JH CERILLES STATE COLLEGE
in consortium with
PATIENT INITIALS:
STUDENT NURSE:
YEAR LEVEL & BATCH:
Assessment
Subjective Data:
“2 ka semana nako
nakabati og sakit sa akong
likod” as verbalized by the
patient.
The patient’s daughter also
verbalized that she noticed
a deformity on her
mother’s back and also
noticed that her mother is
having a loss of height
Objective Data:
 Loss of height:
from 155cm to
150cm
 Deformity
 Kyphosis
Western Mindanao State Univeristy
West Capitol Road, Balangasan District, Pagadian City
N.J.T.A DATE:
JOHEINA CYNDRIL L. ZACARIAS CLINICAL INSTRUCTOR: ODESSA S. BUGARIN
BSN 2 – QUERENCIA
Nursing Care Plan
Diagnosis Planning Intervention Rationale Evaluation
Imbalanced nutrition: After 8 hours of nursing Instruct recommended daily intake for Premenopausal women (19-50 years Goal met.
less than body intervention the patient calcium. old) need 1,500 mg of calcium daily. After 8 hours of nursing
requirements in related will be able to After menopause, the requirement is intervention the patient
to inadequate calcium demonstrate adequate 1,200 mg daily. is be able to intake
and vitamin d as intake of calcium and adequate amount of
evidenced by deformity vitamin D. Instruct on the importance of The patient should be outside 15 calcium and vitamin D.
and loss of height. adequate exposure to sunlight to minutes daily.
prevent vitamin D deficiency.
Encourage vitamin D Supplementation will ensure
supplementation. adequate vitamin D intake.
Instruct patient to perform gentle Exercise can help build strong bones
exercises. and slow bone loss.
Limit alcohol and caffeine intake Consuming more than two alcoholic
drinks a day may decrease bone
formation and reduce the body’s
ability to absorb calcium.
Collaboration: For the effective management of the
 Administer medication as prescribed disease
by the attending physician

JH CERILLES STATE COLLEGE

in consortium with
 Western Mindanao State Univeristy
West Capitol Road, Balangasan District, Pagadian City

PATIENT INITIALS: Y.V.A DATE:

STUDENT NURSE: JOHEINA CYNDRIL L. ZACARIAS CLINICAL INSTRUCTOR: ODESSA S. BUGARIN
YEAR LEVEL & BATCH: BSN 2 – QUERENCIA

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective Data
“Usa ka bulan ng gasakit
ang akong likod. Mahadlok
na sab ko mag lihok-lihok evidenced by decrease
kay basin mo sakit og
samot. Unya dali ra mo
sakit akong likod inig mag
dugay kog tindog” as
verbalized by the patient.
Impaired physical After 8 hours of nursing Assess the patient’s functional ability Identifies problems and helps to Goal met. After 8 hours
mobility as related to intervention the patient for mobility and note changes. establish a plan of care. of nursing intervention
pain and activity will be able to show the patient is able to
intolerance as increase of functional show an increase of
mobility within Assess the degree of immobility Patient may be restricted by self- functional mobility
in endurance and limitations of disease produced by injury or treatment and view or self-perception out of within limitations of
reluctance to initiate process. note patient’s perception of proportion with actual physical disease process.
movement immobility. limitations, requiring information or
interventions to promote progress
toward wellness.

Provide range of motion exercises Helps to prevent joint contractures

Objective Data every shift. Encourage active range of and muscle atrophy.
 Pain scale: 7/10 motion exercises.
 Insidious back pain
 Loss of height Apply trochanter rolls and/or pillows Prevents musculoskeletal
 Minor Bone to maintain joint alignment. deformities.
fractures
 Stooped posture Assist patient with walking if at all Preserves the patient’s muscle tone
possible, utilizing sufficient help. and helps prevent complications of
immobility.

