PART I

PRELIMINARY
A. BACKGROUND
As known Shelah the main mineral preparation of the bone is calcium.
Lack of calcium will result in reduced consumption of calcium present in the
bones, so that will be long kelaman will be changes in mikroarstektur bones and
bones become soft consequently to loss of bone density and strength so easily
cracked or broken.
Osteomalacia is a form of pathological changes in bone caused
kehilangannyamineralisasi that reduced levels of potassium phosphate samapi
tingat below levels required for normal bone matrix mineralization, the results of
bone mineral resio akirnya Iyalah with reduced bone markes.
Many factors lead to osteomalacia deficiency of calcium and vitamin D especially
true in times of small and adolescents where the formation period of maximum
bone, is a cause osteomalacia potassium intake is low or decline in the body's
ability to absorb potassium, which usually occurs in adults, can cause
osteomalacia, in addition to the disturbance on malabsorsi bowel syndrome, liver
disease, chronic renal failure may also menebabkan osteomalacia.
The occurrence of osteomalacia is circuited the onset of osteoporosis. At the
present time a ngka the incident sharply increased both pad children, adults or the
elderly. Based on the results of researches university of otago, new salandia, in
cooperation with SEAMEO tromped RCCN, Universtas Indonesia, Malaysia
universities, published European Journal of Clinical Nutrition in 2007, the
Indonesian women only consume 270 milligrams of calcium per day.
This means that the intake of Indonesian women even less than 50% of daily
potassium recommendations for maintaining strength and bone health. Intake is
less than 50% of the daily recommendation even occurred in nine Asian countries,
as there are researches conducted lyengar and team paa 2004. The need for
potassium is recommended per day is 1000-1200 mg.
Data were analyzed by the bone density and pengenbangan researches
center (R & D centers) nutrition Bogor in 2005, found 2 of 5 Indonesian people at
risk for bone loss than the amount of the above events and conditions take a
concerted pendektesian yng disease and early treatment.
B. PURPOSE
1. General Purpose
a) Utuk mendaptkan and mengethui picture of how nursing care to clients
osteomalacia
b) To fulfill the tasks subjects muskulosekeletal system
2. Special Purpose
Students are expected to provide an overview keprawatan care include:
a) Being able to provide an overview of the assessments on clients with
osteomalacia
b) Ability to formulate nursing diagnoses in clients with osteomalacia
c) Ability to create nursing plans on clients with osteomalacia

d) Ability to mention faktof supporters and obstacles in the care of osteomalacia

keprawatan
C. BENEFITS
The benefits derived from this paper is as follows:
1. Students can recognize problems osteomalacia
2. Students can provide nursing actions appropriate to the client osteomalacia
Students have an overview of the process of nursing care with clients
osteomalacia.

CHAPTER II
DISCUSSION
A. DEFINITIONS
Osteomalacia is the pathological changes such as the loss of bone mineralization
which caused a lack of calcium phosphate concentration to a level below the level
that is required for normal bone matrix mineralization, the end result is the ratio
between bone mineral bone matrix is reduced.
Osteomalacia is a disease of bone metabolism in karakteristikkan by the lack of
minerals in the bone (resembling a disease that affects children is called rickets) in
adults. Osteomalacia include chronic and skeletal deformities, occurs not as
severe as that affects children as in adults bone growth is complete (complete).
Osteomalacia in the know as one of the main constituent of the bone mineral is
calcium lack of calcium will result in reduced consumption of calcium contained
in the bone so that over time will be changes in bone microarchitecture and bones
become soft. As a result, bone density loss and kekuatanya be so easily cracked /
broken.
B. Etiology
some predisposition that can cause osteomalacia conditions are as follows:
1. Deficiency of vitamin D.
2. malabsorption.
3. Inadequate exposure to sunlight.
4. hypocalcemia.
C. Pathophysiology
There are various causes of osteomalacia that commonly cause disturbances of
mineral metabolism. Factors that are harmful to the development of osteomalacia
among error diet, malabsorption, gastrectomy, chronic renal failure, long-term
anticonvulsant therapy (phenytoin, phenobarbital), and vitamin D insufficiency
(diet matahar rays),
Type malnutrition (vitamin D deficiency is often classified in terms of lack of
calcium), especially disfunction towards destruction, but dietary factors and lack
of knowledge about nutrition can also be a trigger factor. This happens with a
common frequency in which the content of vitamin D in food is less and mistake
diet, and lack of sunlight.
Osteomalacia is likely to occur as a result of failure or lack of calcium absorption
of calcium from the body. Gastrointestinal disorders in which the lack of fat
absorption can also cause osteomalacia. Lack of fat absorption is kekurangnya
other than vitamin D (all the fat-soluble vitamin) and calcium can lead
osteomalsia. The most recent excretion in the feces are mixed with fatty acids
(FAs). For example there may be noise including celiac disease, chronic
obstruction of the digestive system, chronic pancreatitis, and a small stomach
resection.

