In Partial Fulfillment of the Requirements in Nursing Care Management 104 Related Learning Experience

A Compilation Presented to the STI College of Nursing Presented by:

Group Leader:
Rubio, Reshiel

Afante, Booz Andres, Jessica Arcena. Katrine Ann Atienza, Angielique Barron, Edgar Allan Cabutihan, Precious Diane Delos Santos, Rosella De Luna, Leny Macabasco, Queenie

Chapter I
INTRODUCTION Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. Osteoarthritis is 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. Also known as the wear and tear disease, it is characterized by areas of destruction of articular cartilage, sclerosis of the underlying bone, and hypertrophy of soft tissues. This type of arthritis affects more people than any other type. Patients usually know this disease best as old-age arthritis. Patients with OA may have joint pain on only one side of the body and it primarily affects the knees, hands, hips, feet, and spine. In the Philippines, the point prevalence of osteoarthritis is 4.1 percent of an urban population (mean age=34). Manila, its capital city, with a population of 11 million, therefore has approximately half a million sufferers of OA. Considering population growth in the next 25 years as projected in the Summary of Philippine Demographic Data 2000, the number of individuals with OA will more than double by 2025.6 Recently, the Food and Nutrition Research Institute in the National Nutrition Health Survey (NNHES) of 2003 noted a 0.5 percent prevalence of OA among individuals 40 years of age and above, a lower figure compared to the first study, perhaps an effect of the methods employed in this national survey. This figure reflects not only

urban but also rural Philippines. In an 80 million strong population, this will easily be about 3.2 million plus Filipinos with the disease. A. Background of the Study Our patient is a 75-year-old male with Osteoarthritis (OA); he is suffering with this disease for almost 20 years, starting when he was 55 years old. He is former cook in a fishing vessel. B. Rationale for Choosing the Case We chose this case osteoarthritis of Mr. Beneficence because majority of the diseases encountered in the community were already tackled and discussed in previous case presentations like cough and colds, fever and hypertension. This is the only case which was not presented in the previous case presentations and it captures our attention. So far this was the interesting case we encountered in the community. All of us know that everyone will commence on the stage of aging, this could also be of great help to all of us so as we can further understand its development, clinical manifestation and the various means on how to manage it. C. • • Significance of the Study To the patient. This study aims to be of help to our patient by rendering the best care that we could possibly give to him. To the care givers or significant others. To aid and supplement them with information for the better management of his condition.

D. To be of reference to our fellow students who will handle the same case in the future. Drug study of the medications given and other treatments done to the patient. Scope and limitation This study covers and focuses on the following: • • • • • A brief discussion of the disease. To educate the public with knowledge about the disease as well as its management. To the student. its causes. manifestations and proper treatment. Chapter II CLINICAL SUMMARY . Preparation of discharge plan for the patient. Assessment of the patient.• • To the community. Formulation of nursing care plans appropriate for the patient.

symmetrical Absence of masses. Cruz. Laguna Age: 75 years old Sex: Male Marital Status: Married Date of Birth: ??????????????????????????????????????????????? Nationality: Filipino Religion: Roman Catholic Occupation: former cook Diagnosis: Osteoarthritis. Beneficence Address: Sta. lesions or nodules Hair Face Eyes Eyelids Sclera No tenderness.A.knee Allergies: No known allergy Past Medical History:????????????????????????????? Past History of Illness:???????????????????????????? Attending Physician: Dr. bilateral blinking. Biological Data Name: Mr. Physical Assessment Cephalocaudal Assessment BODY PART Head FINDINGS Normocephalic. thin Wrinkled skin Lids close symmetrically. oily. Tan Source of information: wife and himself B. No edema or tenderness over lacrimal gland Appears reddish with visible microvessels . No dandruff White hair.

no tenderness Light pink. moves freely. with usual number of fingers. symmetrical. no Thorax Abdomen tenderness Symmetrical. Nose Dry. no nodules. no bad breath Pink color. cilia present Septum was intact and in midline Mouth • Lips • Teeth • Tongue • Palates Uniform pink in color. moist. arms . smooth (soft palate) Neck Lighter pink. chest wall intact. Upper extremities: can Smooth extend coordinated without movements. no tenderness No adventitious breath sounds Unblemished skin. lesions color. no lesions.Iris Pupils Eye movement Ears With presence of cataract on OU PERRLA OU coordinated. Symmetric and straight. uniform symmetrical. masses and lesions. head centered Free from lumps. ability to purse lips Smooth. Extremities no tenderness. no lesions. irregular texture (hard palate) Muscles equal in size. and masses Skin uniform in color. air moves freely as the client breathes through the nares Mucosa pink. auricle aligned with outer canthus of eye. difficulty. grayish-tan cerumen. move in unison with parallel alignment Color same as facial skin. free from discharge. intact.

