This guide is about Osteoarthritis, Osteoarthritis Treatment, Osteoarthritis Nursing Care Plans, and 2 Osteoarthritis Nursing Care Plan Examples. It can be used to prepare educational nursing care plans for Osteoarthritis.
What is Osteoarthritis (OA)?
Osteoarthritis (OA) also known as degenerative joint disease (DJD) or osteoarthrosis is the most common kind of arthritis associated with progressive degeneration of articular cartilage in synovial joints. Usually, weight-bearing joints and the spine are affected.
Although the disease occurs most often in older adults, osteoarthritis is not part of the normal aging process. Idiopathic (primary) OA is more likely to affect women older than age 65. People with this type of OA have no usually have a family history of the disorder but no direct history of joint disease or injury. Secondary OA occurs more often in men. People with this type of OA are likely to have a previous inflammatory disease and joint injury related to the person’s occupation or sports activity.
Osteoarthritis is characterized by progressive degeneration of the cartilage in a joint. The changes in articular cartilage represent an imbalance between lysosomal enzyme destruction of and chondrocyte production of cartilage matrix. This imbalance leads to an inability of the cartilage to withstand the normal weight-bearing stress in the joint.
Cartilage becomes thin, rough, and uneven, with areas that soften eventually allowing bone ends to come closer together. Micro fragments of the cartilage may float about freely within the joint space, initiating an inflammatory process. True to the progressive nature of the disease, the cartilage continues to degenerate, and bone spurs called osteophytes develop at the margins and at the attachment sites of the tendons and ligaments. Over time these changes have an effect on the mobility and size of the joint. As joint cartilage becomes fissured, synovial fluid leaks out of the subchondral bone and cysts develop on the bone.
What are the Signs and Symptoms of Osteoarthritis?
- Joint soreness and pain – especially during physical activity, overuse, or long periods of physical inactivity
- Bony enlargement – found in the middle and end joints of the fingers
What are the Causes and Risk Factors for Osteoarthritis?
Degenerative Joint Disease or OA can manifest through a variety of forms, and with different risk factors involved. These risk factors may include genetics, obesity, previous injuries, and joint overuse. Inherited defects in the production of collagen, a major component of cartilage, has been correlated with increased susceptibility to develop osteoarthritis. Obesity, on the other hand, has always been associated with long-term health problems, one of which is degenerative joint disease.
The continuous stress brought upon to the joints, by being overweight contributes to the injury of the surrounding tissues. Likewise, a previous injury, such as those acquire through contact sports or an accident, predisposes a person more to osteoarthritis due to the already damaged and weakened structure of the affected joints. Activities that may include joint overuse contribute to the gradual wear and tear of the body, thus developing these joint diseases in the future.
What Happens When Osteoarthritis Goes Untreated?
- Joint deformity. OA can develop bony nodules on the fingers. In the long run, the patient may experience radial or ulnar deviations of the affected joint.
- Functional impairment and disability. Both gross and motor abilities of the hands and fingers are affected due to OA. These can make it difficult to do physical work and activities of daily living for the patient.
- Chronic pain syndrome. The neural pain pathways are persistently activated in degenerative joint disease, which can eventually develop chronic pain syndrome.
How do you Diagnose for Osteoarthritis?
- Physical exam – to check for the signs and symptoms such as bony enlargement of the joints, as well as muscular strength and reflex exams
- Blood tests for complete blood count, biochemistry, rheumatoid factor and anti-CCP antibodies – not indicated to diagnose OA but to rule out other types of arthritis
- Imaging – X-ray of the affected joints; MRI and ultrasound to determine the severity to rule out other types of arthritis
- Joint aspiration – if there is fluid accumulation around the joint, the fluid can be aspirated for testing to rule out other types of arthritis
What nursing interventions are used in the management of osteoarthritis?
- Medications. Depending on the severity of OA, doctors can prescribe pain relievers or nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and relieve pain. Unlike rheumatoid arthritis, degenerative joint disease or OA cannot be treated with drugs that can slow down the progression of joint damage.
- Surgery. The doctor may recommend surgery to resolve unbearable joint pain due to OA. This includes joint replacement (replacing a damaged joint with an artificial joint), arthroscopy (to remove the damaged joint tissues or repair them if possible), osteotomy (for realignment of the bone of the arm or leg), and joint fusion (for realignment and stabilization of the affected joint).
