Osteoarthritis Nursing Care Plans Diagnosis and Interventions
Osteoarthritis NCLEX Review and Nursing Care Plans
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 Osteoarthritis
- 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 Osteoarthritis 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 Osteoarthritis Degenerative Joint Disease
- 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.
- 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.
- Chronic pain syndrome. The neural pain pathways are persistently activated in degenerative joint disease, which can eventually develop chronic pain syndrome.
Diagnosis of Osteoarthritis
- 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 Osteoarthritis Degenerative Joint Disease
- 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.
- 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).
- 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.
- 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 Diagnosis for Osteoarthritis
Nursing Care Plan for Osteoarthritis 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.
|Nursing Interventions Osteoarthritis||Rationales|
|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 for Osteoarthritis 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.
|Nursing Interventions Osteoarthritis||Rationales|
|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.|
Nursing Care Plan for Osteoarthritis 3
Nursing Diagnosis: Acute Pain related to bone deformities and bone degeneration secondary to osteoarthritis as evidenced by facial grimaces, irritability, guarding, and protective behavior on the affected side, and the patient reported a reduced ability to do activities of daily living due to discomfort.
- The patient will report pain control at a level of 3 to 4 to a pain level of 0 to 10.
- The patient will use pharmacological and non-pharmacological strategies for pain relief.
- The patient will show and verbalize the increase in comfort that is evidenced by baseline levels for heart rate, blood pressure, respiratory rate, and relaxed body posture.
- The patient will be able to tolerate activities of daily living without increasing the pain level.
|Nursing Interventions Osteoarthritis||Rationale|
|1. Ask the patient to describe their present pain using a pain scale of 1 to 10, with 1 being the lowest pain and 10 being the worst pain. Identify the location, duration, and quality of pain.||The patient may report pain located in the fingers, hips, knees, lumbar spine, and cervical vertebrae. The nurse should note that the pain is usually provoked by the activities and may be relieved by rest. The patient may experience joint pain when the patient is at rest. The pain may progress to a sharp pain when the affected area of the patient is brought by the range of motion.|
|2. Assess the patient’s experiences with his/her previous pain including the pain medication and relief used.||Previous pain and pain relief methods should be considered when implementing the plan of care and the nurse should check if the modification is necessary when the pain becomes acute.|
|3. Ask the patient about the factors and activities that trigger acute episodes of pain or activities that aggravate chronic pain.||Patients may experience pain that is associated with specific movements and repeated movements that involve the joints. The nurse should know the activities and factors that trigger pain to avoid doing the activities that may contribute to chronic pain.|
|4. Check whether the patient reports all the pain he or she is experiencing.||The pain that is accustomed to living with chronic pain may tolerate basal levels of discomfort that exceed the “normal” levels. The nurse should accurately assess the patient’s pain to provide appropriate intervention and plan.|
|5. Define the patient’s emotional response to the present chronic pain.||The patient may find it difficult to cope with progressive and debilitating diseases. Emotions of the patient to pain may increase the level of pain and may also increase the risk of having anxiety.|
|6. Instruct the patient to apply a hot or cold pain to the painful area.||Pain may be reduced by heat and will help improve the blood flow in the painful areas. The nurse should be careful in giving hot packs to prevent burns. Cold packs will help reduce pain, inflammation, and spasticity of the muscles by decreasing the pain-inducing chemicals and slowing the pain impulse conduction.|
|7. Turn the patient and change the position frequently while maintaining the patient’s functional alignment.||Poor body alignment may happen to the patient because of muscle spasms that may increase the patient’s discomfort. Positioning helps in restoring the proper body functioning.|
|8. Keep a comfortable environment by eliminating the additional stressors to the patient and allowing the patient to have enough rest.||Keeping a comfortable environment and reducing the factors that cause stress help the patient to have greater reserves of the emotional energy that will help in effective coping. Rest is important to the patient because fatigue may affect the ability of the patient to cope with discomfort.|
|9. Maintain support of the joints by using pillows, rolls, and towels.||Muscle spasms and other discomforts may happen due to the flexion of the joints. Supporting the joints also provide comfort to the patient and may prevent flexion of the joints.|
|10. Give the patient pain relief medication as needed and as prescribed by the physician. Instruct the patient about the side effects and other special instructions before taking the medication.||Pain medication and analgesics may be given to a patient with chronic pain to provide comfort and relief.|
Nursing Care Plan for Osteoarthritis 4
Nursing Diagnosis: Activity Intolerance related to decreased muscle tone and joint pain secondary to osteoarthritis as evidenced by fatigue, body malaise, limitation of movement, and muscle atrophy.
- The patient will utilize identified techniques that will help to improve activity intolerance.
- The patient will state a measurable increase in activity intolerance.
