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Tagum Doctors College Inc.

Tagum City College of Nursing

___________________

A CASE STUDY On OSTEOARTHRITIS ___________________

In Partial fulfillment of the Requirements In Related Learning Experience

By Abuda, Shelou Germata, Geza Dee Liquit, Charmaine Lynne Riña, Dyan Bebs Segovia, Cherry Ann Serra, Marlunee Suico, Mary Joy Tanzo, Glezel Ann Verin,Krystel Ybañez, Vanessa Joy YecYec, Ara Annie Del BSN 3

ii

January 23, 2010

TABLE OF CONTENTS

I.

INTRODUCTION Objectives
A. General Objective B. Specific Objective

iv

vii vii 1 1 2 2 3 3 3 4 5 18 18 18 22

II.

ASSESSMENT A. Biographical Data B. Chief Complaint
C. History of Present Illness

D. Past Medical History E. Personal and Family History F. Socio-economic Status G. Nutritional Status H. Family Genogram I. Developmental Task J. Physical Assessment a. b. c. General Survey Vital Signs Physical Examination

III. IV.

REVIEW OF ANATOMY AND PHYSIOLOGY SYMPTOMATOLOGY AND ETIOLOGY

41 44

iv V. PATHOPHYSIOLOGY 51 52 51 Narrative Diagram VI. a. Synthesis of Client’s Condition B. b. VIII. IX. Recommendation X. Nursing Care Plan 1 B. PHARMACOLOGICAL MANAGEMENT DISCHARGE PLAN SYNTHESIS OF CLIENT’S CONDITION A. XI. PLANNING A. Nursing Care Plan C. Nursing Care Plan VII. 54 54 57 61 66 75 79 79 80 82 83 84 EVALUATION OF OBJECTIVES OF THE STUDY BIBLIOGRAPHY . Patient’s Prognosis C.

Osteoarthritis is the most common type of arthritis and is seen especially among older people. Unlike some other forms of arthritis. or the blood vessels. spine. Osteoarthritis commonly affects the hands. such as the hips and knees. Over time. It does not affect skin tissue. Sometimes it is called degenerative joint disease or osteoarthrosis (Gayle Lester. feet. In osteoarthritis. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints (William C. When the cause of the osteoarthritis is known. the lungs. osteoarthritis affects only joint function. This allows bones under the cartilage to rub together. INTRODUCTION Osteoarthritis is a type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints. & Victor M. the joint may lose its normal shape. such as rheumatoid arthritis. Healthy cartilage allows bones to glide over one another. This causes more pain and damage. Shiel Jr. 2010). Brandt. the surface layer of cartilage breaks and wears away. small deposits of bone— called osteophytes or bone spurs—may grow on the edges of the joint. Goldberg. Osteoarthritis does not affect other organs of the body. Also. People with osteoarthritis usually have joint pain and stiffness. 2010). Kenneth D. the eyes. Bits of bone or cartilage can break off and float inside the joint space. It also absorbs energy from the shock of physical movement. causing pain. and large weight-bearing joints. the condition is referred to as secondary osteoarthritis. and loss of motion of the joint. Primary . Most cases of osteoarthritis have no known cause and are referred to as primary osteoarthritis. swelling..I.

The most common symptom of osteoarthritis is pain in the affected joint(s) after repetitive use.vi osteoarthritis in which our patient belongs is mostly related to aging. cartilage begins to degenerate by flaking or forming tiny crevasses. and Southern Chinese have lower rates (William C. 2010). There can be swelling. osteoarthritis occurs more frequently in males. A higher incidence of osteoarthritis exists in the Japanese population. causing pain at rest or pain with limited motion. Osteoarthritis of the knees which occurred in our patient is often associated with excess upper body weight. After 45 years of age. limitations on daily activities. Pain and stiffness of the joints can also occur after long periods of inactivity. Before age 45. In our patient. Symptoms also can be intermittent. Eventually. In severe osteoarthritis. Financial effects include the cost of treatment and wages lost because of disability. Shiel Jr. anxiety. job limitations and difficulty participating in everyday personal and family joys and responsibilities. with obesity. It is not unusual for patients with osteoarthritis of the finger joints of the hands and knees to have years of pain-free intervals between symptoms. East Indians. With aging. Some patients can be debilitated by their symptoms. the water content of the cartilage increases. feelings of helplessness. Joint pain is usually worse later in the day. and the protein makeup of cartilage degenerates. complete loss of the cartilage cushion causes friction between bones. and creaking of the affected joints. Symptoms of osteoarthritis vary greatly from patient to patient. On the other hand.. while South-African blacks. others may have remarkably few symptoms in spite of dramatic degeneration of the joints apparent on X-rays. it occurs more frequently in females. Lifestyle effects include depression. only few of this . or a history of repeated injury and/or joint surgery. warmth.

osteoarthritis is relatively mild and interferes little with day-to-day life. 875. 074 cases . In some people. For this reason. 642 cases . its effects are not just physical. in others. 2010). 341. These statistics are calculated extrapolations of various prevalence or incidence rates against the populations of a particular country or region.570. In the Philippines a number of 6. 686. 020. 015. European Region –787. It may progress quickly. 2009). it causes significant pain and disability. Although osteoarthritis is a disease of the joints. 037 cases with a total of 5. Asia Region – 3. The following are number of cases with osteoarthritis. In African region – 765. Region of the Americas – 752.vii effects happened which were anxiety. lifestyle and finances also decline. 880. 301 cases were noted in the year 2004 (Statistics by Country for Ostearthritis. Brandt. we come to choose this case to determine if the above-mentioned effects occurred in our patient and to know the reason how joint pain in the knee was experienced wherein fact the patient did not have any past injuries or accidents? . Osteoarthritis affects various people differently. but for most people joint damage developed gradually over years. & Victor M. 910 cases globally in the year 2004. limitations on daily activities and the cost of treatment (Gayle Lester. 771. Goldberg. In many people with osteoarthritis. in Davao Regional Hospital a total number of 1229 cases of osteoarthritis were reported in the year 2009 (Medical Records Section. 2004) Locally. Kenneth D. 157 cases .

determine the etiology of osteoarthritis. • • • • • review the developmental stages in accordance with our patient.viii OBJECTIVES a. GENERAL OBJECTIVES: This study aims to deepen our knowledge about acute osteoarthritis its cause and underlying factors which may contribute to its development. SPECIFIC OBJECTIVES: This study was undertaken to: • Present the overview of the patient’s case. trace the pathophysiology of osteoarthritis. • • • identify the underlying symptoms of the chosen case. . • assess the vital signs and overall condition of the patient. • formulate nursing care plans applicable for patient with osteoarthritis. show the biographical data of the patient. identify the objectives. study the patient’s history of past and present illness. b. trace the family genogram of the patient. • review the anatomy and physiology of the affected organs and systems related to the case chosen.

• classify the drugs for osteoarthritis and explain its action and effects to the patient. • identify prognosis of the patient patient’s condition in relation to its etiology and its existing signs and symptoms. . and • list down recommendations for the improvement of health of the patient’s condition.ix • create a discharge plan that are appropriate for patient with osteoarthritis.

& 5 mos.59 years old Husband: Ernesto De Jesus Children: • Erik. Manila. Merville Subd. ASSESSMENT A.II. Severa De Jesus Brother: • Reymundo.45 – normal Father’s name: Mr. Philippines Age: 63 yrs. Carlos De Jesus Mother’s name: Mrs. Tagum City Sex: Female Date of birth: July 12. Height: 5”5’ft.59 years old Carmelita. BMI: 20. BIOGRAPHICAL DATA Name: Lantican.40 years old . Elizabeth De Jesus Address: #73 Catleya St. Nationality: Filipino Weight: 55 kg.67 years old Sisters: • • Carmensita. 1947 Place of birth: Tondo.

2010 Admission time: 11:05 am Attending Physician: Dr. Dr. C. 2010 the patient had experienced right knee pain and difficulty of walking. Peñalver Admission Diagnosis: Osteoarthritis. that was her first time to be admitted in a hospital. 2010 at 8:00 AM. the patient was unable to stand or walk due to severe right knee pain that's why she decided to go to the hospital for a check up. CHIEF COMPLAINT The patient is 63 years and 5 months old with complaints of right knee pain affecting her walking ability. HISTORY OF PRESENT ILLNESS Last November 10. Glenn Renegado Admitting Physician: Dr. r/o Gouty Arthritis B. She was seen and examined by the admitting physician.11 • • • • Gary– 39 years old Erwin – deceased Eleonor– 36 years old Emerson – 35 years old Admission date: November 13. she was accompanied by her husband and son.Penalver with admitting diagnosis of . At 11: 05 am the same day. For that reason. she had self medication and took “Skelan” as to relieve the pain temporarily. On November 13.

