Nursing Care Plan (NCP) for Osteoarthritis (OA), Degenerative Joint Disease

Lesson Objective for Osteoarthritis (OA), Degenerative Joint Disease

By the end of this lesson, nursing students will be able to formulate a comprehensive Nursing Care Plan (NCP) for individuals diagnosed with Osteoarthritis (OA)

• Understanding Osteoarthritis:
  • Gain knowledge about the pathophysiology and clinical manifestations of Osteoarthritis.
  • Differentiate between Osteoarthritis and other types of arthritis.
  • Learn how to perform a thorough assessment to diagnose and stage Osteoarthritis.
  • Understand the importance of imaging studies and laboratory tests in confirming the diagnosis.
  • Explore various pain management approaches, including pharmacological and non-pharmacological interventions.
  • Emphasize the significance of individualized pain management plans.
  • Understand the role of lifestyle modifications, exercise, and weight management in OA management.
  • Educate patients on self-management strategies to enhance their ability to cope with OA.
  • Recognize the importance of interdisciplinary collaboration in OA care.
  • Learn how to monitor the effectiveness of interventions and adjust the care plan accordingly.

  Pathophysiology for Osteoarthritis (OA), Degenerative Joint Disease

  • Articular Cartilage Breakdown:
    • Gradual breakdown and loss of articular cartilage in joints.
    • Altered biomechanics and increased stress on the affected joints.
    • Formation of osteophytes (bone spurs) at joint margins.
    • Joint space narrowing and reduced range of motion.
    • Mild inflammation of the synovial membrane.
    • Production of inflammatory mediators contributing to joint damage.
    • Changes in the subchondral bone, including sclerosis and cyst formation.
    • Affects the structural integrity of the joint.
    • Gradual onset of joint stiffness, especially after periods of inactivity.
    • Joint pain, often exacerbated by weight-bearing and movement.

    Etiology for Osteoarthritis (OA), Degenerative Joint Disease

    • Age and Wear:
      • Increased incidence with aging due to wear and tear on joints.
      • Cumulative impact on joint structures over time.
      • Genetic predisposition contributing to the development of OA.
      • Family history as a risk factor.
      • Previous joint injuries or trauma increase the risk.
      • Post-traumatic OA can develop after joint injuries.
      • Excessive body weight as a significant risk factor.
      • Increased stress on weight-bearing joints.
      • Structural abnormalities or joint malalignment.
      • Altered joint mechanics contributing to OA development.

      Desired Outcome for Osteoarthritis (OA), Degenerative Joint Disease

      • Pain Management:
        • Alleviation of joint pain through effective pain management strategies.
        • Improvement in the quality of life related to pain reduction.
        • Preservation and enhancement of joint function.
        • Optimization of the individual’s ability to perform activities of daily living.
        • Increased joint mobility and range of motion.
        • Restoration of functional mobility for better independence.
        • Successful adoption of lifestyle modifications.
        • Implementation of weight management and exercise routines.
        • Empowerment of the patient through education on self-management.
        • Active participation in the management of OA and its symptoms.
        • Minimize further degeneration of affected joints through a combination of pharmacological and non-pharmacological interventions, aiming to slow the progression of osteoarthritis and preserve joint structure.
        • Foster the development of effective coping mechanisms to help the patient manage the psychological and emotional aspects of living with osteoarthritis. This includes strategies for dealing with pain, stress, and potential fluctuations in mood.
        • Facilitate increased social participation and engagement by supporting the patient in maintaining or establishing connections with their community. This may involve adapting activities to accommodate physical limitations and promoting a sense of belonging and support

        Osteoarthritis (OA), Degenerative Joint Disease Nursing Care Plan

        Subjective Data:

        • Pain
        • Tenderness
        • Stiffness
        • Loss of flexibility
        • Grating sensation

        Objective Data:

        • Bone spurs
        • Swelling around the joint
        • Limited ROM
        • Crepitus

