Plan for Teaching
Abstract
A key strategy for management of most conditions by the health care team is health education or teaching. Moreover, information sharing is a vital pillar that holds patient-centered care practice. This preventive strategy involves teaching the patient and family through health talks, video presentations, brochures, etc. the patients and their families. The content in the teaching varies depending outcomes of the health needs assessment of the patients and their families. Below is a lesson plan for Asian American women with osteoporosis and calcium intolerance.
What is Osteoporosis?
Osteoporosis is a debilitating disease; it causes the individual to have a low bone mass making the person susceptible to fractures. If the disease is not prevented or left untreated, it can progress painlessly and cause fractures of the hip, the spine and the wrist. Such fractures limit the mobility of the individual and can cause loss of independence by the person, height loss, stooping posture and chronic pain (Solomon, Black, & Rosen, 2016).
Recently concluded studies have revealed that a number factors that predispose them to osteoporosis. To being with, a comparison between Caucasian women and Asian women shows that the Asian women take a significantly less amount of calcium. The Asian individual’s biphosphonates small calcium levels because up to 90% of Asians are lactose intolerant; they, therefore, avoid taking dairy products. Dairy products are the primary source of calcium to the human body; the Asian individuals, therefore, miss out on a significant source of calcium that is the chief component in the maintenance of healthy bones (Tung, 2012).
Asian women also have lower hip fractures than their Caucasian counterparts. The Asian women, however, have more cases of fractures of the vertebral bone. The Asian women are also generally slender as compared to the other races (Solomon, Black, & Rosen, 2016). They, therefore, have fewer bone masses as compared to heavier or obese women hence the greater risk of osteoporotic fractures of the bone.
Management of Osteoporosis
Diet and Lifestyle
To protect against skeletal demineralization, one should take a diet that is adequate, balanced and rich in vitamin D and calcium throughout their lives. Moreover, individuals should increase their intake of calcium through their middle, adolescent, and young adulthood (Pedersini et al., 2017).
Instruct the patient to take foods rich in calcium such as canned salmon, bones soup and broccoli and avoid milk since they are lactose intolerant (Pedersini et al., 2017).
Teach the patient that to be sure of adequate calcium intake their doctor may prescribe calcium supplementation such as citrocal. The supplements should be taken with meals, alternatively with beverages rich in vitamin C to promote absorption. The daily dose that the doctor recommends should be split and should not be taken once. Inform the patient to watch out for side effects such as constipation and abdominal distension (Solomon, Black, & Rosen, 2016).
Instruct the patient to perform weight-bearing exercises regularly since they promote the formation of the bone. Recommend aerobic exercises such as walking for 20 to 30 minutes for three days or more each week.
Pharmacologic Therapy
Review the indications for hormone replacement therapy (HRT); teach the patient that for women past their menopause HRT is the primary form of treatment to slow bone loss and prevent fractures. Inform the patient that estrogen therapy reduces bone resorption and increases the bone density, therefore, lowering the chances of one getting fractures.
Advise the patient that the doctor may prescribe selective estrogen receptor modulators (SERM) e.g. raloxifene which will protect against osteoporosis by preserving bone density at the same time not causing any uterine activity. The drug can be used for both treatment and prevention. Inform the patient that the doctor may also prescribe bisphosphonates such as alendronate, calcitonin, and risedronate. Alendronate will be a good alternative to HRT and increase bone mass while reducing resorption. The bisphosphonates reduce the cases of hip and spinal fractures attributed to osteoporosis (Compston & Rosen, 2009)
Furthermore, instruct the patient to take the bisphosphonates together with vitamin D and calcium to achieve maximum effect. The patient should, however, not take the supplements at the same time as the biphosophonates. The likely side effects include diarrhea, flatulence, nausea, and constipation. Calcitonin mainly reduces bone loss through action on osteoclasts reducing bone turnover rate (Compston & Rosen, 2009). Inform the client that the drug is administered via nasal sprays or through injections. It may cause irritation in the nose, urine frequency, and gastrointestinal disturbances (Guiducci et al., 2017).
Finally inform the patient that the doctor may throw in a statin to control hyperlipidemia and promote bone formation.
Fracture management
Inform the patient that the clients with osteoporotic fractures are managed surgically through open reduction and internal fixation. Surgery is followed by early ambulation, adequate nutrition and physical therapy.
All women over the age of 65 years old and men over 70 years should go for osteoporosis screening tests at their doctor’s clinics. Instruct the patient to avoid smoking while at home; smoking increases the rate of bone loss (Ediriweera de Silva et al., 2014). Further instruct the patient to avoid excessive consumption of alcohol to reduce the risk of fracture related to falling. Excess alcohol also hastens osteoporosis.
Instruct patients to see a doctor if they went through early menopause or took corticosteroids for long or have a family history of osteoporosis. Tell the patient to look out for the following signs:
- A stooped posture
- Bone fractures that occur too easily
- Loss of height
- Back pain by a fractured vertebra.
In conclusion, osteoporosis is a condition that occurs when the bone is too thin. The rate of bone resorption is higher than the rate of bone formation. The condition predisposes people to fracture of bones and subsequent complications. The teaching plan has described in detail the management of the condition (Compston & Rosen, 2009). Diet therapy, physical therapy, pharmacologic therapy and at times surgery can be used to manage the condition. Finally, the patient has received teaching on what to look out for upon discharge.
References
Compston, J. & Rosen, C. (2009). Osteoporosis (1st ed.). Abingdon: Health Press.
Ediriweera de Silva, R., Haniffa, M., Gunathillaka, K., Atukorala, I., Fernando, E., & Perera, W. (2014). A descriptive study of knowledge, beliefs and practices regarding osteoporosis among female medical school entrants in Sri Lanka. Asia Pacific Family Medicine, 13(1). http://dx.doi.org/10.1186/s12930-014-0015-y
Guiducci, L., Maffei, S., Sabatino, L., Zyw, L., Battaglia, D., & Vannucci, A. et al. (2017). Significance of the ionized calcium measurement to assess calcium status in osteopenic/osteoporosis postmenopausal outpatients. Gynecological Endocrinology, 1-6. http://dx.doi.org/10.1080/09513590.2016.1270932
Pedersini, R., Monteverdi, S., Mazziotti, G., Amoroso, V., Roca, E., & Maffezzoni, F. et al. (2017). Morphometric vertebral fractures in breast cancer patients treated with adjuvant aromatase inhibitor therapy: A cross-sectional study. Bone, 97, 147-152. http://dx.doi.org/10.1016/j.bone.2017.01.013
Solomon, C., Black, D., & Rosen, C. (2016). Postmenopausal Osteoporosis. New England Journal Of Medicine, 374(3), 254-262. http://dx.doi.org/10.1056/nejmcp1513724
Tung, W. (2012). Osteoporosis Among Asian American Women. Home Health Care Management & Practice, 24(4), 205-207. http://dx.doi.org/10.1177/1084822312441702
