Adult Health Nursing

1. Unit VII- MUSCULOSKELETAL
DISEASES
Osteoarthritis
BY
SEHRISH NAZ
RN, Post RN, MSN
Lecturer, Institute of Nursing Sciences, Khyber Medical
University
Subject: Adult Health Nursing
2/8/2020 Post RN semester one 1

2. Objectives
By the end of this presentation participants will be able to:
• Utilize Functional health pattern to identify patients problems related to
musculoskeletal disorder Osteoarthritis.
• Integrate pathophysiology and pharmacology concepts of Osteoarthritis.
• Apply nursing process with support on Evidence-Based Nursing (EBN) to
provide to the clients with Osteoarthritis.
• Discuss the holistic approach for nursing management of the patient with
Osteoarthritis.
• Develop a teaching plan for a client experiencing disorders of the Osteoarthritis.
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3. Anatomy of the skeletal system
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4. Physiology
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5. Case Study
Patient name: XYZ
Age: 59 years
Gender: Female
Weight: 82 kg
Height: 5.5 feet
Chief complaint:
• Pain right knee joint for the last two years and
exacerbate with excessive walking and household
activities
• Mild swelling of the joint
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6. cont…
Past History:
• Diabetes for the last 5 years but well controlled
• Hypertension for the last 4 years
Family history:
• Mother and other sisters have also joint pain
Socio-economic history: Middle class
Diagnostic test:
• X-ray of knee joints
• CBC, RBS, ESR and CRP (C-Reactive Protein)
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7. PHYSICAL EXAMINATION
• CVS: S1+S2 audible with no added sounds
• Chest: B/L Clear, B/L air entry normal, normal vesicular
breathing
• GIT (Abdomin): Soft, Non tender
• CNS: GCS 15/15, Pupils reactive to light, power of limbs
is normal
• Vitals Signs:
• BP: 140/70mmHg
• Pulse: 90b/m
• Temp: 98F
• R/R: 18 b/ms
7

8. cont…
• Physical examination of the joint revealed
minor swelling and tenderness of right knee
joint. Function of the joint was intact with
intact ROM.
• X-ray revealed joint space narrowing and
cartilage loss at the edges with small
osteophytes.
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9. What is Arthritis?
• Arthritis means inflamed joint (in Latin).
Collectively it’s a leading cause of disability for
adults and even children.
• There are over 100 types of arthritis, although
the most common is osteoarthritis sometimes
referred to as “wear and tear” of bones and
joints or degenerative arthritis.
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10. Osteoarthritis(OA)
• OA is a chronic irreversible degenerative disease of
synovial joints that causes progressive softening and
disintegration or loss of articular cartilage (hyaline cartilage)
(cartilage is a central tissue of joint health). Accompanied by:
• New growth of cartilage and bone at the joint margins
(osteophytes)
• Cyst formation and sclerosis in the subchondral bone
• Mild synovitis and capsular fibrosis
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11. Risk Factors
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12. 2/8/2020 Osteoarthritis 12

13. Pathophysiology (Obesity)
Weight-bearing joints
Begins with erosion of the joint cartilage
Causing fissures/craking
Loss of cartilage
Bone contact
Bone destruction/remodeling
Pain, Reduced ROM and Inflammation
(Osteoarthritis)
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14. Reduced proteoglycan, Reduced synovial fluid production in joints
Dry cartilage
Less lubrication and more friction
Cartilage thins and disintegrates releasing pieces into synovial space–
“joint mice.”
Cartilaginous debris cause inflammation, instability and pain
Boney contact causes more inflammation, pain, reduced ROM and
bone spurs)
(Osteoarthritis)
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Pathophysiology (Age)

15. • Osteophytes or “bone spurs” form in an
attempt to stablize the joint and ultimately fuse
it together.
• Bone spurs can injure nerves, blood vessels and
connective tissues.
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16. 2/8/2020 16Osteoarthritis