Instruct patient or assist with active Increases blood flow to muscles and
and passive ROM exercises of affected bone to improve muscle tone,
and unaffected extremities. maintain joint mobility; prevent
contractures or atrophy and calcium
resorption from disuse

Encourage use of isometric exercises Isometrics contract muscles without

starting with the unaffected limb. bending joints or moving limbs and
help maintain muscle strength and
mass.

Collaboration:
Administer medication as prescribed For effective management of the
by the attending physician disease

PATIENT INITIALS:
STUDENT NURSE:
YEAR LEVEL & BATCH:
Assessment
Subjective data
“Nurse wala kaayo ko
kasabot ni doc ganiha
katong nag explain siya
kung para aha ni nga mga
tambal. Pwede ko mag pa
explain balik kung para aha
ni sila nurse?” as verbalized
by the patient
Objective
 Confused facial
expression
JH CERILLES STATE COLLEGE
in consortium with
Western Mindanao State Univeristy
West Capitol Road, Balangasan District, Pagadian City
M.A.B.P DATE:
JOHEINA CYNDRIL L. ZACARIAS CLINICAL INSTRUCTOR: ODESSA S. BUGARIN
BSN 2 – QUERENCIA
Diagnosis Planning Intervention Rationale Evaluation
Deficient knowledge Short term: Assess patient’s knowledge of disease, Provides a basis for teaching and Goals met. After 8
In related to lack of After 1 hour of nursing diet, medication, and exercise techniques to promote compliance. hours of nursing
information regarding intervention the patient program to arrest the progression of Disease is not usually detected until intervention the patient
medications as will be able to: bone deterioration. 24-40% of calcium in bone is lost. is able to:
evidenced by
verbalization of the  Achieve an Most individuals with osteoporosis  Achieve and
problem and request for increased Assess the patient’s understanding of are not diagnosed until an acute increased
information knowledge osteoporosis. fracture occurs. knowledge
regarding the regarding the
disease and the Assists patient to cope with disease and the
medications Provide support for body image and chronicity of disease and potential medications
prescribed by the lifestyle changes. fractures causing pain and prescribed by
attending immobility. the attending
physician. physician
Exercise will strengthen bone.
Long Term  Perform daily
Assist to plan an exercise program Vertebral collapse is common and
exercises within
according to capabilities; to avoid corset provides support.
After 8 hours of nursing identified
flexion of the spine and wear a corset
intervention the patient limitations
if appropriate (walking is preferred to
will be able to
jogging).  Patient and/or
 Perform daily
exercises within family is able to
Teach patient about nutrition and Adequate calcium helps to prevent accurately
identified
limitations calcium intake. osteoporosis in women with a small verbalize
frame, increased age, Asians, and understanding
Caucasians.
 Patient and/or of medications
family will be able Instruct patient in methods to perform Prevents injury that can occur with and methods of
to accurately activities of daily living and to avoid osteoporosis with minimal trauma. administration.
verbalize lifting, bending, or carrying heavy
understanding of objects.
medications and
methods of Instruct patient about medication for An informed patient is likely to
administration. osteoporosis, adverse effects, adhere to the medication regimen
administration, and need for follow-up and report adverse effects.
tests.

Collaboration:
Administer and teach the patient For the effective management of the
about the drugs that are prescribed by disease
the attending physician.
 JH CERILLES STATE COLLEGE
in consortium with
Western Mindanao State Univeristy
West Capitol Road, Balangasan District, Pagadian City

STUDENT NURSE: CLINICAL INSTRUCTOR:

YEAR LEVEL & BATCH: DATE:

