Osteoarthritis (OA) is a degenerative joint disease and the most common type of arthritis. It is associated with the gradual loss of cartilage between joints and the formation of osteophytes or outgrowths at the margins of the joints. This causes pain and can lead to joint damage. The hands, knees, hips, and spine are most commonly affected.
While this condition is not expected as part of the normal aging process, it is primarily observed in older adults and is often referred to as “wear and tear arthritis.” This breakdown of joints over time is primary osteoarthritis.
Osteoarthritis that occurs due to a specific cause, such as trauma or direct injury to the joints, or even another type of arthritis, is known as secondary arthritis.
Once osteoarthritis occurs, it can’t be reversed, but treatments are available to prevent further joint damage and manage symptoms.
In this article:
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- Deficient Knowledge
- Impaired Physical Mobility
- Risk for Adult Falls
- Risk for Injury
Nursing Process
Since there is no cure for osteoarthritis, nursing care focuses on pain management, comfort measures, preventing disability, and improving joint function. In more severe cases, nurses may care for patients following joint replacement surgery. Nurses can also educate patients on nonpharmacologic and outpatient strategies to reduce pain and improve mobility.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section, we will cover subjective and objective data related to osteoarthritis.
Review of Health History
1. Interview the patient about their general symptoms.
Clinical manifestations of OA can range from mild discomfort to significant and severe disability and may include the following:
- Joint pain with activity
- Joint stiffness, especially upon waking or after rest
- Joint swelling
- Limited range of motion
- Joint weakness or instability
- Clicking of the joint with movement
2. Determine the patient’s risk factors.
Anyone is at risk for osteoarthritis, though the following factors increase the risk:
- Older age
- Obesity
- Joint overuse
- Family history of OA
- Female gender after menopause
3. Review for past injuries or trauma.
Inquire about any motor vehicle accidents, serious falls, or injuries from contact sports that may contribute to OA.
4. Track the patient’s medical and surgical history.
Note conditions that may affect joint cartilage, such as:
- Orthopedic surgeries
- Diabetes
- High cholesterol
- Autoimmune diseases, such as lupus
- Ehlers-Danlos syndrome
- Avascular necrosis
Other types of arthritis may also contribute to OA, such as:
- Gout
- Rheumatoid arthritis
- Psoriatic arthritis
5. Ask about the patient’s pain management or other treatments.
Interview the patient about how they manage their OA symptoms. Document the use of prescription or over-the-counter medications and the frequency of their intake. Assess for the use of braces, heat or cold therapy, or physical therapy.
Physical Assessment
1. Assess the patient’s musculoskeletal status.
Note the following when assessing the musculoskeletal system:
- Limited range of motion
- Muscle weakness
- Impaired balance
2. Assess the joint.
With OA, joint stiffness develops due to prolonged inactivity, such as while sleeping, and persists for up to 30 minutes. The patient may report pain with passive movement. Assess for swelling, deformity, or instability. OA can affect one joint or multiple joints. Palpate the joints for bone enlargement, crepitus (clicking or grinding with joint movement), and Heberden’s or Bouchard’s nodes, which are characteristic bony swellings at specific joints.
Diagnostic Procedures
1. Complete blood tests to rule out other conditions.
OA is typically a clinical diagnosis, but it is important to rule out other types of arthritis or conditions through the following tests:
- Complete blood count
- Erythrocyte sedimentation rate
- Rheumatoid factor
- Antinuclear antibody test
2. Explain the joint fluid analysis procedure to the patient.
Arthrocentesis (joint aspiration) extracts joint fluid to evaluate for inflammation or infection. This procedure can rule out conditions such as gout or septic arthritis or confirm OA.
3. Prepare the patient for imaging.
An X-ray, MRI, or ultrasound can detect joint abnormalities such as osteophytes or joint space narrowing to diagnose OA. Imaging findings do not correlate with disease severity and may not detect OA in the early stages of the condition.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient suffering from osteoarthritis.
1. Administer medications as ordered.
The following medications can help with OA pain and swelling:
- Acetaminophen
- Nonsteroidal anti-inflammatory drugs (oral and topical)
- Duloxetine
- Pregabalin
2. Refer to physical and occupational therapy.
Physical therapists can tailor an exercise program personalized for the patient to strengthen their joints and resume their activities of daily living. A combination of aerobic and resistance training is recommended to strengthen the muscles around joints, while low-impact activities like swimming reduce stress on the joints. Occupational therapists can assist the patient with utilizing equipment or other modifications to improve their mobility and quality of life.
