The goal of the information leaflet is to apply knowledge of pathophysiology processes of disease and evidence-based literature to the health promotion, ambulatory and home care information you provide as a nurse or midwife to promote adaptation and recovery in medical and surgical settings. You also apply the Code of Ethics and social justice framework to your professional role and responsibilities.
Leaflet Title
Pathophysiology and risk factors of osteoporosis, bone fracture and bone healing (approx. 500 words):
Osteoporosis refers to a condition that develops when a person’s bone mineral density and bone mass decrease (Akkawi & Zmerly, 2018). The condition lowers the bone strength increasing someone’s vulnerability to fractures. When the body loses too much bone while making very little, the bones become weak. Osteoporotic bones usually have numerous and big hole structures that look like a sponge which results in the weakening of the bone.
After a fracture occurs, second healing occurs. The second healing occurs in four steps namely hematoma formation, fibrocartilaginous callus, bony callus formation, and bone remodelling (Sheen & Garla, 2021). Hematoma, which is the first step, entails the formation of hematoma clots on the temporary frame that supports the healing process. After the fracture, pro-inflammatory cytokines such as the bone morphogenetic proteins, bone morphogenetic proteins, interleukins, and tumour necrosis factor-alpha. The second step of healing which is the formation of the fibrocartilaginous callus involves the development of the fibrin-rich granulation tissue. At this stage, chondrogenesis occurs facilitating the laying down of the collagen-rich fibrocartilaginous network. The third step entails the formation of the bony callus where the cartilaginous callus passes through the endochondral ossification (Sheen & Garla, 2021). The last step of remodelling is where the hard callus goes through a repeated remodeling, a process that takes place for several months facilitating the generation of a normal bone structure.
The risk factors for developing osteoporosis include being of the Caucasian race, sex, family history, body size, having low oestrogen levels, a history of smoking, and a sedentary lifestyle (Sozen et al., 2017). Women are at a greater risk of developing osteoporosis as compared to men (Hyassat et al., 2017). Women tend to have a peak bone mass as well as smaller bones as compared to men. Age is another significant risk factor. As people age, bone loss tends to happen quickly and the generation of new bone is slower. Individuals with small body sizes have a higher risk of developing the disease. This is because individuals with small body sizes have less bone. The patient has a small body size with a bodyweight of 52 kilograms. The race is also a significant factor. White and Asian women are at heightened risk as compared to African-American and Mexican American women.
Other risk factors include lifestyle and diet. Individuals that take a diet low in calcium and Vitamin D have a risk of developing the condition and getting fractures. Similarly, excessive dieting or the poor intake of proteins has been associated with a risk for bone loss and osteoporosis (Tian et al., 2017). Lifestyle factors that could contribute to a person getting the disease include smoking, alcohol drinking, and inactivity (Pouresmaeili et al., 2018). Low levels of physical activity are likely to contribute to bone loss. More so, it can result in a poor physical condition that can increase a person’s risk of falling. Smoking is also a risk factor for developing osteoporosis and the patient has a history of smoking heavily.
Health Promotion, ambulatory and home Care (approx. 800 words)
Health Promotion
Health promotion refers to a process that aims at enabling people to increase control over their health, and improve their health and overall well-being (Pati et al., 2017). One health promotion theory is ‘The Health Belief Model (HBM) which derives from the behavioural and psychological theory. The model assumes that the two elements of health-related behaviour is the desire for a person to prevent illness and a belief that a specific health-linked action is likely to prevent or cure illness. The six components of the HBM model are perceived vulnerability, perceived severity, perceived benefits, perceived barriers, cue to action as well as self-efficacy. Mrs. Walker was diagnosed with osteoporosis, has been stressed off late, and has lost significant weight and therefore would need to adopt a health promotion into her life with the goal of improving her health outcomes. She would need to understand the perceived benefits of any suggested change of behaviour, must demonstrate confidence, and most importantly must recognize barriers which she would need to work on to facilitate the achievement of positive outcomes. The health promotion activities will touch on the following:
Diet- The patient should consume an optimal diet rich in proteins, calories, and plenty of calcium and vitamin D. The above nutrients are likely to ensure that the patient despite the old age maintains a proper bone formation and density. Nutrition experts recommend that post-menopausal women consume 1200 grams of calcium per day. The 1200 grams of calcium should be from diet and supplements. Some sources of calcium that the patient should take include dairy products like cottage cheese, yogurt, and cheese. Other sources are green leafy vegetables such as kale and broccoli. Calcium supplements usually are in the form of calcium carbonate. Post-menopausal women should consume 800 international units (20 micrograms) of vitamin day daily (Rosen, 2019). The dose has been associated with a reduction in bone loss and fracture rate in older women.