Liver and kidney disease can lead to vitamin D deficiency, but on the other hand
these organs can convert vitamin D into its active form. Lastly,
hyperparathyroidism support the formation of calcium deficiency, osteomalacia
thereby causing an increase in phosphate excretion in the urine.
Pathway
Lack of calcium in the diet
malabsorption of calcium
gastrointestinal disorders
Chronic renal failure
Lack of vitamin D
Failure of bone mineralization
Softening and weakening occurs the body frame
Whalebone arch causes pain and pathologic fractures
Osteomalsia
D. Manifestations
Generally, there are ten major signs of clinical osteomalsia is as follows:
1. Weak bones
2. Bone pain
3. Pain pelvis
4. Pain of long bones
5. Painful spine
6. Muscle weakness
7. Hypocalcemia
8. Bone vertebra under pressure
9. leveling pelvis
10. Fractures, both in number and easy fractures
E. Investigations
laboratory examination showed than the average serum calcium as well as the
lack of increase in alkaline phosphate. Urinary excretion of calcium and slow
kreatine
x-rays will be visible bones in general
veterbrata examination will show their compression fractures without clear
boundaries vertebrate

 Bone biopsy
In plain in getting their osteosclerosis and erosion in the periosteum.
Kondrokalsinosis condition can occur in fibrokartilage most often in the knees
F. MEDICAL MANAGEMENT
The optimal management of patients with osteomalacia include such things as the
following:
Overcome the basic causes of osteomalacia
Giving vitamin D both supplements and a diet high in vitamin D
Provision of a diet rich in protein, high in calcium and vitamin D
Treatment in case hipoklasemia
Increased pejanan sunlight as ultraviolet radiation to transform materials
available cholesterol in the skin into vitamin D need to be at the recommended
Long-term Penantauan clients need to ensure stabilization or recurrence of
osteomalacia
review the administration of drugs that can accelerate vitamin D such as dilantin,
rifampin, phenobarbito
G. COMPLICATIONS
In children, if the disease is not immediately treat the growth will be hindered boy
was so slow to sit, crawl and walk. His weight might bend the knee, spine and
other joints, causing leg O (genu varum0, breast edema (pigeon chest) and knees
bent inwards (genu valgum)
In adults, bone weakness raises the risk of fractures. Os will soften pressured
vertebrates to be short so that people would be reduced height or midgets. Truncus
shortened thereby transforming the so-called thoracic kyphosis and scoliosis
which saw humpback.
H. NURSING NURSING THEORY
A. Assessment
1. History
Patients with osteomalacia disorder usually complain of bone pain Common
on the lower back and extremities accompanied by tenderness. Things that need to
be asked in patients include:
a. Information regarding malabsorption syndromes
b. dietary habits
c. Muscle weakness occurs or not
2. Physical examination
On physical examination, obtained skeletal deformity, vertebral deformity and
curvature deformity of the long bones that make normal appearance and the way

the client does not shorten. Muscle weakness can occur. This client merasatidak
comfortable with their appearance.
3. Examination of diagnostic
Radiologically visible on x-rays extensive deformities in the skeleton (emphasis
vertebrae, pelvic distortion, bending long bones) and depletion of whole bone. In
the milkman syndrome seen pseudofractures the ribs, pelvis, and femur base.
examination showed vertebral compression fractures without clear boundaries
vertebra.
Found microscopic picture is widening the area around the bone osteocytes
experiencing classification. In severe osteomalacia can be found pseudofractures
known as syndrome milkman.
4. Laboratory tests
a. Increased blood fosfatasealkali
b. A decrease in urinary phosphate darahKalsium and lower creatinine excretion
B. Nursing Diagnosis
1. Pain associated with the possibility of pathologic fracture
2. Impaired self-concept associated with deformity
3. Lack of knowledge related to the disease process
C. Nursing Interventions
Nursing diagnoses
1.

Interest (NOC)
Pain associated Relieves pain
with

pathological

fracture

Intervention
Perencanaan (NIC)
Physical
effort,
pharmacological

pisikologis,
used

to

and
relieve

nyaribelakang do changing position with a

soft mattress that is dense and soft pillow
can ante up the body and give comfort to the
deformity exists, distract the patient from
nyridengan watch TV or read the newspaper,
collaboration in the delivery of analgesics to
reduce discomfort, to monitor the effects of
drugs against pain. No changes after taking

Impaired

self- Improve

the drug or no response

self- Develop a relationship of trust between

concept associated concept

nurses and patients

with

Give a chance to express her image changes

problems

deformity

and efforts made by the patient

Encourage the patient to recognize and use

their power and input in the planning of
nursing care. It is the active participation
srta can improve control of and improve
self-esteem
Encourage the patient to perform intraksi
with family and friends. It can give a sense
of accepted regardless of the physical
changes that occur

Lack of knowledge Understanding of Explain

the

occurrence

of

disease

about the disease disease processes osteomalacia

process

and

treatment Explain the dietary sources of vitamin D

programs

found in milk and cereal, eggs, chicken

livers, etc.
Explain the use of supplements and their
side effects. For example, very high doses of
vitamin D toxin and increase the risk of
hypercalcemia.
Explain the importance of serum calcium
levels.
Encourage the patient to perform activities
outside the ward or at home if it is out of the
hospital so that skin exposure occurs on the
sun's ultraviolet rays that need to produce
vitamin D in the body