Osteoarthritis (OA) is a degenerative joint disease and the most common type of arthritis. This condition is associated with the gradual loss of cartilage between joints and the formation of osteophytes or outgrowths at the margins of the joints. This is what causes pain and can lead to joint damage. The hands, knees, hips, and spine are most commonly affected.
While this condition is not part of the normal aging process, it is common in older adults with aging as a risk factor. It affects women more often than men.
Clinical manifestations of OA can range from mild discomfort to significant and severe disability and may include the following:
- Joint pain that intensifies with use
- Joint stiffness
- Joint inflammation
- Limited range of motion
- Heberden’s nodes
- Bouchard’s nodes
- Fatigue
This condition is diagnosed through an x-ray or MRI. These diagnostic tests can determine the presence of bone spurs and the stage of joint damage.
Nursing Process
Since there is no cure for osteoarthritis, nursing care focuses on pain management, comfort measures, preventing disability, and improving joint function. In more severe cases, nurses may care for patients following joint replacement surgery. Nurses can also educate patients on nonpharmacologic and outpatient strategies to reduce pain and improve mobility.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for osteoarthritis, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for osteoarthritis.
Chronic Pain
Osteoarthritis causes ongoing pain. Pain is often worse with activity and may improve with rest. Stiffness in the morning does not last beyond 30 minutes.
Nursing Diagnosis: Chronic Pain
Related to:
- Disease process
- Joint stiffness
- Joint degeneration
- Bone deformities
- Inflammatory process
- Bone spurs
As evidenced by:
- Diaphoresis
- Distraction behavior
- Expressive behavior
- Guarding behavior
- Facial grimacing
- Positioning to ease pain
- Reports pain intensity
- Hesitancy to move joints
Expected outcomes:
- The patient will report pain relief and comfort
- The patient will demonstrate two strategies to reduce pain
Assessment:
1. Conduct a comprehensive pain assessment.
Results from a comprehensive pain assessment are critical to identifying the underlying cause of pain and the effectiveness of treatment.
2. Assess factors that precipitate pain.
Pain in osteoarthritis may be associated with specific movements of affected joints. Joint pain when waking is normal but should dissipate within 15-20 minutes.
Interventions:
1. Apply a hot or cold compress for 30 minutes.
Heat improves blood flow and reduces pain reflexes. Cold can help reduce inflammation, pain, and muscle elasticity. Each patient may prefer one over the other.
2. Take breaks.
Joint pain with OA often worsens with activity and lessens with rest. The patient may need to take breaks when working, exercising, or completing tasks.
3. Administer oral and topical pain relief.
NSAIDs are recommended for OA pain. Over-the-counter topical creams and gels such as diclofenac are commonly used to relieve arthritic pain.
4. Consider injections.
Cortisone injections injected into the joint space can relieve pain temporarily for a few weeks. Lubrication injections that use hyaluronic acid may help cushion the joints.
5. Instruct on a TENS unit.
Transcutaneous electrical nerve stimulation sends low-voltage currents to the area around the joint to provide short-term relief.
Deficient Knowledge
A lack of knowledge about osteoarthritis and its management options can decrease the patient’s adherence to the treatment regimen. If left untreated, osteoarthritis can affect mobility function and quality of life.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Misinformation
- Inadequate access to resources
- Inadequate commitment to learning
- Inadequate awareness of resources
- Inadequate interest in learning
- Inadequate participation in care planning
As evidenced by:
- Inaccurate follow-through of instructions
- Poor adherence to therapy or exercise
- Inaccurate statements about a topic
- Development of irreversible joint damage
Expected outcomes:
- The patient will explain the disease process and the necessity of the treatment regimen
- The patient will adhere to the treatment regimen and exhibit improved symptoms, as evidenced by reduced pain and stiffness and a more active lifestyle
Assessment:
1. Assess the patient’s existing knowledge about the disease.
Evaluating the patient’s understanding and how the patient perceives the management of osteoarthritis allows healthcare providers to plan appropriate care and provide correct patient education.
2. Assess the patient’s readiness and motivation to learn.
The patient’s motivation and readiness to learn will affect retention and adherence to the treatment regimen.
Interventions:
1. Reinforce patient education through frequent repetition and follow-up sessions.
Frequent and regular education sessions promote medication and self-care management adherence with improved outcomes.
2. Educate the patient about proper medication use.
NSAIDs are commonly prescribed in the treatment regimen of osteoarthritis but can have side effects if taken incorrectly. Proper timing, dosage, and use of medications should be provided to the patient.
3. Educate on supplements.
If prescribed by the provider, the nurse can educate the patient on supplements for joint health. These often include collagen, glucosamine, and chondroitin.
4. Encourage the use of devices.
The nurse can educate the patient on devices to make everyday activities easier. Electric can openers and large-handled utensils can reduce stress on finger joints. Rubber grips on knobs and handles can make turning easier. Gloves and knee/elbow sleeves can keep joints aligned for better mobility.
Impaired Physical Mobility
Osteoarthritis can cause bone deformity and degrade cartilage which can cause permanent joint damage leading to impaired physical mobility.
Nursing Diagnosis: Impaired Physical Mobility
Related to:
- Disease process
- Joint pain
- Joint stiffness
- Muscle weakness
- Fatigue
- Restricted joint movement
- Inflammatory process
- Decreased muscle strength
As evidenced by:
- Decreased range of motion
- Difficulty turning
- Engages in substitutions for movement
- Expresses discomfort
- Uncoordinated movement
- Sedentary lifestyle
Expected outcomes:
- The patient will perform activities without discomfort and with minimal supervision
- The patient will participate in therapy and exercise to improve mobility
Assessment:
1. Assess the patient’s ability to ambulate and perform ADLs.
It is important to determine the extent of the patient’s physical immobility to determine the resources needed.
2. Assess the passive and active range of motion in the patient’s joints.
Osteoarthritis causes joint deformity and stiffness leading to progressive loss of range of motion.
Interventions:
1. Encourage the use of assistive devices.
The correct use of assistive devices can help improve the patient’s mobility, promote safety, and reduce the risk of injury.
2. Encourage the patient to increase activities as tolerated.
The patient may be hesitant to participate in exercise that can cause pain, but increasing activity can help improve and maintain joint function and independence. The patient can partake in low-impact activities like swimming and biking, which may be easier on joints.
3. Refer the patient to physical therapy.
A physical therapist can help formulate an exercise program addressing the immobility and joint dysfunction of the patient.
4. Refer the patient to community resources.
Local gyms or clubs may offer “joint-friendly” classes such as chair yoga or water aerobics that also provide socialization.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- Osteoarthritis. Arthritis Foundation. 2022. From: https://www.arthritis.org/diseases/osteoarthritis
- Osteoarthritis. Mayo Clinic. Reviewed: June 16, 2021. From: https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925
- Osteoarthritis (OA). Centers for Disease Control and Prevention. Reviewed: July 27, 2020. From: https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
- Osteoarthritis (OA). Versus Arthritis. 2022. From: https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/
- Osteoarthritis. Sen R, Hurley JA. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482326/