DRUG STUDY
Generic Name, Prescribed Dosage, Mechanism of Indication Contraindication Adverse Reaction Nursing Responsibilities
Brand Name, Frequency, and Action
Classification Route of
Administration
alendronate, 10 mg, once daily Inhibits bone Treatment of Hypocalcemia, Overdose produces BASELINE ASSESSMENT
Fosamax, bone in the morning or 70 resorption via glucocorticoid-induced abnormalities of the hypocalcemia,  Obtain baseline serum calcium,
resorption mg weekly, PO actions on osteoporosis in men and esophagus, inability to hypophosphatemia, phosphate, alkaline phosphatase.
inhibitor, osteoclasts or women with low bone stand or sit upright for at significant GI  Hypocalcemia, vitamin D
osteoclast mineral density who are least 30 min, sensitivity to disturbances. deficiency must be corrected before
precursors. receiving at least 7.5 mg alendronate or other Esophageal irritation beginning therapy.
predniSONE (or bisphosphonates; oral occurs if not given  Assess pt’s ability to remain
Therapeutic equivalent). Treatment solution or effervescent with 6–8 oz of plain upright for at least 30 minutes.
Effect: and prevention of tablet should not be used water or if pt lies down
Leads to indirect osteoporosis in males in pts at risk for within 30 min of INTERVENTION/EVALUATION
increase in bone and postmenopausal aspiration. administration. May  Monitor chemistries (esp. serum
mineral density. women. Treatment of increase risk of calcium, phosphorus, alkaline
Paget’s Disease: Paget’s disease of the osteonecrosis of the phosphatase levels).
Inhibits bone bone in pts who are jaw
resorption, leading symptomatic, at risk for PATIENT/FAMILY TEACHING
to an indirect future complications, or  Expected benefits occur only when
decrease in bone with alkaline medication is taken with full glass
formation, but phosphatase equal to or (6–8 oz) of plain water, first thing
in the morning and at least 30 min
bone has a more greater than 2 times
before first food, beverage, or
normal ULN.
medication of the day is taken. Any
architecture.
other beverage (mineral water,
orange juice, coffee) significantly
reduces absorption of medication.
  Do not lie down for at least 30 min
after taking medication (potentiates
delivery to stomach, reducing risk
of esophageal irritation).
 Report new swallowing difficulties,
pain when swallowing, chest pain,
new/worsening heartburn.
 Consider weight-bearing exercises,
modify behavioral factors (e.g.,
cigarette smoking, alcohol
consumption).
 Supplemental calcium and vitamin
D should be taken if dietary intake
inadequate

JH CERILLES STATE COLLEGE

in consortium with
Western Mindanao State Univeristy
West Capitol Road, Balangasan District, Pagadian City

STUDENT NURSE: CLINICAL INSTRUCTOR:

YEAR LEVEL & BATCH: DATE:
 DRUG STUDY
Generic Name, Prescribed Dosage, Mechanism of
Brand Name, Frequency, and Action Indication Contraindication Adverse Reaction Nursing Responsibilities
Classification Route of
Administration
risedronate, Prophylaxis, Inhibits bone Treatment of Paget’s Hypersensitivity to Overdose produces BASELINE ASSESSMENT
Actonel, calcium treatment of resorption by disease of bone. risedronate, other hypocalcemia,  Assess symptoms of Paget’s
regulator Postmenopausal action on Treatment/prevention of bisphosphonates (e.g., hypophosphatemia, disease (bone
osteoporosis: osteoclasts or osteoporosis in alendronate); inability to significant GI  pain, bone deformities).
Adults, elderly: osteoclast postmenopausal women, stand or sit upright for at disturbances,  Hypocalcemia, vitamin D
5 mg/ day or 35 mg precursors. glucocorticoid-induced least 30 min; osteonecrosis of jaw deficiency must be corrected before
once wkly or 150 mg osteoporosis (daily dose abnormalities of therapy begins. Obtain baseline
once monthly, PO Therapeutic 7.5 mg predniSONE or esophagus that delay laboratory studies, esp. serum
Effect: greater). Treatment of esophageal emptying; electrolytes, renal function.
Treatment of Male Osteoporosis: osteoporosis in men. hypocalcemia.  Verify pt is able to stand or sit
Osteoporosis: Decreases bone Atelvia: Treatment of upright for at least 30 min.
ADULTS, resorption osteoporosis in
ELDERLY: 35 mg (indirectly postmenopausal women. INTERVENTION/EVALUATION
once wkly, PO increases bone  Check serum electrolytes (esp.
mineral density). calcium, ionized calcium,
Glucocorticoid- phosphorus, alkaline phosphatase
levels).
Induced Paget’s Disease:
 Monitor I&O, BUN, creatinine in
Osteoporosis Inhibition of bone
pts with renal impairment.
PO: (Actonel): resorption
ADULTS, causes a decrease
PATIENT/FAMILY TEACHING
ELDERLY: (but more normal
 Expected benefits occur only when
5 mg/day, PO architecture) in
medication is taken with full glass
bone formation.
(6–8 oz) of plain water first thing
in the morning and at least 30 min
before first food, beverage,
medication of the day. Any other
beverage (mineral water, orange
juice, coffee) significantly reduces
absorption of medication.
 Do not lie down for at least 30 min
after taking medication (potentiates
delivery to stomach, reduces risk of
esophageal irritation).
  Report swallowing difficulties,
pain when swallowing, chest pain,
new/worsening heartburn.
 Consider weightbearing exercises;
modify behavioral factors
(cigarette smoking, alcohol
consumption).
 Report jaw pain, incapacitating
bone, joint, or muscle pain.