- Physical therapy. This is an important part of the treatment regimen for OA and includes a physical therapist who can guide the patient with effective exercises to reduce the joint pain. Low impact exercises such as walking on flat surfaces and swimming are recommended to reduce the risk of putting stress on the damaged joint.
- Weight loss. Obesity is one of the most common risk factors for degenerative joint disease or OA, thus, a crucial part of the treatment is to lose weight through diet and exercise.
Osteoarthritis Nursing Care Plans
How do you care for a patient with osteoarthritis?
Nursing care plan for clients with osteoarthritis involves relieving pain, promoting comfort measures, maintaining optimal joint function, and preventing progressive disability.
1. Acute Pain/Chronic Pain
- Acute Pain
- Chronic Pain
May be related to
- Bone deformities
- Joint degeneration
- Muscle spasm
- Physical mobility
Possibly evidenced by
- Facial grimaces
- Protective, guarded behavior
- Refusal or inability to participate in ongoing exercise or rehabilitation program
- Reports of a decreased ability to perform ADLs because of discomfort
- Reports of pain, spasm, tingling, numbness
- Client will report satisfactory pain control at a level less than 3 to 4 on a scale of 0 to 10.
- Client will use pharmacological and nonpharmacological pain relief strategies.
- Client will exhibit increased comfort such as baseline levels for HR, BP, respiration, and relaxed muscle tone or body posture.
- Client will engage in desired activities without an increase in pain level.
|Assess the client’s description of pain.||The client may report pain in the fingers, hips, knees, lower lumbar spine, and cervical vertebrae. Pain is usually provoked by activity and relieved by rest; joint pain and aching may also be present when the client is at rest. Pain may manifest as an ache, progressing to sharp pain when the affected area is brought to full weight-bearing or a full range of motion (ROM). The client may experience sharp, painful muscle spasms and paresthesias.|
|Assess the client’s previous experiences with pain and pain relief.||The client may have a tried-and-true plan to implement hen OA becomes exacerbated. Consideration should be given to implementing this plan, with modifications if necessary, when pain becomes acute.|
|Identify factors or activities that seem to precipitate acute episodes or aggravate a chronic condition.||Pain may be associated with specific movements, especially repetitive movements of the involved joints.|
|Determine whether the client is reporting all of the pain he or she is experiencing.||Clients who have become accustomed to living with chronic pain may learn to tolerate basal levels of discomfort and only reports those discomforts that exceed these “normal” levels. The care provider is not getting an accurate picture of the client’s status if this pain is not reported. The nurse may need to be sensitive to nonverbal cues that pain is present.|
|Determine the client’s emotional reaction to chronic pain.||The client may find coping with a progressive, debilitating disease difficult.|
|Develop a pain relief regimen based on the client’s identified aggravating and relieving factors. Instruct the client to do the following:|
||Heat reduces pain through improved blood flow to the area and through the reduction of pain reflexes. Special attention needs to be given to preventing burns with this intervention. Cold reduces pain, inflammation, and muscle spasticity by decreasing the release of pain-inducing chemicals and slowing the conduction of pain impulses. These interventions require no special equipment and can be cost-effective. Hot or cold applications should last about 20 to 30 min/hr.|
||Muscle spasms may result from poor body alignment, resulting in increased discomfort.|
||Chronic pain takes an enormous emotional toll on clients. Reducing other factors that cause stress may make it possible for the client to have greater reserves of emotional energy for effective coping.|
||Exercise is necessary to maintain joint mobility, but clients may be reluctant to participate in exercise if they are in too much pain.|
||Fatigue impairs the ability to cope with discomfort.|
||Flexion of the joints may reduce muscle spasms and other discomforts.|
||These aids assist in ambulation and reduce joint stress.|
|Instruct the client to take prescribed analgesics and/or anti-inflammatory medications. Provide instruction on important side effects:|
||It is the first-line drug for pharmacologic management. It relieves pain but has no effect on inflammation. This drug has fewer gastrointestinal (GI) side effects than nonsteroidal anti-inflammatory drugs (NSAIDs).|
||This class of drugs acts by reducing prostaglandin synthesis via the inhibition of cyclooxygenase-2 (COX-2). These drugs are used with caution in people with a history of gastric ulcers, liver disease, stroke, or cardiovascular disease.|
||These drugs are anti-inflammatory, antipyretic, and analgesic agents. They are|
||These drugs may relax painful muscle spasms. They may cause drowsiness and may exaggerate the central nervous system depressive effects of alcohol and other drugs.|
||These drugs are anti-inflammatory and usually used over a short period for the treatment of acute episodes of musculoskeletal pain disorders. In long-term therapy (exceeding 1 week), a vast array of symptoms may be seen, including sodium retention and edema, weight gain, glaucoma, psychosis, Cushing-like syndrome, and altered adrenal function.|
2. Impaired Physical Mobility
- Impaired Physical Mobility
May be related to
- Muscle weakness
- Restricted joint movement
Possibly evidenced by
- Decreased muscle strength
- Limited range of motion
- Refusal to transfer and ambulate or perform ADLs
- Reluctance to move
- Client will perform physical activity independently or within limits of activity restrictions.