Fortunately. cough and chicken pox during her childhood years. flu. E. common colds. when she met her husband she had experienced stable life. She works as a flower vendor and rents out a business stall at Trade Center. She had her elementary years at Lopez Elementary School in Manila but her family moved to Laguna the preceding year meant for financial reasons. and Mrs. TT. she experienced common health problems such as fever.She was raised up by her parents. Her husband assisted her in their flower shop selling. however she did not finished her college studies. PERSONAL AND FAMILY HISTORY The patient is a Filipino citizen born in Tondo. she was admitted right away at Tagum Doctors Hospital ward. She had her high school years at Los Baños School of Fisheries and took commerce for three years at Far Eastern University. r/o Gouty Arthritis.12 Osteoarthritis. She had no history of allergies or skin disorders. Tagum City. She has no past hospital admission or any surgery experience. When she . Mr. . De Jesus bestowed upon Christian belief. Subsequently. DPT. D. married and blessed with five children. PAST MEDICAL HISTORY Like a normal person. She is now a 63 year old active mother. She received complete immunization such as BCG. During spare time. Hepa-B and OPV as reported by the patient. she enjoys gardening and cleaning the yard. Manila .

13 was only two years old. her three siblings have hypertension as well. NUTRITIONAL STATUS The patient’s weight is 55 kg. F. Her children has their own family and own houses separately. The patient seldom eats processed foods .00 pesos which comes from their flower shop business. Tagum City. radio. living room equipped with home appliances such as television. her way of relaxation is reading magazines. SOCIO-ECONOMIC STATUS The patient lives together with her husband at #73 Catleya Street Merville Subdivision. and refrigerator and three comfort rooms with a flushed type toilet as described by the patient. cooking stove. G. and a height of 5’5”ft. Their estimated annual income is 90. vegetables and citrus fruits daily for every meal. Sometimes. At home. Her way of doing exercise is walking. meat once a week and sea foods for two times a week. Their source of water is from water district and dumoy as potable water. They live in a two storey concrete house with six bedrooms. Food intake is three times a day with an estimation of three to four cups of rice. watching television and play with her grandsons and granddaughters whenever they visit. her parents died because of hypertension. she doesn’t want to eat breakfast and only drinks coffee as her meal. Her body mass index (BMI) is 20. has a small kitchen.45 which is considered normal. Presently. electric fan. 000.

and hotdog. She doesn’t drink alcohol yet loves to drink sodas about 2-3 times a week. sardines. .14 such as corned beef. Fluid intake is 8-10 glasses per day as reported.

FAMILY GENOGRAM MS Grandmoth er MS Grandfathe r PS Grandfath er PS Grandmother Legend: Hypertension Arthritis Alive and well Brain Tumor Deceased Paternal side .MS Male Female Vehicular accident Paternal side .MS Male Female Erik 40y/o Gary 39y/o PATIENT 63y/o Severa Carlos Reymundo 67 y/o Carmensita 59 y/o Carmelita 59 y/o Ernesto 63 y/o 15 Erwin 35 y/o Eleonor 36y/o Eeo mrs n .H.PS Maternal side .PS Maternal side .

economicstandard of living Successfulachieve .I. As a mother she’s responsible managing their individual. He defines a developmental task as Fulfill a social civic and √ also teaches their children become responsible by to taskwhich arises at responsibilities or about a certain period in the life of Maintain an an √ way of discipline. was able to earn enough money in order to sustain learning is basic to person’s life life and that is concerned with peoplecontinue to theachievement of learn throughout the followingtask: their children and daily need. She life. she was a She years old) currently Robert Havighurst believed that This stage in a Housewife. Developmental Task Theorist Theory Developmental Task Rating Result Justification and Robert Havighurst Activity aging during Middle Adulthood (35 t0 55or 65 Patient was able to achieve this entire task.

to live tasks.disappro val by society and difficulty tasks. while failure and become √ home. in later Robert Havighurst (1971) J. and happily married.17 Assistadolescent ment of these children tasks leads to his responsible happiness and to happy adults. √ . successand later Learning leads to withpartner unhappiness in the individual.

the consensus of her significant others. Moral is followed. stages.18 Lawrence Kohlberg Moral Theory The theory holds that reasoning. has six OfLawrence identifiable developmental Kohlberg’s Development. basis for moral Her age correlates √ to post-conventional level. She laws knows must that be development and values. In to Stage five (social driven). morality develop areregarded . She is an active and community. post- Patient knows and understands the basic social rules that and should laws be the The ethical conventional level behavior. each more also known as the adequate responding moral than predecessor. dilemmas contract She is coming up with with a decision the its the world is viewed as holding different rights Kohlberg followed opinions. She is also what and according society’s aware is of wrong right to laws. Such of moral judgment perspectives far ages beyond the should be mutually as to each or Laws as studied respected abided because it is her earlier by Piaget unique who also claimed person that logic responsibility as a citizen of the state. at principled level.

that dialogue spawned on the (Lickona. a notion compromise. (http. on Piaget's work.19 through constructive social rather contracts than rigid Those do not the welfare voter and pays taxes on the right time.1976) philosophical implications such of research. which Kohlberg determined the moral process promote that general rules. Expanding dictums. She she knows can that of should be changed when necessary to violate some laws if it is untoward and development was meet "the greatest principally concerned good for the unjust. and that it people". As a moral person she is herself.org) Erik Erikson Psychosocial Theory Middle Adulthood: The Patient has positively 35 to 55 or 65 . And agrees on basic state’s stages. capable with greatest number of This is justice.wikipedia. continued throughout individual's achieved the majority and through decision. inevitable enough to reflect on her own conscience. lifetime.

20 Ego Development √ achieved this Stageof All of the stages in Outcome: Erikson's epigenetic are Generativity theory Self-absorption implicitly Stagnation Strengths: vs. She was also thankful to have children and family middle-age is the time people their more when like days most filling with member who are always there to meaningful subsequent stages. work become priority. stage Each is and creative work and family issues. but unfold according to both an innate scheme and one's upDuring this stage. or development. Each stage builds on the preceding stages. and paves the way for Erikson that responsible. Also. She views her life asmeaningful because already and she married has 5 and their to present at birth (at Basic least in latent Production and Care form). observed seems a to high children helping children become bringing in a family that expresses the values of a culture. characterized by a psychosocial adulthood is when we can expect to She reaffirms the . middle care for her and to support.

in order for to Source: *Fundamentals Nursing 8thedition. also on demands to take the values put on the of your own family by such as raising and individual parents society. passing them onto the crisis in each the next generation stage should be to help guide them resolved by the ego in that stage. and physiological development.page 353 of development proceed correctly." the on role we've longer envied.21 crisis. but can be altered by later experiences. The outcome of one stage is not permanent. based which is "be in charge. and/or children Ideally. religious. social. The main but goal of this stage is values of life that have real meaning – philosophical. Everyone mixture has of a the .

place and to the people around her. awake and responsive. General Survey The patient was alert. but personality development considered successful if the individual has is more of the "good" traits than the "bad" traits. PHYSICAL ASSESSMENT A. B. She was also oriented to time. She’s not able to walk and stand without assistance and for long period of time. She experienced right knee pain with the pain scale of 5/10. J. VITAL SIGNS DATE TIME VITAL SIGNS NORMAL ACTUAL INTERPRETATION .22 traits attained at each stage.

functions muscle exercise. and by the accuracy and type of thermometer Blood Pressure Systolic: 90130mmHg used. shivering.5 C0 36. Normal BP varies with age and others factors such as stress. drinking hot or cold fluids. contraction.8 C0 Temperature normal Temperature maintained the body’s is within range. sitting in a cold room. and thyroid activity). 2005) 120/80 Blood Pressure is within mmHg normal range. .23 11/13/10 (Upon Admission) 11:05 am Temperature 36. is between heat- producing (metabolism. exercise. Temperature can vary with such other as factors. (McKesson. fighting an infection.5-37.

supine. exercise and weight. medications. 86 bpm standing. Respiratory Rate 18-25 22 exercise. (Pillitteri. heavy meals. sitting and Pulse Rate 60-100 beats/min. (Dillon 2007) Normal. during notably. 2007) Respiratory Rate is within normal range. The heart rate changes based upon the body's most need for oxygen. It also tends to be fit lower in cycles/min cpm physically people. The normal respiratory rate varies with age.24 Diastolic : 60-90 mmHg genetics.A. It can be often taken in several positions. Respiratory Rate tends to increase with age. because exercise makes the heart stronger so it can pump more blood through the body with each contraction. Control (Respiration Mechanisms . Diurnal variations.

Temperature can vary with such other as factors. sitting in a cold room. shivering.) 11/15/10 (Upon Assessment) 8:00 am Temperature 36. 2005-2006. and by the accuracy and type of thermometer Blood Systolic: 120/80 used.2 C0 Temperature normal Temperature maintained the body’s is within range. (McKesson. is between heat- producing (metabolism. contraction. 2005) Blood pressure is within . functions muscle exercise. drinking hot or cold fluids. fighting an infection. and thyroid activity). exercise.5-37.5 C0 37.25 from World of Anatomy and Physiology.

26

Pressure

90130mmHg

mmHg

normal

range.

Various

factors influence a person's average BP and variations.

