In this article, we will discuss the nursing diagnosis for osteoarthritis nursing care plans, as well as nursing interventions, nursing management, and effective strategies for managing this condition.
What is Osteoarthritis?
Osteoarthritis (OA) also known as a 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 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 and chondrocyte production of the 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 to 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
Nursing care plan for clients with osteoarthritis involves relieving pain, promoting comfort measures, maintaining the optimal joint function, and preventing progressive disability.
Here are four (4) nursing care plans (NCP) and nursing diagnoses for patients with osteoarthritis:
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.
- 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, spasms, tingling, numbness
- 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.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans for musculoskeletal disorders and conditions:
- Amputation | 4 Care Plans
- Congenital Hip Dysplasia | 4 Care Plans
- Fracture | 11 Care Plans
- Juvenile Rheumatoid Arthritis | 4 Care Plans
- Laminectomy (Disc Surgery) | 8 Care Plans
- Osteoarthritis | 4 Care Plans
- Osteoporosis | 4 Care Plans
- Rheumatoid Arthritis | 6 Care Plans
- Scoliosis | 4 Care Plans
- Spinal Cord Injury | 12 Care Plans
- Total Joint (Knee, Hip) Replacement | 5 Care Plans
1 thought on “4 Osteoarthritis Nursing Care Plans”
Hi, this was very educational!