JH CERILLES STATE COLLEGE

in consortium with
Western Mindanao State Univeristy
West Capitol Road, Balangasan District, Pagadian City

STUDENT NURSE: CLINICAL INSTRUCTOR:

YEAR LEVEL & BATCH: DATE:

DRUG STUDY
Generic Name, Prescribed Dosage, Mechanism of Indication Contraindication Adverse Reaction Nursing Responsibilities
Brand Name, Frequency, and Action
 Classification Route of
Administration
ibandronate, Adults, Elderly: Inhibits bone Treatment/prevention of Hypersensitivity to Upper respiratory BASELINE ASSESSMENT
Boniva, calcium 150 mg once resorption via osteoporosis in ibandronate, other infection occurs  Hypocalcemia, vitamin D
regulator monthly, PO activity on postmenopausal women. bisphosphonates; oral occasionally. deficiency must be corrected before
osteoclasts. OFF-LABEL: tablets in pts unable to Overdose results in beginning therapy.
Adults, Elderly: Hypercalcemia of stand or sit upright hypocalcemia,  Obtain laboratory baselines, esp.
3 mg, q3mos, IV Therapeutic malignancy; reduces for at least 60 min; pts hypophosphatemia, serum chemistries, renal function.
Effect: Reduces bone pain and skeletal with abnormalities significant GI  Obtain results of bone density
rate of bone complications from of the esophagus that disturbances. study.
resorption, metastatic bone disease would delay emptying
resulting in due to breast cancer (e.g., stricture, achalasia), INTERVENTION/EVALUATION
indirect increased hypocalcemia  Monitor electrolytes, esp. serum
bone mineral calcium, phosphate.
density.  Monitor renal function tests.

PATIENT/FAMILY TEACHING
 Expected benefits occur only when
medication is taken with full glass
(6–8 oz) of plain water, first thing
in the morning and at least 60 min
before first food, beverage,
medication of the day. Any other
beverage (mineral water, orange
juice, coffee) significantly reduces
absorption of medication.
 Do not chew, crush, dissolve, or
divide tablets; swallow whole.

 Do not lie down for at least 60 min

after taking medication (potentiates
delivery to stomach, reduces risk of
esophageal irritation).
 Report swallowing difficulties,
pain when swallowing, chest pain,
new/worsening heartburn.
 Consider weight-bearing exercises;
modify behavioral factors (e.g.,
cigarette smoking, alcohol
consumption).
 Calcium and vitamin D
supplements should be taken if
dietary intake inadequate