Diastolic : 60-90 mmHg

Factors such as age and gender values. influence As average age,

adults

systolic pressure tends to rise and diastolic tends to fall. Pulse Rate 60-100 beats/min. 90 bpm (Pillitteri,A. 2007). Normal. The heart rate

changes based upon the body's most need for oxygen, during

notably,

Respiratory Rate

18-25

20

exercise. (Pillitteri,A. 2007) Respiratory Rate is within normal range. The normal respiratory rate varies with age. Respiratory Rate tends to increase with age. It also tends to be fit lower in

cycles/min cpm .

physically

people,

because exercise makes the heart stronger so it can

27

pump more blood through the body with each

contraction. Control

(Respiration Mechanisms

from World of Anatomy and Physiology. 2005-2006.) C. Physical Assessment ASSESSMENT NORMAL FINDINGS • Neurologic Fully Status alert and Oriented to ACTUAL FINDINGS INTERPRETATION time, Patient’s level of people consciousness is

conscious. Oriented place

and

to time, place and around her. Able to good and he is a people. No speech respond to questions responsive defects and uses and maintains to eye correspondent. the Memory is intact

appropriate Thought

words. contact

is interviewer. Thought and is based in is reality reality. Good

comprehensible and content based Positive tendon reflex. Reference: (2007). in reality. based

without Language skills.

deep speech defects. Uses Reference: appropriate words in Dillon Dillon answering questions. Assessing Sensory(2007). the

Assessing Memory is intact.

28

the

Sensory-

Neurologic System, Nursing Health Assessment A

Neurologic System, Nursing Assessment critical Case Approach. Davis 1915 Health A

Thinking, Studies F.A. Company Arch Street PA

critical Thinking, Case Studies F.A.

Approach. Davis

Company

1915 Arch Street Philadelphia, PA 19103

Philadelphia, 19103

Integumentary System Methods Assessment Used: Inspection Palpation • Skin Skin is uniform in Skin is fair, soft warm Good skin turgor color, warm to touch to touch and uniform indicates patient with good skin in color with slightly is not of

Mucous membranes Mucous membranes Pink mucous pink in color. sores. darker areas. No cyanosis. any redness indicate lesions hematologic upon disease like no anemia. No sign of redness in the mucosal area shows that there is inflammatory infectious disorder present. of exposure Decreased turgor noted. skin the heat of the sun. moist pink and moist with membranes with no lesions or no inflammations.29 turgor. scars Exposed areas usually because to noted or any lesions are on the upper and darker lower extremities. No exposed dehydrated. no or • Hair and Hair is evenly Hair is evenly Fair distribution . and noted inspection.

Scalp is distributed. No masses tenderness upon palpation. Nail beds pink diseases that Dillon in color. No clubbing associated Assessing and bluish affect the level of noted. oxygenation such Integumentary discoloration . Fine body genetically hair noted over the linked. Hair and are and black in color. shape. convex Nails are convex in smooth texture with present shape and firm no inflammations signifies without clubbing. thin. Reference: (2007). White color hair noted upon distribution inspection. silky thick of hair. Free from and pediculosis. soften or trimmed. lice and nits noted. No scalp lesions. intact and free of strand. Clubbing is not which no skinned individuals. and noted • Nails Nails vary from light Fingernails skinned brown in to light toenails darker and well in are and Nails may grow clean longer. body.30 Scalp distributed. dandruff. the noted. lesions pediculosis.

bluish discoloration nails and of no No Philadelphia. Case Approach. Davis Company . Case Studies F. Nursing Health Assessment A critical Thinking. the System. Reference: Dillon Assessing Integumentary (2007). A critical Thinking. 19103 . Approach. clubbing indicate no peripheral or disease hypoxia.31 System. Davis 1915 Studies F.A. Company Arch Street PA pulmonary diseases. Nursing Capillary refill of less as heart and congenital disorders chronic Health Assessment than 2 seconds.A.

and swelling noted indicate Facial features and upon inspection and previous trauma. lesions or tenderness and swelling and lesions. or upon inspection. • Eyes In parallel alignment Sclera is white with Clear with white Positive smooth eyes and no lesions. palpable and Normocephalic with Symmetry of of No no palpable masses. palpation. Symmetrical features movements congenital facial deformity. Both eyes indicate that the sclera. febrile state. are clear and bright patient is not in pupillary in parallel alignment. facial features movements no masses. and paralysis noted edema. . movements symmetrical. PA 19103 HEENT Methods Assessment Used: Inspection Palpation • Head Round symmetrical.32 1915 Arch Street Philadelphia.

directions. Fair Eyebrows eyelashes evenly and eyebrows are eyelashes distributed presence with no lesions or discharges. round. innervates that the muscle. intact. Eyelids or inflammations. occurs since it swelling of and no edema or without fair in distribution and eyelashes are distribution of eyebrows and . correspond-ding Iris is brown in color extraocular upon inspection. Pupil without is eyelid lag show damage. irritation Both pupils constricts pressure in response to light.33 reaction to light and Parallel blinking Smooth. or on and nystagmus. Eyelashes outward curves will indicate without carcinoma. equal in size no and reactive to light. reflex. Eyelids. in all movements Parallel directions movement of the Positive eye in all no and conjugate noted. in all directions Cornea is shiny and nystagmus eyelid lag smooth. No muscle or cranial corrective lenses or nerves eyeglasses noted. movement of eyes blinking reflex noted. swelling any swelling.

lesions. or Conjunctiva Eyelids smooth is and intact without lesions. Consistent the No tenderness swelling. with skin color. Pinkish color – peach pinkish in color. small amount.34 crusting infestations. nodules and eyes. Red conjunctiva conjunctiva Conjunctiva is pinkish indicates in color or with no conjunctivitis with no lesions. palpable nodules or Cerumen noted upon skin exudates. lesions noted. the eyes. No swelling noted. it is pale pink. swelling while in anemia. consistent color. Positive reflexes in the eyes no signify neurological problems. Consistent with skin • Ears color with and the aligned Aligned with the Normally. ears external external canthus of are aligned with external of Color the is with No canthus of the eyes. No canthus and lesions. . inspection and in lesions abnormal found.

moist and and . smooth. lymph nodes movable 180 degrees and swelling. Left and reported. no or Pink. No Neck palpable masses or Is in the midline and bulges. right cervical superficial nodes not palpable. No bulges or masses.35 findings of having lesions in the ears will indicate skin cancer from Skin is intact. tenderness nodularity noted. moist. lesions and swelling Thyroid lower anterior is half noted. without feeling of sun exposure. Enlargement. Mucosa Throat/mouth redness pink. in of mid the No neck. Pink. Thyroid glands not discomfort enlarge.

No and signs of tonsillitis. cheilosis. pink lips noted cracks are intact. no with signify without any lesions that the patient is and swelling. mobile condition of oral with no lesions or mucosa. Gums pink with no lesions. No not experiencing dehydration. inflamed oral discolorations. Tonsils are sometimes pink and indicate no accompanied by signs inflammation. disorders. redness bleeding. No lesions. Tongue is indicates mucosa good pink in color. of ulcerations. swelling and any Reddened. Reference: . Gums are consistent licking and in color with other infectious No mucosa with no inflammatory or bleeding. swelling. and glistening and intact intact mucosa. discharges exudates. Lateral margins mucosa present. Lips that moist Moist. moist and intact.36 inflammations lesions. Lips pink. lip and or cracks noted. swelling exudates noted.

Reports no critical Thinking. Davis Company Assessing 1915 Arch Street Philadelphia. Assessing good occlusion and intact. Health A Thinking. Reference: (2007). . Davis 1915 and Ear. Company Arch Street PA Philadelphia. Teeth are white in Assessing teeth are white in color. in Case Studies F.37 Hard and soft palate pink and Dillon (2007). difficulty or feeling of difficulty pain. Hard and soft Head. Health A repair.A. Assessing the Eye Nursing Assessment critical Case Approach.A. Studies F. not loose with palate is pink and Neck. Face and color. Face and Neck. Dillon swallowing. noted on the upper Nursing Swallowing is easily portion of the buccal Assessment done without mucosa. PA 19103 the Head. in good Dentures the Eye and Ear. Approach. the intact.

Chest midline. is in the midline. equal upper anterior chest. Dillon (2007). 20 respiratory minute. Not in ranges from 18 -25 of cycles per minute. Septum intact and in midline. Company 1915 Arch Street Philadelphia. Davis Dillon is symmetric. dyspnea Assessing the symmetrical with no over discharges. Studies F. indicates Equal rise and fall of with no discharges fremitus the chest when Septum intact and in accumulation breathing. secretions Nursing presence of cough not noted. Breathing pattern is Respiratory System. even. Tactile rhythm of respiration respiration. If there this of Nose is symmetrical is an increase in and nasal flaring. distress.38 Pulmonary System Methods Assessment Used: Inspection Palpation Auscultation 19103 Respiratory rate Respiration recorded cycles per rate as is Normal. Health Assessment A critical Thinking. There in is equal rise and fall Even of color. Approach. breathing no in consistent with skin with indicates the midline. full and even. the System. Reference: (2007). Trachea is in the chest rate regular and difficulty the Trachea is fluid or exudates lungs. Nursing Health A noted. fremitus equal without any masses Reference: noted upon palpation.A. Nose is No pain the no reported chest. Vocal fremitus bilaterally No on the Assessment and Case Studies F. bilaterally. PA .A. Case Approach. Assessing Respiratory critical Thinking.