Symptoms felt include stiffness of both knees mostly during every early in the morning and during cold weather. Both knees are swollen. get in and out of chairs and do other activities. prominently on the left. 2010 August 36. System Assessment The major system involved in the case study is the musculoskeletal system.Lower extremities: With presence of inflammation on both knees. with pain upon movement Capillary refill = 2secs C. Vital Signs Date Temperature (°C) July 27. Both knees are the joints most affected to Mr.9 36. 2010 August 2.7 36. prominently on the left and pain felt upon movement which makes him find hard to walk. Beneficience.3 Pulse rate (bpm) 70 67 66 Respiratory rate (cpm) 22 23 20 Blood Pressure (mmHg) 120/90 120/80 120/80 .

Anatomy and Physiology Joints • • Also called articulations It is placed where two bones come together .3. Course in the Community July 27. 2010 36. 2010 ???????????????????????????????????????????????????????????????? Maam.. 2010 August 9. Chapter III Clinical Discussion A. ung course in the community po n kay miss delos santos po.7 68 22 120/80 Height and Weight • • Height: 5’8’’ Weight: 70 kg D.

hip. vertebrae).g.permits little or no mobility.slight movement . Most amphiarthrosis joints are cartilaginous joints (e.• It is usually considered movable but not all the time.non-movable joints .freely movable joints . Most synarthrosis joints are fibrous joints (e.. many joints have limited movements while others are almost completely or completely immovable. shoulder. skull sutures).g. All diarthrosis joints are synovial joints (e. o Amphiarthrosis. • The 3 major structural classes of joints are: o Fibrous joints. .freely movable joints .not directly joined • There are 3 classifications of joints based on the degree of motions: o Synoarthrosis.permits slight mobility.slightly movable joints .. elbow.little movement ..g.joined by cartilage o Synovial joints.joined by fibrous connective tissue o Cartilaginous joints. o Diarthrosis . knee).permits a variety of movements.

The Synovial Joints • It contains synovial fluid in a cavity surrounding the end of articulating bones. It also for a thin lubricating film that covers the surface of the joint. This membrane is responsible for the production of synovial fluid. The synovial fluid is a complex mixture of polysaccharides. They are also responsible for the reduction of friction. that damages the structure involve. • Tendon sheaths serves as the extension along with some tendons associated with the joints. . Portion of the joint capsule maybe thickened to form ligaments and tendons outside the joint capsule that helps in strengthening of the joint. • The joint cavity is filled with a fluid called synovial fluid that is enclosed by a joint capsule that helps hold the bone together and allows movement. fats and cells. protein. • The synovial membrane lines the joint cavity everywhere except over the articular cartilage. • The articular cartilage is a thin layer of cartilage that covers the surface of the bone within the synovial joint that provides a smooth surface where the bones meet. In certain synovial joint the synovial fluid extends up to a pocket called bursa. • Bursa or bursae are pocket located between the structures that rub together.

Saddle 4. Ball and socket 2. Hinge 5.Types of Synovial Joints 1. Condyloid (ellipsoid) 3. Pivot • Plane or gliding joints .

knee and finger joints . • Saddle joint o Consist of 2 saddle shaped articulating surface oriented at right angles to each other. thumb • Hinge joints o Permits movement in 1 plane only o They consist of convex cylinder of bone o Elbow. o Articular surface between vertebrae. o Movements in these joints can occur in 2 planes.o consist of 2 opposed flat surface that glides over each other. o Joints between the metatarsals and carpals.

