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Osteoarthritis

In 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 Lids close symmetrically, bilateral blinking.
No edema or tenderness over lacrimal gland
Sclera Appears reddish with visible microvessels
Iris With presence of cataract on OU
Pupils PERRLA
Eye movement 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 Uniform pink in color, free from discharge,
ability to purse lips
• Teeth Smooth, intact, no bad breath
• Tongue Pink color, moist, no lesions, moves freely,
• Palates 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 Temperature Pulse Respiratory Blood


(°C) rate rate (cpm) Pressure
(bpm) (mmHg)
July 27, 36.9 70 22 120/90
2010
August 36.7 67 23 120/80
2, 2010
August 36.3 66 20 120/80
3, 2010
August 36.7 68 22 120/80
9, 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 Repair
Stages 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
Age, Advancing Loss of Diet, Obesity,
Nature of work ---------
See
Pinch/crowd Formation of n in
Narrowing of joint ! x-ra
Osteocytes spaces y

Pai
------------------------------ Decrease in synovial Pressure between Obliteration of joint
n fluid joint space
! !
Degeneration of Pai
! -------------
n !
cartilage
! ! !
Continuous use of Difficulty
! ! !
joint of
! ---------movement Formation of subchondral
Disappearing of full cysts
! thickness of articular ! ! !

! Wear and tear of articular cartilage Hardening of the


underlying bone
! ! !
Release of chemical Inflammatory
! mediators ! !
response
! ! !
Immobilizatio
Acts on Increase Increase
n ! Repair and
pain blood vascular
remodelling
receptors permeablity ! !

WBC !
Pai
Redness, increase
edema ! If not remodeled
Osteoarthritis
n Surgery, GH & stem
cell injection
!-------------------------------!-------------------------------!------------------------ --------------------- !-------------------------------------------
-------- !

C. Drug Study
Drug Name Classification Mechan
of Actio

Flanax Analgesic, Inhibition


( Naproxen Antipyretic, prostagl
Sodium) Antiinflammatory in
synthesi
500mg PO
Bid
Drug Name Classification Mechanism
of Action

B complex Vitamin B A coenzyme


1 tab OD Complex that stimulat
to be taken metabolic
orally. function and
is needed for
cell
replication,
Chapter IV
Nursing Care Plan

Assessment Diagnosis Planning Intervention Rationale Evaluation


Subjective: Impaired After series of • Support the • To maintain After series of
“Nahihirapan physical nursing affected position of nursing
akong kumilos mobility related intervention the body function and intervention the
sa umaga,” to loss of client will be parts/joints reduced risk client was able
as verbalized by integrity of able to by using of pressure to maintain
the patient. bone structure maintain/ pillow or ulcers. strength and
as evidenced by increase rolls, foot function of the
Objective: client’s strength and support or affected body
• Limited verbalization function of the shoes, air • To reduce part as
ability to and slowed affected and/or mattress. fatigue. evidenced by
perform movement. compensatory • Schedule the client can
skills body part. activities now perform
• Felt stiffness with simple exercise
every early adequate • To prevent such as walking
morning or rest periods fall. for at least 15-
during cold during the 30minutes
weather day. everyday and
• Limited • Provide for drink glass of
range of safety milk every
motion measures as morning.
• Slowed indicated by
movement individual
• Joint swelling situation • To promote
• Decreased including well being,
walking environment strengthen
speed al bone density
management and
. maximize
• Encourage energy
adequate production.
intake of
fluids or
nutritious • To permit
foods maximal
particularly effort or
foods that involvement
are rich in in activity.
calcium.
• Encourage to • To improve
take the blood
medications circulation in
prior to the joints.
activity as
needed for
pain relief. • To reduce
• Encourage to weight that
do simple would reduce
exercise the pressure
such as in the joints.
walking for • To aid in
at least 15 walking and
minutes. minimize
• Teach weight injuries.
loss diet, if
appropriate.