Blood Blood pressure was rate changes of recorded as 120/80 based upon the mmHg. per rate was Pulse rate and 90 blood pressure is normal minute. The heart seconds pressure 90/60mmHg140/90mmHg Reference: (2007). adults . Dillon reported. No chest pain oxygen. recorded as Capillary beats per minute and within refill of less than 2 is in regular rhythm. range. Health Assessment A critical Thinking. Nursing System. Factors such as age and gender influence average As values. No murmurs body's need for noted.39 Davis 1915 Company Arch Street PA 19103 Philadelphia. Company Arch Street PA average BP and variations. most during Assessing capillary less exercise. Davis 1915 Studies F. 19103 Cardiovascular System Methods Assessment Used: Inspection Palpation Auscultation Heart rate of 60-100 Pulse beats of regular. Various factors influence a person's Cardiovascular than 2 seconds. age. Philadelphia.A. the . refill Good notably. Case Approach.

masses Bowel sound is with no lesions. clicks per minute . Approach. Davis Company 1915 Arch Street Philadelphia. the Cardiovascular System. and scars noted over within and the abdomen. Nursing Health Assessment A critical Thinking. PA 19103 •Gastrointestinal System Methods Assessment Abdomen is intact No lesions. range of normal 5-30 of masses consistent with skin Umbilicus noted.40 19103 systolic pressure tends to rise and diastolic tends to fall.A. Reference: Dillon Assessing (2007). Case Studies F.

Abdomen. minute auscultation. Audible audible sounds abdominal quadrants No scars in the may no present 5-30 clicks with 13 clicks per abdomen per minute. the Thinking. Bowel sound that the patient is at four not constipated. surgery done. Philadelphia. Davis 1915 Dillon bowel upon indicate Last previous movement: abdominal Assessing November 15. Davis Company 1915 Arch Street Philadelphia. inverted midline. 6:00 in the morning Reference: Health with no difficulty in Dillon A defecation and with Assessing (2007).41 Used: Inspection Palpation Auscultation color. 19103 Approach. Reference: (2007). PA • Genitourinary System No sensation 19103 burning No burning sensation No difficulty during and difficulty in in urination signifies . Case Studies F. soft yellowish stool Abdomen. Studies as reported. 2010. bowel Umbilicus inverted and and in which suggest in midline. Company Arch Street PA Nursing Health A Assessment critical Thinking. the Nursing Assessment critical Case Approach.A.A. F.

Coordinated midline. Reference: (2007). Assessing November 15. All able to fully bend. Reference: Female in the afternoon with Dillon yellowish colored Assessing (2007). Davis 1915 Studies F. the urination Dillon Last reported. PA •Musculoskeletal System Methods Assessment Used: Inspection Palpation Posture erect. Philadelphia. Nursing urine with total output Female Health Assessment of 400cc throughout Genitourinary A critical Thinking.A. Case Approach. movements range noted.A. head Posture midline and weight head of evenly Both in is 19103 erect. Company Arch Street PA System. 19103 Approach. . of indicate Not cerebellar good distributed. Reduced feet point motion straight ahead. movements coordinated flex and extend her Reference: and knees. 2010. the shift. Nursing Health Assessment A critical Thinking.42 Methods Assessment Used: Inspection of urination. Davis Company 1915 Arch Street Philadelphia. Case Studies F. the Genitourinary System. Muscle Dillon (2007). function. no urinary tract voided: problems.

A.walk for only 4-5 Assessment A Musculoskeletal System. extremities Philadelphia.)HEMOGLOBIN VALUE 131 g/L 120-150 g/L INTERPRETATION The result was within normal range. Nursing Pain reported on the Case Health Assessment right knee with the Approach. Assessing the opposition. Studies F. Balance Patient cannot stand Motorintact. Able to Health Motor. Philadelphia. pain scale of 5/10. Nursing Assessing assistance. LABORATORY AND DIAGNOSTIC EXAMINATION HEMATOLOGY RESULT NORMAL 11/13/10 A. A critical Thinking. PA Company Complete upper and 19103 Arch Street lower PA noted. failure of oxygenation because of congestive heart failure and normally in people living at high altitudes. If decrease it . Reference: (2007). chronic obstructive pulmonary disease. 19103 III.A. If increase it indicates polycythemia. the or walk for a long Musculoskeletal Dillon period of time without System.43 arms swings in weakness noted. steps with assistance critical Thinking. knee area reported. Davis 1915 Company Studies Stiffness on the right 1915 Arch Street F. Davis Case Approach.

40 The result was within normal range.25-0.44 implicates various enemas.) LEUKOCYTE 6. pregnancy.06 The result was above normal range. A low WBC count will make the individual susceptible and vulnerable to diseases and foreign invasive organism. D. haloperidol. pertussis. severe or prolonged hemorrhage and with excessive fluid intake.) LYMPHOCYTES 0. toxoplasmosis. A mature lymphocyte count >7. and .09 0. .34 0. Drugs increasing the lymphocyte count include aminosalicyclic acid.) MONOCYTES 0.1 x 12 g/ 5-10 x12 g/L L The result was within normal range. Lymphocytosis is seen in infectious viral mononucleosis. mephenytoin. tetrachloroethane. TB. and arsenical poisonings.000/µL is an individual over 50 years of age is highly suggestive of chronic lymphocytic leukemia (CLL). other infections. lymphocytic leukemias. B. An increase a viral in result indicates infection. E. syphilis. niacinamide. cytomegalovirus infection. levodopa. carbon disulfide. brucellosis. phenytoin.02-0. and lead. griseofulvin.

45

parasitic disease, collagen and hemolytic disorder. Monocytosis is seen in the recovery phase of many acute infections. It is also seen in diseases characterized by chronic inflammation sarcoidosis), systemic many granulomatous (TB, ulcerative lupus, syphilis, colitis,

brucellosis, Crohn's disease, and rheumatoid neoplasms. and as well as of griseofulvin,

arthritis, polyarteritisnodosa, and hematologic Poisoning by carbon disulfide, phosphorus, tetrachloroethane, administration

haloperidol, and methsuximide, may cause monocytosis. F.) EOSINOPHILS 0.01 0.01-0.05 The result was within normal range. If increase it specifies allergy, infection. G. BASOPHILS 0.01 0.00 – 0.01 The result was within normal range. If increase with acute leukemia and following surgery and trauma. If decrease with allergic reactions, stress, allergy, parasitic disease and use of corticosteroids. H. 187 x 10 9/L 130 – 400 x The result was within normal parasitic disease, collagen disease and subacute

46

THROMBOCYTE S (PLATELETS)

10 9/L

range. If increase, thrombocytosis is seen in many inflammatory disorders and myeloproliferative states, as well as in acute or chronic blood loss, hemolytic anemias, carcinomatosis, status post-splenectomy, post- exercise, etc. If decrease, hrombocytopenia is into divided pathophysiologically defects and production

consumption defects based on examination of the bone marrow aspirate presence or of biopsy for the megakaryocytes.

Production defects are seen in Wiskott-Aldritch syndrome, MayHegglin anomaly, Bernard-Soulier syndrome, anomaly, above), Chediak-Higashi Fanconi's marrow syndrome,

aplastic anemia (see list of drugs, replacement, megaloblastic and severe iron deficiency anemias, uremia, etc. Consumption defects are seen in autoimmune (including lupus), DIC, thrombocytopenias ITP and TTP, systemic congenital

hemangiomas,

hypersplenism,

following massive hemorrhage, G.) HEMATOCRIT 0. 40 0.36-0.44 and in many severe infections. The result was within normal

47

range. in

If

increase dehydration

it

shows or

erythrocytosis of any cause and hemoconcentration severe anemias, associated anemia of

with shock. If decrease it shows pregnancy and acute massive blood loss. HEMATOLOGY 11/13/10 A.)HEMOGLOBIN RESULT NORMAL VALUE 131 g/L 120-150 g/L The result was within normal range. If increase it indicates polycythemia, chronic obstructive pulmonary disease, failure of oxygenation because of congestive heart failure and normally in people living at high altitudes. implicates If decrease it various enemas, INTERPRETATION

pregnancy, severe or prolonged hemorrhage and with excessive fluid intake. B.) LEUKOCYTE 6.1 x 12 g/ 5-10 x12 g/L L The result was within normal range. A low WBC count will make the individual susceptible and vulnerable to diseases and foreign invasive organism. D.) LYMPHOCYTES 0.34 0.25-0.40 The result was within normal range. Lymphocytosis is seen in infectious mononucleosis, ,

brucellosis. syphilis. carbon disulfide. levodopa. TB. pertussis. phenytoin. colitis. and lead. and arsenical poisonings. haloperidol. A mature lymphocyte count >7. toxoplasmosis.) MONOCYTES 0.02-0. systemic many granulomatous (TB. niacinamide. It is also seen in diseases characterized by chronic inflammation sarcoidosis). arthritis. Monocytosis is seen in the recovery phase of many acute infections. An increase a viral in result indicates infection. brucellosis. griseofulvin.06 The result was above normal range. polyarteritisnodosa. and hematologic . and rheumatoid neoplasms.000/µL is an individual over 50 years of age is highly suggestive of chronic lymphocytic leukemia (CLL). other viral infections.48 cytomegalovirus infection. mephenytoin. ulcerative lupus. E. collagen and hemolytic disorder. Crohn's disease. lymphocytic leukemias.09 0. Drugs increasing the lymphocyte count include aminosalicyclic acid. tetrachloroethane. syphilis. and parasitic disease.