3. Manage pain with nonpharmacological methods.
Patients with mild OA may find relief from symptoms with nonpharmacological strategies, such as:
- Transcutaneous electrical nerve stimulation (TENS)
- Heat or cold therapy
- Acupuncture
- Movement and stretching (yoga, tai chi)
4. Consider cortisone injections.
The healthcare provider may offer corticosteroid injections to relieve symptoms temporarily.
5. Prepare the patient for surgery.
If conservative therapies are unsuccessful, surgery is available for severe joint damage to relieve symptoms and restore mobility. Options include:
- Osteotomy: Removing part of a bone near the damaged joint to realign the joint and relieve pressure or pain.
- Joint replacement: Removing all or part of a damaged joint and replacing it with a prosthesis.
6. Maintain an ideal weight.
Excess weight places pressure on the joints and contributes to joint deterioration. Collaborate with a dietitian about safe weight loss strategies individualized for the patient.
7. Consider orthotics or other medical devices.
Shoe inserts can reduce pain with walking, while ankle, knee, or wrist braces or compression sleeves can stabilize the joints.
8. Ensure safety.
Patients with OA are at an increased risk for falls and fractures. Instruct the patient on environmental strategies to ensure their safety at home and outside. Encourage patients to protect their joints during physical activity through stretching, using protective equipment like knee or elbow sleeves, and performing movements with correct form.
9. Encourage treatment adherence.
Emphasize the importance of treatment adherence to preserve joints and reduce further damage. Patients will need to manage chronic medical conditions, keep their weight within a healthy range, exercise, and avoid repetitive activities that may cause injuries.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for osteoarthritis, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for osteoarthritis.
Chronic Pain
Osteoarthritis causes ongoing pain. Pain is often worse with activity and may improve with rest. Stiffness in the morning does not last beyond 30 minutes.
Nursing Diagnosis: Chronic Pain
Related to:
- Disease process
- Joint stiffness
- Joint degeneration
- Bone deformities
- Inflammatory process
- Bone spurs
As evidenced by:
- Diaphoresis
- Distraction behavior
- Expressive behavior
- Guarding behavior
- Facial grimacing
- Positioning to ease pain
- Reports pain intensity
- Hesitancy to move joints
Expected outcomes:
- Patient will report pain relief and comfort.
- Patient will demonstrate two strategies to reduce pain.
Assessment:
1. Conduct a comprehensive pain assessment.
Results from a comprehensive pain assessment are critical to identifying the underlying cause of pain and the effectiveness of treatment.
2. Assess factors that precipitate pain.
Pain in osteoarthritis may be associated with specific movements of affected joints. Joint pain when waking is normal but should dissipate within 15-20 minutes.
Interventions:
1. Apply a hot or cold compress for 30 minutes.
Heat improves blood flow and reduces pain reflexes. Cold can help reduce inflammation, pain, and muscle elasticity. Each patient may prefer one over the other.
2. Take breaks.
Joint pain with OA often worsens with activity and lessens with rest. The patient may need to take breaks when working, exercising, or completing tasks.
3. Administer oral and topical pain relief.
NSAIDs are recommended for OA pain. Over-the-counter topical creams and gels such as diclofenac are commonly used to relieve arthritic pain.
4. Consider injections.
Cortisone injections injected into the joint space can relieve pain temporarily for a few weeks. Lubrication injections that use hyaluronic acid may help cushion the joints.
5. Instruct on a TENS unit.
Transcutaneous electrical nerve stimulation sends low-voltage currents to the area around the joint to provide short-term relief.
Deficient Knowledge
A lack of knowledge about osteoarthritis and its management options can decrease the patient’s adherence to the treatment regimen. If left untreated, osteoarthritis can affect mobility function and quality of life.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Misinformation
- Inadequate access to resources
- Inadequate commitment to learning
- Inadequate awareness of resources
- Inadequate interest in learning
- Inadequate participation in care planning
As evidenced by:
- Inaccurate follow-through of instructions
- Poor adherence to therapy or exercise
- Inaccurate statements about a topic
- Development of irreversible joint damage
Expected outcomes:
- Patient will explain the disease process and the necessity of the treatment regimen.
