Nursing Care Process

Of Older Adults with Musculosceletal

Problems : Osteoporosis
by: Herawati, S.Kep., Ns., M.Kep
Department of Gerontologic Nursing

Age-Related Changes
in Structure And Function
Decrease in muscle mass and muscle strength
(penurunan masa otot dan kekuatan otot)
The actual number of muscle cells decreases, replaced
by fibrous connective tisue (penurunan umlah sel otot.
Digantikan dengan aringan fibros atau aringan ikat)
The elasticity of ligaments, tendons, and cartilage
decreases (penurunan elastisitas ligamen. Tendon. Dan
kartilago)
The intervertebral disks lose water, causing a narowing
of vertebral space, may result in a loss of 1,5 to 3 inches
of height. (intervertebra kehilangan cairan disebabkan
karena arak antar tulangyang menyempit)

Age-Related Changes
in Structure And Function
Posture & gait change (perubahan postur dan gaya
beralan)
Posture: as a result of change in the spine,
assumes a position of flexion. Change in posture
result in a shift in the center of gravity (posisi
beralan membungkuk)
Gait: In men, the gait becomes small stepped with
a wider-based stance. Women become bowlegged, with a narrow standing base, and walk
with a waddling gait. (pada laki laki tampak
melangkah sedikit2. pada perempuan tampak
bergoyang)

All of the changes (semua perubahan)

May caused the problems for older adults (dapat meyebabkan

masalah pada proses penuaan)
Pain, impaired mobility, self care deficit,
increased risk of falls (nyeri. Hambatan mobilitas. Defisit perawatan diri.
Resiko atuh)

Older Adult With Osteoporosis

Assessment

Family history (riwayat keluarga)

Presence of risk factors (adanya faktor resiko)

Level of exercise (tingkat aktivitas)
Alcohol & caffein intake, smoking
Consumption of corticosteroid (mengkonsumsi kortikosteroid)
Women: age of onset of menopause (pada wanita. Waktu menopause)
Intake of calsium in their lifelong (pemasukan Ca selama hidup)
Presence of pain (adanya nyeri)
History of fracture & history of falls (riwayat fraktur dan riwayat atuh)
Physical examination: inspection to determine the presence of kyphosis, gait impairments, muscles weaknes (pengkaian
latihan fisik)

Older Adult With Osteoporosis

Nursing Diagnoses
Altered nutrition: less than body requirements related to
decreased intake of calsium and vitamin D (ketidakseimbangan
nutrisi kurang dari kebutuhan tubuh b.d kekurangan intake Ca
dan vit. D)
Risk for injury related to weakening of the bones (resiko cedera
b.d kelamahan tulang)
Pain related to inadequate pain relief secondary to bone fractures
(nyeri b.d ketidakadekuatan akibat nyeri berulang setelah fraktur)
Body image disturbance related to spinal deformities and loss of
height (gangguan citra diri b.d deformitas tulang dan penyusutan
tinggi badan)
Knowledge deficit: disease process, risk factors, and measures of
prevention related to lack of previous exposure ( defisiensi
pengetahuan)

Older Adult With Osteoporosis

Planning
Awareness of risk factors and education
about the life-time prevention of
osteoporosis and its complications, such as
falls and fractures, are the most important
aspects of planning the care of older adults
with osteoporosis
(menyampaikan faktor resiko dan edukasi
tentang pencegahan dari osteoporosis dan
komplikasinya. Termasuk mencegah jatuh
dan fraktur)

Older Adult With Osteoporosis

Expected outcomes

The client will demonstrate taking precaution at home and in

community to prevent falls and activities that may result in fractures
(klien dapat mendemostrasikan pencegahan di rumahdan di komunitas
untuk mencegah jatuh dan aktivitas yg dapat menyebabkan fraktur)
The client will report adequate level of pain control in presence of bone
fractures (klien melaporkan level nyeri jika adanya fraktur tulang)
The client will consume nutritional supplements, food products, and
medication recommended or prescribed for meeting dietary needs, as
evidence by diet log (klien mengkonsumsi suplemen nutrisi. Makanan.
Dan pengobatan yg dianurkan atau oleh terapi giziuntuk menentukan
diet yg tepat)
The client will verbalize acceptance of changes brought about by the
disease and understanding of treatment and prevention of further
deformities (klien secara verbal mengerti tentang perubahan yg teradi
pada dirinya berupa penyakit dan mengerti tentang pengobatan dan
pencegahan dari deformitas)

Older Adult With Osteoporosis

Intervention

The nurses role will focus on client education about the

disease process, strategies to prevent further injury or
deformity, and measures that can be taken to promote
decreased loss of bone. Education should emphasize the
identification and minimization of controllable risk factors.
These include cigarette smoking, excessive use of alcohol
and caffein intake.
(perawat berfokus pada mengedukasi klien tentang
proses penyakit. Strategi pencegahan untuk mencegah
cedera dan deformitas dan lebih mengerti dengan
tulangnya yg hilang. Edukasi harus sesuai dengan
identikasi dan dapat meminimalisir faktor resiko termasuk
mncegah mengkonsumsi roko alkohol dan kafein)

Older Adult With Osteoporosis

Intervention

Exercise programs are recommended that will place some

stress on the bones, such as walking and lifting light weights,
to strengthen them. (program latihan yang direkomendasikan
dapat mengurangi kekakuan tulang. Dengan cara ber jalan
untuk. Meningkatkan masa otot dan kekuatan)
Control of pain is achieved through the use of analgesics,
NSAIDs, positioning, relaxation techniques and other pain
management modalities. (kontrol nyeri pada klien yang sudah
diberikan analgetik. Efeknya. Teknik relaksasi dan
managemen nyeri lainnya)
Body image can be supported by discussions of acceptance of
changes that have occurred. (citra diri dapat di support
dengan mendiskusikannya agar menerima perubahan yang
terjadi)

Older Adult With Osteoporosis

Evaluation

A client with osteoporosis should be able to describe measures that

can be taken to decrease the potential for development of the
disease and maintain a save living environment to reduce the risk of
injury resulting from falls. (klien dengan osteoporosis dapat
menjelaskan secara rinci cara mengurangi potensi terkena
komplikasi dan resiko cedera krna jatuh)
Client will be able to describe the benefits of appropriate diet,
lifestyle modifications, and diet supplements or medications if
needed. (klien dapat menjelaskan keuntungan dari diet teratur.
Modifikasi gaya hidup. Dan suplemen diet atau medikasi yang
dibutuhkan)
Client will be able to participate in regular exercise programs and
able to identify resources available for prevention of disease. (klien
dapat berpartisipsi dalam latihan teratur yg diprogramkandan dapat
mengidentifikasi sumber yg tersedia untuk mencegah kekambuhan)

Thank you