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.
Nursing Care Plans
Nursing care plan for clients with osteoarthritis involves relieving pain, promoting comfort measures, maintaining optimal joint function, and preventing progressive disability.
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).|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
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