        Nursing Assessment for Osteoarthritis (OA), Degenerative Joint Disease

        • Pain Assessment:
          • Evaluate the patient’s experience of pain, including the location, intensity, quality, and duration of joint pain associated with osteoarthritis. Utilize pain scales to quantify the pain level.
          • Assess the patient’s joint function and mobility, noting any limitations or restrictions. Evaluate the range of motion, joint stiffness, and the impact of pain on daily activities.
          • Explore the patient’s usual activity level and the extent to which osteoarthritis affects their ability to perform activities of daily living (ADLs). Identify any modifications or adaptations they have made to cope with limitations.
          • Examine the affected joints for any signs of deformities, such as swelling, bony nodules, or changes in joint alignment. Document the presence of Heberden’s or Bouchard’s nodes, which are characteristic of osteoarthritis.
          • Evaluate the patient’s overall functional independence, including their ability to independently perform self-care activities, ambulate, and participate in social and recreational activities.
          • Assess the psychosocial impact of osteoarthritis on the patient’s mental health and well-being. Inquire about any feelings of frustration, anxiety, or depression related to the chronic nature of the condition and its impact on daily life.
          • Obtain a detailed medication history, including over-the-counter and prescription medications used to manage osteoarthritis. Assess the effectiveness of current medications and identify any adverse reactions.
          • Evaluate the patient’s nutritional status, with a focus on weight management and dietary habits. Excessive weight can exacerbate symptoms, and nutritional interventions may be necessary for overall joint health.

          Implementation for Osteoarthritis (OA), Degenerative Joint Disease

          • Pharmacological Interventions:
            • Administer prescribed medications, including analgesics and anti-inflammatory drugs.
            • Monitor for side effects and assess the effectiveness of pain management.
            • Implement non-pharmacological pain management techniques (heat/cold therapy, joint protection strategies).
            • Educate patients on the use of assistive devices for pain relief.
            • Collaborate with physical therapists to develop individualized exercise programs.
            • Monitor and encourage adherence to prescribed exercise routines.
            • Provide comprehensive education on Osteoarthritis, its progression, and management.
            • Emphasize the importance of lifestyle modifications and self-management.
            • Collaborate with a multidisciplinary team, including physical therapists, dietitians, and pain management specialists.
            • Ensure coordinated and comprehensive care.

            Nursing Interventions and Rationales for Osteoarthritis (OA), Degenerative Joint Disease

            • Assess chronic pain

            Pain is the most common and long-standing symptom of OA. Assess the patient’s description of pain and what has worked for them in the past. They may describe the pain as a constant ache while at rest that worsens with movement.

            • Assess acute, breakthrough pain

            Patients often become accustomed to constant pain of OA but will experience a sharp or exacerbated pain when applying full weight to the joint or with movement such as walking.

            • Monitor joint swelling and RICE

            Joints often swell with stress such as walking or with an injury. Remember RICE: Rest, Ice, Compression, Elevation

            • Apply heat/cold as appropriate; heat may help reduce pain as it increases blood flow, but can also cause increased inflammation. Cold helps reduce pain and inflammation

            Alternate between warm and cold compresses, allowing only 20-30 minutes of each with 20-30 minute rest periods in between. Make sure the warm compresses are not too hot and avoid using arthritis creams with heat to prevent burns. Monitor the skin to avoid cold damage to tissues.

            • Assist with ROM exercises, AROM and PROM; coordinate physical/occupational therapy as appropriate

            Encourage ROM activity to loosen joints and prevent stiffness. Consider medicating before exercise to reduce pain.

            • Administer medications as appropriate to relieve pain and reduce inflammation.
            • Acetaminophen is a safe and effective analgesic
            • NSAIDs provide pain relief and help reduce inflammation
            • Corticosteroids– relieve inflammation in severe cases or when NSAIDs are not indicated as with a history of GI bleed, peptic ulcers, or allergies.
            • Duloxetine may be given to treat chronic OA pain
            • Diclofenac helps relieve pain and inflammation; it comes in oral and topical applications for target areas
            • Provide adaptive equipment as necessary to encourage self-care
              • Walkers, canes
              • Largely handled eating utensils and grooming products (toothbrush or hairbrush)

              Patients with OA of the hands, wrists, and elbows often have difficulty performing self-care and feeding themselves. Offer tools and encouragement to promote as much independence as possible.

              • Initiate fall precautions
                • Non-slip shoes/socks
                • Clear walkways
                • Ensure adequate lighting
                • Provide handrails
                Joint damage causes weakness and increases the risk of falls and injuries.
                • Initiate fall precautions
                  • Non-slip shoes/socks
                  • Clear walkways
                  • Ensure adequate lighting
                  • Provide handrails
                  Joint damage causes weakness and increases the risk of falls and injuries.
                  • Assist with ambulation and ADLs as required

                  Patients are often unsteady and nervous about ambulation. Provide assistance with transfers and walking, use gait belts, and assist with ADLs as necessary.

