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OsteoarthritisIn Partial Fulfillment of the Requirements in
Nursing Care Management 104
Related Learning Experience
A Compilation Presented to the STI College of Nursing
Presented by:
GROUP BENEFICENCE
Group Leader:
Rubio, Reshiel
Members:
Afante, Booz
Andres, Jessica
Arcena. Katrine Ann
Atienza, Angielique
Barron, Edgar Allan
Cabutihan, Precious Diane
Delos Santos, Rosella
De Luna, Leny
Macabasco, Queenie
Chapter I
INTRODUCTION
Osteoarthritis is a type of arthritis that is caused by the
breakdown and eventual loss of the cartilage of one or more joints.
Cartilage is a protein substance that serves as a "cushion" between the
bones of the joints. Osteoarthritis is also known as degenerative
arthritis or degenerative joint disease, is a group of mechanical
abnormalities involving degradation of joints, including articular
cartilage and subchondral bone.
Also known as the wear and tear disease, it is characterized by
areas of destruction of articular cartilage, sclerosis of the underlying
bone, and hypertrophy of soft tissues. This type of arthritis affects
more people than any other type. Patients usually know this disease
best as old-age arthritis. Patients with OA may have joint pain on only
one side of the body and it primarily affects the knees, hands, hips,
feet, and spine.
In the Philippines, the point prevalence of osteoarthritis is 4.1
percent of an urban population (mean age=34). Manila, its capital city,
with a population of 11 million, therefore has approximately half a
million sufferers of OA. Considering population growth in the next 25
years as projected in the Summary of Philippine Demographic Data
2000, the number of individuals with OA will more than double by
2025.6 Recently, the Food and Nutrition Research Institute in the
National Nutrition Health Survey (NNHES) of 2003 noted a 0.5 percent
prevalence of OA among individuals 40 years of age and above, a
lower figure compared to the first study, perhaps an effect of the
methods employed in this national survey. This figure reflects not only
urban but also rural Philippines. In an 80 million strong population, this
will easily be about 3.2 million plus Filipinos with the disease.
A. Background of the Study
Our patient is a 75-year-old male with Osteoarthritis (OA);
he is suffering with this disease for almost 20 years, starting
when he was 55 years old. He is former cook in a fishing vessel.
B. Rationale for Choosing the Case
We chose this case osteoarthritis of Mr. Beneficence
because majority of the diseases encountered in the community
were already tackled and discussed in previous case
presentations like cough and colds, fever and hypertension. This
is the only case which was not presented in the previous case
presentations and it captures our attention. So far this was the
interesting case we encountered in the community. All of us
know that everyone will commence on the stage of aging, this
could also be of great help to all of us so as we can further
understand its development, clinical manifestation and the
various means on how to manage it.
C. Significance of the Study
To the patient. This study aims to be of help to our
patient by rendering the best care that we could possibly
give to him.
To the care givers or significant others. To aid and
supplement them with information for the better
management of his condition.
To the community. To educate the public with knowledge
about the disease as well as its management.
To the student. To be of reference to our fellow students
who will handle the same case in the future.
D. Scope and limitation
This study covers and focuses on the following:
A brief discussion of the disease, its causes, manifestations
and proper treatment.
Assessment of the patient.
Drug study of the medications given and other treatments
done to the patient.
Formulation of nursing care plans appropriate for the
patient.
Preparation of discharge plan for the patient.
Chapter II
CLINICAL SUMMARY
A. Biological Data
Name: Mr. Beneficence
Address: Sta. Cruz, Laguna
Age: 75 years old
Sex: Male
Marital Status: Married
Date of Birth: ???????????????????????????????????????????????
Nationality: Filipino
Religion: Roman Catholic
Occupation: former cook
Diagnosis: Osteoarthritis- knee
Allergies: No known allergy
Past Medical History:?????????????????????????????
Past History of Illness:????????????????????????????
Attending Physician: Dr. Tan
Source of information: wife and himself
B. Physical Assessment
Cephalocaudal Assessment
BODY PART FINDINGS
Head Normocephalic, symmetrical
Absence of masses, lesions or nodules
No tenderness, No dandruff
Hair White hair; oily; thin
Face Wrinkled skin
Eyes
Eyelids
Sclera
Iris
Pupils
Eye movement
Lids close symmetrically, bilateral blinking.
No edema or tenderness over lacrimal gland
Appears reddish with visible microvessels
With presence of cataract on OU
PERRLA
OU coordinated, move in unison with parallel
alignment
Ears Color same as facial skin; symmetrical;
auricle aligned with outer canthus of eye.
Dry, grayish-tan cerumen.