- Client will demonstrate the use of adaptive changes that promote ambulation and transferring.
- Client will be free of complications of immobility, as evidenced by intact skin, absence of thrombophlebitis, normal bowel pattern, and clear breath sounds.
|Assess the client’s posture and gait.||It is important to assess for indicators of a decreased ability to ambulate and move purposefully: shorter steps, making gait appear unstable; uneven weight-bearing; an observable limp; or rounding of the back or hunching of the shoulders.|
|Assess the client’s weight.||Excessive weight may add stress to painful joints.|
|Assess range of motion (ROM) in all joints, comparing passive and active ROM.||Pain or joint deformity may cause a progressive loss of ROM.|
|Assess the client’s ability to perform ADLs. Determine what adaptive measures the client has already taken to be able to perform self-care measures.||Joint deformity, especially in the hands, that occurs with OA may limit certain self-care activities by the client. A spouse may assist in buttoning the clothes or picking up dropped objects. The client may have had the assistive device installed in the shower or near the toilet (handlebars, raised toilet seat). This information gives the nurse a sense of the measures the client has had to take remain functional.|
|Assess the client’s comfort with and knowledge of how to use assistive devices.||The correct use of assistive devices for ambulation can improve mobility and reduce the risk for falls. Some clients refuse to use assistive devices because they attract attention to their disability.|
|Assess the client’s vital signs after physical activity.||Elevations in HR, respiratory rate, and BP may be a function of increased effort and discomfort during the performance of tasks.|
|Encourage the client to increase activity as indicated.||Increasing activity at home can be effective in maintaining joint function and independence. A balance must exist between the client performing enough activity to keep joints mobile and not taxing the joint too much.|
|Increase the client in how to perform isometric, and active and passive ROM exercises to all extremities.||Muscular exertion through exercise promotes circulation and free joint mobility, strengthens muscle tone, develops coordination, and prevents nonfunctional contracture.|
|Discuss the environmental barriers to mobility.||It may no longer be reasonable for the client to continue to live in a home or apartment with multiple flight or stairs or continue to try to take care of a large home. If the client is using a cane or walker, carpets must be tacked down or removed. Items that are used often should be kept within reach.|
|Encourage sitting in a chair with a raised seat and firm support.||This adaptive technique facilitates getting in and out of chair safety.|
|Encourage the client to ambulate with assistive devices (such as cane, crutches, walker).||Using mobility aids reduces the load on the joint and promotes safety.|
|Encourage the client to rest in between activities that are tiring. Suggest strategies for getting out of bed, rising from chairs, and picking up objects from the floor to conserve energy.||Rest periods are necessary to conserve energy. The client must learn to respect limitations of his or her joints; pushing beyond the joint of pain will only increase the stress on the joint. The client needs to recognize and accept the limitations of his or her joints. Rushing is likely to be frustrating and self-defeating and may result in unsafe conditions for the client.|
|Provide the client with access to and support during weight-reduction programs.||Weight reduction results in decreased trauma to bones, muscles, and joints.|
|Consult physical therapy staff to prescribe an exercise program.||The physical therapist can help the client to promote muscle strength and joint mobility and therapies to promote the relaxation of tense muscles. These interventions also may contribute to effective pain management.|
|Suggest a referral to community resources such as the Arthritis Foundation.||Community resources can provide the client with peer support nd additional information about resources (e.g, assistive devices).|
3. Activity Intolerance
- Activity Intolerance
May be related to
- Decrease muscle tone
- Joint pain
Possibly evidenced by
- Fatigue, Malaise
- Limitation of movement, muscle atrophy
- Client will use identified techniques to enhance activity intolerance.