and methsuximide. may cause monocytosis. THROMBOCYTE S (PLATELETS) 187 x 10 9/L 130 – 400 x The result was within normal 10 9/L range. as well as in acute or chronic blood loss. If decrease.01 0. parasitic disease and use of corticosteroids.01-0. If decrease with allergic reactions. phosphorus.exercise. collagen disease and subacute consumption defects based on examination of the bone marrow .01 0. thrombocytosis is seen in many inflammatory disorders and myeloproliferative states.05 The result was within normal range. post. If increase with acute leukemia and following surgery and trauma. administration of as well and as griseofulvin. stress. BASOPHILS 0. If increase it specifies allergy. If increase. allergy. hemolytic anemias. F. haloperidol.49 Poisoning by carbon disulfide. H. G. hrombocytopenia is into divided pathophysiologically defects and production parasitic disease.01 The result was within normal range. etc.00 – 0. tetrachloroethane.) EOSINOPHILS 0. infection. status post-splenectomy. carcinomatosis.

Bernard-Soulier syndrome. systemic congenital hemangiomas. megaloblastic and severe iron deficiency anemias. anomaly. 40 0. Chediak-Higashi Fanconi's marrow syndrome. hypersplenism. replacement.) HEMATOCRIT 0. DIC. following massive hemorrhage.50 aspirate presence or of biopsy for the megakaryocytes. aplastic anemia (see list of drugs. in If increase dehydration it shows or associated anemia of erythrocytosis of any cause and hemoconcentration severe anemias. MayHegglin anomaly.44 and in many severe infections. . Production defects are seen in Wiskott-Aldritch syndrome. with shock. thrombocytopenias ITP and TTP. The result was within normal range. etc. G. above). If decrease it shows pregnancy and acute massive blood loss. uremia. Consumption defects are seen in autoimmune (including lupus).36-0.

REVIEW OF ANATOMY AND PHYSIOLOGY The Skeletal System Functions of the Skeleton . IV.51 RADIOLOGIC FINDING (11/15/10) RADIOLOGIC FINDING 11/15/10 Procedure: Knee APL-DLX INTERPRETATION INTERPRETATION No significant bony nor joint abnormality is noted save for a patellar base degenerative bony spur.

legs. 3. ) Protects some internal organs from mechanical injury. neck. 4. and feet (but not the wrists and ankles). hip bones and cranial bones. Divisions of the Skeleton The human skeleton is divided into two distinct parts: The axial skeleton consists of bones that form the axis of the body and support and protect the organs of the head. which is essential for blood clotting and proper functioning of muscles and nerves.the ribs. and trunk. ) Provide a framework that supports the body. ) Long bones.bones of the arms. Classification of Bones 1. ) Irregular bones. ) Provides a storage site for excess calcium. the primary hemopoietic (blood forming) tissue. 3. • The Skull . ) Flat bones.52 1. 2. 2. 4. shoulder blades. the rib cage protects the heart and lungs. Short bones. hands.the vertebrae and facial bones. Calcium may be removed from bone to maintain a normal blood calcium level. for example. the muscles that are attached to bones move the skeleton.the bones of the wrists and ankles. ) Contains and protects the red bone marrow.

53 • • • The Sternum The Ribs The Vertebral Column The appendicular skeleton is composed of bones that anchor the appendages to the axial skeleton. Synovial joints . • • • The Upper Extremities The Lower Extremities The Shoulder Girdle The Pelvic Girdle--(the sacrum and coccyx are considered part of the vertebral column) • Joints Is where two bones meet. the pivot. such as suture between two cranial bones. or articulate. A diarthrosis is a freely movable joint. This is the largest category of joints and includes the ball-and-socket joint. An amphiarthrosis is a slightly movable joint. hinge and others. A synarthrosis is an immovable joint. The classification of Joints The classification of joints is based on the amount of movement possible. such as the symphysis joint between adjacent vertebrae.

or freely movable joints. made of fibrous connective tissue. This fluid is thick and slippery and prevents friction as the bones move. are synovial joints because they share similarities of structure.54 All diarthroses. Secondary cartilaginous bonejoint where the surfaces of the two bones are connected by a piece of cartilage so that they cannot move.temporary joint where the intervening cartilage is converted into adult bone. encloses the joint in a strong sheath. Lining the joint capsule is the synovial membrane. Primary cartilaginous bone. which provides a smooth surface. Cartilaginous Joint Made up of cartilage. like sleeve. Ball and socket joint . On the joint surface of each joint is the articular cartilage. Joint where cartilage fixes two bones together so that they cannot move. The joint capsule. which secretes synovial fluid into the joint cavity.

55 Joint where the rounded edge of along bone fits into a socket or another bone. Saddle joint Synovial joint where one element is concave and the other convex. SYMPTOMATOLOGY AND ETIOLOGY . Pivot joint Joint where bone can rotate easily. Hinge Joint Joint which allows the two bones to move in one plane only. IV. Fibrous joint Joint where two bones are fixed together by fibrous tissue. so that they can move only slightly. like the joint between the thumb and wrist.

SYMTOMATOLOGY Symptoms Pain: Your Actual Symptoms joints may  Moderate pain in the right knee. pain Constant while you sleep may be a sign that your arthritis is getting worse. getting up in the morning can be .56 A. greatly decreasing its ability to act as a shock absorber. Over time. For some people. If the the condition bones worsens. Most sufferers find that the you have arthritis. As the cartilage tendons wears away. Interpretation Osteoarthritis causes the cartilage in a joint to become stiff and lose its elasticity. Stiffness will also occur when the joints are used more than normal. could rub other. making it more susceptible to damage. against each causing even more pain • Stiffness: When  Stiffness in the right knee. the pain may come pain and or go. ache. or the pain may feel burning or sharp. causing pain. and ligaments stretch. and loss of movement. the cartilage may wear away in some areas.

Your joints stiffness is the worst in the morning. and severe stiffness will last less than 30 minutes.57 hard. This happens a lot with arthritis in the knee. osteoarthritis of the knee exists and is not fully explained by the effects of aging. You may also get stiff from sitting. • moderate way can often help  Muscle weakness in the right leg. requires but preliminary evidence for a causative emerging. Muscle has an integral role in the structure and function Evidence weakness of for joints. role is Muscle . The temporal relationship further study. Weakness is associated with pain and disability. Moving the joint repeatedly in may feel stiff and creaky for a short time. to alleviate the Muscle weakness: The around may get muscles the joint stiffness. until you get moving. muscle in weaker.

effort may be influenced by pain and Swelling/ Arthritis Tenderness: can cause  Swelling in the right knee. Progressive breakdown of cartilage may lead to the formation of enlarged bony growths or "spurs especially as arthritis gets . psychologic outlook. In osteoarthritic as in other patients. tissue that surrounds the joint) becomes irritated by the erosion of cartilage.58 weakness assessed ways. or occasional swelling. it may produce an excessive amount of fluid that can collect within the joint and lead to continual Deformed joints: Joints can start to look like they are the wrong shape. Once the synovial membrane (smooth swelling in joints. patient groups. making them feel tender and sore. can in be various Voluntary measures of strength are affected by degree of effort.

The range of motion of a given joint depends arthritis gets worse. "on the bone ends. primarily on the structure and function of bone. position while lying on bed. Such growths increase the appearance of swelling and knobbiness as they continue • the cycle of Reduced range of motion: As your  Difficulty in changing irritation and swelling.59 worse. such that range of motion and reduced. flex. muscle and connective tissue. flexibility are B. OA affects the structure of these tissues. you may not be able to fully bend. ETIOLOGY Predisposing Factors Actual findings Implications Since the patient’s Grandfather was diagnosed having . Or you may not be able to use them at all. or extend your joints.

<http://www. Age The patient was considered old as evidenced by her age. It also suggests that defective genes. osteoarthritis is more common in women after age 45 compared to men who experienced osteoarthritis before age 45.html> . Since the patient is a female. Gender  can be passed down from parent to child. which cause deterioration of the joint. and that means the tendons in her lower body are more elastic than men. nearly every person will have this condition. based on researches a patient is more likely to develop osteoarthritis if one or both of your parents had the condition. Also.home-remedies-foryou.com/blog/osteoarthritis-hereditary-disease. Osteoarthritis usually occurs in older people (although it can afflict young adults who experience joint injuries). and by age 70. Almost all people over 65 show some signs of developing osteoarthritis.60 Hereditary  Osteoarthritis. her body is designed to give birth.