Nose Symmetric and straight, air moves freely as
the client breathes through the nares
Mucosa pink, cilia present
Septum was intact and in midline
Mouth
Lips
Teeth
Tongue
Palates
Uniform pink in color, free from discharge,
ability to purse lips
Smooth, intact, no bad breath
Pink color, moist, no lesions, moves freely, no
tenderness
Light pink, smooth (soft palate)
Lighter pink, irregular texture (hard palate)
Neck Muscles equal in size; head centered
Free from lumps, masses and lesions; no
tenderness
Thorax Symmetrical, chest wall intact, no tenderness
No adventitious breath sounds
Abdomen Unblemished skin, uniform color,
symmetrical; no tenderness, lesions and
masses
Extremities Skin uniform in color, no lesions, no nodules,
with usual number of fingers.
Upper extremities: Smooth coordinated
movements, can extend arms without
difficulty.
Lower extremities: With presence of
inflammation on both knees, prominently on
the left; with pain upon movement
Capillary refill = 2secs
C. System Assessment
The major system involved in the case study is the
musculoskeletal system. Both knees are the joints most affected to Mr.
Beneficience. Symptoms felt include stiffness of both knees mostly
during every early in the morning and during cold weather. Both knees
are swollen, prominently on the left and pain felt upon movement
which makes him find hard to walk, get in and out of chairs and do
other activities.
Vital Signs
Date Temperatur
e (°C)
Pulse
rate
(bpm)
Respiratory
rate (cpm)
Blood
Pressure
(mmHg)
July 27,
2010
36.9 70 22 120/90
August 2,
2010
36.7 67 23 120/80
August 3,
2010
36.3 66 20 120/80
August 9, 36.7 68 22 120/80
2010
Height and Weight
Height: 5’8’’
Weight: 70 kg
D. Course in the Community
July 27, 2010
????????????????????????????????????????????????????????????????
Maam, ung course in the community po n kay miss delos santos po..
Chapter III
Clinical Discussion
A. Anatomy and Physiology
Joints
Also called articulations
It is placed where two bones come together
It is usually considered movable but not all the time, many joints
have limited movements while others are almost completely or
completely immovable.
The 3 major structural classes of joints are:
o Fibrous joints- little movement
- joined by fibrous connective tissue
o Cartilaginous joints- slight movement
- joined by cartilage
o Synovial joints- freely movable joints
- not directly joined
There are 3 classifications of joints based on the degree of
motions:
o Synoarthrosis- non-movable joints
- permits little or no mobility. Most
synarthrosis joints are fibrous joints (e.g., skull sutures).
o Amphiarthrosis- slightly movable joints
- permits slight mobility. Most
amphiarthrosis joints are cartilaginous joints (e.g.,
vertebrae).
o Diarthrosis - freely movable joints
- permits a variety of movements. All
diarthrosis joints are synovial joints (e.g., shoulder, hip,
elbow, knee).
The Synovial Joints
It contains synovial fluid in a cavity surrounding the end of
articulating bones.
The articular cartilage is a thin layer of cartilage that covers the
surface of the bone within the synovial joint that provides a
smooth surface where the bones meet.
The joint cavity is filled with a fluid called synovial fluid that is
enclosed by a joint capsule that helps hold the bone together
and allows movement. Portion of the joint capsule maybe
thickened to form ligaments and tendons outside the joint
capsule that helps in strengthening of the joint.
The synovial membrane lines the joint cavity everywhere except
over the articular cartilage. This membrane is responsible for the
production of synovial fluid. The synovial fluid is a complex
mixture of polysaccharides, protein, fats and cells. It also for a
thin lubricating film that covers the surface of the joint. In certain
synovial joint the synovial fluid extends up to a pocket called
bursa.
Bursa or bursae are pocket located between the structures that
rub together. They are also responsible for the reduction of
friction, that damages the structure involve.
Tendon sheaths serves as the extension along with some
tendons associated with the joints.
Types of Synovial Joints
1. Ball and socket 2. Condyloid (ellipsoid) 3. Saddle
4. Hinge 5. Pivot
Plane or gliding joints
o consist of 2 opposed flat surface that glides over each
other.
o Articular surface between vertebrae.
Saddle joint
o Consist of 2 saddle shaped articulating surface oriented at
right angles to each other.
o Movements in these joints can occur in 2 planes.
o Joints between the metatarsals and carpals, thumb
Hinge joints
o Permits movement in 1 plane only
o They consist of convex cylinder of bone
o Elbow, knee and finger joints
Pivot joints
o Restrict movements to rotation around a single axis
o Each of these joint is consist of cylindrical bony process
that rotates within a ring composed partly of ligaments.
Ball-and-socket joints
o It consists of the ball or the head at the end of 1 bone and
a socket in an adjacent bone into which portion of the ball
fits.
o It allows a wide range of movements in almost any
directions
o Shoulder and hip joints
Ellipsoid or Condyloid joints
o Are elongated ball-and-socket joint
o The shape of the joint limit the range of movement nearly
to a hinge motion but in 2 planes
o The joint between the occipital condyles of the skull and
the atlas of the vertebral column
Bone tissue is removed by osteoclasts, and then new bone tissue is formed by osteoblasts. Both
processes utilize cytokine (TGF-β, IGF) signalling.
