OSTEOARTHRITIS

 most common cause of disability in the elderly population over 65 years of age
 cartilage breaks down and the bones begin to grate against each other,
resulting in pain and degeneration progression.
 Occurs in joints that are exposed to weight bearing and stress, especially
knees, hips and spine

ANATOMY AND PHYSIOLOGY

 Mechanical injury - OA starts from an injury of the articular cartilage,
subchondral bone, and synovium.
 Chondrocyte response - Factors that initiate chondrocyte response
include previous joint damage, genetic and hormonal factors, and others.
 Cytokines - After the chondrocyte response, the release of cytokines occurs.
 Stimulation of enzymes - Proteolytic enzymes, metalloproteases,
and collagenase are stimulated, produced, and, released.
 Damage - The resulting damage predisposes to damage further as the
chondrocyte is triggered to respond again.

MODIFIABLE FACTORS NON-MODIFIABLE FACTORS

- Overweight - Hereditary
- repetitive stress injuries - Age (>45 years old and up)
- improper repaired meniscal tear - Gender (female)
- fractures
- Bowlegs or knock knees

SIGNS AND SYMPTOMS:

- pain to the affected
joints/limb
- degenerative changes COMPLICATIONS
with erosive osteophyte
formation
- Stress Fracture
- pain usually relieved by - Bone death
rest and worsened by (osteonecrosis)
movement and weight - Bleeding inside the
bearing exercise joint
- crepitus/grating type noise - Infection in the joint
may be heard when the - Pinched nerve (in OA PATHOPHYSIOLOGY
joints are moved
- muscle weakness or
of the spine)
wasting
Aging (Long term Trauma)
- stiffness
- (+) Heberden’s Node
- (+) Bouchard’s Node
Alteration in chondrocyte function
In movable joints
Cartilage softening, alteration in
Yellowish color subchondral bone

Fissures and sclerosis or formation

Pitting of joint of new bone near a joint

Diffuse ulceration of joint cyst formation

Cartilage erosion osteophyte spur formation

Cartilage thinning and

Destruction to the bone

- aching pain at joints (hands, feet, hips, knees, cervical vertebrae)

- stiffness of joints especially in the morning
- joint enlargement
- limited movement of joint
- synovitis

DIAGNOSTIC TESTS
 X-RAY

Definition X-ray imaging creates pictures of the inside of the body.

The images show the parts of the body in different
shades of black and white
Normal Values/ Findings Normal:
Image shows an anteroposterior and oblique view x-ray.
 Fidings:
*cartilage loss is revealed by a narrowing of the space
between the bones in the joint. An X-ray may also show
bone spurs around a joint.
Significance To examine and monitor the progression of a diagnosed
disease

 MRI

Definition An MRI scan uses a large magnet, radio waves, and a

computer to create a detailed, cross-sectional image of
internal organs and structures.
Normal Values / Findings Normal:

Findings:
*demonstrate reactive bone edema or soft tissue swelling
as well as small cartilage or bone fragments in the joint
Significance To detect any injuries or abnormalities of the joints,
possible tears and strains in other tissues surrounding the
joint.

NURSING DIAGNOSIS

 Pain (Chronic/Acute) rt joint degeneration

Desired Outcomes:
 pain control at a level less than 3 to 4 on a scale of 0 to 10.
 Follows pharmacological and nonpharmacological pain relief
strategies.
 engage in desired activities without an increase in pain level.

Nursing Intervention Rationale

Apply a hot or cold pack.
Change positions frequently while
maintaining functional alignment.
Heat reduces pain through improved blood flow to the
area and through the reduction of pain reflexes. Cold
reduces pain, inflammation, and muscle spasticity by
decreasing the release of pain-inducing chemicals and
slowing the conduction of pain impulses. Hot or cold
applications should last about 20 to 30 min/hr.
Muscle spasms may result from poor body alignment,
resulting in increased discomfort.

