Osteoarthritis CP - pathophysiology PDF

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NURSING CARE PLAN DIAGNOSES SHEET: NUR 131 Student:

Suzanna Morales #12______

Diagnosis: Osteoarthritis (Degenerative Joint Disease) Definition: A type of arthritis that is characterized by a slow and steady progression of destructive changes in weight-bearing joints and those that are repeatedly used for work. Pathophysiology: Osteoarthritis is the most common form of arthritis and is also known as the “wear and tear” disease. It typically affects the weight-bearing joints and has a gradual onset, no remissions, and no systemic symptoms, such as malaise and fever. A lifetime of repeated trauma leads to degenerative joint changes that affect the hands, knees, the spine, hips, and the distal and proximal interphalangeal joints in the hands. Risk factors include increasing age, previous joint injury, obesity, congenital and developmental disorders, repetitive use (occupational/recreational), heredity factors, and decreased bone density. Osteoarthritis may be thought of as the end result of many factors that, when combined, predispose the patient to the disease. It affects the articular cartilage, subchondral bone (the bony plate that supports the articular cartilage), and synovium. A combination of cartilage degradation, bone stiffening, and reactive inflammation of the synovium occur. The degenerative process begins when the cartilage that covers the bone ends becomes thin, rough, and ragged which leads to malacia and development of soft spots. The cartilage no longer springs back into space after normal use. As the cartilage wears away, the joint space decreases, so that bone surfaces are closer and rub together. In an attempt to repair itself, new bone develops in the form of bone spurs, bone cysts, or osteophytes, which are extended margins of the joint. As a result the bone becomes deformed, which causes pain and limited joint movement. Ankylosis (permanent fixation of the joint) does not occur, but the resulting deformity may partially dislocate the joint. Structures around the affected joint, such as the joint, capsule, synovial membrane, and ligaments, demonstrate degenerative changes. Eventually the joint undergoes enlargement and increased limitation of movement. When osteoarthritis affects the hands, the fingers frequently develop painless bony nodules on the dorsolateral surface of the interphalangeal joints: Heberden’s nodes (bony enlargement of the distal interphalageal joints) and Bouchard’s nodes (bony enlargement of the proximal interphalageal joints). Also crepitus may be heard of felt when the joint is moved. Osteoarthritis can be classified as idiopathic, with no previous event or disease related to osteoarthritis, and secondary, resulting from previous joint injury or inflammation disease. It is characterized by site specific, with certain synovial joints showing higher disease prevalence. Osteoarthritis is the most prevent articular disease in adults over 65 years of age and affects more men than woman before the age of 50. Early symptoms include brief joint stiffness and pain after period of inactivity. The pain increases with heavy use and is relieved by rest. As the disease progresses ROM of the affected joint becomes progressively limited, and stiffness and pain become worse. Eventually, even rest may not adequately relieve the pain. Some of the treatment for osteoarthritis includes resting the affected joint , heat, weight reduction (in obesity), exercise (helps preserve joint ROM and strength), medications, TENS unit, and surgery. Source: 10th Ed. Medical-Surgical Nursing 1004-1006 2nd Ed. All-in-One Care Planning Resource 529-533 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 1914-1917 In each column, copy the information from your text book __________________________________________ ____________________________________________________________________________________________ Assessment/Symptoms (Subjective & Objective) Diagnostic Techniques (Labs/Tests/Exams) Complications __________________________________________________________________________________________________________ ____________________________

- ACTIVITY/REST *Joint pain and tenderness, usually LPN Server/Data/Clinicals/Nur131/2013-14/pink nursing diagnosis sheet

- BLOOD TESTS * Inflammatory markers: Cyclic citrullinated peptide antibody test

- Decreased mobility

2 asymmetrical, that increases with joint use and is relieved by rest * Erythrocyte sedimentation rate (ESR) * Morning stiffness (typically lasts less than 30 minutes * Rheumatoid factor (RF)

* Generalized weakness * C-reactive protein ( CRP)

* Pain that increases with cool, damp, and rainy weather * CBC

* Pain that is worse with using stairs, standing, walking

* Stiffness after periods of rest or inactivity

* Squeaking, creaking, or grating with movement (crepitus)

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Assessment/Symptoms (Subjective & Objective)

- Decreased mobility * Renal and liver function tests

- OTHER DIAGNOSTIC TESTS * X-rays/radiographs

* Joint ultrasound; power Doppler ultrasonography (PDUS); quantitative ultrasound (QUS) ____________________________________________________________________________________________

Diagnostic Techniques (Labs/Tests/Exams

Complications

3 * Decreased ROM

* Computed tomography (CT) scan

* Locking of affects joints during movement

* Magnetic resonance imaging (MRI)

* Fatigue; sleep disturbances

* Direct arthroscopy

* Functional limitations affecting desired lifestyle, leisure time, and occupation

* Synovial fluid aspirate

- Total joint replacement

- Insomnia

* Bone density scan * Deformities of affected joints

- Hip fracture / Total joint replacement

- CARDIOVASCULAR * Changes in color or fingers or toes

- Impaired circulation

- EGO INTEGRITY * Acute and/or chronic stress factors, including financial, employment, disability, and relationship

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Assessment/Symptoms (Subjective & Objective)

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Diagnostic Techniques (Labs/Tests/Exams

Complications

4 * Hopelessness and powerlessness over incapacitating situation

- HYGIENE * Varying difficulty performing self-care activities

- Risk for self-care deficit

* Dependence on others

- Withdrawal / Depression

- NEUROSENSORY * Numbness, tingling of hands and feet

- PAIN/ DISCOMFORT * Acute episodes of pain that may not be accompanied by soft tissue swelling in joints

- Total joint replacement

* Asymmetrical pattern of pain involving joints

* Chronic aching pain and stiffness after periods of rest or inactivity, may be worse in mornings __________________________________________

Assessment/Symptoms (Subjective & Objective)

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Diagnostic Techniques (Labs/Tests/Exams

Complications

5

- SAFETY * Difficulty managing homemaker or maintenance tasks

- Risk for injury secondary to impaired mobility

- Risk for falls

* Decreased muscle strength, altered gait, and/ or decreased ROM

- SEXUALITY * Difficulty engaging in sexual activity as desired; abstinence

* Risk for pregnancy complications

- SOCIAL INTERACTION * Impaired interactions with family and others

- Altered family interaction

* Changes in roles, responsibilities

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Assessment/Symptoms (Subjective & Objective)

- Depression / Psychosocial aspects of care

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Diagnostic Techniques (Labs/Tests/Exams

Complications

6 - Social Isolation

* Isolation

- TEACHING/ LEARNING * Higher risk of heart and lung disorders, including pericarditis, thrombophlebitis, valvular lesions, pulmonary fibrosis, pleuritis

- Venous Stasis

- Depression / Psychosocial aspects or care

* History of obesity

* Use of health foods, vitamins, untested arthritis “cures”

- DISCHARGE PLAN CONSIDERATIONS * May require assistance with transportation, self-care activities, homemaker, maintenance tasks, and changes in physical layout of home

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Assessment/Symptoms (Subjective & Objective)

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Diagnostic Techniques (Labs/Tests/Exams

Complications...