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 a 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.
Nursing Care Plans
Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of less than six (6) months.
Chronic Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain); sudden or slow onset of any intensity from mild to severe, constant or recurring without an anticipated or predictable end and a duration of greater than six (6) months.
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, respirations, 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 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 in 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.|
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Select books and recommended resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans