of training programs, teach clients about the activities of daily living that can be done. - Give encouragement to perform the activity / self-care gradually if tolerated. Provide assistance as needed. 3 Monday, 10 oct '11 12.00 1 - Create an environment free from hazards eg: place the client on a low bed, provide adequate lighting, place the client in a room that is easy to observe. - Teach the client to stop slowly, do not go up the stairs and lifting heavy loads. - Observation of the side effects of drugs used. 4 Monday, 10 oct '11 Hours of 1:00 1 - Assess the ability to participate in any care activity. - Rate adaptive equipment if necessary eg under the shower chair, place the handle on the bathroom wall, footwear or a non-slip mat, shaving equipment, spray shower with handle holder. - Plan for individuals to learn and demonstrate the activity of one part before moving on to more advanced levels. EVALUATION NO Dx's Day Date Hours DK Evaluation of S O A P Signed Full name 1 Monday, 10 October 2011 At 10.00 1 S: Px says Pain is reduced Px said fulfillment of physical mobility Px say no injury O: To fulfill the needs of self-care a balanced psychological status Demonstrate the normal emptying of the bowel Terpeneuhinya knowledge and information needs. A: The problem teratasisebagian

P: Continue intervention 2 Monday, 10 October 2011 At 10.00 1 S: Px says Pain is reduced Px said fulfillment of physical mobility Px say no injury O: To fulfill the needs of self-care a balanced psychological status Demonstrate the normal emptying of the bowel Terpeneuhinya knowledge and information needs. A: Problem solved Q: Intervensidihentikan 3 Monday, 10 October 2011-10-11 10:00 1 S: Px says Pain is reduced Px said fulfillment of physical mobility Px say no injury O: To fulfill the needs of self-care a balanced psychological status Demonstrate the normal emptying of the bowel Terpeneuhinya knowledge and information needs. A: The problem is resolved in part P: Continue intervention 4 Monday, 10 October 2011 1 S: Px says Pain is reduced Px said fulfillment of physical mobility Px say no injury O: To fulfill the needs of self-care a balanced psychological status Demonstrate the normal emptying of the bowel Terpeneuhinya knowledge and information needs. A: Problem solved Q: Intervensidihentikan