• Ball-and-socket joints .• Pivot joints o Restrict movements to rotation around a single axis o Each of these joint is consist of cylindrical bony process that rotates within a ring composed partly of ligaments.

o It consists of the ball or the head at the end of 1 bone and a socket in an adjacent bone into which portion of the ball fits. o It allows a wide range of movements in almost any directions o Shoulder and hip joints • Ellipsoid or Condyloid joints o Are elongated ball-and-socket joint o The shape of the joint limit the range of movement nearly to a hinge motion but in 2 planes o The joint between the occipital condyles of the skull and the atlas of the vertebral column .

results in many metabolic bone diseases.----.-----------healed fracture Bone Repair Stages of Healing . Bone remodeling (or bone metabolism) is a life-long process where mature bone tissue is removed from the skeleton (a process called bone resorption) and new bone tissue is formed (a process called ossification or new bone formation).----. As a result. almost 100% of the skeleton is replaced. remodeling proceeds at about 10% per year. In the first year of life. normal bone ---------.Bone tissue is removed by osteoclasts. and then new bone tissue is formed by osteoblasts. Remodeling responds also to functional demands of the mechanical loading. IGF) signalling.--------. such as osteoporosis. These processes also control the reshaping or replacement of bone during growth and following injuries like fractures but also micro-damage.[1] An imbalance in the regulation of bone remodeling's two sub-processes.---------. bone resorption and bone formation. Both processes utilize cytokine (TGF-β. In adults. bone is added where needed and removed where it is not required. which occurs during normal activity.

When a bone is broken. Please include also how bone remodeling & repair occur??? It was written in your anaphys book coz this will be included in your pathophysio. . Callus ossification. called a callus. Clot formation. the clot and produce a fibrous network and cartilage between the broken bones. a clot Callus formation. The cancellous bone is slowly and form cancellous bone. 4.Clot formation Callus formation Callus ossification Bone remodeling 1. 2. Blood vessels and cells invade forms in the damaged area. remodeled to form compact bone and the repair is complete. It usually happens when damage occur but if it does not work that is the time surgery or stem cell or growth hormone injection will advisable to be done. 3. Osteoblasts enter the callus Bone remodeling.

Pinch/crowd Pai -----------------------------n ! ! ! ! ! ! ! ! ! ! Acts on pain receptors Pai n Release of chemical mediators Increase blood Increase vascular permeablity edema Inflammatory response Immobilizatio n Advancing Loss of Formation of Osteocytes Decrease in synovial fluid Degeneration of cartilage Continuous use of joint Disappearing of full thickness of articular Wear and tear of articular cartilage ! ! ! ! ! ! Osteoarthritis ! If not remodeled Surgery. increase WBC . Pathophysiology Predisposing Factors Age. Obesity.B. GH & stem cell injection Precipitating Factors Diet. Nature of work Narrowing of joint spaces Pressure between joint Pai ------------n ! Difficulty of --------movement ! ! --------! See n in x-ra y Obliteration of joint space ! ! ! ! Formation of subchondral cysts ! ! Hardening of the underlying bone ! ! ! Repair and remodelling ! Redness.

!-------------------------------!-------------------------------!-----------------------. Drug Study .! !------------------------------------------- C.---------------------------.

Antiinflammatory Inhibition prostagl in synthesi .Drug Name Classification Mechan of Actio Flanax ( Naproxen Sodium) 500mg PO Bid Analgesic. Antipyretic.

Vitamin B Complex A coenzyme that stimulat metabolic function and is needed for cell replication.Drug Name Classification Mechanism of Action B complex 1 tab OD to be taken orally. .

Objective: • Limited ability to perform skills • Felt stiffness every early morning or during cold weather Diagnosis Impaired physical mobility related to loss of bone structure as evidenced by client’s verbalization and slowed movement.” the patient. Rationale To maintain position of function and reduced risk of pressure ulcers. • To prevent fall.Chapter IV Nursing Care Plan Assessment Subjective: “Nahihirapan akong kumilos sa umaga. • To reduce fatigue. • Intervention • Support the affected body parts/joints by using pillow or rolls. air mattress. Schedule activities with adequate rest periods during the day. Evaluation After series of nursing intervention the client was able to maintain strength and function of the affected body part as evidenced by the client can now perform simple exercise such as walking for at least 1530minutes everyday and • as verbalized by integrity of . foot support or shoes. Planning After series of nursing intervention the client will be able to maintain/ increase strength and function of the affected and/or compensatory body part.

.• Limited range of motion • Provide for safety measures as indicated by individual situation including environment al management . • To permit maximal effort or involvement in activity. • • • Slowed movement Joint swelling Decreased walking speed • Encourage adequate intake of fluids or nutritious foods particularly foods that are rich in calcium. strengthen bone density and maximize energy production. drink glass of milk every morning. • To promote well being.

• Teach the importance . • To improve the blood circulation in the joints. • Encourage to do simple exercise such as walking for at least 15 minutes. • To aid in walking and minimize injuries. • To minimize the use of body energy. • To reduce weight that would reduce the pressure in the joints.• Encourage to take medications prior to activity as needed for pain relief. • Teach weight loss diet. if appropriate.

