Enhancing Adaptation
The nursing care of the patient with pain and disability from
bone metastasis may involve the use of different complementary
approaches tailored to the individual’s needs (see Table
2). Physical and occupational therapies also should be offered
to improve mobility, provide instruction in ergonomic principles,
and facilitate adaptation.
About 50% of patients, most commonly those with myeloma,
breast cancer, and bone metastasis, develop fractures
requiring medical or surgical intervention (Rubens, 2000).
The femur is the most common site of these fractures (Galasko,
1993). Lesions in weight-bearing bones should be
evaluated radiographically to evaluate the potential for pathologic
fracture. Osteolytic lesions place the patient at a higher
risk for fracture than osteosclerotic or mixed lesions. Bone
pain that is worsened by activity can occur before fracture.
Metastasis involving 66% of the long bones places the patient
at a higher risk for fracture (Rubens, 1998) and may require
prophylactic orthopedic intervention followed by radiation
therapy.