17. Clinical manifestation
mnemonic (Osteo)
• Outgrowth “bony” from bone Spurs. (haberdens’
nodes- distal interphalangeal joint) & (bouchards
nodes-proximal interphalangeal joint)
• Stiffness (sunrise stiffness less then 30 minutes in
morning and pain and stiffness worsen at the end of
the day)
• Tenderness
• Experience crepitus (joint pain-when doing activity
and goes away with rest)
• Only joints (e.g. weight bearing joints)
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18. Causes & Risk Factors
Exact cause is unknown but may due to the
following risk factors
• Age
• Obesity
• Poor Posture
• Trauma
• Genetics
• Occupation
• Joint dysplasia
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19. Diagnostic tests
• History & Physical exam
• Imaging
• Arthroscopy
• Joint aspiration
• Blood tests: CBC, ESR and CRP
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20. Treatment Approaches
Early treatment
• Analgesics
• Physical Activity
• Load reduction
Intermediate :
• Joint debridement
Late Treatment (surgery):
• Joint replacement
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21. Non-pharmacological approaches
Life style changes
• Weight loss especially via exercise, helps
prevent OA and reduce symptoms.
(Every 10 pounds of weight loss over 10 years
reduces the risk of developing knee OA by
50%)
• Exercise also improves muscle strength,
decreases joint pain and stiffness, and lowers
risk of disability.
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22. Cont…
Physical treatments
• Physiotherapy
• Massage
• Acupunture
• Yoga
• Hydrotherapy
(All proven to reduce the symptoms and sometimes the
progression of OA, particularly of the spine and Hips)
Devices
• Foot orthotics
• Orthropedic pillows/seats and braces can relieve or
prevent OA symptoms
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23. Conti…
Herbal remedies
• Some herbs are anti-inflammatories/analgesics.
• Other natural compunds:
• Vitamin C
• Omega-3 fatty acids
• Diet: vegetables, fruits, grains
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24. Nursing diagnosis
Acute pain related to swollen, inflamed joints
and restricted movement
Management
• Assess the client’s description of pain.
• Identify factors or activities that seem to
precipitate acute episodes or aggravate a
chronic condition.
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25. Conti….
• Determine the client’s emotional reaction to
chronic pain.
• Apply a hot or cold pack.
• Medicate for pain before activity and exercise
therapy.
• Provide for adequate rest periods.
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26. Conti….
• Support joints in a slightly flexed position
through the use of pillows, rolls, and towels
• Use adaptive equipment (such as cane,
walker), as indicated.
• Instruct the client to take prescribed
analgesics and/or anti-inflammatory
medications.
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27. cont…
ND: Impaired physical mobility related to pain and
restricted joint movement.
Management
• Assess the client’s posture and gait.
• Assess the client’s weight.
• Assess range of motion (ROM) in all joints,
comparing passive and active ROM.
• Assess the client’s ability to perform ADLs.
• Determine what adaptive measures the client has
already taken to be able to perform self-care
measures.
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28. Conti…
• Assess the client’s comfort with and
knowledge of how to use assistive devices.
• Assess the client’s vital signs after physical
activity.
• Encourage the client to increase activity as
indicated.
• Increase the client in how to perform
isometric, and active and passive ROM
exercises to all extremities.
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29. Cont…
• Discuss the environmental barriers to mobility.
• Encourage sitting in a chair with a raised seat and
firm support.
• Encourage the client to ambulate with assistive
devices (such as cane, crutches, walker).
• Encourage the client to rest in between activities
that are tiring.
• Suggest strategies for getting out of bed, rising
from chairs, and picking up objects from the floor
to conserve energy.
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30. Conti…
• Consult physical therapy staff to prescribe an
exercise program.
• Provide the client with access to and support
during weight-reduction programs.
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31. References
• 1. Solomom L, Warwick D, Nayagam S. Apley’s
System of orthopaedics and Fractures. ninth Edition.
• 2. Lawrence RC, Felson DT, Helmick CG, et
al. Estimates of the prevalence of arthritis and other
rheumatic conditions in the United States. Part
II, Arthritis Rheum , 2008, vol. 58 (pg. 26-35)
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