Degenerative Joint Disease DJD

Degenerative Joint Disease DJD Osteoarthritis Nursing Diagnosis Interventions and Care Plans

Degenerative Joint Disease DJD Osteoarthritis NCLEX Review Care Plans

Nursing Study Guide for Degenerative Joint Disease or Osteoarthritis

Arthritis is a collective term that is used to describe joint inflammation among individuals. The most common type of arthritis is degenerative joint disease, also known as osteoarthritis (OA).

This happens when there is progressive deterioration of the cartilage in joints.

It can occur anywhere in the body, but it is mostly seen in weight-bearing joints that acquire the greatest stress, such as the hips, knees, and spine.

There are also instances wherein OA affects the fingers, thumb, neck, and large toe.

Unless there is presence of trauma, excessive stress or previous injury, OA is rarely to develop in the other joints of the body.

Signs and Symptoms of Degenerative Joint Disease

  • Joint soreness and pain – especially during physical activity, overuse, or long periods of physical inactivity
  • Bony enlargement – found in the middle and end joints of the fingers

Causes and Risk Factors for Degenerative Joint Disease

Degenerative Joint Disease or OA can manifest through a variety of forms, and with different risk factors involved.

These risk factors may include genetics, obesity, previous injuries, and joint overuse.

Inherited defects in the production of collagen, a major component of cartilage, has been correlated with increased susceptibility to develop osteoarthritis.

Obesity, on the other hand, has always been associated with long-term health problems, one of which is degenerative joint disease.

The continuous stress brought upon to the joints, by being overweight contributes to the injury of the surrounding tissues.

Likewise, a previous injury, such as those acquire through contact sports or an accident, predisposes a person more to osteoarthritis due to the already damaged and weakened structure of the affected joints.

Activities that may include joint overuse contribute to the gradual wear and tear of the body, thus developing these joint diseases in the future.

Complications of Degenerative Joint Disease

  1. Joint deformity. OA can develop bony nodules on the fingers. In the long run, the patient may experience radial or ulnar deviations of the affected joint.
  2. Functional impairment and disability. Both gross and motor abilities of the hands and fingers are affected due to OA. These can make it difficult to do physical work and activities of daily living for the patient.
  3. Chronic pain syndrome. The neural pain pathways are persistently activated in degenerative joint disease, which can eventually develop chronic pain syndrome.

Diagnosis of Degenerative Joint Disease

  • Physical exam – to check for the signs and symptoms such as bony enlargement of the joints, as well as muscular strength and reflex exams
  • Blood tests for complete blood count, biochemistry, rheumatoid factor and anti-CCP antibodies – not indicated to diagnose OA but to rule out other types of arthritis
  • Imaging – X-ray of the affected joints; MRI and ultrasound to determine the severity to rule out other types of arthritis
  • Joint aspiration – if there is fluid accumulation around the joint, the fluid can be aspirated for testing to rule out other types of arthritis

Treatment for Degenerative Joint Disease

  1. Medications. Depending on the severity of OA, doctors can prescribe pain relievers or nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and relieve pain. Unlike rheumatoid arthritis, degenerative joint disease or OA cannot be treated with drugs that can slow down the progression of joint damage.
  2. Surgery. The doctor may recommend surgery to resolve unbearable joint pain due to OA. This includes joint replacement (replacing a damaged joint with an artificial joint), arthroscopy (to remove the damaged joint tissues or repair them if possible), osteotomy (for realignment of the bone of the arm or leg), and joint fusion (for realignment and stabilization of the affected joint).
  3. Physical therapy. This is an important part of the treatment regimen for OA and includes a physical therapist who can guide the patient with effective exercises to reduce the joint pain. Low impact exercises such as walking on flat surfaces and swimming are recommended to reduce the risk of putting stress on the damaged joint.
  4. Weight loss. Obesity is one of the most common risk factors for degenerative joint disease or OA, thus, a crucial part of the treatment is to lose weight through diet and exercise.

Nursing Care Plans for Degenerative Joint Disease

Nursing Care Plan 1

Nursing Diagnosis: Deficient Knowledge related new diagnosis of Degenerative Joint Disease or Osteoarthritis, as evidenced by patient’s verbalization of “I want to know more how to manage my illness.”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of his/her acute pain and its management.

InterventionsRationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits).To address the patient’s cognition and mental status towards disease management and to help the patient overcome blocks to learning.
Explain what his/her pain management program entails (e.g. medications, relaxation techniques, diet, and related physiotherapy or exercises). Avoid using medical jargons and explain in layman’s terms.To provide information on his/her pain management program for OA.
Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to treat acute pain. Ask the patient to repeat or demonstrate the self-administration details to you.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Educate the patient about non-pharmacological methods for acute pain such as imagery, distraction techniques, recommended exercises, and relaxation techniques.To reduce stress and to promote optimal pain relief without too much dependence on pharmacological means.
If the patient is for surgery, explain the surgical procedure related to osteoarthritis to the patient and carer.The doctor may recommend surgery to resolve unbearable joint pain due to OA.

Nursing Care Plan 2

Nursing Diagnosis: Activity intolerance related to joint inflammation and pain  secondary to osteoarthritis, as evidenced by pain score of 10 out of 10, fatigue, disinterest in ADLs due to pain, verbalization of tiredness and generalized weakness

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to chronic pain, fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.To gradually increase the patient’s tolerance to physical activity. To prevent triggering pain by allowing the patient to pace activity versus rest.
Administer analgesics as prescribed  prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/ her build confidence in increasing daily physical activity.
If the patient is overweight or obese, create a weight loss plan with the patient, carer, physiotherapy/occupational therapy, doctors, and dietitian.Obesity is one of the most common risk factors for degenerative joint disease or OA, thus, a crucial part of the treatment is to lose weight through diet and exercise.

Other possible nursing diagnoses:

  • Pain
  • Fatigue
  • Situational Low Self-Esteem

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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