                  Evaluation for Osteoarthritis (OA), Degenerative Joint Disease

                  • Pain Assessment:
                    • Regularly reassess pain using standardized tools.
                    • Modify pain management strategies based on assessment findings.
                    • Evaluate improvements or changes in joint function and mobility.
                    • Adjust interventions to address limitations.
                    • Assess patient adherence to prescribed exercise programs.
                    • Identify and address barriers to compliance.
                    • Monitor psychosocial well-being and mental health.
                    • Provide additional support or referrals as needed.
                    • Evaluate the impact of interventions on the patient’s overall quality of life.
                    • Make adjustments to the care plan to optimize outcomes.

                    References

                    • https://www.mayoclinic.org/diseases-conditions/osteoarthritis/diagnosis-treatment/drc-20351930
                    • https://www.arthritis.org/about-arthritis/types/osteoarthritis/symptoms.php
                    • https://www.webmd.com/osteoarthritis/guide/osteoarthritis-basics#1-3
                    • https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteoarthritis

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                    Transcript

                    Okay. Let's work through an example Nursing Care Plan for a patient with arthritis. Now don't get a little caught up here. There's a couple different types of arthritis. There's osteoarthritis, rheumatoid arthritis, gouty arthritis. But really when we're looking just generally at arthritis, we're going to see a lot of really common themes between these patients. So this is going to be our hypothetical patient with a form of arthritis. Okay. So first step is gather all the information. So again, hypothetical patient. Let's just think through some of the data we might see specifically related to arthritis. So most of what we have here is probably subjective cause what's happening is the patient's going to say, Hey, I'm in pain, my joints hurt, my joints are tender, right? Painful tender joints is like one of the top things you're going to see with these patients. They also might say that they’re stiff, that they're really having trouble moving around.

                    Things that might be objective. We might actually see some swelling. We might be able to objectively, say, hey, they've got decreased range of motion and we may actually be able to feel some crepitus. Especially in that osteoarthritis, you start to get bone on bone and you'll feel the crepitus. You'll potentially hear the crepitus and it's a problem. So the number one thing here that we see is joint issues, right? It's arthritis literally means inflammation in the joints. You might even have some warmth around the joints because of that inflammation. So take this information, analyze it, decide what the problems are. So what's a big problem for this patient? Well, any kind of movement that they do is probably painful, right? It's painful. They're really struggling. We also know that their movement is limited, right? So if their movement is limited and they can't really move around as well, what's another problem we're gonna have?

                    Here's a patient. Everything hurts. Everything's stiff. It's hard to move. So what happens if they trip right? They're probably going to fall. They're probably going to fall. So this is one of the big things we see with our arthritis patients, especially when they have arthritis of their lower extremities, is that they can't move as quickly or as easily to actually catch themselves if something happens. And so really important that we remember how risky this is for them as far as falls go. So that being said, what's our major priority? It's going to be safety. We have got to address their safety and keep them safe and then we'll work on the rest of the pain and the limited range of motion as well. So we have asked our how questions, how do we know it was a problem? Again, this is where we just start linking our data together.

                    We go back to all the assessment data and we say, you know what? This is what tells me this is a problem. Patient has a pain score of 9 out of 10 that tells me that their movement is too painful. So let's look at these things we just came up with and decide how we would address it. So of course we've got some assessments to do, right? We're going to assess pain. I really need to know where I'm at with all of that. I need to know where their pain levels at so I know how to treat it. I can also do things like heat and cold for pain or I can do meds for pain, so whatever works for them. We usually try the nonpharmacologic first and then we'll move to the pharmacologic pain meds. I also want to promote rest. If I can get them to rest, I can decrease some of that inflammation in the joints and I can make things a little bit less painful for them.

                    I also want to do some range of motion exercises and get like PT involved, right? All of this is going to really help improve their mobility, improve their functional ability, improve that range of motion. And then also I can just help, right? If the, if I've got somebody who's really struggling to move around, I can assist them with their ADLs. I can assist them with ambulation and then remember, remember we said one of our priorities was safety and so I might actually educate them and help them use those assistive devices as well. Things like walkers or canes and that just really gives them a little bit more stability so that we don't worry about them falling. So again, how do I know if it gets better? I look back, look back at my data. So patient's going to report decreased pain. We're going to see increased range of motion.