- Patient will adhere to the treatment regimen and exhibit improved symptoms, as evidenced by reduced pain and stiffness and a more active lifestyle.
Assessment:
1. Assess the patient’s existing knowledge about the disease.
Evaluating the patient’s understanding and how the patient perceives the management of osteoarthritis allows healthcare providers to plan appropriate care and provide correct patient education.
2. Assess the patient’s readiness and motivation to learn.
The patient’s motivation and readiness to learn will affect retention and adherence to the treatment regimen.
Interventions:
1. Reinforce patient education through frequent repetition and follow-up sessions.
Frequent and regular education sessions promote medication and self-care management adherence with improved outcomes.
2. Educate the patient about proper medication use.
NSAIDs are commonly prescribed in the treatment regimen of osteoarthritis but can have side effects if taken incorrectly. Proper timing, dosage, and use of medications should be provided to the patient.
3. Educate on supplements.
If prescribed by the provider, the nurse can educate the patient on supplements for joint health. These often include collagen, glucosamine, and chondroitin.
4. Encourage the use of devices.
The nurse can educate the patient on devices to make everyday activities easier. Electric can openers and large-handled utensils can reduce stress on finger joints. Rubber grips on knobs and handles can make turning easier. Gloves and knee/elbow sleeves can keep joints aligned for better mobility.
Impaired Physical Mobility
Osteoarthritis can cause bone deformity and degrade cartilage which can cause permanent joint damage leading to impaired physical mobility.
Nursing Diagnosis: Impaired Physical Mobility
Related to:
- Disease process
- Joint pain
- Joint stiffness
- Muscle weakness
- Fatigue
- Restricted joint movement
- Inflammatory process
- Decreased muscle strength
As evidenced by:
- Decreased range of motion
- Difficulty turning
- Engages in substitutions for movement
- Expresses discomfort
- Uncoordinated movement
- Sedentary lifestyle
Expected outcomes:
- Patient will perform activities without discomfort and with minimal supervision.
- Patient will participate in therapy and exercise to improve mobility.
Assessment:
1. Assess the patient’s ability to ambulate and perform ADLs.
It is important to determine the extent of the patient’s physical immobility to determine the resources needed.
2. Assess the passive and active range of motion in the patient’s joints.
Osteoarthritis causes joint deformity and stiffness leading to progressive loss of range of motion.
Interventions:
1. Encourage the use of assistive devices.
The correct use of assistive devices can help improve the patient’s mobility, promote safety, and reduce the risk of injury.
2. Encourage the patient to increase activities as tolerated.
The patient may be hesitant to participate in exercise that can cause pain, but increasing activity can help improve and maintain joint function and independence. The patient can partake in low-impact activities like swimming and biking, which may be easier on joints.
3. Refer the patient to physical therapy.
A physical therapist can help formulate an exercise program addressing the immobility and joint dysfunction of the patient.
4. Refer the patient to community resources.
Local gyms or clubs may offer “joint-friendly” classes such as chair yoga or water aerobics that also provide socialization.
Risk for Adult Falls
Joint deterioration from osteoarthritis causes reduced strength, poor mobility, pain, and impaired balance, increasing the patient’s fall risk.
Nursing Diagnosis: Risk for Adult Falls
Related to:
- Disease process
- Limited range of motion
- Chronic pain
- Weakness
- Joint stiffness
- Joint instability
- Older age
- Use of assistive devices
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at prevention.
Expected outcomes:
- Patient will remain free from falls.
- Patient will identify and demonstrate interventions to prevent falls.
Assessment:
1. Assess the patient’s mobility, balance, and gait.
Patients with osteoarthritis often experience mobility difficulties due to joint pain and stiffness. Assess the patient’s gait and balance and perform passive range of motion exercises on affected joints to assess the severity of symptoms.
2. Assess the patient’s environment for potential hazards.
The nurse should ask the patient if their living environment includes stairs, uneven or sloping flooring, carpet or rugs, and grab bars or handrails to determine additional needs to prevent falls.
Interventions:
1. Advise on pain medications before activities or exercise.
Exercise is essential in the management of osteoarthritis as this will help maintain joint mobility. Patients with osteoarthritis are often reluctant to move and have difficulty mobilizing due to the pain, which increases the patient’s risk for falls. Oral pain medications and topical ointments or sprays can help reduce pain and allow for movement.
