ACU Principles of Nursing: Osteoporosis Care Plan (NRSG266)

This assignment presents a nursing care plan for an elderly patient with osteoporosis, developed using the clinical reasoning cycle (steps 5-8). The plan addresses key nursing diagnoses including reduced physical movement, inadequate nutrition, risk for toxicity, and inadequate knowledge. The care plan establishes SMART goals related to improving functional mobility, calcium and vitamin D intake, medication management, and patient education. Actions include exercises to prevent bone loss, ensuring safe medication practices, and family involvement. The reflection section emphasizes the importance of critical thinking and evidence-based practice in managing osteoporosis, highlighting the use of patient cues, symptoms, and available interventions. The document references key sources for osteoporosis management and care.

CLINICAL REASONING CYCLE

CLINICAL REASONING CYCLE (5th Step)- Establish goals
• Osteoporosis is referred as a significant bone disorder in which there is an
imbalance between the rate of bone formation and rate of bone degradation
(Black & Rosen, 2016). This, in turn, leads to loss of bone mass in the affected
individual (In this case Lina).
There are four nursing care plans (SMART goals) for the patient with
osteoporosis.
• Reduced physical movement- Improve physical mobility.
• Inadequate nutrition: Excessively lower than body requirements- Improve
body calcium level.
• Risk for toxicity- Manage adverse effects associated with osteoporosis.
• Inadequate knowledge- Develop a proper medical knowledge on osteoporosis
(Sözen, Özışık, & Başaran, 2017).

CLINICAL REASONING CYCLE (6th Step)- Take actions
Nursing Interventions Rationale
Patient’s (in this case Lina)
knowledge of the particular
disease (osteoporosis), diet,
medication, and health
exercise programme can be
assessed to reduce the
further progression of bone
mineral degradation (Black
& Rosen, 2016).
Osteoporosis is not detected
until the 24-40% of calcium in
bone is lost.
Lina’s understanding of
osteoporosis can also be
assessed.
Osteoporosis are diagnosed
accurately only when bone
fracture occurs.
The application of assisted
devices (which help to
maintain mobility) can be
taught to the patient (in this
case Lina).
This, in turn, prevents further
fall of the patient for lack of
support.
The patient (Lina) will be
encouraged to take advice
from one primary doctor to
control care.
This, in turn, helps to prevent
the utilization of
several physicians who are
unaware of each other’s
treatment regimens.
Drugs has to be administered
as ordered by healthcare
experts.
In several cases, the ageing
patients (Lina) are on
numerous medications. As a
consequence, the drugs used
in the management of the
osteoporosis can also
interfere with other drugs.
This, in turn, reduces the
potentiation of the other
drug’s action (Lewiecki,
2017).
Nursing Interventions Rationale

Nursing Interventions Rationale
Importance of vitamin D. Ample exposure
to sunlight in order to prevent further
vitamin D deficiency in the patient (Lina)
affected with osteoporosis.
The patient (in this case Lina) should be
exposed to sunlight for around 15 minutes
daily.
Vitamin D supplementation has to be given. Supplementation will confirm adequate
vitamin D intake.
Instruction to the patient (In this case Lina)
to perform gentle exercises.
Exercise may help to develop strong bones
as well as can reduce the immense bone loss
occur due to osteoporosis (Shahbo et al.,
2016).
Balanced diet has to be provided.
A balanced diet high in nutrients are
needed in order to support skeletal muscle
metabolism of the osteoporosis patient
(Lina).
Assessing the patient’s (Lina) practical
ability to move and note the changes.
Identification of problems and develops
a plan of care.
In every shift different motion exercises
are needed to be performed by the
patient (Lina).
Prevention of muscular atrophy as well
as joint contractures.
.
Repositioning of the patient within
every two hours.
Repositioning at consistent intervals
helps to prevent skin breakdown from
pressure injury.
Trochanter rolls as well as pillows are
applied to maintain the proper joint
alignment.
Helps to prevent musculoskeletal
abnormalities.
Assist patient with walking if at all
possible, utilizing sufficient help.
A one or two-person pivot transfer
utilizing a transfer belt can be used if the
patient has a weight-bearing ability.
Preserves the patient’s muscle tone and
helps prevent complications of
immobility.
Nursing Interventions Rationale
•Alendronate (Fosamax)
Bisphosphonates hinder the activity of
osteoclasts. Mechanism of Fosamax
includes preventing the loss of bone
mass.
•Ibandronate (Boniva) Ibandronate can be administered once in
a month in order to treat osteoporosis.
•Raloxifene (Evista)
Evista acts as an estrogen receptor
modulator. It produces a specific positive
effects on bone mineral density in order
to treat osteoporosis (Shahbo et al.,
2016). .