Eventually. In Osteoarthritis. Fluid may also build up in your joints. Repetitive use of worn joints over the years can irritate the cartilage. The reason this normal repair process is disrupted is not known but it is likely caused by several factors. the water content of the cartilage increases. the bones thicken and broaden. As the bones thicken and broaden. the result will be bone to bone contact.61 V. and the protein makeup of cartilage breaks down. If the cartilage wears down completely. This inflammation may stimulate new bone outgrowths called spurs (also called osteophytes) to form around the joints. It occurs when the cartilage that covers and cushions the ends of bones in your joints deteriorates over time. joints become stiff. causing inflammation. and may be difficult to move. causing joint pain and inflammation of surrounding tissues. In healthy cartilage. painful. With aging. PATHOPHYSIOLOGY a. the smooth surface of the cartilage begins to deteriorate and become worn causing friction between the bones. damaged cartilage cannot repair itself in the normal way. Cartilage is composed of water. As pieces of cartilage break off. leading to cartilage deterioration and an abnormal repair response. and specific proteins. . there is a continual process of natural breaking down and repair of the cartilage in joints. collagen. Narrative The main cause of Osteoarthritis is an imbalance in the natural breakdown and repair process that occurs with cartilage. This process becomes disrupted in Osteoarthritis.

+ Grandfather Gender .b.Female Loss of HMGB2 that can cause loss of chondrocytes in the cartilage Degeneration of cartilage • • Diet Excessive Activity level Pinch/crowd nerve Pai n Formation of osteophytes Narrowing of joint spaces Formation of subchondral cysts Increase in synovial fluid Pressure between joint Pain Difficulty of moveme nt Continuous use of joint . Diagram Predisposing Factors Precipitating Factors • • • Age – 63 years old Hereditary .

GH & stem cell injection Redness. increase WBC 63 .Disappearing of full thickness of articular cartilage Release of chemical mediators Inflammatory response Immobilization If treated: Repair and remodelling Acts on pain receptors Pai n Increase blood flow Increase vascular permeablity edem a Osteoarthriti s If not remodeled Surgery.

2 nalang xa” as verbalize by the patient. Osteoarthritis is to 4 or lesser distinguished by a as evidence progressive degeneration of the cartilage in a joint— by: usually weight-bearing joint. Absence of and bone spurs called nako from 1-10. PLANNING Nursing Care Plan 1 DATE /SHIFT CUES NSG. True to the facial progressive nature of the disease. No . resulting in increased discomfort. A. women pain scale of 7 are more frequently affected. DIAGNOSIS OBJECTIVE OF CARE Independent: November 15. ® The patient may manifest any or part of the defining characteristics. so focused assessment is important.VI. Goal met as evidence by “Dili na kaayo xa sakit makaya kaya na kung irate Changed positions frequently while maintaining functional alignment.2010 7-3 Subjective: “Sakit pa akong tuhod day” as verbalized by the patient Pain Scale: 7 0 – 10 Numeric Rating Scale Acute Pain related to joint degeneration secondary to Osteoarthritis Scientific basis: After 2 hours of nursing interventions the patient will manifest reduction of Assessed the patient’s description of pain. Supported joints in slightly 64 INTERVENTION Evaluation 0-None 1-3 Mild 4-6 Moderate In patients older than pain from a 55 years of age. the cartilage grimacing and continues to degenerate. ®Muscle spasm may result from poor alignment. but any joint can be Absence of affected.

Nursing Care Plans 6th pp.2°C Eustice.20cpm PR-90bpm BP. . and towels.com Guide. Pain: Clinical Manual for Nursing 65 .777-780. Provided for adequate rest periods ®Fatigue impairs ability to cope with discomfort. M. & Beebe.g. Objective: 63 years old Female Facial grimace Limited ROM Gulanick/Myers Restlessness Vital signs: Temp-37. rolls. A. June 2008 McCaffery. Provided assistance and utilized adaptive equipment (e. “What a Osteoarthritis Joint?”About. (1993). Mosby 2007 Inc..13. cane. ®Some patients prefer hot therapy over cold therapy to provide comfort. Reference: restlessness. flexed position through the use of pillows. In the joint margin..10 Severe osteophytes develop at the joint margins and at the attachment sites of the tendons and ligaments. ®These aids assist in ambulation and reduce joint stress facial grimacing and signs of restlessnes s noted. there can be thickening of the joint capsule and the formation of osteophytes that may cause pain. ® Flexion of the joint may reduce muscle spasms and other discomforts. in Edition. RR. walker) when needed.7. Applied hot pack.120/80 mmHg Causes Pain Carol.

Dependent: Administered a muscle relaxant drug (Myonal 50 mg tid) as ordered. ® This drug may cause drowsiness and may exaggerate the CNS depressive effects of alcohol and other drugs. ®This drug may relax painful muscle spasm. Mosby Company. Baltimore: V. 66 .V. Provided instruction in important side effect of muscle relaxant.Practice.

B. the patient will demonstrate Assisted patient to do active/passive ROM exercise to affected and unaffected extremities ® To increase the blood flow to muscles and bone to improve muscle tone Observed movement of the client Goal met as evidenced by demonstrating flexion/extension of extremities and able to care one self by bathing herself and combing herself SB: OA was associated with significant impairment.2010 7-3 Subjective cues: “Dili na kayo naku malihok lihok akong tiil kay magsakit man gud. DIAGNOSIS OBJECTIVE OF CARE INTERVENTION EXPECTED OUTCOMES November 15. After 6-hours of rendering nursing interventions and health teachings. Nursing Care Plan 2 DATE /SHIFT CUES NSG.” as verbalize by the patient. Objective: Limited Range of Motion (Able to walk for Impaired physical Mobility r/t joint degeneration as evidenced by verbalization of limited range of motion. and had an important impact on. healthrelated quality of life in behaviors that enable resumption of activities such as active and passive ROM .

Items that contributed to the differences between OA patients and controls were mainly related to physical limitations. ® To note any incongruence with report of abilities Assisted client or encourage client to do self care activities like bathing ® To improve muscle strength circulation and promote self directed wellness Monitored Vital signs ® It serves as a baseline data Reference: http://journals. exercise. sleep and rest.cambrid Removed excess clothing especially 68 . emotional behavior. especially in patients ages 41–60.only 4-5 steps) Stiffness of the right knee Unable to flex/bend her right knee Difficulty in changing position while lying on bed Walks and stands with assistance (Able to walk for only 4-5 steps) 63 years old Female Diagnosed with osteoarthritis the areas of ambulation. home management. The older patients differed less from the controls than did the younger ones. body care and movement. and work.

org/action/displayA bstract? fromPage=online&aid =565320 the rough ones ® This would lead to further damage of the skin Responded immediately to complaint of the patient ® prompt responses to complaints may result in decreased anxiety in patient Provided rest periods to facilitate comfort.ge. sleep and relaxation 69 .

Cold compress promote some 70 .® Fatigue on the patient may exaggerate on the pain he experienced Dependent Administration of analgesics as prescribed ® To relieve pain Application of heat or cold compress as ordered ® Hot moist compress have penetrating effect.

numbing thereby promoting comfort C. Nursing Care Plan 3 71 .

) no falls or accidents b. 3. level of competence.1) raising 72 of side rails -Vital signs: Temp-36°C RR.) Noted age and sex. a woman who cannot fully bend her knee joint may be prone to falls or injuries to muscle groups in the leg. old/new bruises. trauma. ® Serves as a baseline data in avoiding injury.) Observed for signs of injury (e. decisionmaking ability. gross and fine motor coordination. including disease.) Evaluated developmental level.DATE /SHIFT November 15.) provide a safe environ ment for the patient such as. People with a limited range of motion may experience frustration because they cannot engage in many common tasks. 2. For example.2010 7-3 CUES NSG. DIAGNOSIS OBJECTIVE OF CARE That within our 6-hour span of care. elderly persons and men are at greater risk. a. a.20cpm PR-74bpm BP. young adults. our patient will be safe and remain free from injury as evidenced by: INTERVENTION EXPECTED OUTCOMES GOAL MET! After 6 hour span of care our patient was free from injury as evidenced by: Objective: Limited Range of motion Stiffness of right knee Walks and stands with assistance (Able to walk for only 4-5 steps) 63 years old Female Diagnosed with osteoarthritis Risk for injury r/t limited range of motion secondary to joint degeneration 1. ® Children. ® To serve as a baseline date for the tolerance of exercise and other activities.120/80 mmHg . frequent absences from work).) no falls or accident s. c. b.) absence of possible complic ations from fall. history of fractures.g. and other events. c.) Assessed muscle strength. 4.) absence of possible complicat ions from fall. ® To evaluate degree/source of risk inherent in the Scientific basis: A huge assortment of things can influence range of motion. injury. physical activity. and they can be at increased risk of injury and other medical problems as a result of their stiffer joints and muscle groups.