.and appropriate use of devices such as walker. canes and crutches. • Advised client to rest between each activities.

facial grimace. • • Note client’s attitude towards pain medication. Intervention • Assessed for referred pain. • The client follow pharmacologi cal regimen as prescribed. • Determine factors of client’s lifestyle. Evaluation After series of nursing intervention the client’s pain was lessened from 6/10 to 3/10 and ways on how to provide relief as evidenced by. Objective: • • Pain scale of 6/10 With guarded behavior • • • With facial grimace Immobility Swollen joints P= cold weather/ Diagnosis Acute pain related to loss of integrity of bone structure as evidenced by client’s verbal reports. immobility & swollen joints. • Took glasses of milk everyday. • To determine demonstrated the effectiveness of relieving pain.” as verbalized by the client.Assessment Subjective: “Masakit ang tuhod ko. • Rationale To help determine possibility of underlying conditions requiring treatment. To determine the effect response to analgesic or choice of intervention for pain management . Planning After series of nursing intervention the client’s pain scale of 6/10 will decrease to 2/10.

• To promote nonpharmacolog ical pain management and avoid being dependant to pain relievers. • . listening to music and socialization with others. To prevent fatigue and conserve • Encourage adequate . • Walk for 1530minutes as a means of exercise. This usually alters when pain occurs. • Provide comfort measure such as use of hot compress and encourage the use of diversional activities like watching tv.analgesic Q=pressing R=thigh & lower leg S= 6/10 T= • Monitor vital signs and skin color.

rest periods. • To strengthen the bone density and reduce inflammatory response. . • Instructed the client to eat nutritious foods especially food that are rich in calcium. protein and carbohydrate . energy. • Instruct the client to follow medication regimen as prescribed by the physician. • To help reduce the pain sensation.

Assessment Subjective: “Bakit po kaya lagi paring sumasakit ang Diagnosis Deficient knowledge related to lack of information Planning After 8 hours of nursing intervention the client will verbalized understanding Intervention • Determine the client’s ability or readiness and barriers to learning. • Be alert in the signs of avoidance. emotionally or mentally capable at this time. • Rationale Individual may not be physically. Evaluation After 8 hours of nursing intervention the client was able to verbalized and demonstrated understanding of situation and individual treatment regimen and safety measures AEB client followed safety measures & treatment regimen such as: does simple exercise every tuhod ko tuwing and umaga at kapag unfamiliarity malamig ang panahon. with information of situation and treatment regimen and safety measures. May need the help of SO or .” As verbalized by the client Objective: • Does not know how to manage the present condition particularly as to what type of resource. • Client may need to suffer consequence of lack of knowledge • Assess the level of client’s capabilities and the possibilities of the • before he is ready to accept information.

. Can encourage continuation of efforts.. takes analgesic as prescribed. signs and symptoms. causes. • Provide feed back. treatment and management . drinks milk every morning. • Always asking questions as related to the condition. Can improve understandin g about the disease condition thereby acquiring clients cooperation on disease management . • Begin the information • caregivers to learn. Provide information relevant only to the situation such as definition of osteoarthritis . • situation. morning for 1530min.action to be done and diet to be followed.

• Can arouse interest or limit sense of being overwhelmed . progressing from simple to complex.the client already knows and more to what the client does not know. • To monitor the progression of the disease and effectiveness of therapy. • Advised the client the importance of having a regular check up to the physician or RHU. .

 Support affected body parts / joints using pillows / rolls.  Encourage adequate intake of fluids as well as nutritious foods. To maintain position of function and reduce risk of pressure ulcers. . To promotes well being and maximizes energy production. Objective:  Limited range of motion  Slow ed movement Impaired Physical Mobility related to loss of integrity of bone structure. foot support / shoes.Assessment Diagnosis Planning Intervention Rationale Evaluation Goal met Subjective: “ Kadalasan hindi agad ako makakilos o makagalaw lalo na tuwing umaga” as verbalized by the patient. After series of nursing intervention the patient will be maintain or increase strength & function of affected and or compensatory body part.

 Encourage the patient to ambulate with assistive devices. To keep joints mobile and not taxing the joint too much To reduces the load on the joint and promotes safety. Gait  Stiffness (early morning until about an half hour after rising  Muscle spasms  Joint swelling  Encourage the patient to increase activity as indicated. .

Chapter V Discharge Planning .

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