CLINICAL REASONING CYCLE (7th Step)- Establish goals
• Lina will develop functional mobility within the limitation of the disease process.
• As the disease condition progresses Lina will have a few difficulties related to functional
immobility.
• Lina swill be able to perform daily exercises within identified limitations. This helps to prevent
bone loss.
• Lina will exhibit no injury, fall that might predispose to a fracture.
• After the interventions Lina will be independent in performing ADLs with significant
modifications.
• Lina will develop a significant functional mobility (Reuben et al., 2017).
• Lina will demonstrate adequate intake of calcium as well as vitamin D.
• Lina will be able to correctly express consideration of need for single therapeutic provider to
control care.
• Lina’s family will be compliant with providing safe environment for Lina. This can be done by
keeping the medications in a protected location.
• Patient will be able to accurately verbalize understanding of appropriate medication administration.
• Lina will be exhibiting no symptoms of drug toxicity (Miller & Emory, 2015).

CLINICAL REASONING CYCLE (8th Step)-Reflection
• For evaluation of the nursing practice currently (for osteoporosis), reflection
is the supreme appropriate tool for proper evaluation.
• Moreover, completion of the assignment successfully helped me to collect
correct information of concept of clinical reasoning cycle and its application
to manage osteoporosis.
• Before the completion of the case study I was completely uninformed of
evidenced-based understanding associated with osteoporosis. However, after
analyzing the proper patient cues, I understand the symptoms and
pathophysiology in addition to the available interventions for the treatment of
osteoporosis.
• While the case study of Lina challenges my critical thinking, it also
stimulated me to involve in laborious research for recovering appropriate
answers to manage osteoporosis in elderly patients as well as assist my
clinical and theoretical skills.

REFERENCES
Black, D. M., & Rosen, C. J. (2016). Postmenopausal osteoporosis. New England Journal of Medicine, 374(3), 254-262.
Cummings, S. R., Cosman, F., Lewiecki, E. M., Schousboe, J. T., Bauer, D. C., Black, D. M., ... & Diez‐Perez, A. (2017). Goal‐directed treatment for
osteoporosis: a progress report from the ASBMR‐NOF Working Group on Goal‐Directed Treatment for Osteoporosis. Journal of bone and mineral
research, 32(1), 3-10.
Lewiecki, E. M. (2017). Osteoporosis: treat-to-target. Current Osteoporosis Reports, 15(2), 103-109.
Miller, A. N., Lake, A. F., & Emory, C. L. (2015). Establishing a fracture liaison service: an orthopaedic approach. JBJS, 97(8), 675-681.
Reuben, D. B., Gazarian, P., Alexander, N., Araujo, K., Baker, D., Bean, J. F., ... & Leipzig, R. M. (2017). The Strategies to Reduce Injuries and Develop
Confidence in Elders Intervention: Falls Risk Factor Assessment and Management, Patient Engagement, and Nurse Co‐management. Journal of the
American Geriatrics Society, 65(12), 2733-2739.
Shahbo, G. M. A. E. M., El-Rahman, M. A., & El-Mowafy, R. (2016). Evaluation of knowledge and self-efficacy about osteoporosis perception among
females in the faculty of nursing in Port-Said, Egypt. International Journal of Caring Sciences, 9(1), 72.
Sözen, T., Özışık, L., & Başaran, N. Ç. (2017). An overview and management of osteoporosis. European journal of rheumatology, 4(1), 46.