73 .

VII. asthma and urticaria. nonopioids analgesics.euphoria .headache . who has Date/ Shift Name of Drug/Classification Dosage/ Drawing . 2010 Ketorolac Time/ Route Nonsteroidal 30mg/q antiinflammatory agents. PHARMACOLOGICAL MANAGEMENT Indication Mechanism ofSide Effects Action Short term Inhibits the-drowsiness -abnormal thinking .vasodilation following . risk for and nasal polyns developing hypersensitivity reactions. for allperipherally mediated analgesics. also exceed 5 daysproducing total routes combined).pallor Nursing Responsibilities Pt.dyspnea . November 13. Assess for rhinitis. aspirin – induced are at allergy.asthma . location. . -Assess pain (note type.edema . and intensity) prior to and 1-2 hrs / 7³ properties. Also have antipyretic and antiinflammatory asthma. Write the frequency 8°/IVTT management prostaglandin of pain (not tosynthesis.

to if consult health care professionals disturbances. rash. influenza-like syndrome aches. Advice pt. weight persistent or (drills. stools. . visual -renal toxicity fever.oliguria administration..paresthesia occurs.sweating . 75 .GI bleeding . itching. muscle pain) gain. black headache.GI pain .nausea -urinary frequency .dry mouth . edema.diarrhea . tinnitus.

the leukotrienes(al -cramping pro-nausea inflammatory auta coids. fever. also speculation that diclofenac inhibit phospholipase A2 as part of its mechanism action. or an . of may There is -gastritis -Advise the patient not to lie down for at least 30 minutes after taking this drug.Date/ Name of Drug/Classificati Dosage/ Shift Drawing Nov. this 76 with stomach take medication antacid. 13. milk. To prevent upset. thus reducing formation so -abdominal Burning pain of mouth with a full glass of water (8 ounces directed phycisian. or 240 by milliliters)as inflammation. 2010 / (NSAIDs) 73 Diclofenac on nonsteroidal antiinflammator y drug 6-6 25 mg BID Time/ Route 1Tab Indication Mechanism Action ofSide Effects Nursing Responsibilities . and of Inhibits the Lipo--Ulcerations toxygenase pathways. ask the patient to food.Advise patient to take this by medication Treatment mild moderate pain.

77 .

-headache painThis enzyme is required for the-insomnia synthesis of -edema including dysmenor. Inhibits ofenzyme the-dizziness COX-2. 13 2010 nonsteroidal antiinflammatory agents / Shift Nov. Pt. Celebrex Dosage/ Time/ Route 400mg/ 1cap/ OD/PO Indication Mechanism Action ofSide Effects Nursing Responsibilities Management acute primary rhea. 78 . degree of swelling.-GI bleeding antiinflammatory. and -Diarrhea antipyretic -Dyspepsia -Flatulence -Nausea -Rash -Abdominal pain . with these allergies should not receive celecoxib. and pain in affected joints before and periodically throughout therapy.Date Name of Drug/Classification / Drawing Antirheumatics. Have analgesics. or NSAIDs. aspirin.Assess pt for allergy to sulfonamides.Assess range of motion. 7³ properties. .prostaglandins.

2010 / 73 of Drug/Classification Dosage/ Indication Mechanism ofSide Effects Nursing Responsibilities -Patients should be in cautioned potentially against engaging hazardous activities requiring alertness.O diseases: suppresses Cervical intercollicu-lar 6-12-6 -Head syndrome section-induced Periarthritis decerebrate of the rigidity (γ-rigidity)Ache shoulder. lu and ischemic -numbmbargo decerebrate rigidity (α-rigidity) in rats dose-ness dependently. it is -weakness advisable to take -lightheadedness measures.Date/ Name Shift Drawing Nov. Myonal 15. as dosage careful such in under reduction 79 . -Since the elderly theoften have a or Muscle relaxant Time/ Route Action 1 Tab Improvemen Inhibition of-Sleepit of Experimen-tallymyotonic Induced Muscleness 50mg TID symptoms in Rigidity: the following Eperisone HCl-Insomia P. such as operating machinery driving a car. Discharge Plan in extremi-ties physiological hypofunction.

should carefully observed. treatment be and may patients be 80 . symptoms such as urticaria. of itching. edema of the face or other parts and dyspnea etc. In the event redness.. .supervision.Since shock and anaphylactoid reactions occur. should discontinued appropriate measures taken.

81 .

and therapeutic regimen understood. Medications • Instruct the patient the importance of compliance to medicines. Rationale: to • Instruct the patient to report adverse reaction promptly. • Explain the medications how they work. Dealing with current situation realistically.VIII. Prognosis. 2. DISCHARGE PLAN DISCHARGE GOALS: 1. 4. . the side effects. 3. Mobility/function regained or compensated for. Complications prevented/minimized. achieve appropriate therapeutic effects. and precautions. Pain relieved/controlled. • Give adequate instructions to the significant others about the importance of the following medications and dietary regimens. Rationale: to know how to react on unexpected problem during the course of taking the medication. 5. Rationale: to prevent further complications.

Exercise/Environment • Encourage walking. Treatment: • Promote monotherapy (treatment with a single agent) if appropriate . • Encourage/advise patient to use/wear a clean cotton T-shirt to prevent perspiration. Home environment must be free from slipping or accident hazards. Rationale: to support the back and prevent further complications. • Reinforce the need to continue exercises at home. & strength pressure joint mobility & improve cardiac & respiratory function. sitting recommendations. quiet environment. • Instruct patient to stay in calm. contact between the skin & shoulder harness & to promote absorption of Rationale: to prevent pulmonary problems. a little bed rest and frequent positioning of the patient as much as possible. • Abduction of pillows. tone. Rationale: this may contribute to different kinds of injury.83 Rationale: so that the patient’s condition can remain stable as soon as possible. Rationale: to prevent further complications. Active ROM exercises increase muscle mass. Rationale: to endure musculoskeletal functioning. Rationale: for the patient not to be uneasy all the time.

Rationale: to maintain weight and prevent being overweight or underweight. Rationale: this may lead to muscle pain. • Getting regular exercise and plenty of sleep. including monitoring of blood pressure and diet. Rationale: for increased compliance. • Remind client’s relative on close monitoring of client’s activities. . • Practice good preventive measures by eating proper diet. some may interfere with ongoing treatment and procedures Rationale: as Health Teachings: • Practice good hygiene. Rationale: to prevent acquiring bacteria and germs that may lead to inflammation and fever. • Instruct patient to avoid strenuous activity. • Encourage the client to relax and have adequate rest stress and promote healing. Rationale: to prevent • Encourage the client to compliance on further treatment proper maintenance and gain of optimal health.84 Rationale: to simplify the medication regimen and make it less expensive. Rationale: to regain energy. self- Rationale: for the • Encourage active participation of patient in the program.

• Inform patient that there are no restrictions in the diet except for foods that could interact & delay absorption of some medications. Rationale: this may contribute to acute attacks of arthritis. . Rationale: for the bones and to prevent osteoporosis • Discourage the client to eat sardines. • Recommend cessation of smoking. Diet: • Encourage the patient to drink Milk.85 Out-patient Referral: • Remind the patient with an immediate family member or her son for a follow-up appointment in the hospital 1-2 weeks after discharge or when complications of the disease appear. vasoconstriction. Rationale: to have a close monitoring on her condition. • Encourage patient to increase fluid intake Rationale: to prevent dehydration. impairing circulation and Rationale: Smoking potentate’s peripheral tissue oxygenation. & those that are included in her food-allergy list.

Duration of Illness Duration of illness is rated as good since her condition was being monitored and followed the advices by her physician. taken the consideration of implementing prescriptive orders of medicine are given importance. therefore modifications in activities. There is also a need for the patient as well as the family members to watch more closely in monitoring and assessing her condition well to avoid further complications. However the progress and fast recuperation of the client depends on the cause and severity of the condition. B.86 • Instruct the patient to eat at the right time. SYNTHESIS OFCLIENT’S CONDITION A. Osteoarthritis was given emphasis during the course of case study. PATIENT’S PROGNOSIS CRITERIA Onset Illness of GOOD FAIR POOR JUSTIFICATION The patient resorted into seeking medical attention upon the onset of the disease episode. r/o Gouty Arthritis. CONCLUSION In line with the information being gathered. exercise and diet particularly in taking foods which are rich in purines are prohibited. our patient was diagnosed of Osteoarthritis. there is a need to monitor client’s condition in terms of signs and symptoms of this disease as well as the degree and severity of its occurrence so as to collaboratively intervene to stabilize the patient. . Moreover. With these. Rationale: to prevent skipping of meals and further complications X.