Bone remodeling (or bone metabolism) is a life-long process where
mature bone tissue is removed from the skeleton (a process called bone
resorption) and new bone tissue is formed (a process
called ossification or new bone formation). These processes also control the
reshaping or replacement of bone during growth and following injuries
like fractures but also micro-damage, which occurs during normal activity.
Remodeling responds also to functional demands of the mechanical loading.
As a result, bone is added where needed and removed where it is not
required.
In the first year of life, almost 100% of the skeleton is replaced. In
adults, remodeling proceeds at about 10% per year.[1]
An imbalance in the regulation of bone remodeling's two sub-processes, bone
resorption and bone formation, results in many metabolic bone diseases,
such as osteoporosis.
Bone RepairStages of Healing
normal bone ---------- ----- --------- ----- ---------- -----------healed fracture
Clot formation Callus formation Callus ossification Bone remodeling
1. Clot formation. When a bone is broken, a clot forms
in the damaged area.
2. Callus formation. Blood vessels and cells invade
the clot and produce a fibrous network and cartilage between the
broken bones, called a callus.
3. Callus ossification. Osteoblasts enter the callus
and form cancellous bone.
4. Bone remodeling. The cancellous bone is slowly
remodeled to form compact bone and the repair is complete.
Please include also how bone remodeling & repair occur??? It
was written in your anaphys book coz this will be included in your
pathophysio. It usually happens when damage occur but if it
does not work that is the time surgery or stem cell or growth
hormone injection will advisable to be done.
B. Pathophysiology
Predisposing Factors Precipitating Factors
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Age, Diet, Obesity, Nature of work
Advancing Loss of
Formation of Osteocytes
Decrease in synovial fluid
Pinch/crowd
Pain
Narrowing of joint spaces
Obliteration of joint space
Pressure between joint
Formation of subchondral cysts
Hardening of the underlying bone
Repair and remodelling
If not remodeled Surgery, GH & stem cell injection
Pain
Difficulty of movement
Degeneration of cartilage
Continuous use of joint
Disappearing of full thickness of articular
Wear and tear of articular cartilage
Inflammatory response
Release of chemical mediators
Acts on pain receptors
Increase vascular permeablity
Increase blood
Pain
edemaRedness, increase WBC
Immobilization
Osteoarthritis
Seen in x-ray
!-------------------------------!-------------------------------!------------------------ --------------------- !--------------------------------------------
------- !
C. Drug Study
Chapter IV
Nursing Care Plan
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective:
“Nahihirapan
akong kumilos
sa umaga,”
as verbalized by
the patient.
Objective:
Limited
ability to
perform
skills
Felt stiffness
every early
morning or
during cold
weather
Limited
Impaired
physical
mobility related
to loss of
integrity of
bone structure
as evidenced by
client’s
verbalization
and slowed
movement.
After series of
nursing
intervention the
client will be
able to
maintain/
increase
strength and
function of the
affected and/or
compensatory
body part.
Support the
affected
body
parts/joints
by using
pillow or
rolls, foot
support or
shoes, air
mattress.
Schedule
activities
with
adequate
rest periods
during the
day.
Provide for
To maintain
position of
function and
reduced risk
of pressure
ulcers.
To reduce
fatigue.
To prevent
fall.
After series of
nursing
intervention the
client was able
to maintain
strength and
function of the
affected body
part as
evidenced by
the client can
now perform
simple exercise
such as walking
for at least 15-
30minutes
everyday and
drink glass of
range of
motion
Slowed
movement
Joint swelling
Decreased
walking
speed
safety
measures as
indicated by
individual
situation
including
environment
al
management
.
Encourage
adequate
intake of
fluids or
nutritious
foods
particularly
foods that
are rich in
calcium.
Encourage to
take
To promote
well being,
strengthen
bone density
and
maximize
energy
production.
To permit
maximal
effort or
involvement
in activity.
To improve
the blood
milk every
morning.
medications
prior to
activity as
needed for
pain relief.
Encourage to
do simple
exercise
such as
walking for
at least 15
minutes.
Teach weight
loss diet, if
appropriate.
Teach the
importance
and
appropriate
use of
circulation in
the joints.
To reduce
weight that
would
reduce the
pressure in
the joints.
To aid in
walking and
minimize
injuries.
To minimize
the use of
body energy.
devices such
as walker,
canes and
crutches.
Advised
client to rest
between
each
activities.
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective:
“Masakit ang
tuhod ko,” as
Acute pain
related to loss
of integrity of
After series of
nursing
intervention the
Assessed for
referred
pain.
