Nursing Care Plan for Osteoarthritis

Osteoarthritis

Osteoarthritis (OA) also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. A variety of causes—hereditary, developmental, metabolic, and mechanical—may initiate processes leading to loss of cartilage. When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax.

Treatment generally involves a combination of exercise, lifestyle modification and analgesics. If pain becomes debilitating joint replacement surgery may be used to improve the quality of life. OA is the most common form of arthritis, and the leading cause of chronic disability in the United States. It affects about 8 million people in the United Kingdom and nearly 27 million people in the United States.


Causes

Exercise, including running in the absence of injury, has not been found to increase one's risk of developing osteoarthritis. Some investigators believe that mechanical stress on joints underlies all osteoarthritis, with many and varied sources of mechanical stress, including misalignments of bones caused by congenital or pathogenic causes; mechanical injury; overweight; loss of strength in muscles supporting joints; and impairment of peripheral nerves, leading to sudden or uncoordinated movements that overstress joints.

Primary
Primary osteoarthritis of the left knee. Note the osteophytes, narrowing of the joint space (arrow), and increased subchondral bone density (arrow).

This type of OA is a chronic degenerative disorder related to but not caused by aging, as there are people well into their nineties who have no clinical or functional signs of the disease. As a person ages, the water content of the cartilage decreases as a result of a reduced proteoglycan content, thus causing the cartilage to be less resilient. Without the protective effects of the proteoglycans, the collagen fibers of the cartilage can become susceptible to degradation and thus exacerbate the degeneration. Inflammation of the surrounding joint capsule can also occur, though often mild (compared to that which occurs in rheumatoid arthritis). This can happen as breakdown products from the cartilage are released into the synovial space, and the cells lining the joint attempt to remove them. New bone outgrowths, called "spurs" or osteophytes, can form on the margins of the joints, possibly in an attempt to improve the congruence of the articular cartilage surfaces. These bone changes, together with the inflammation, can be both painful and debilitating.

A number of studies have shown that there is a greater prevalence of the disease between siblings and especially identical twins, indicating a hereditary basis. Up to 60% of OA cases are thought to result from genetic factors.

Both primary generalized nodal OA and erosive OA (EOA. also called inflammatory OA) are sub-sets of primary OA. EOA is a much less common, and more aggressive inflammatory form of OA which often affects the DIPs and has characteristic changes on X-Ray.

Secondary
This type of OA is caused by other factors but the resulting pathology is the same as for primary OA:

* Congenital disorders of joints
* Diabetes.
* Inflammatory diseases (such as Perthes' disease), (Lyme disease), and all chronic forms of arthritis (e.g. costochondritis, gout, and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace.
* Injury to joints, as a result of an accident or orthodontic operations.
* Septic arthritis (infection of a joint )
* Ligamentous deterioration or instability may be a factor.
* Marfan syndrome
* Obesity
* Alkaptonuria
* Hemochromatosis and Wilson's disease


Signs and symptoms

The main symptom is pain, causing loss of ability and often stiffness. "Pain" is generally described as a sharp ache, or a burning sensation in the associate muscles and tendons. OA can cause a crackling noise (called "crepitus") when the affected joint is moved or touched, and patients may experience muscle spasm and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Humid and cold weather increases the pain in many patients.

OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff and painful, and usually feel worse, the more they are used throughout the day, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain.

OA is the most common cause of joint effusion, sometimes called water on the knee in lay terms, an accumulation of excess fluid in or around the knee joint.
Source : http://en.wikipedia.org/wiki/Osteoarthritis

 Nursing Care Plan for Osteoarthritis

Nursing Assessment for Osteoarthritis

1. Activity / Rest
   • Joint pain due to movement, tenderness worsened by stress on the joints, stiffness in the morning, usually occurs bilaterally and symmetrically functional limitations that affect lifestyle, leisure, work, fatigue, malaise.
   • Limitation of movement, muscle atrophy, skin: contractor / abnormalities in the joints and muscles.
2. Cardiovascular
   • Raynaud's phenomenon of the hand (eg litermiten pale, cyanosis and redness on the fingers before the color returned to normal.
3. Ego Integrity
   • Stress factors of acute / chronic (eg, financial jobs, disability, relationship factors.
   • Hopelessness and helplessness (inability situation).
   • Threats to the self-concept, body image, personal identity, for example dependence on others.
4. Food / Fluids
   • The inability to produce or consume food or liquids adequately nausea, anorexia.
   • Difficulty chewing, weight loss, dryness of mucous membranes.
5. Hygiene
   • The difficulties to implement self-care activities, dependence on others.
6. Neurosensory
   • Tingling in hands and feet, swollen joints
7. Pain / comfort
   • The acute phase of pain (probably not accompanied by soft tissue swelling in the joints. chronic pain and stiffness (especially in the morning).
8. Security
   • Skin shiny, taut, nodules sub mitaneus
   • Skin lesions, foot ulcers
   • The difficulty in handling the task / household maintenance
   • Mild fever settled
   • Dryness in the eyes and mucous membranes
9. Social Interaction
• Damage interaction with family or others, the changing role: isolation.
10. Counseling / Learning
    • Family history of rheumatic
    • The use of health foods, vitamins, cure disease without testing
    • History pericarditis, valve lesion edge. Pulmonary fibrosis, pleuritis.

Nursing Diagnosis for Osteoarthritis

1. Pain Acute / Chronic related to distention of tissue by the accumulation of fluid / inflammatory process, Liquor joints.
2. Impaired Physical Mobility related to skeletal deformities, pain, discomfort, decreased muscle strength.

Nursing Diagnosis and Nursing Intervention for Osteoarthritis

1. Pain Acute / Chronic related to distention of tissue by the accumulation of fluid / inflammatory process, Liquor joints.
 
Expected Outcomes :

• Showing pain is reduced or controlled
• Looks relaxed, to rest, sleep and participate in activities based on ability.
• Following the therapy program.
• Using the skills of relaxation and entertainment activity in the pain control program.

Nursing Intervention :

• Assess pain; note the location and intensity of pain (scale 0-10). Write down the factors that accelerate and signs of non-verbal pain.
• Give the hard mattress, small pillow. Elevate bed when a client needs to rest / sleep.
• Help the client take a comfortable position when sleeping or sitting in a chair. Depth of bed rest as indicated.
• Monitor the use of a pillow.
• Help clients to frequently change positions.
• Help the client to a warm bath at the time of waking.
Help the client to a warm compress on the sore joints several times a day.
• Monitor temperature compress.
Give a massage.Encourage the use of stress management techniques such as progressive relaxation bio-feedback therapeutic touch, visualization, self hypnosis guidelines imagination, and breath control.Engage in activities of entertainment that is suitable for individual situations.
• Give the drug before activity / exercise that is planned as directed.
• Assist clients with physical therapy.

2. Impaired Physical Mobility related to skeletal deformities, pain, discomfort, decreased muscle strength.  

Expected Outcomes :

Maintain or improve strength and function of the compensation part of the body

Demonstrating techniques / behaviors that allow doing activities.

 
Nursing Intervention

• Monitor the level of inflammation / pain in joints
• Maintain bed rest / sit if necessary
• Schedule of activities to provide a rest period of continuous and uninterrupted nighttime sleep.
• Assist clients with range of motion active / passive and resistive exercise and isometric if possible.
• Slide to maintain an upright position and sitting height, standing, and walking.
• Provide a safe environment, for example, raise the chair / toilet, use a high grip and tub and toilet, the use of mobility aids / wheelchairs rescue.
• Collaboration physical therapist / occupational and specialist vasional.