0 Fair: 1. during her hospital stay and verbalized that they would try their best to help the patient recover easily. Legend: Good .4 – 3. Computation: . Environment Gender Family Support The family had supported the client during her condition has been identified. Since this accompanies with aging.6 Fair . Ages 45 and above are the highest age risk of acquiring osteoarthritis.3 Poor: 1 – 1. Poor -1pt.87 Willingness to take treatment regimen Age Patient is very cooperative in achieving fast recuperation by religiously taking her prescribed medications.7 – 2.3pts.2pts. Rating: Good: 2. Both males and females are prone of having osteoarthritis. The environment of the client is not hazardous to her condition. patient is rated as poor.

The family assured that they will support the client financially and emotionally and will see to it that the patient will religiously take the medications prescribed on time.1 (Fair Prognosis) GENERAL PROGNOSIS: Based on the aforementioned result.88 Good: 3 x 5 = 15 Fair: 2 x 0 = 0 Poor: 1 x 2 = 2 *15/7 = 2. Advice to drink milk or to eat milk containing foods which is good for the bones and thus prevents the formation of osteoarthritis. The client is on the process of achieving a state of good care providence given by the health care team as well as the support rendered by her family members. Encourage the patient to avoid foods which contains purine such as sardines since this will contribute to the severity and worsening of the disease. RECOMMENDATION Home Treatment If the doctor has prescribed medications. Provide comfort measures such as rubbing three inches away of the area of pain or . This will help the patient recover faster and will decrease the chance that the condition will worsen. Moreover. give the medicine on schedule for as long as directed. the overall prognosis of the client is fair. Apply alternate warm and cold compress to alleviate the pain felt by the patient. C. the client is willing to subject herself into treatment that will therefore facilitate her fast recuperation.

Promote good hygiene for the patients’ comfort measures since the patient is immobilized momentarily. reviewed the procedures that have been done on the patient during her admission. comprehended and traced the pathophysiology pertaining to osteoarthritis recognized the course in the ward and appropriate nursing interventions to be done. reviewed the anatomy and physiology of the affected organs and system. XI. rated the overall prognosis of the patient. provided recommendations regarding with patient’s case. distinguished the family history to trace the possibilities of the occurrence of the disease. formulated and enumerated discharge plans for the patient.89 provide diversional activities. We have performed physical assessment and identified the chief complaints of the patient. . enumerated the normal values and interpretations of the diagnostic examinations that was being performed to the patient. enumerated and classified the drugs that was given to the patient and associated its action or effects to the patient. and evaluated the objectives of the study in the end. EVALUATION OF THE OBJECTIVES OF STUDY Our target objectives were met after we have done our study for our patient.

XI. M. & Vallerand. V. (2010). Assessing the Integumentary System. FAAn. 2009. Nursing Health Assessment A critical Thinking.H. Case Studies Approach. Assessing the Head. Case Studies Approach. Davis Company • Dillon (2007). PA 19103 • Dillon (2007). . Nursing Health Assessment A critical Thinking. W.H.A. Philadelphia. Case Studies Approach.B. Assessing the Sensory-Neurologic System. Pharma D.A. 1995. BOOKS • Applegate.A. • Boyer. 11th Edition. PA 19103 • Dillon (2007). BIBLIOGRAPHY A. DAVIS’s DRUG GUIDE for NURSES.A. Davis Company 1915 Arch Street Philadelphia. April. Nursing Health Assessment A critical Thinking.Surgical Nursing. The Study Guide for Brunner & Suddarth’s Textbook of Medical . F. PhD. Saunders Company. The Anatomy and Physiology Learning System: Textbook. Assessing the Eye and Ear. F. PA 19103 . Davis Company 1915 Arch Street Philadelphia. F. F. Philadelphia : Lippincott Williams & Wilkins • Deglin. Edith J.J. Davis Company 1915 Arch Street Philadelphia. Face and Neck. 12th ed. RN.

F. Pillitteri. Davis Company 1915 Arch Street Philadelphia. Assessing the Female Genitourinary System.Maternal & Child Health Nursing:Care of the Childbearing Family. F. Kent M. Nursing Health Assessment A critical Thinking.page 353 Gulanick/Myers 2007 Nursing Care Plans 6th Edition. pp. 1998.A. .A.91 • Dillon (2007). Longman. Case Studies Approach. Davis Company 1915 Arch Street Philadelphia. Nursing Health Assessment A critical Thinking.Musculoskeletal System. Nursing Health Assessment A critical Thinking. Case Studies Approach. Assessing the Motor. PA 19103 • Dillon (2007). F. New York. PA 19103 • Dillon (2007).777-780.A.A. PA 19103 • • Fundamentals of Nursing 8thedition. Nursing Health Assessment A critical Thinking. Davis Company 1915 Arch Street Philadelphia. Davis Company 1915 Arch Street Philadelphia. Havighurst (1971) Developmental Tasks and Education.A. Nursing Health Assessment A critical Thinking. Third Edition. MA. Mosby Inc.(2007). PA 19103 • Dillon (2007). • Van De Graaff. New York: Lippincott Williams & Wilkins • • Robert J. F. Human Anatomy 5th Edition.A. Case Studies Approach. Assessing the Respiratory System. Case Studies Approach. Assessing the Abdomen. WEB McGraw-Hill. PA 19103 • Dillon (2007). Davis Company 1915 Arch Street Philadelphia. Boston. F. Assessing the Cardiovascular System. Case Studies Approach.

irvingcrowley. Philadelphia PA 19106:Wolters Kluwer Health/Lippincott Willams & Wilkins. Essentials of Anatomy and Physiology..asp . Smeltzer.niams. Clinical Laboratory Science: Urinalysis. Best.et al. Chennaionline Archives. • B.com/health/homoeopathy/2005/04homoeopathy40. file:///C:/Documents %20and%20Settings/angelo%20gaebriel/My%20Documents/LAbtst. & Victor M.chennaionline.com/St- Wr/Urinalysis.E. 2010 from http://www. Kenneth D. Medical Technology. Interpretation of Lab Test Profiles. from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): http://www. I. Scanlon. V. M. WEB • Chidambaranathan.. I. U.nih..com/cls/urin.d. n.d. Retrieved July 25.A. S.htm • DeMoranville.surgeryencyclopedia.92 • • Valerie C. MD. All About Urine – Urinalysis. Encyclopedia of Surgery. M. n. 2010 from http://archives.Medical-Surgical Nursing.html • Ed Uthman.2010. n.-S.Volume1.12th edition.d.gov/Health_Info/Osteoarthritis/default. Retrieved July 25. Goldberg. 5th Ed. Handout on Health: Osteoarthritis. july). (2010. M. Retrieved July 25. Urinalysis.. Retrieved 2010. 2010 from http://www. Tina Sanders.htm • Gayle Lester. J. Brandt. Suzanne C.530 Walnut St. P. asp • Crowley. (2009).

ehealthmd.php http://www.ihaveosteoarthritis.osteoarthritisremedy.htmlCopyrig http.93 • • • • • http://www.cambridge.webmd.com .com/blog/osteoarthritis-hereditarydisease.webmd.org/action/displayAbstract? fromPage=online&aid=565320 • http://www.com/osteoarthritis/tc/osteoarthritis-symptoms http://www.ph/books? id=G7uXK9Z2TSoC&pg=PA668&lpg=PA668&dq.wikipedia.haverford.com/what-causes-it. http://books.google.html • • http://www.ehealthmd.com/osteoarthritis/tc/osteoarthritis-symptoms Integrative medicine by David Rake.home-remedies-for-you.microbiologytext.php http://www.com/index.com/herbal remedies/osteoarthritisremedy/osteoarthritis-stiffness • • • • http://www.com/osteoarthritis-and-knee-pain-increase-risk-of-fallsin-elderly/ • http://journals.com/library/osteoarthritis/OSA_symptoms.org/wik http://www.html http://en.jarretmorrow.com/library/osteoarthritis/OSA_causes.com.com http://www.

94 • Kennedy. UK. Rheumatology Nottingham Hospital. The Doctor’s Medical Library.htm • William C. O'Reilly S. osteoarthritis.nih. http://www.wrongdiagnosis. Tagum City. Jones City A.aspx) C.OTHERS • Medical Records Section. R.com/o/osteoarthritis/stats-country.com/science/medical/articles/30891. from Wrong Diagnosis: http://www. 2010 from http://www.html Zaykoski. M.medical- library.htm • What causes osteoarthritis.A.d.nlm. Davao Regional Hospital (2009).brighthub. The hub for bright minds. (2010.com/library/osteoarthritis/OSA_causes. Bright hub. .medicinenet. from Medicinenet. Retrieved 2004. n. Doherty M. Retrieved July 25.ncbi. May 4).net/urinalysis_interpretation. F. 2010 from http://www. (2010).html • Muscle weakness in Unit. (2004). Cases of Osteoarthritis.gov/pubmed/9204263 • Statistics by Country for Ostearthritis. eHealthMD 2010. Urinalysis Report Interpretation. Osteoarthritis. L.com: http://www. Urinalysis Interpretation: Information on Urinalysis Values. http://www.com/osteoarthritis/article.. Retrieved July 25.ehealthmd. Retrieved 2010. Shiel Jr.

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