4 Osteoarthritis Nursing Care Plans

Acute Pain/Chronic Pain

Patients with osteoarthritis experience acute pain due to the degeneration of the protective cartilage in their joints, which results in bone-on-bone friction during movement. This friction causes inflammation and irritation of the joint, leading to the sensation of pain.

Nursing Diagnosis

• Acute Pain
• Chronic Pain

May be related to

• Bone deformities
• Joint degeneration
• Muscle spasm
• Physical mobility

Possibly evidenced by

• Crying
• Facial grimaces
• Irritability
• Protective, guarded behavior
• Restlessness
• 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, spasms, tingling, numbness
• Withdrawal

Desired Outcomes

• The client will report satisfactory pain control at a level of less than 3 to 4 on a scale of 0 to 10.
• The client will use pharmacological and nonpharmacological pain relief strategies.
• The client will exhibit increased comfort such as baseline levels for HR, BP, respiration, and relaxed muscle tone or body posture.
• The client will engage in desired activities without an increase in pain level.

Nursing Assessment and Rationales

1. 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.

2. Assess the client’s previous experiences with pain and pain relief.
The client may have a tried-and-true plan to implement when OA becomes exacerbated. Consideration should be given to implementing this plan, with modifications if necessary, when the pain becomes acute.

3. 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.

4. 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.

5. Determine the client’s emotional reaction to chronic pain.
The client may find coping with a progressive, debilitating disease difficult.

Nursing Interventions and Rationales

1. Develop a pain relief regimen based on the client’s identified aggravating and relieving factors. Instruct the client to do the following:

• 1.1. Apply a hot or cold pack.
  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.

• 1.2. Change positions frequently while maintaining functional alignment.
  Muscle spasms may result from poor body alignment, resulting in increased discomfort.

• 1.3. Eliminate additional stressors.
  Chronic pain takes an enormous emotional toll on clients. Reducing other factors that cause stress may make it possible for the client to have more significant reserves of emotional energy for effective coping.

• 1.4. Medicate for pain before activity and exercise therapy.
  Exercise is necessary to maintain joint mobility, but clients may be reluctant to participate in exercise if they are in too much pain.

• 1.5. Provide adequate rest periods.
  Fatigue impairs the ability to cope with discomfort.

• 1.6. Support joints in a slightly flexed position through the use of pillows, rolls, and towels.
  Flexion of the joints may reduce muscle spasms and other discomforts.

• 1.7. Use adaptive equipment (such as a cane, or walker), as indicated.
  These aids assist in ambulation and reduce joint stress.

2. Instruct the client to take prescribed analgesics and/or anti-inflammatory medications. Provide instruction on important side effects: 

• 2.1. Acetaminophen
  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).

• 2.2. Selective 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.

• 2.3. Nonselective NSAIDs
  These drugs are anti-inflammatory, antipyretic, and analgesic agents. They are

• 2.4. Muscle relaxants
  These drugs may relax painful muscle spasms. They may cause drowsiness and may exaggerate the central nervous system‘s depressive effects of alcohol and other drugs.

• 2.5. Corticosteroids
  These drugs are anti-inflammatory and are 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.