Introduction to Osteoarthritis

Select the correct choice in the sentences below to accurately describe Osteoarthritis. Osteoarthritis is a chronic, condition that is progressively debilitating. The main characteristic is pain with changes. It primarily attacks joints . There extra-articular symptoms associated with this condition. The onset of osteoarthritis symptoms are worst between . If left untreated, can occur from continued injury can lead to permanent immobility and chronic pain.

localized degenerative larger asymmetrically are no 60 and 75 joint destruction mechanical Osteoarthritis is a chronic, localized condition that is progressively debilitating. The main characteristic is pain with degenerative changes. It primarily attacks larger joints asymmetrically. There are no extra-articular symptoms associated with this condition. The onset of osteoarthritis symptoms are worst between 60 and 75. If left untreated, joint destruction, can occur from continued mechanical injury can lead to permanent immobility and chronic pain.

Review the nursing progress note below and select the priority nursing assessment cues.​ Mary Johnson, a 74-year-old female, was admitted to the post-surgical unit after having a right knee replacement. She has a history of diabetes, peripheral vascular disease, and renal failure. Surgery went well with no complications noted. She is awake and alert. She says that she is having some pain from her surgical incision. She describes this as a dull throbbing pain that is a 5 on a scale of 1 to 10. Vital signs include temperature of 97.5, blood pressure 110/70, pulse 99, respirations 20, and oxygen saturation is 95%. Blood sugar is 94. Her lungs are clear to auscultation with no abnormalities. Her heart rate is regular rate and rhythm. Surgical incision is well approximated and is clean, dry, and intact. There is no drainage or no erythema.

Dull throbbing pain that is a 5 The current nursing priority is her pain level. The rest of the note does not indicate any priority cues

The nurse is preparing a discharge plan for a client post total right knee replacement. Which information that would promote healing should the nurse review with the client? Select all that apply. Exercise as prescribed by physical therapist Smoking cessation Bedrest Increase protein in your diet No activity if there is pain

Exercise as prescribed by physical therapist Smoking cessation Increase protein in your diet Things that can speed up healing include smoking cessation, increased dietary protein, and exercising. Things that can slow healing include bedrest, and decreased activity due to pain.

Mary is being transferred to a rehabilitation unit today. She can pivot transfer from a bed to a wheelchair with assistance. She has been having pain of 5/10 even after pain medication two hours ago. Her dressing is dry and intact with no drainage. Occupational therapy has not been able to see the patient yet. Vital signs: T=98.6, blood pressure 120/68, pulse 95, oxygen saturation 96% on room air.​ Review the nursing discharge note and check if the goal is being met at this time or check whether further follow-up is required before the transfer.

Goal Addressed Impaired physical mobility Impaired tissue integrity Not Addressed Acute pain Self-care deficit Patient's physical therapist has taught transfer techniques and will continue treatment in rehabilitation unit. The pain does not appear to be controlled at this time and requires further nursing action. The surgical incision appears to be normal and healing well. The patient has not seen the occupational therapist, which should be done before discharge.

Nursing Actions. - Osteoarthritis

Impaired mobility Assistive devices Assistance with movement Pain Cool or warm compresses Distraction (music, reading, etc.) Repositioning Aromatherapy Pain medicine Anti-inflammatory medicine Altered Coping Therapeutic communication Self-care deficit Referral to occupational health Assistance with ADLs Risk for falls Assistance with ambulation Handrails up Call-light within reach

Osteoarthritis - Impaired physical mobility Post surgical knee replacement - Acute pain Fresh surgical incision - Impaired tissue integrity Inability to perform ADLs

Impaired mobility is due to the osteoarthritis. The acute pain is related to post surgical knee replacement. The client has a surgical incision that leads to impaired tissue integrity. Due to surgery and mobility, the client has a self care deficit.

Nursing Diagnosis - Planning Interventions

Impaired mobility​ - wheelchair Pain (acute or chronic)​ - disclofenac gel Altered coping​ - therapeutic communication Self-care deficit​ - shower chair Risk for disuse syndrome - passive range of motion

hich statement describes the primary cause of osteoarthritis? Joint destruction from excessive used caused by intrinsic and environmental factors. A genetic variation that causes bone and muscle weakness. Autoimmune condition that attacks small joints. An erosive process that causes joint inflammation.​

Joint destruction from excessive used caused by intrinsic and environmental factors. Osteoarthritis is caused by excessive use caused by intrinsic and environmental factors. Rheumatoid arthritis is an autoimmune condition that attacks small joints and causes erosive joint inflammation. A genetic variation that causes bone and muscle weakness is not caused by osteoarthritis.

Nursing Actions - Osteoarthritis

Orders Nursing diagnosis Physical therapy referral Impaired physical mobility Oxycodone/apap Acute pain Dressing changes Impaired tissue integrity Occupational health referral Self-care deficit

Analyzing Cues

Osteoarthritis is a chronic, localized condition that is progressively debilitating. The main characteristic is pain with degenerative changes. It primarily attacks larger joints asymmetrically. There are no extra-articular symptoms associated with this condition. The onset of osteoarthritis symptoms are worst between 60 and 75. If left untreated, joint destruction, can occur from continued mechanical injury can lead to permanent immobility and chronic pain.