                    We talked about safety and falls. How about patient doesn't fall, right? So we look back at our data, we look back at the things that we're worried about and that's how we know if it gets better. So time to translate. Let's be really concise. Let's pick our top three nursing concepts for this patient. So number one we already said is safety. We have got to keep them safe. We've got to keep them from falling, keep them from hurting themselves. And the second thing we'll probably start addressing their pain, their pain or their comfort level because the less pain they're in, the easier it is to move around. And the easier it is to move around, the more likely they're going to be safe. They're going to be able to take care of themselves and have a little bit more of independence. And then I think from there we can start worrying about their mobility.

                    Um, so that we can increase range of motion and really get them functioning at a higher level. All right, let's transcribe it. Let's put it, put it on paper. So again, our top three are going to be safety because of that risk for falls, comfort and pain control and mobility. So again, this is really that place where we get to connect one thing to the other. We get to connect and say, what's the problem and how do I know, what am I doing and why and what do I expect to find? So let's go across the top for safety. So why are they at risk for falls? There's joints are stiff, their range of motion is limited. It's going to be difficult for them to keep their balance and catch themselves if something bad happens. So first thing I'm going to do is educate them on the use of assistive devices.

                    Again, this could be a cane, could be a walker. Either way, I just want to give them a little bit more stability and then I'm going to institute any kind of fall precautions that need to be in place. So that might be side rails. That might be a bed alarm. That might be just making sure that they have their call light. Either way. The goal here is going to be to encourage self care. So the more that they can get around by themselves, the more independent they can be. And then of course decreasing any risk for falls. So again, our expected outcome, our worry was they were going to fall. So what's our expected outcome? They don't fall, right? So everything lines up. All right, so let's look at the next one. So how do I know they're in pain? They tell me they're in pain, right?

                    Also, crepitus is not comfortable. I guarantee you. So having that crepitus in your joints definitely, uh, could be part of that comfort issue. So what are we going to do? We're going to assess that pain level. We're going to apply heat or cold. A lot of times we'll apply heat and cold and we'll just alternate. So we'll go back and forth every 20 minutes. Because the heat is going to be good for circulation and the cold is going to be good for getting rid of the inflammation. And then of course we're going to get pain meds because we can, right? So knowing their baseline so that we can treat it appropriately. We always start with the nonpharmacologic interventions first. So he in cold rest, things like that. Um, and then we just know that getting their pain under control is going to help them be safer.

                    It's going to improve their mobility, it's going to prove their ability to take care of themselves. So look back at your data to figure out your extent, expected outcome. Patient reports, decreased pain level. There you go. I want to see them be more comfortable. All right. Mobility. Why do they have mobility issues? Because there's swelling at the joints and the range of motion is limited. And so if they're swelling, it's going to make it more difficult to move around and they're gonna limit that range of motion. They're not going to be able to do all the same things that they did before, if they didn't have the swelling or if they didn't have the stiffness or problems that they're having with their joints. So big goal here, promote rest, get PT and OT involved, do those range of motion exercises and assist the patient with their ADL as needed.

                    So our goal here is going to be to decrease swelling, increase that range of motion and mobility and PT and OT are fabulous for these things. And then also remember, remember that ADL are difficult with poor mobility. So getting PT, OT involved, um, is really gonna help improve their ability to do that. So our expected outcome, I want to see improve range of motion. So maybe over here they had, you know, a certain number of degrees, I'm just picking numbers safe. They had, they were able to go 30 degrees [00:08:30] and to now I'm going to say I want them to be able to go at least 50, whatever's appropriate PT can really help you with that. And then I want to see that they performed their atls independently. So the goal is always to help the patient be as independent as possible. All right, let's review first things first is always assess, collect your data, figure out everything that's going on with your patient.

                    Then analyze that information, the relevant, important information. Figure out what your problems are, prioritize what's going on with your patient. Then you can ask your how questions, how did I know it was a problem? How am I going to address it? And how will I know if I fixed it? And then translate. If you need to put it into concise terms, be really specific. I'd be able to name your top two or three priorities. Don't just start talking, really be concise with those terms and then get it on paper. So transcribe it. Use a form or a template that you prefer. Use whatever you need to use to make sure that you have a written plan for your patient. So that's it for our sample care plan for a patient with arthritis. Obviously if we had something specific like Gout, we could talk about administering medications to decrease uric acid. If we were talking rheumatoid, we could talk about the immune, but really overall our big concerns are going to be mobility, safety, and pain and comfort. So make sure that you check out the rest of the examples found in this course, as well as our nursing care plan library. And I go out and be your best self today, gys. As always, happy nursing.

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