Osteoarthritis

A. Pusey Murray (Mrs)

 Objectives
At the end of this session students will be able
to:
• Define the term osteoarthritis
• Outline the etiology of osteoarthritis
• List the clinical manifestations of osteoarthritis
• State the diagnostic and laboratory studies
• Discuss the nursing management of the
patient with osteoarthritis.
 Definition
• Osteoarthritis is a non-inflammatory
progressive joint disease causing erosion of
the cartilage between bones, development of
bone cysts and osteophytes (bony
outgrowths), thickening of the bone plates,
narrowing of the joint space, and
inflammation and swelling of the joint
capsule.
 Definition
• Osteoarthritis may be secondary to injury
(trauma, overuse) of a joint or idiopathic
(cause unknown).
 Causes
• Osteoarthritis is caused by 'wear and tear' on
a joint.
• Cartilage is the firm, rubbery tissue that
cushions your bones at the joints, and allows
bones to glide over one another.
 Causes
• Cartilage can break down and wear away. As a
result, the bones rub together, causing pain,
swelling, and stiffness.
• Bony spurs or extra bone may form around
the joint, and the ligaments and muscles
around the hip become weaker and stiffer.
 Causes
• Being overweight increases the risk of OA in
the hip, knee, ankle, and foot joints
• Fractures or other joint injuries can lead to OA
later in life
• Hereditary
• Bleeding disorders that cause bleeding in the
joint, such as hemophilia
 Clinical Manifestations
• Joint movement may cause a cracking
(grating) sound, called crepitation
• Joint swelling (bones around the joints may
feel larger than normal)
• Limited range of motion
 Clinical Manifestations
• Tenderness when the joint is pressed
• Normal movement is often painful
• The joints most likely to be involved are the
hip and knee joints.
 Diagnostic & Laboratory Studies
• Radiographs may reveal a narrowing of the
joint space.
• CBC to screen for anemia caused by occult
gastrointestinal bleeding.
 Diagnostic & Laboratory Studies
• Renal and liver function test for older clients
starting aspirin or NSAID therapy, with further
testing done every 6 months to monitor
occasional side effects such as electrolyte
imbalance, hepatitis or renal insufficiency.
• MRI scan much more sensitive than x-ray
examination in marking progression of joint
destruction.
 Nursing Management
• Administer prescribed medications which may
include analgesics, non-steroidal anti-
inflammatory drugs (NSAIDS)
• Apply warm compresses to sore joints.
• Massage surrounding muscles, not over
inflamed joints.
 Nursing Management
• The nurse’s primary concern for a client
diagnosed with degenerative joint disease
caused by osteoarthritis that is scheduled for
total hip replacement of the right leg is
leukocytosis and localized bone pain.
 Nursing Management cont’d
• Promote adequate rest and reduction of
stress.
• Maintain non-judgemental attitude and
respect the client’s right to choose any
alternative treatment if she obtains relief.
• Position client to prevent flexion deformity
using a foot board, splints or pillows as
needed.
 Nursing Management cont’d
• Plan activities that promote optimal function
and independence.
• Refer to physical therapy(may prescribe and
implement modified weight-bearing exercises
within the patient’s tolerance level), and
occupational therapy (help with se;f-
management strategies).
 Nursing Management cont’d
• Prepare the client for surgical treatment as
indicated e.g. total joint replacement,
arthroplasty, osteotomy.
• Patient teaching should include information
about the nature of the treatment of the
disease, pain management, correct posture,
body mechanics and correct use of devices
such as crutches, and cane.
 Nursing Management cont’d
• Weight reduction if necessary.
• Importance of joint protection, with balance
of rest activity.
• Proper use of heat or cold therapy, as
appropriate to joint condition.
• Referral to community resources including
local arthritis support activities.
 Nursing Interventions
• Schedule of activities to provide a rest period
of continuous and uninterrupted nighttime
sleep.
• Assist clients with range of motion active /
passive and resistive exercise and isometric if
possible.
 Nursing Intervention
• Provide a safe environment, for example,
raise the chair / toilet, use a high grip and tub
and toilet, the use of mobility aids /
wheelchairs rescue.
• Collaboration with the physical therapist and
occupational.
 Question
Which of the following would best indicate
the effectiveness of analgesic medications for
osteoarthritis?
• The client has increased range of motion in
joints with contractures
• The client reports decreased pain after
exercises and at night
 Question cont’d
• The client demonstrates the ability to perform
activities of daily living
• The client’s Heberden nodes have
disappeared
 References
Gregory PJ, Sperry M, Wilson AF.(2008)
Dietary supplements for osteoarthritis. Am
Fam Physician. 77:177-184. PubMed:
18246887
Hunter, D.J. In the clinic: Osteoarthritis. Ann
Intern Med. 2007;147(3):ITC8-1-ITC8-16
PubMed: 17679702