Which factors increase the risk of osteoarthritis arthritis (OA)? Select all that apply. Smoking Socioeconomic status Overuse of a joint Gender Family history Age

Overuse of a joint Age Smoking Factors that increase the risk of osteoarthritis include age, overuse of a joint, and smoking. Family history, gender, and socioeconomic status do not appear to be factors that increase the risk for OA.

Osteoarthritis Pain​ Inability to bear weight Reduced range of motion Mainly mechanical damage Gait and/or balance abnormality

Rheumatoid arthritis Pain​ Inflammatory response early Inability to bear weight Symmetrical small joint pain Reduced range of motion Gait and/or balance abnormality Rheumatoid arthritis has an early inflammatory response, where OA's response is late. RA is mainly associated with small joints and damage is mainly due to immune response

n analyzing the patient record, which assessment items are consistent with degenerative joint disease caused by osteoarthritis? Select all that apply. Unilateral joint pain Erythema Edema Joint deformity Crepitus

Unilateral joint pain joint deformity crepitus Osteoarthritis can present to joint pain, deformity, and crepitus. Erythema and edema are only usually present after significant overuse.

Recognizing Cues - Nursing Assessment​ Review the case below and select all assessment items that are expected for this client based on the admission diagnosis of degenerative joint disease. Linda, a 69-year-old client, was admitted for degenerative joint disease. She ambulates with a walker. Her vital signs: T=97.5, BP 118/77, P 98, R 20, Oxygen saturation 97% on room air. Basal metabolic index (BMI): 35. Skin is warm and dry with normal turgor and capillary refill < 3. Lungs clear in all lobes. Heart is regular, rate and rhythm with no murmur. No edema is present. She has a valgus deformity to her right knee. There is crepitus with extension of the right knee. There is no erythema to the right knee. There is no edema to the right knee. She is experiencing right knee pain, and she is unable to bear full weight on the knee. Pedal pulses are bilaterally palpable at 2+. She is a non-smoker, retired. Medical history includes hypertension, heart disease, osteoporosis, dyslipidemia, and hypothyroidism. Medications include celecoxib, vitamin c, calcium, ibuprofen, omeprazole, levothyroxine, atorvastatin, and

69 yr old BMI: 35 Valgus deformity crepitus right knee pain unable to bear Degenerative joint disease is more common after 65 years of age, and includes deformity, crepitus, and pain of the affected joint. In addition, there is reduced weight bearing abilities to the lower extremity joints affected. More commonly seen in obese clients. The rest of the assessment is usually normal.

The nurse is teaching a class and looks for some examples of different things that can affect treatment of osteoarthritis. Review the examples below and identify the barrier to each situation from the drop-down choices. A client who only uses acupuncture to treat the osteoarthritis pain - A client in a dementia unit with severe degenerative joint disease to the knee. - A client, a single wage earner, cannot take time off to get a joint replacement. - A client needing hip replacement who lives in a small town with no surgeon. -

Cultural & Tradition Aging Family Dynamics Access to healthcare Acupuncture, though more popular now, has always been a culturally specific treatment for many illnesses and based on tradition. Dementia is an age-related condition that may impact how aggressive treatment for arthritis is. Someone who is the main wage earner is often limited by family dynamics and limited resources to get a surgery done that could require weeks to months off work. Rural care always encounters healthcare access challenges due to the limited number of specialists that live in those communities.

Nurses Progress Note​: At 1400, Linda is voicing pain in right knee. Vitals: BP-152/88, P-102, R-22. Oxygen saturation 96%. She describes it as a soreness with intermittent throbbing. The nurse asks her to identify her pain on a numeric pain scale, which she describes as 5/10. Which prescribed medication would have the least likelihood of adverse effects? Celecoxib 200mg PO twice daily Diclofenac 1% gel 4 grams four times daily Morphine 4mg IV q2 hours for severe pain Ibuprofen 1000mg PO every 6 hours

Diclofenac 1% gel 4 grams four times daily The topical gel has the best safety profile because it is localized, topical, and has limited side effects compared to the other medications. Morphine can cause respiratory depression. Ibuprofen can cause gastritis. Celecoxib has fewer side effects but is not as safe as the diclofenac gel.

Planning for Intervention - Osteoarthitis

Diclofenac topical: Non-steroidal anti-inflammatories Little systemic absorption, limited side effects. Celecoxib: COX-2 inhibitor Less cardiovascular risk than most NSAIDs. Ibuprofen: Non-steroidal anti-inflammatories Give with food, watch for signs of gastritis, bleeding, stomach ulceration. Prednisone: Systemic corticosteroid Avoid long term use, monitor blood glucose levels in diabetic clients. Oxycodone: Opioids Monitor for signs of abuse or illegal diversion of medication.