Exercise- among premenopausal women, exercise may decrease fracture by improving bone mass and maintaining bone density. Exercise is also likely to improve balance, strengthen the muscles, and make an individual less prone to more falls and injuries (Jones et al., 2021; Kerr et al., 2017). The patient can engage in different types of exercise such as jogging, walking, and jumping. Weight bearing is also another exercise activity that is recommended among individuals suffering from fractures. Weight bearing entails carrying body weight on either the lower or the upper extremities. Through weight bearing, a person’s skeletal system can adapt to the body weight and muscles hence becoming stable and stronger (Anderson & Duong, 2021). The exercises help to build bone mass and should be done for approximately 30 to 45 minutes four times a week.
Avoiding smoking-the patient has a history of smoking. Therefore, it would be important to recommend the patient stop smoking. Smoking cigarettes has been associated with speedy bone loss. Add asserts that women who smoke a packet of cigarettes once a day during their adulthood tend to have 5 to 10 percent of bone density loss (Rosen, 2019).
Avoiding falls-avoiding falls is another measure to avoid falls. Falling increases a patient’s risk of osteoporotic fractures among older adults. Hence, taking measures that can prevent falls are likely to reduce the risk of fractures. One can take measures such as removing loose rugs or electrical cords, avoiding walking in unfamiliar places, providing adequate lighting, and avoiding walking in unfamiliar areas.
Ambulatory and Home Care
Patients that suffer from osteoporosis should have access to quality and patient-centred care ambulatory care and home care. Some of the measures that a patient should have access to would aim at lowering the risk of fractures. People with the disease are managed with drugs, which slow the breakdown. Similarly, the patients can be prescribed drugs that simulate drug formation. The United States National Osteoporosis Foundation (NOF) recommends that postmenopausal women be treated with medication. Some of the medications that can be used include anti-resorptive drugs, which slow the breakdown and the removal of bone. They include Alendronate, Risedronate, Ibandronate, and Zoledronic acid (Eastell, 2019). People that cannot tolerate oral bisphosphonates, can be put on intravenous zoledronic acid, which is an alternative. Patients can also be put on hormonal therapy (Gosset et al., 2021; Jiang & Kagn, 2021). Studies have shown that oestrogen-progestin treatment lowers the incidence of hip and vertebral fracture risk by 34 percent. More so, oestrogen also is known for controlling menopausal symptoms.
Osteoporosis limits the population’s mobility and hence the affected patients are likely to feel isolated due to the lack of contact with others (Stanghelle et al., 2019). Therefore, it would be essential for the families to plan for home care services that will help the patients in managing their daily life. The use of healthcare assistants and nurses would be of paramount importance in providing support and caregiving services to guide the patients through their daily life. The case study presented shows that the patient recently had a marriage breakdown, feels stressed, and at the same time is not sleeping well. The patient, therefore, needs support to help her heal quickly, adhere to medication and lifestyle modifications, and her overall well-being throughout her healing journey. The patient would need an assistant who would help her with the recommended physical activities. The physical activities will ensure that she has muscle strength and help her get back on her feet as soon as possible as she states that she has little time left before her retirement. The healthcare assistant will also keep the patient company and keep her engaged thus reducing her stress levels and improving her coping skills and mental health before she goes back to work.
Social Justice (approx. 250 words)
Social justice refers to the provision of equal rights, liberties, and opportunities, especially for the disadvantaged members of society (Wallack, 2019). In healthcare social justice is achieved when the disadvantaged members of the society have equal access to healthcare services just like average people. The capability of individuals to be healthy is a consideration is central in healthcare social justice provides an opportunity to achieve optimal health. The five principles of social justice are equity, access, diversity, participation and human rights.
Mrs. Walker is a 60- year-old who asserts that she has limited time to be stable before her retirement. The two variables that apply to her case are age and gender which would determine her ability to seek care. The patient needs access to healthcare services both ambulatory and homecare to facilitate her recovery. The principle of equity touches on specific tools such as policies and in this context, despite her financial situation and nearness to retirement; she can use government-sponsored health insurance to access care services for her condition. Through the principle of participation, she can take place in decision-making concerning her health and health decisions. The principle of diversity touches on different factors such as sex, ethnicity, age and race, which could result in discriminatory practices. The patient is 60 years-old and therefore, she is likely to face financial difficulties when catering to her healthcare especially if she lacks insurance. Limited income and lack of health insurance have been associated with poor access to healthcare services. The fifth principle is about human rights. Human rights are moral principles, which require that individuals should hold moral principles for certain human behaviour. Mrs. Walker should be treated with dignity despite her age, gender and health needs.