2. Instruct on how to use equipment properly.
Canes and walkers assist patients with osteoarthritis in ambulation and reduce stress on the affected joints. Ensure patients know how to use equipment correctly to prevent falls.
3. Encourage the use of appropriate footwear.
Appropriate footwear is essential in the management of osteoarthritis. Low, stable, and non-skid shoes with good arch support are ideal for osteoarthritis and will help reduce the risk of falls.
4. Encourage balance exercises and strength training.
Exercise is essential for bone health and overall physical strength. A combination of aerobic exercises and strength training is recommended. Age-related changes contribute to balance issues, and the patient can participate in tai chi, yoga, or specific movements like single-leg exercises to improve proprioception.
Risk for Injury
As osteoarthritis progresses, it can lead to disability and loss of function, which significantly increases the patient’s risk for injuries.
Nursing Diagnosis: Risk for Injury
Related to:
- Disease process
- Altered motor function
- Advanced age
- Knowledge deficit
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at prevention.
Expected outcomes:
- Patient will remain free from any injuries.
- Patient will demonstrate interventions and behaviors that can prevent joint damage and other injuries.
Assessment:
1. Assess the severity of joint immobility.
Pain, along with joint stiffness and deformity in patients with osteoarthritis, can cause progressive loss of range of motion. Assess for these symptoms and their effect on the patient’s ability to ambulate and perform ADLs to gauge their risk for injury.
2. Assess the patient’s understanding of their disease process.
The nurse should assess the patient’s knowledge about osteoarthritis, including that it is irreversible and requires lifestyle modifications to prevent further joint damage. The nurse can assess for gaps in knowledge related to injury prevention and joint protection.
Interventions:
1. Educate on positioning aids to support joints.
Pillows, wedges, and cushions can be used to reduce discomfort, maintain proper joint alignment when sitting or sleeping, and elevate extremities to promote circulation and prevent injuries.
2. Refer the patient to physical and occupational therapy.
Physical and occupational therapy can help patients with osteoarthritis adhere to appropriate exercises that promote muscle strength and joint mobility, which can reduce the risk of injuries.
3. Instruct the patient regarding the safe use of adaptive equipment.
Patients with osteoarthritis may need adaptive equipment such as electric can openers, jar openers, special utensils, grab bars and handrails, and dressing aids due to pain and stiffness. Ensure patients know how to install or operate these devices to prevent injuries.
4. Instruct on joint protection strategies.
The patient can reduce the risk of injuries by stretching appropriately before exercising, wearing protective gear, performing movements with correct form, and limiting activities that require repetitive movements.
5. “Warm up” before initiating movement.
After long periods of inactivity, such as sleeping, the joints may become stiff for up to 30 minutes. Instruct the patient to “warm up” the joints with stretches or literally with a heat pack before getting out of bed to prevent injuries.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Lozada, C. J. (2024, January 24). Osteoarthritis workup: Approach considerations, plain radiography, MRI, CT, and ultrasonography. Diseases & Conditions – Medscape Reference. Retrieved March 2024, from https://emedicine.medscape.com/article/330487-workup#c11
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- Osteoarthritis. Arthritis Foundation. 2022. From: https://www.arthritis.org/diseases/osteoarthritis
- Osteoarthritis. Mayo Clinic. Reviewed: June 16, 2021. From: https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925
- Osteoarthritis (OA). Centers for Disease Control and Prevention. Reviewed: July 27, 2020. From: https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
- Osteoarthritis (OA). Versus Arthritis. 2022. From: https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/
- Osteoarthritis. Sen R, Hurley JA. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482326/
- Osteoarthritis. (2021, June 16). Mayo Clinic. Retrieved March 2024, from https://www.mayoclinic.org/diseases-conditions/osteoarthritis/diagnosis-treatment/drc-20351930
- Osteoarthritis. (2023, June 13). Centers for Disease Control and Prevention. Retrieved March 2024, from https://www.cdc.gov/arthritis/types/osteoarthritis.htm
- Osteoarthritis: Symptoms, causes and treatment. (2023, October 2). Cleveland Clinic. Retrieved March 2024, from https://my.clevelandclinic.org/health/diseases/5599-osteoarthritis
- Testing for Osteoarthritis| Arthritis Foundation. (2022, June 15). Arthritis Foundation | Arthritis Support, Resources, Research & Advocacy. Retrieved March 2024, from https://www.arthritis.org/diseases/more-about/tests-for-osteoarthritis
