Osteoporosis Care Strategies (Nursing)

00:01 There are four important care strategies when you're working with a client who has osteoporosis.

00:07 Now the first two of these get really personal, you're right up in their personal business.

00:13 Number one.

00:14 We want to encourage the client to decrease the amount of cigarette smoke they're exposed to.

00:20 Now, here's why.

00:21 Cigarette smoke unfortunately, reduces the amount of calcium absorbed.

00:26 Hey, our bones need that calcium.

00:29 But it's also toxic to osteoblasts.

00:32 Remember, the osteoblast job is to build bones, right? If they're taking in cigarette smoke, than they are toxic to the cells that actually build up your bones.

00:43 And you're not absorbing enough calcium to actually build stronger bones.

00:47 You've got a double whammy. So it is no bueno.

00:50 But like I said, it's a very personal habit, and it's tough to stop.

00:57 Now, I wanted to make sure that we mentioned secondhand smoke, because that is also detrimental to your bones.

01:02 So maybe the person lives with someone who's a smoker or they carpool all the time with someone who's a smoker.

01:09 These are the things we want to introduce to your client without judgment.

01:14 Okay, sometimes this is tough to do.

01:16 Maybe you think this habit or that habit was like, Ah, why would anyone do that? Not our place as healthcare providers.

01:24 Our job, our role, if we want to help people live healthier lives, is to present them options, give them steps that they can take, small steps, toward the eventual goal and approach them eye to eye with a smile and a warmth that tells them "Hey, it's okay. I understand, I empathize that this is a difficult thing that we're working together to do, but help them be successful.

01:50 Now, if you thought the first one was meddling, the second care strategy of four is also meddling.

01:58 Patients who drink greater than more than two alcoholic drinks a day may also decrease their bone formation.

02:06 Right. Can you imagine this? If you're talking with someone who is a heavy smoker and a heavy drinker? Yeah, this is going to be a really sticky conversation.

02:17 But you can do it if you practice how to use things like motivational interviewing.

02:22 Help the patient understand how their quality of life would be better if they can move towards this level of health.

02:30 Now, here's the deal with alcohol.

02:32 See, it can deplete the body's calcium reserves.

02:35 Why is that so bad? Well, calcium is what keeps our bones strong.

02:39 We've learned that since you're little, right.

02:41 So too much alcohol can deplete the body's calcium reserves.

02:46 And it decreases the absorption of calcium from food.

02:51 Wow. So the reserves I normally have are less and I don't seem to be able to absorb calcium from the food I'm eating.

02:59 So that's two big problems of drinking excess alcohol and osteoporosis.

03:05 Now, third. Look, alcohol in excess can impact the levels of the hormones that are involved in forming our bones.

03:13 And it's toxic to the bone cells.

03:16 Yeah, so there is no good news there for excessive alcohol and osteoporosis.

03:22 The other thing is, if excess alcohol can make your osteoporosis worse, what do you like when you're intoxicated? When you're drinking too much? Right, you're going to increase your risk to fall to trip, to do something because your balance has been impaired after too much alcohol.

03:42 So what's the goal? Encourage the client to limit alcohol.

03:46 And keep in mind, that's no small task.

03:49 If someone has already developed a lifetime habit of drinking excess alcohol, it's going to be a big deal to try to back off and limit that alcohol.

03:58 So make sure to refer them appropriately.

04:01 One education session with you is probably not going to stick.

04:06 In fact, we know it's likely not to be as an effective plan.

04:09 You're going to need some type of follow up care and education.

04:15 The third care strategy is prevention of false.

04:18 Now we do this in the hospital, and we have all kinds of special systems, and armbands and colors.

04:23 But what I want to talk about is helping the client make their home environment safe.

04:29 Okay, no common things that trip people up I mean, literally and figuratively, are looking at their shoes.

04:36 Do they fit them well? Is the soul disconnected from the shoe? Does it have a slick bottom? Because if they're on a surface, will it cause them to fall if it doesn't have good grip? What about throw rugs? Wow. I removed the throw rugs from my parents home It was just too big of a risk.

04:54 My dad did not pick his feet up very much and so they always catch their foot on that rug, it caused them to trip.

05:01 Now some people prefer to tape them down, but I did not want to take the risk from my parents.

05:07 So at the very minimum, make sure all throw rugs are taped to the other surface.

05:13 Think about cords.

05:15 Don't stretch a cord across a walking area, tuck them under things where it's not likely that a client could walk by catch their foot and slip.

05:25 What about slippery surfaces? Man, in the bathtub, if they're taking a shower in a bathtub, make sure the bottom has some type of grip, whether the little stickers that you can get on there, or it's got something in the grout, but make sure those surfaces are covered.

05:40 If there's tile in their home, lots of people have tile in their kitchens in their entryways.

05:46 If that gets wet, it can be really dangerous for anyone and especially the elderly.

05:52 Also think about dark lighting.

05:54 It's really important as people age they need brighter lighting to read things, and to also visualize their environment so they can avoid things that might put them at risk.

06:04 Grab bars in the shower and near the toilet are excellent.

06:08 When they're having to move from a sitting position to standing up.

