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Nursing Care and Pathophysiology of Osteoarthritis (OA)

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Overview: Progressive disorder of the articulating joints

Pathophysiology:

Osteoarthritis is caused by the degeneration of the joints. Joints that are used frequently or have to bear more weight are more at risk for the degeneration. A healthy joint has fluid and cartilage. As the joint is used and worn down the fluid and cartilage are decreased. This causes joint degeneration and pain.
The body attempt to repair the join and inflammation occurs.

General:

1. Affects weight-bearing joints and joints that receive a lot of stress: Back, hips, knees, hands, feet
2. Risk Factors: Age, gender, genetics, joint use
3. Stages
a. Mild bone spurs
b. Worsening bone spurs, pain
c. Loss/Damage of cartilage, pain
d. Bone on bone” due to loss of cartilage and synovial fluid

Assessment:

  1. Joint pain relieved with rest

  2. Heberden’s Nodes (distal)

  3. Bouchard’s Nodes (medial)

  4. Difficulty standing up after sitting

  5. Crepitus in joints grating sensation)

Therapeutic Management

  1. Administer Analgesics
  2. Topical agents
  3. NSAIDs
  4. Muscle Relaxants
  5. Corticosteroid injections

Reference Links

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Video Transcript

Okay guys, let’s talk about osteoarthritis. If you break down this word, you can see that this is inflammation (itis) of bones (osteo) and joints (arthro).

Osteoarthritis is also known as degenerative joint disease. It is a progressive disease of articulating joints, which just means any joints that move. It’s most common in weight-bearing joints like the back, hips, and knees, and high stress joints like the hands and feet. It is very unlikely that any of us go a day without frequently using at least one if not all of these joints. Major risk factors for osteoarthritis are age, genetics, and use of the joints, which, again, there really isn’t much we can do about that. We have to function, and we need our joints to do that.

Osteoarthritis varies in stages from stage 1 to 4. Stage 0 is a perfectly normal joint with plenty of cartilage and synovial fluid and no damage to the bones. All the way to stage 4 which involves a loss of cartilage, a loss of synovial fluid and narrowing of the joint, and bone spurs and irritation of the bone itself. Think of it like the tread wearing down on a tire. The more you skid and squeal your tires, the faster the tread gets worn down and the higher the likelihood of a blowout. Just looking at this bone, you can imagine how painful this gets as the patient progresses through the stages of osteoarthritis.

Most of your patients will be being seen by you for some other reason, but they will have osteoarthritis, so we want to know what to look for. First, is that they will have joint pain that is typically relieved with rest. This is one way that we can tell the difference between rheumatoid arthritis and osteoarthritis, is that the pain Pence to be relieved with rest in osteoarthritis, whereas pain in RA is continuous. we will also see the patient develop these nodes on their joints. This is where the bone has been irritated and is trying to repair itself. Specifically in the hands, they’re called Heberden’s nodes and Bouchard’s nodes. The only difference between the two is that Heberden’s nodes affects the Distal joints and Bouchard’s nodes affects the medial joints. I remember this because B – Bouchard’s is closest to the Body. And if you were to point to a guy and say “He did it”, it would be with the end of your finger. Patients will also have trouble standing up after they’ve been sitting for a while. They may moan and groan or just be a little slow standing up because of the pain and stiffness. They’ll also experience crepitus in joints. Crepitus is like a cracking, grating feeling. Patients may feel it, but it can also be heard sometimes. If you ever get a chance to meet me in person, ask to listen to my knees, because they have some pretty epic crepitus. Again, the knees are weight-bearing and high stress joints.

So, what do we do for these patients? Well there are topical analgesics they can use like topical steroids or even lidocaine patches. Even any kind of over the counter muscle or pain relief cream or patch can help. We’ll also give them NSAIDs to decrease inflammation and possibly muscle relaxants to ease any pain or spasming around that joint. The other thing we can do is steroid injections. The doctor will inject a corticosteroid right here into the joint space where the inflammation is. This will help to decrease some of the pain. It’s only temporary, though, so a lot of patients will have to come back for injections every 3-6 months. As with any other type of musculoskeletal injury, we can also do heat/cold therapy and make sure we arrange for periods of rest.

This may be relatively obvious, but our priority nursing concepts for a patient with osteoarthritis are comfort and Mobility. Make sure you check out the care plan attached to this lesson to see more detailed nursing interventions.

So let’s do a quick recap of osteoarthritis. It is a degenerative joint disease that is Progressive and involves a loss of cartilage and synovial fluid, as well as development of bone spurs and irritation of the bones. It most commonly affects high-stress joints and weight bearing joints like the hips, knees, back, hands and feet. Joints will be painful, but relieved with rest, they will have stiffness and possibly crepitus, as well as the potential for heberden’s or Bouchard’s nodes in their hands. We want to give analgesics and anti-inflammatory medications, and provide for frequent rest periods to help alleviate some of their symptoms.

So those are the basics of osteoarthritis. don’t forget to check out all of their resources attached to this lesson to learn more. Now, go out and be your best selves today. And, as always, happy nursing!

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