Provide for adequate rest periods. Fatigue impairs the ability to cope with discomfort.

Support joints in a slightly flexed position Flexion of the joints may reduce muscle spasms and
through the use of pillows, rolls, and towels. other discomforts.

Use adaptive equipment (such as cane, These aids assist in ambulation and reduce joint
walker), as indicated. stress.

 Impaired Physical Mobility rt restricted joint movement

Desired Outcomes:
 Performs physical activity within limits of activity restrictions

Nursing Interventions Rationale
Encourage the client to increase activity Muscular exertion through exercise promotes circulation and
as indicated. free joint mobility, strengthens muscle tone, develops
coordination, and prevents nonfunctional contracture.

Encourage the client to ambulate with Using mobility aids reduces the load on the joint and
assistive devices (such as cane, crutches, promotes safety.
walker).

Encourage the client to rest in between Rest periods are necessary to conserve energy.
activities that are tiring.

Provide the client with access to and Weight reduction results in decreased trauma to bones,
support during weight-reduction muscles, and joints.
programs.

Consult physical therapy staff to prescribe The physical therapist can help the client to promote muscle
an exercise program. strength and joint mobility and therapies to promote the
relaxation of tense muscles.

 Risk for Injury

Desired Outcomes:
 Free of injury
 Modify environment as indicated to enhance safety

Nursing Intervention Rationale

Assist client with active and passive ROM
exercises and isometrics as tolerated.
Encourage client to lose weight to decrease stress
on weight-bearing joints.
Instruct the client to use the softest surface
available during exercise.
Instruct the use of adaptive mobility equipment
such as:
walkers, canes, and crutches as indicated.
Instruct the client regarding safety measures:
- Raised chairs and toilet seat
- Use of handrails
- Accurate use of mobility equipment and
wheelchair safety.
Maintains and enhances muscle strength, joint
function, and endurance.
Excess weight adds extra stress on the joints, which
can accelerate joint cartilage deterioration.
A soft and flat surface minimizes shaking of client’s
joints and chances of hurtful steps that could
aggravate the condition.
This will keep the joints mobile, promote safety, and
maintain a high quality of life.
Helps prevent accidental injuries and falls.
NURSING INTERVENTIONS

 Weight loss. Weight loss is an important approach to pain and disability

improvement.
 Assistive devices. Canes and other ambulatory devices are very helpful for
ambulation.
 Exercise. Exercises such as walking should begin moderately and increase
gradually.
 Analgesic. Adequate pain management is essential to the success of an
exercise program.
 Physical therapy. A referral for physical therapy for people with similar
problems can be very helpful.

Surgical Management
 Osteotomy. Osteotomy is performed to alter the distribution of weight
within the joint.
 Arthroplasty. Diseased joint components are replaced in arthroplasty.

DRUG STUDY

Drug # 1
Generic Name Diclofenac Sodium –  used to
relieve pain, swelling (inflammation),
and joint stiffness caused
by arthritis. 
Trade Name Votaren
Drug Anti-Inflammatory NSAID
Classification
Side Effects Headache, dizziness, drowsiness,
hypertension, diarrhea, hurt burn
Nursing - Observe and report signs of
responsibility bleeding
- Monitor BP for hypertension and
blood sugar for hyperglycemia.
- Monitor for increased serum
sodium and potassium in patients
receiving potassium-sparing
diuretics.
- Monitor for signs and symptoms of
GI irritation and ulceration.
Drug # 2
Celecoxib – It works by reducing
hormones that cause inflammation and
pain in the body.
Celebrex
Analgesic COX-2, Cyclooxygenase 2
Inhibitors
Abdominal pain, diarrhea, nausea,
edema, dizziness, headache, insomnia,
upper respiratory tract infections; rash
- Be aware that patient may be at
increased risk for CV events, GI bleeding;
monitor accordingly.
- Administer drug with food or after meals
if GI upset occurs.
- Establish safety measures if CNS, visual
disturbances occur.