• To minimize
• Teach the the use of
importance body energy.
and
appropriate
use of
devices such
as walker,
canes and
crutches.
• Advised
client to rest
between
each
activities.
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective: Acute pain After series of • Assessed for • To help After series of
“Masakit ang related to loss nursing referred determine nursing
tuhod ko,” as of integrity of intervention the pain. possibility of intervention the
verbalized by bone structure client’s pain underlying client’s pain was
the client. as evidenced by scale of 6/10 conditions lessened from
client’s verbal will decrease to requiring 6/10 to 3/10
Objective: reports, facial 2/10. treatment. and
• Pain scale of grimace, • To determine demonstrated
6/10 immobility & • Note client’s the ways on how to
• With swollen joints. attitude effectiveness provide relief as
guarded towards pain of relieving evidenced by;
behavior medication. pain. • The client
• With facial • Determine • To determine follow
grimace factors of the effect pharmacologi
• Immobility client’s response to cal regimen
• Swollen lifestyle. analgesic or as
joints choice of prescribed.
intervention • Took glasses
P= cold for pain of milk
weather/ management everyday.
analgesic • Monitor vital . • Walk for 15-
Q=pressing signs and • This usually 30minutes as
R=thigh & lower skin color. alters when a means of
leg • Provide pain occurs. exercise.
S= 6/10 comfort • To promote
T= measure non-
such as use pharmacolog
of hot ical pain
compress management
and and avoid
encourage being
the use of dependant to
diversional pain
activities like relievers.
watching tv,
listening to
music and
socialization
with others. To prevent
• Encourage fatigue and
adequate conserve
rest periods. energy.
• Instruct the
client to • To help
follow reduce the
medication pain
regimen as sensation.
prescribed
by the
physician.
• Instructed • To
the client to strengthen
eat nutritious the bone
foods density and
especially reduce
food that are inflammatory
rich in response.
calcium,
protein and
carbohydrate
.
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective: Deficient After 8 hours of • Determine • Individual After 8 hours of
“Bakit po kaya knowledge nursing the client’s may not be nursing
lagi paring related to lack intervention the ability or physically, intervention the
sumasakit ang of information client will readiness emotionally client was able
tuhod ko tuwing and verbalized and barriers or mentally to verbalized
umaga at kapag unfamiliarity understanding to learning. capable at and
malamig ang with information of situation and • Be alert in this time. demonstrated
panahon.” As resource. treatment the signs of • Client may understanding
verbalized by regimen and avoidance. need to of situation and
the client safety suffer individual
measures. consequence treatment
Objective: of lack of regimen and
• Does not knowledge safety measures
know how to • Assess the before he is AEB client
manage the level of ready to followed safety
present client’s accept measures &
condition capabilities information. treatment
particularly and the • May need regimen such
as to what possibilities the help of as: does simple
type of of the SO or exercise every
action to be situation. caregivers to morning for 15-
done and • Provide learn. 30min., drinks
diet to be information milk every
followed. relevant only Can improve morning, takes
• Always to the understandin analgesic as
asking situation g about the prescribed.
questions as such as disease
related to definition of condition
the osteoarthritis thereby
condition. , causes, acquiring
signs and clients
symptoms, cooperation
treatment on disease
and management
management .
.
• Provide feed
back. • Can
encourage
• Begin the continuation
information of efforts.
the client • Can arouse
already interest or
knows and limit sense of
more to being
what the overwhelmed
client does .
not know,
progressing
from simple
to complex.

• Advised the
client the • To monitor
importance the
of having a progression
regular of the
check up to disease and
the physician effectiveness
or RHU. of therapy.
Assessment Diagnosis Planning Intervention Rationale Evaluation

Goal met
Subjective: Impaired After series of  Support To maintain
“ Kadalasan Physical nursing affected position of
hindi agad ako Mobility related intervention the body parts / function and
makakilos o to loss of patient will be joints using reduce risk of
makagalaw lalo integrity of maintain or pillows / pressure ulcers.
na tuwing bone structure. increase rolls, foot
umaga” as strength & support /
verbalized by function of shoes.
the patient. affected and or
compensatory  Encourage To promotes
Objective: body part. adequate well being and
 Limited intake of maximizes
range of fluids as well energy
motion as nutritious production.
 Slow ed foods.
movement
 Gait  Encourage To keep joints
 Stiffness the patient mobile and not
(early to increase taxing the joint
morning activity as too much
until about indicated.
an half hour
after rising  Encourage To reduces the
 Muscle the patient load on the
spasms to ambulate joint and
 Joint with promotes
swelling assistive safety.
devices.
Chapter V
Discharge Planning