Code of Ethics (approx. 250 words)
Nurses have a fundamental responsibility to prevent illness, promote health, restore health as well as alleviate suffering among patients. Nurses, therefore, provide health care, which is respectful of the patient’s age, colour, culture, disability, nationality, race, and social status. The ICN Code of Ethics for Nurses has four principles outlining the standards of ethical conduct.
Code 1 element requires that the nurses provide care, which is respectful of human rights and is sensitive to the patient’s values, customs, and the beliefs of the people. Nurses should also provide continuing education on ethical issues (International Council of Nurses, 2022). With concern to Mrs., Walker’s case, the nurse should educate the patient about the need for s healthy diet rich in calcium, protein, and vitamin D to help strengthen the bones and regenerate bones based on her osteoporosis condition.
Code 2 element on ‘Nurses and Practices’ requires that nurse practitioners provide standards of care, which create a work setting, which promotes quality care (International Council of Nurses, 2022). Quality care based on this case study would entail care that is reflective of the patient’s needs, one that incorporates the evidence-based practice, and the incorporation of the standards of care.
Code 3 element on ‘Nurses and Profession’ requires that the nurse practitioners and the managers set standards for nursing practice, education, research, and management (International Council of Nurses, 2022). The nurse practitioners need to collaborate with each other with the ultimate goal of utilising research and advancements about osteoporosis.
Code 4 element on ‘Nurses and Co-workers’ requires that the nurse practitioners and the managers develop workplace systems that support common professional ethical values and behaviour (International Council of Nurses, 2022). The nurses can apply this code on Mrs., Walker by applying ethical principles such as beneficence, non-maleficence, social justice, and patient autonomy to provide quality and patient centred education and care relating to her osteoporosis diagnosis.
Synopsis (approx. 200 words):
Osteoporosis is a health condition that is prevalent among the elderly, and which lowers the quality of life among patients. It exposes the elderly to falls and other health. Some of the risk factors that exposed the patient in the case study to the disease include being 60 years old, having low-oestrogen levels, cigarette smoking, as well as a sedentary lifestyle. Health promotion to enhance the patient’s health outcomes would include education on the recommended diet, physical activity, and cessation of smoking. The patient should be educated on the need to adhere to medication and regular health monitoring. The patient should have access to outpatient care and home care services due to her mobility limitation, which would impede her from carrying out many activities on her own
The social justice framework requires that the healthcare practitioners as primary care providers ensure that is equality during the provision of care. The patient in the case study is likely to be affected by the age and gender variables, which could result in inequalities in healthcare resulting in negative healthcare outcomes. The nurse practitioners have a responsibility to incorporate the ICN codes of ethics to provide quality care, which upholds the patient’s dignity.
Reference list
Akkawi, I., & Zmerly, H. (2018). Osteoporosis: Current Concepts. Joints, 6(2), 122-127.
Anderson, T. B., & Duong, H. (2020). Weight Bearing. In StatPearls [Internet]. StatPearls Publishing.
Eastell, R., Rosen, C. J., Black, D. M., Cheung, A. M., Murad, M. H., & Shoback, D. (2019). Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(5), 1595-1622.
Gosset, A., Pouillès, J. M., & Trémollieres, F. (2021). Menopausal hormone therapy for the management of osteoporosis. Best Practice & Research Clinical Endocrinology & Metabolism, 35(6), 101551.
Hyassat, D., Alyan, T., Jaddou, H., & Ajlouni, K. M. (2017). Prevalence and Risk Factors of Osteoporosis Among Jordanian Postmenopausal Women Attending the National Center for Diabetes, Endocrinology and Genetics in Jordan. BioResearch open access, 6(1), 85–93. https://doi.org/10.1089/biores.2016.0045
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Pouresmaeili, F., Kamalidehghan, B., Kamarehei, M., & Goh, Y. M. (2018). A comprehensive overview on osteoporosis and its risk factors. Therapeutics and clinical risk management, 14, 2029.
Rosen, H. N. (2019). Patient education: Osteoporosis prevention and treatment (Beyond the basics). UpToDate.(Accessed on Aug. 5, 2017, at https://www. uptodate. com/contents/osteoporosis-prevention-andtreatment-beyond-the-basics.
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