- Client will report a measurable increase in activity intolerance.
|Assess the physical activity level and mobility of the client.||Provides baseline information for formulating nursing goals during goal setting.|
|Assess the client’s nutritional status.||Adequate energy reserves are needed during activity.|
|Assess the need for ambulation aids (e.g., cane, walker) for ADLs.||Assistive devices enhance the mobility of the patient by helping him overcome limitations.|
|Assist with ADLs while avoiding client dependency.||Assisting the patient with ADLs allows conservation of energy. Carefully balance provision of assistance; facilitating progressive endurance will ultimately enhance the patient’s activity tolerance and self-esteem.|
|Encourage active ROM exercises. Encourage the patient to participate in planning activities that gradually build endurance.||Exercise maintains muscle strength, joint ROM, and exercise tolerance. Physical inactive patients need to improve functional capacity through repetitive exercises over a long period of time. Strength training is valuable in enhancing the endurance of many ADLs.|
4. Risk For Injury
- Risk for Injury
May be related to
- Altered mobility
- Decreased bone function
Possibly evidenced by
- [not applicable]
- Client will be free of injuries.
- Client will identify measures to prevent injury.
|Assist client with active and passive ROM exercises and isometrics as tolerated.||Maintains and enhances muscle strength, joint function, and endurance.|
|Encourage client to lose weight to decrease stress on weight-bearing joints.||Excess weight adds extra stress on the joints, which can accelerate joint cartilage deterioration.|
|Use a buffer bed and positioning the bed as low when sleeping.||This will reduce possible injury from falling during sleep.|
|Instruct the client to use the softest surface available during exercise.||A soft and flat surface minimizes shaking of client’s joints and chances of hurtful steps that could aggravate the condition.|
|Instruct the use of adaptive mobility equipment such as walkers, canes, and crutches as indicated.||This will keep the joints mobile, promote safety, and maintain a high quality of life.|
|Instruct the client regarding safety measures:
||Helps prevent accidental injuries and falls.|
2 Osteoarthritis Nursing Care Plan Examples
Nursing Care Plan 1
Nursing Diagnosis: Deficient Knowledge related new diagnosis of Degenerative Joint Disease or Osteoarthritis, as evidenced by patient’s verbalization of “I want to know more how to manage my illness.”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of his/her acute pain and its management.
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits).||To address the patient’s cognition and mental status towards disease management and to help the patient overcome blocks to learning.|
|Explain what his/her pain management program entails (e.g. medications, relaxation techniques, diet, and related physiotherapy or exercises). Avoid using medical jargons and explain in layman’s terms.||To provide information on his/her pain management program for OA.|
|Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to treat acute pain. Ask the patient to repeat or demonstrate the self-administration details to you.||To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.|
|Educate the patient about non-pharmacological methods for acute pain such as imagery, distraction techniques, recommended exercises, and relaxation techniques.||To reduce stress and to promote optimal pain relief without too much dependence on pharmacological means.|
|If the patient is for surgery, explain the surgical procedure related to osteoarthritis to the patient and carer.||The doctor may recommend surgery to resolve unbearable joint pain due to OA.|
Nursing Care Plan 2
Nursing Diagnosis: Activity intolerance related to joint inflammation and pain secondary to osteoarthritis, as evidenced by pain score of 10 out of 10, fatigue, disinterest in ADLs due to pain, verbalization of tiredness and generalized weakness
Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.
|Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.||To create a baseline of activity levels and mental status related to chronic pain, fatigue and activity intolerance.|
|Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.||To gradually increase the patient’s tolerance to physical activity. To prevent triggering pain by allowing the patient to pace activity versus rest.|
|Administer analgesics as prescribed prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.|
|Refer the patient to physiotherapy / occupational therapy team as required.||To provide a more specialized care for the patient in terms of helping him/ her build confidence in increasing daily physical activity.|
|If the patient is overweight or obese, create a weight loss plan with the patient, carer, physiotherapy/occupational therapy, doctors, and dietitian.||Obesity is one of the most common risk factors for degenerative joint disease or OA, thus, a crucial part of the treatment is to lose weight through diet and exercise.|