06:12 When they're in a slippery shower.

06:14 They need something to grab on to to steady themselves.

06:17 They're really easy to install. You can get them at any home center.

06:22 But make sure you think about grab bars by the shower and by the toilet.

06:27 Now check their beds.

06:28 Some people have these really beautiful four poster beds, but they're super high.

06:32 There probably was a day when they could just hop up a couple stairs, and they didn't have any problem.

06:37 But see if that's still a safe arrangement for your clients, or for your loved ones, if you're going through their home to make sure it's safe, that they have a bed that is easy for them to get into.

06:48 and to get out of.

06:50 Now encouraging a cane and walker can also be kind of touchy.

06:53 People don't like to use those sometimes, But help them understand, it's just to help you study yourself, and to catch your balance in case you lose it.

07:03 So look for the appropriate cane or walker.

07:05 You might also want to talk to a physical therapist to see what they recommend.

07:09 Now preventative. If you can do some exercise, like encourage them to get into a yoga class, I took my mom to a Tai Chi class and it was wonderful for her balance.

07:19 So it helps with muscle tone and balance and any weight bearing exercise for bones is good.

07:26 So walking, it's a beautiful opportunity for them to do that.

07:30 So we've talked about three care strategies.

07:33 Can you name the first three care strategies before we go on to the fourth? Okay, limit smoking. And hopefully eliminate smoking.

07:43 Don't drink excessively.

07:46 Take a look at your environment and make some of those arrangements or changes that we discussed.

07:52 Now before we talk about the next slide, I want you to see if you can picture a home in your mind and identify four areas that should be fixed in that home.

08:02 So you'll have to imagine that in the home.

08:05 But what would you think like, oh, there's a lot of floor rugs that are tapped down.

08:10 Think of three other things in your home in your mind to help that patient education tip be right in your memory.

08:19 The fourth care strategy involves how to get more calcium to be available in your body from food that you ingest.

08:27 Now, there's nothing wrong with supplements, but always remember it is better to get nutrients and vitamins from a healthy diet.

08:34 Now we're gonna look for sources of vitamin D and for sources of calcium.

08:38 Whoa, where did vitamin D come from? Okay, well, you need vitamin D in order to absorb calcium.

08:47 So talk with your healthcare provider, see if additional supplements are needed.

08:52 But you're gonna need both.

08:53 In order for you to absorb that calcium, you're going to need sources for vitamin D, and sources for calcium.

09:00 Now we've got those listed for you there.

09:02 There's just some examples of them.

09:04 There are other foods that are high in D and or high in calcium.

09:08 But take some time, rewrite these practice with these because dietary questions are a common type of question on nursing exams, and on the NCLEX.

09:19 So you want to make sure you're aware of these special foods.

09:25 So let's break down these seven medications that can cause bone loss.

09:29 Hey, anytime I see a list of seven things, you are far beyond the capacity of my working memory.

09:35 So here's what we recommend.

09:37 You see the drug names there, right? So first, let's go through them and kind of look at what they treat.

09:42 See if that'll help us give us some clues.

09:45 Well, heparin and warfarin.

09:48 We use both of those medications for people that are good at making clots, right.

09:52 So you don't want them to make clots.

09:54 So I would write clotting over both of those.

09:58 Cyclosporine. Well, that's an immunosuppressant.

10:03 Glucocorticoids those are what you often call steroids and we use those to suppress inflammation.

10:11 Wow, that next one.

10:12 Medroxyprogesterone acetate.

10:15 You may know this as a name Depo-Provera.

10:18 This is what's used as a birth control method.

10:21 Cancer drugs, can do much more with that.

10:24 And then thyroid hormone.

10:27 Okay, so how can I break these down a little bit? What can I chunk together? Well, heparin and warfarin,those seem to be an easy part, right.

10:34 We can put them together.

10:36 Cyclosporine is an immunosuppressant and glucocorticoids.

10:41 Hey, those both suppress inflammation or the inflammatory response.

10:46 So we can group those together.

10:48 That's a birth control and the medroxyprogesterone acetate, and cancer drugs, and thyroid hormone.

10:55 Well, it looks like the best I can do with this list is think about people make clots, people we need to suppress inflammation, birth control, cancer, and thyroid.

11:05 Really, all we're going to be able to link together are the go from seven to five.

11:11 Heparin and Warfarin together for clotting.

11:13 Cyclosporine glucocorticoids, for suppressing inflammation, then we've got birth control, cancer drugs, and thyroid hormone.

11:21 So my best recommendation is you're going to need to look at these drugs on a fairly regular basis. Why would this matter? Well, if you're admitting a patient, you're going through their history.

11:30 You know, they're on these medications, and they're being tested for osteoporosis, or you see signs or cues that may indicate osteoporosis is a problem.

11:40 This is something you want to bring to the healthcare providers attention.

11:44 So you can plan some type of treatment plan, see what the next best step is.

11:48 So don't think about this as just another list of information that you have to remember.

11:54 This is important because you're going to help patients in your future or your family members in the future, stay safer and have less adverse effects.

12:04 If you remember, these are the medications that can cause bone loss, and who is at risk if they take them?