Palliative care: a challenge for orthopaedic nursing care.

Patients who face chronic, incurable, or life-ending musculoskeletal conditions often receive inadequate care either due to a lack of caregiver awareness or inattention to maintaining the highest quality at the end of life. Palliative care focuses on the comprehensive physical, psychological, social, spiritual, and existential needs of patients with life-threatening or debilitating illness. Orthopaedic nurses and all nurses in general are challenged to incorporate palliative care principles into care planned with patients and families facing end-of-life issues. This article addresses the leadership role the National Association of Orthopaedic Nurses (NAON) has taken to develop a consensus document which endorses the Last Acts Precepts of Palliative Care and affirms the need for palliative care with patients who experience life-threatening illness. A case study is used to illustrate the opportunity a multidisciplinary team has to center care on the individual, while remaining sensitive to the holistic needs of the patient for self-determination at the end of life.

Postmenopausal survivors of breast cancer at risk for osteoporosis: nutritional intake and body size.

Postmenopausal survivors of breast cancer for whom hormone replacement therapy is contraindicated are at risk for development of osteoporosis. The primary purpose of this article is to describe, in a sample of 30 postmenopausal survivors of breast cancer, their calcium and vitamin D intake compared with recommended dietary guidelines for those nutrients for postmenopausal women not taking hormone replacement therapy and the body mass index of these women as nutritional status risk factors for development of osteoporosis. Bone health and presence of osteoporosis were determined by bone mineral density testing of the spine, hip, and forearm. To obtain calcium and vitamin D intake, including supplements, 3-day diet records were completed; height and weight measures were used to calculate body mass index. The sample participants ranged in age from 42 to 65 years; the majority (56%) had been menopausal or off hormone replacement therapy for 5 years or less, and 70% had completed breast cancer treatment for 5 years or less (except tamoxifen). The majority (63%) were of medium body frame size; 30% were of small frame size. The mean body mass index (27.3) and mean weight (160 lbs) indicate that these women, as a group, were over-weight. Although a large percent (63%) were taking calcium supplements, the mean daily intake (diet and supplements) of calcium (1,353 mg) and vitamin D (403 IU) was less than the recommended dietary guidelines for these nutrients in this population. At study entry, 80% of the women were osteopenic (60%) or osteoporotic (20%) and none was receiving treatment/prevention for osteoporosis; only 1 had a previous known osteoporosis diagnosis. This is a special group of women for whom screening and preventive strategies for osteoporosis are imperative.

Prevention of osteoporosis: the calcium controversy.

The continuing scientific controversy regarding the use of calcium supplements for the prevention of osteoporosis during menopause presents a challenge to the nurse practitioner. There is little doubt that estrogen prevents bone loss following menopause, but there is a growing doubt among many researchers whether calcium supplementation beyond 800 mg/per day produces any benefit at all in preventing postmenopausal osteoporosis. Yet, the medical consensus in this country continues to recommend 1500 mg of calcium per day for menopausal women. The practitioner's clinical questions relate to the effectiveness, cost, and compliance of calcium prescription. An alternate recommendation and protocol are presented here.