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N U R S IN G P R O C ESS :

TH E PATIEN T W ITH A
S P O N TA N EO U S
V ER TEB R A L FR A C TU R E
R ELATED
TO
O S TEO P O R O S IS
Ns. Heri Kristianto, MKep.,Sp.Kep.MB
Nursing School
Faculty of Medicine

A ssessm ent
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

N ursing D iagnoses

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

P lanning and G oals


Knowledge about osteoporosis and

the treatment regimen


Relief of pain
Improved bowel elimination
Absence of additional fractures

N ursing 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

M edication
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.

RELIEVIN G 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

IM PRO VIN G BO W EL
ELIM IN ATIO N
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 T10L2
vertebrae, the patient may develop an ileus.
The nurse therefore monitors the patients
intake, bowel sounds, and bowel activity.

PREVEN TIN G IN JU RY
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.

Evaluation
1. 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

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

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