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INTRODUCTION :Inappropriate functioning of the metabolic processes results in disorders manifested by changes in both physical and chemical structure of the bone. Disorders that alter bony equilibrium and affect bone turnover can be due to estrogen deficiency, parathyroid gland abnormalities, vitamin deficiency, malabsorption, or physical inactivity. Black board

What are the causes of bone disorders

Explain Osteoporosis

MEANING :2min Osteoporosis is a major public health problem in Lecture many parts of the world and its scope will increase as the cum population ages. It affects about 20% of the postmenopausal discussion women and one of the every two women will experience a fracture at some point during her life. Even women and men are also at risk for osteoporotic fractures. 3min DEFINITION :Osteoporosis is defined as a systemic skeletal disorder Lecture characterized by compromised bone strength predisposing to an cum increased risk of fracture. discussion - Joyce M Black ETIOLOGY :Many factors , both genetic and environmental , are Lecture involved in the development of osteoporosis. Bone mass, which is cum measured by bone densitometry and reported as Bone Mineral discussion Content (BMC) or Bone Mineral Density (BMD), is an important risk factor in osteoporosis. For osteoporosis value for BMD is

Listening

What do you mean by osteoporosis ?

Define osteoporosis

Writing notes

OHP chart

Define osteoporosis?

5min List out etiology and risk factors of

Active listening

Flash cards

List out the etiology and risk factors of

osteoporosis .

more than 2.5 SD below the young adult mean value. Risk factors for Osteoporosis : Individual Risk Factors - Female - Increased age - Low weight and body mass index - Estrogen deficiency or menopause - Family history - Low initial bone mass - Contributing, coexisting medical conditions (eg. celiac disease ) and medications ( eg, corticosteroids, anticonvulsant medications) Lifestyle risk factors - Diets low in calcium and vitamin D - Cigarette smoking - Use of alcohol and/or caffeine - Lack of weight-bearing exercise - Lack of exposure to sunshine Risk lowering strategies - Increased dietary calcium and vitamin D intake - Smoking cessation - Alcohol and caffeine consumption in modernization - Regular weight- bearing exercise regimen - Walk or exercise out of doors

osteoporosis

Explain the pathophysio logy of

8min

PATHOPHYSIOLOGY :Normal bone remodeling in the adult results in gradually increased bone mass until the early 30s. Gender, race, Lecture genetics, aging, low body weight and body mass index, nutrition, cum

Writing notes

Model Explain

osteoporosis.

lifestyle choices and physical activity influence peak bone mass discussion and the development of osteoporosis. Loss of bone mass is a universal phenomenon associated with aging. Age-related loss begins soon after the peak bone mass is achieved. Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. The withdrawal of estrogens at menopause or with oopherectomy causes an accelerated bone resorption that continues during the postmenopausal years. Women develop osteoporosis more frequently and more extensively than men because of lower peak bone mass and the effect of estrogen loss during menopause. Secondary osteoporosis is associated with many disease states, nutritional deficiencies, and medications. Coexisting medical conditions ( malabsorption syndrome, renal failure, liver failure, hyperthyroidism ) contribute to bone loss and the development of osteoporosis. Medications ( eg. corticosteroids, antiseizure medications, heparin ,tetracycline ) affect the bodys use and metabolism therapy. When the therapy is discontinued or the metabolic problem is corrected, the progression of osteoporosis is halted, but restoration of lost bone mass usually does not occur. CLINICAL MANIFESTATIONS:Lecture cum Mostly diagnosis of osteoporosis is made after a fracture , discussion often a vertebral compression fracture . Clinical Active PPT listening and writing notes

briefly the pathophysio Logy of osteoporosis.

Know the 5min clinical manifestation

What are clinical manifestat-

ns of osteoporosis.

manifestations of it include sudden onset of severe back pain that worsens on movement and is relieved by rest. This acute pain usually subsides within 2 to 6 weeks. Shortened stature and progressive dorsal kyphosis Abdominal distension and bloating as lower ribs eventually rest on the iliac crests and causes downward pressure on viscera. Respiration may also be impaired by restricted lung expansion. Bone loss can also occur in the mandible which may lead loss of teeth or poorly fitting dentures as well as changes in the appearance of the face. Writing notes Ppt

ions of osteoporosis ?