To help
determine
possibility of
After series of
nursing
intervention the
verbalized by
the client.
Objective:
Pain scale of
6/10
With
guarded
behavior
With facial
grimace
Immobility
Swollen
joints
P= cold
weather/
analgesic
Q=pressing
R=thigh &
lower leg
S= 6/10
bone structure
as evidenced by
client’s verbal
reports, facial
grimace,
immobility &
swollen joints.
client’s pain
scale of 6/10
will decrease to
2/10.
Note client’s
attitude
towards pain
medication.
Determine
factors of
client’s
lifestyle.
Monitor vital
signs and
skin color.
Provide
comfort
underlying
conditions
requiring
treatment.
To determine
the
effectiveness
of relieving
pain.
To determine
the effect
response to
analgesic or
choice of
intervention
for pain
management
.
This usually
alters when
pain occurs.
To promote
client’s pain
was lessened
from 6/10 to
3/10 and
demonstrated
ways on how to
provide relief as
evidenced by;
The client
follow
pharmacolog
ical regimen
as
prescribed.
Took glasses
of milk
everyday.
Walk for 15-
30minutes
as a means
of exercise.
T= measure
such as use
of hot
compress
and
encourage
the use of
diversional
activities like
watching tv,
listening to
music and
socialization
with others.
Encourage
adequate
rest periods.
Instruct the
client to
follow
medication
regimen as
non-
pharmacolog
ical pain
management
and avoid
being
dependant to
pain
relievers.
To prevent
fatigue and
conserve
energy.
To help
reduce the
pain
sensation.
prescribed
by the
physician.
Instructed
the client to
eat nutritious
foods
especially
food that are
rich in
calcium,
protein and
carbohydrate
.
To
strengthen
the bone
density and
reduce
inflammatory
response.
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective:
“Bakit po kaya
lagi paring
sumasakit ang
tuhod ko tuwing
umaga at kapag
Deficient
knowledge
related to lack
of information
and
unfamiliarity
After 8 hours of
nursing
intervention the
client will
verbalized
understanding
Determine
the client’s
ability or
readiness
and barriers
to learning.
Individual
may not be
physically,
emotionally
or mentally
capable at
After 8 hours of
nursing
intervention the
client was able
to verbalized
and
malamig ang
panahon.” As
verbalized by
the client
Objective:
Does not
know how to
manage the
present
condition
particularly
as to what
type of
action to be
done and
diet to be
followed.
Always
asking
questions as
related to
with information
resource.
of situation and
treatment
regimen and
safety
measures.
Be alert in
the signs of
avoidance.
Assess the
level of
client’s
capabilities
and the
possibilities
of the
situation.
Provide
information
relevant only
to the
situation
such as
definition of
this time.
Client may
need to
suffer
consequence
of lack of
knowledge
before he is
ready to
accept
information.
May need
the help of
SO or
caregivers to
learn.
Can improve
understandin
g about the
disease
condition
demonstrated
understanding
of situation and
individual
treatment
regimen and
safety
measures AEB
client followed
safety
measures &
treatment
regimen such
as: does simple
exercise every
morning for 15-
30min., drinks
milk every
morning, takes
analgesic as
prescribed.
the
condition.
osteoarthritis
, causes,
signs and
symptoms,
treatment
and
management
.
Provide feed
back.
Begin the
information
the client
already
knows and
more to what
the client
does not
know,
progressing
from simple
thereby
acquiring
clients
cooperation
on disease
management
.
Can
encourage
continuation
of efforts.
Can arouse
interest or
limit sense of
being
overwhelme
d.
to complex.
Advised the
client the
importance
of having a
regular
check up to
the physician
or RHU.
To monitor
the
progression
of the
disease and
effectiveness
of therapy.
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective:
“ Kadalasan
hindi agad ako
makakilos o
makagalaw lalo
na tuwing
umaga” as
verbalized by
the patient.
Objective:
Limited
range of
motion
Slow ed
movement
Gait
Impaired
Physical
Mobility related
to loss of
integrity of
bone structure.
After series of
nursing
intervention the
patient will be
maintain or
increase
strength &
function of
affected and or
compensatory
body part.
Support
affected
body parts /
joints using
pillows /
rolls, foot
support /
shoes.
Encourage
adequate
intake of
fluids as well
as nutritious
foods.
Encourage
To maintain
position of
function and
reduce risk of
pressure ulcers.
To promotes
well being and
maximizes
energy
production.
To keep joints
Goal met
Stiffness
(early
morning
until about
an half hour
after rising
Muscle
spasms
Joint swelling
the patient
to increase
activity as
indicated.
Encourage
the patient
to ambulate
with
assistive
devices.
mobile and not
taxing the joint
too much
To reduces the
load on the joint
and promotes
safety.
Chapter V
Discharge Planning