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Unit 7 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. 2/8/2020 2Osteoarthritis
- 3. Anatomy of the skeletal system 2/8/2020 Osteoarthritis 3
- 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 2/8/2020 5Osteoarthritis
- 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) 2/8/2020 6Osteoarthritis
- 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. 2/8/2020 Osteoarthritis 8
- 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. 2/8/2020 9Osteoarthritis
- 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 2/8/2020 10Osteoarthritis
- 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) 2/8/2020 13Osteoarthritis
- 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) 2/8/2020 14Osteoarthritis 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. 2/8/2020 15Osteoarthritis
- 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) 2/8/2020 17Osteoarthritis
- 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 2/8/2020 18Osteoarthritis
- 19. Diagnostic tests • History & Physical exam • Imaging • Arthroscopy • Joint aspiration • Blood tests: CBC, ESR and CRP 2/8/2020 19Osteoarthritis
- 20. Treatment Approaches Early treatment • Analgesics • Physical Activity • Load reduction Intermediate : • Joint debridement Late Treatment (surgery): • Joint replacement 2/8/2020 20Osteoarthritis
- 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. 2/8/2020 21Osteoarthritis
- 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 2/8/2020 22Osteoarthritis
- 23. Conti… Herbal remedies • Some herbs are anti-inflammatories/analgesics. • Other natural compunds: • Vitamin C • Omega-3 fatty acids • Diet: vegetables, fruits, grains 2/8/2020 23Osteoarthritis
- 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. 2/8/2020 24Osteoarthritis
- 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. 2/8/2020 25Osteoarthritis
- 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. 2/8/2020 26Osteoarthritis
- 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. 2/8/2020 27Osteoarthritis
- 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. 2/8/2020 28Osteoarthritis
- 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. 2/8/2020 29Osteoarthritis
- 30. Conti… • Consult physical therapy staff to prescribe an exercise program. • Provide the client with access to and support during weight-reduction programs. 2/8/2020 30Osteoarthritis
- 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) 2/8/2020 31Osteoarthritis
Editor's Notes
- C-reactive protein is an annular, pentameric protein found in blood plasma, whose circulating concentrations rise in response to inflammation. It is an acute-phase protein of hepatic origin that increases following interleukin-6 secretion by macrophages and T cells. CRP is synthesized by the liver[6] in response to factors released by macrophages and fat cells (adipocytes).[7] It is a member of the pentraxin family of proteins.[6] It is not related to C-peptide (insulin) or protein C (blood coagulation). C-reactive protein was the first pattern recognition receptor (PRR) to be identified.[8]
- in osteoarthritis, the early osteochondral plate angiogenesis may further enhance the ability of microbiota to locate close to the deeper layers of cartilage, and this might lead to focal dysbiosis, low-grade inflammation, cartilage degradation, epigenetic changes in chondrocytes and worsening of osteoarthritis.
- .g., estrogen and thyroid hormone