List out the diagnostic findings of osteoporosis

3 min

Lecture DIAGNOSTIC FINDINGS : Routine X-Rays when there has been 25% to 40 % cum discussion demineralization. Dual energy X-ray absorptiometry ( DEXA) , which provides information about the BMD at Spine and Hip. Quantitative ultrasound studies (QUS) of the heel also are used to diagnose osteoporosis and to predict the risk of the hip and non vertebral fracture. Laboratory studies ( Eg. serum calcium, serum phosphate, serum alkaline phosphate, urine calcium excretion , urinary hydroxyproline excretion, hematocrit, erythrocyte sedimentation rate). Lecture MEDICAL MANAGEMENT :cum The goal of medical management is to prevent bone loss discussion and fragility fractures. Life style changes focused on dietary

List out the diagnostic findings of osteoporosis.

Explain the medical management

8min

Active listening

Chart Briefly explain the

of osteoporosis

intake of adequate calcium and vitamin D and weight bearing exercise are prescribed to prevent bone loss. Hormone replacement therapy (HRT) is considered for women who are peri menopausal . Preventing loss of bone mass :Strategies for prevention are most effective when they are started in childhood to maximize peak bone and to establish life long bone healthy behaviors. Other Several interventions include adequate intake of calcium and vitamin D and regular weight bearing exercises and avoidance of tobacco and alcohol abuse. Calcium and vitamin D intake :The major sources of calcium include diary products. Calcium can also be obtained from the wide range of calcium fortified foods . Exercise :Weight bearing exercise such as walking and running, is necessary for maintaining bone mass. The inactivity of older people increases the rate of bone loss and the risk of hip fracture. In has been suggested that regular exercise by older people would reduce the risk of the hip fracture by atleast half. Alcohol and tobacco :Alcohol abuse and smoking cigarettes increase the risk of osteoporosis. Pharmaceutical prevention and Treatment of Osteoporosis :Medications include HRT, alendronate, raloxifene, risedronate, calcitonine and teriparatide. Clients receiving drug therapy for osteoporosis should be taught

medical management of osteoporosis.

about the importance of dietary intake and activity. Fracture management :Fractures of the hip are managed surgically by joint replacement or by closed or open reduction with internal fixation eg, hip pinning. Surgery , early ambulation, intensive physical therapy, and adequate nutrition result in decreased morbidity and improved outcomes. NURSING MANAGEMENT :Discuss the nursing management of osteoporosis 8min Lecture cum Assessment :- Health promotion, identification of people at risk for discussion osteoporosis, and recognition of problems associated with osteoporosis form the basis for nursing assessment. - The heath history include family history, previous fractures, dietary consumption of calcium , exercise pattern, onset of menopause and use of corticosteroids as well as alcohol, smoking , and caffeine intake. - Any symptoms such as back pain , constipation or altered body image are explored. - Physical examination may disclose fracture , kyphosis of the thoracic spine or shortened stature. Nursing diagnosis :- Acute pain related to fracture and muscle spasm - Risk for injury: additional fractures related to osteoporosis - Risk for constipation related to immobility or development of ileus ( intestinal obstruction). - Deficient knowledge about the osteoporotic process and treatment regimen. Writing notes Hand out Write in detail the nursing management of osteoporosis.

Conclude the topic.

CONCLUSION :By the end of the class students will gain knowledge about Osteoporosis, its definition, etiology, pathophysiology, clinical manifestations, diagnostic findings, medical and nursing management. BIBLIOGRAPHY :- Joyce M Black & Jane Hokanson Hawks, MEDICALSURGICAL NURSING, -VOLUME -1, 7TH edition, 2007,Elseiver Publication, Page no : 564- 597. - Brunner & Suddarth, MEDICAL SURGICAL NURSING, 10TH edition, 2004, Lippincott Williams & Wilkins Publications, Page no : 2057-2061.

NAME OF THE STUDENT : CLASS SUBJECT TOPIC AV-AIDS DATE PLACE TIME DURATION METHOD OF TEACHING GROUP SUPERVISED BY : : : : : : : : : :
:

RUBY KURIAKOSE MS.C( N) 1YEAR NURSING EDUCATION OSTEOPOROSIS BLACK BOARD, CHARTS, PPT, OHP, FLASH CARDS, MODELS, HAND OUT 6 NOVEMBER , 2013

45 min LECTURE CUM DISCUSSION B.Sc NURSING II YEAR STUDENTS

LESSON PLAN ON OSTEOPOROSIS

Submitted By: Ms. Ruby Kuriakose, M.Sc Nursing 1ST year, Owaisi college of Nursing.

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