|Nursing Interventions Osteoarthritis||Rationale|
|1. Assess the patient’s level of tolerance to physical activity and mobility.||This will provide baseline information for formulating goals. Knowing the level of tolerance will guide the nurse in planning and doing interventions.|
|2. Check for the nutritional status of the patient and advise the patient to seek a dietician if necessary.||Nutritional status may affect the patient’s tolerance to activities. Checking the nutritional status of the patient will help in defining clinically relevant malnutrition. Nutrition is important because it provides an energy source for the patient to be able to engage in the activities of daily living. Seeking a dietician can help the patient adjust the nutritional needs for the patient’s situation.|
|3. Assess the need for assistive devices that will help the patient with ambulation such as a cane and walker. These assistive devices will help with the activities of daily living while maintaining the patient’s safety.||Assistive devices for ambulation helps in enhancing the mobility of the patient and will help the patient overcome his limitation. The nurse should also emphasize safety while using assistive devices.|
|4. Support and assist the patient with the activities of daily living while avoiding the patient’s dependency.||Assisting the patient with activities of daily living will help the patient to conserve energy. Provision of assistance should be balanced carefully and facilitate progressive endurance that will ultimately enhance the activity tolerance and self-esteem of the patient. The patient’s ability may be changed because of the situation. The nurse should adjust the amount of assistance given to the patient and keep the balance between assisting the patient when needed and allowing independence of the patient should be practiced as much as possible.|
|5. Educate the patient about the active range of motion or ROM exercise and encourage the patient’s participation in planning the activities that will gradually build endurance.||Instructing the patient to exercise will help the physically inactive patients to maintain muscle strength, joint ROM, and exercise tolerance. Physically inactive patients should be encouraged to improve patient capacity by repetitive exercises for a long period of time. Repeated exercises will help increase tolerance which is important in performing the activities of daily living.|
|6. Assess and monitor the patient’s vital signs before and during exercises.||Checking the patient’s vital signs before exercise serves as a baseline and will give information in case of overexertion during exercises and interventions.|
|7. Check for the emotional and motivational status of the patient.||Patients with osteoarthritis may experience depression and frustration because of activity intolerance. The nurse and significant others should support the patient emotionally and always motivate the patient because the mental state and the mood of the patient may affect the status and the recovery process.|
|8. Organize a rest period for the patient before activities.||Rest allows the patient to conserve energy and also allows the heart rate and breathing to be at their normal range.|
|9. Encourage the patient to express positive and negative feelings about the condition.||The patient may be affected by the condition and illness and may experience a lot of change. It is important to encourage the patient to vent and talk about his or her condition.|
|10. Position the patient properly and comfortably by placing the patient in an upright position several times a day.||Positioning the patient in an upright position will help to prevent the deconditioning of the heart and the lungs. If the patient is lying in bed for a long time may cause decreased cardiac output, increased resting rate, and orthostatic hypotension.|
|11. Monitor the patient’s skin integrity for any changes from time to time.||Patients who are experiencing activity intolerance may lead to the growth of pressure ulcers. Monitoring the skin integrity from time to time will reduce medical complications of patients experiencing immobility and will reduce the risk of infection.|
|12. Refer the patient to a physical and occupational therapist if necessary.||Referral to the physical and occupational therapist will help the patient to learn about regular exercise suited for the patient’s condition. Doing regular exercise will help the patient increase the activity levels, endurance, and strength.|
Nursing Care Plan for Osteoarthritis 5
Nursing Diagnosis: Risk for Injury related to altered mobility, decreased bone function, pain, and discomfort secondary to osteoarthritis.
- The patient will be free from having injuries and will be able to identify the measures and ways to prevent injury.
- The body part of the patient that is affected by the condition will increase its strength, function, and mobility.
- The patient will maintain a position of function with decreased muscular contractures.
|Nursing Interventions Osteoarthritis||Rationale|
|1. Assess the patient for any history of injury and the risks related to the injury to the patient such as age and previous history of falls.||Elderly patients have an increased risk of fall-related re-sadmission, and this may happen again if the patient has a history of one or more falls for the last 6 months. The nurse should check for any age-related physical changes because the elderly may have weaker muscles, lesser flexibility, and are at most risk of injury.|
|2. Teach the patient about the active and passive range of motion exercises and isometrics as tolerated by the patient.||Range of motion exercises helps to maintain and enhance muscle strength, and joint function and increase the patient’s endurance. Range of motion exercises is done to maintain flexibility and mobility of the patient’s joints. Passive range of motion exercises can be done when an outside force causes movement to the joint while the active range of motion exercises in which the body parts are moved by using the muscles. The muscles are used to start the movement and do the work.|
|3. Educate the patient on ways to reduce weight to decrease stress on the weight-bearing joints of the patient.||Excessive weight may add extra stress on the joints of the patient which can cause deterioration of the accelerated joint cartilages.|
|4. Encourage the use of buffer beds and position the bed at a low position when sleeping.||Buffer beds and proper positioning may reduce possible injury from falling during sleep.|
|5. Educate the patient to use the soft available surface during exercise.||Instructing the patient to exercise on a soft and flat available surface will minimize shaking of the joints and decrease the chance of having hurtful steps that may aggravate the patient’s condition.|
|6. Instruct the patient on the proper way to use adaptive mobility equipment such as walkers, canes, and crutches as needed.||Adaptive mobility equipment such as walkers, canes, and crutches will help the joints to easily move. Using adaptive mobility equipment will also help in promoting the safety of the patient to maintain a high quality of life.|
|7. Educate the patient about the safety measures such as: Raising the chairs and toilet seatUse of handrailsCorrect use of mobility equipment and wheelchair safety||Safety measures should always be followed to help prevent accidental injuries and prevent the patient from falling.|
|8. Place the patient in a reachable room that is closer to the nurse.||This will help in providing continuous monitoring and will help the nurse to respond quickly to the needs of the patient.|
|9. Position the personal items of the patient within easy reach, such as call light, water, urinal, and telephone.||Positioning the personal items near the patient will prevent the patient from going out of bed alone.|
|10. Place an anti-slip floor mat at the bedside of the patient.||Anti-slip floor mats will provide cushions and may decrease the impact during falls.|
|11. Keep the room of the patient well-lit, especially at night.||Proper lighting decreases the risk of injuries like falls among elderly patients.|
|12. Instruct the family and significant others about the safety and the ways to prevent accidents at home.||It is important to instruct the family members about the safety measures to prevent accidents and injuries to the patient even at home.|
More Osteoarthritis Nursing Diagnosis
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. (2022). 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. (2020). 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
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