Introduction

Osteoarthritis is the most common form of arthritis, affecting millions of people around
the world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective
cartilage on the ends of your bones wears down over time.
While osteoarthritis can damage any joint in your body, the disorder most commonly
affects joints in your hands, neck, lower back, knees and hips.
Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis
treatments can slow the progression of the disease, relieve pain and improve joint
function.
Osteoarthritis symptoms often develop slowly and worsen over time. Signs and
symptoms of osteoarthritis include:
Pain. Your joint may hurt during or after movement.
Tenderness. Your joint may feel tender when you apply light pressure to it.
Stiffness. Joint stiffness may be most noticeable when you wake up in the
morning or after a period of inactivity.
Loss of flexibility. You may not be able to move your joint through its full range
of motion.
Grating sensation. You may hear or feel a grating sensation when you use the
joint.
Bone spurs. These extra bits of bone, which feel like hard lumps, may form
around the affected joint.

Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints
deteriorates over time. Cartilage is a firm, slippery tissue that permits nearly frictionless
joint motion. In osteoarthritis, the slick surface of the cartilage becomes rough.
Eventually, if the cartilage wears down completely, you may be left with bone rubbing on
bone.
Factors that increase your risk of osteoarthritis include:
Older age. The risk of osteoarthritis increases with age.
Sex. Women are more likely to develop osteoarthritis, though it isn't clear why.
Bone deformities. Some people are born with malformed joints or defective
cartilage, which can increase the risk of osteoarthritis.
Joint injuries. Injuries, such as those that occur when playing sports or from an
accident, may increase the risk of osteoarthritis.
Obesity. Carrying more body weight puts added stress on your weight-bearing
joints, such as your knees.
Certain occupations. If your job includes tasks that place repetitive stress on a
particular joint, that joint may eventually develop osteoarthritis.
Other diseases. Having diabetes, underactive thyroid, gout or Paget's disease of
bone can increase your risk of developing osteoarthritis.
Osteoarthritis is a degenerative disease that worsens over time. Joint pain and
stiffness may become severe enough to make daily tasks difficult. Some people are
no longer able to work. When joint pain is this severe, doctors may suggest joint
replacement surgery.
I choose this topic, because it is the most common form of arthritis and one of the
leading causes of pain, stiffness, joint deformity, loss of joint mobility and disability
worldwide. In this study, I can help people especially elderly to be aware in this
kind of condition and the same time, they know how to manage.



















Learning Objectives
Comprehend and recognize salient points that are important to remember when
dealing with patient who manifested degenerative disease: Its nature, causes,
symptoms, clinical manifestation, management, and prognosis. This is to enhance the
student and other health care providers awareness, knowledge and understanding of it
in order to promote health, prevent the disease and help manage patient with them.
Specific Objectives:
-Present introduction of the studied disease.
-Present the obtained initial database of the patient.
-Present the nursing history including the past and present illness of the patient.
-Identify the anatomy and physiology of the disease.
-Explain the assessment and cognitive findings.
-Interpret the laboratory results.
-Outline the drug study
-State the discharge planning






Profile of the Patient
A, Personal Data:
Patient name: L.M
Age: 75 years old Gender: Female
Status: Widow Religion: Catholic
Address: 4-C Mabilis St., Pinyahan Quezon City
Birthday: April 6, 195 Birthplace: Visayas
Educational Attainment: High School Graduate
Language/Dialect spoken: Tagalog, Bisaya, English
Work: Retired
No of children: 7
B. Vital Information:
Vital signs: T: 36.6, BP: 130/70, PR:84, R:18,
Weight: 63Kg Height: 5
Date admitted: November 18,2013
Reason for Admission: Degenerative Osteoarthritis

Past, Present and Family History
Past Illness History
The patient L.M a 78 yrs old female. She had 7 normal spontaneous delivery. In her
50s she was diagnosed with hypertension and taking maintenance medication.

Family History
There is no known inherited condition present in both paternal and maternal family.

Present Illness History
A month ago before the admission, LM experienced inability to mobilize her legs
especially the right one. She also recalled and claimed that its approximately a year
that she has been suffering from immobility. She cited that pain start getting worst.
Then they decided to seen a physician, the physician advised the patient to be
admitted on that day.





Gordons Functional Health Pattern
System Normal Findings Actual Findings Remarks
General
Appearance

-Appears as its age
-In good hygience
-Appearance
appropriate on his
age
-Alert and active
-Appears happy
-Cooperative
-Appears well
nourished
-Can speak and can
express what he
wanted.
-Body hair is fine
and thinly
distributed
-Appears as its age
-In good hygience
-Appearance
appropriate on his
age
-Alert and active
-Appears happy
-Cooperative
-Appears well
nourished
-Can speak and can
express what he
wanted.
-Body hair is fine
and thinly
distributed
The general
appearance of the
patient is
appropriate to the
age and found to
be normal.

Vitals signs -RR: 20-30 cpm
-Heart rate: 30-
110pbm
Temperature:36.5-
-RR: 18 cpm
-Heart rate: 84
pbm
Temperature: 36.6
All the findings for
the vitals signs are
found to be within
normal range.
37.5
Nutritional Status -Normal weight of
39 to 79.
-Normal height of
40-52 inches.
-Eat balances diet
and exercise.
-Patient weight is
6.6 kg.
-Height of 5 feet
-Patient eats 3
times a day.
The Nutritional
status is not
normal since the
patient doesnt
have balance diet
and loves to eat.
Neurologic status -Oriented to
people, time and
place.
-Calm behavior
-Attitude of
behavior.

Oriented to people,
time and place.

-Calm behavior
-Attitude of
behavior.

All the findings in
neurological status
are found to be
appropriate.
Skin -Skin color ranges
from pale to dark
brown or black. No
odor and no skin
lesions.
-Skin should be
soft warm, moist
with good turgor.
-light brown, no
lesions, with
slightly edema.
-Slightly soft
-Warm to touch
-Skin is intact
-smooth and even
-body hair is fine
All of the findings
for the skin are
found to be within
normal.

-Boy hair is fine
and thinly
distributed.
and thinly
distributed.

Hair -Even distribution
-Hair color is black.
-No masses
-Clean and neat
-Characteristics of
hair is elastic and
lustrous and silky.
-Well distributed
-No lesions
-No masses
-Clean and neat
-Silky , elastic,
lustrous
All of the findings
of the hair are
found to be ithin
normal.
Nail -Pinkish nail bed
-Concave shape
-Nails clean and
well trimmed
-Color of the nail
back to original
color after 1-2
-Pinkish nail bed
- Slightly Concave
shape
-Nails clean and
well trimmed
-Color of the nail
back to original
color after 1-2
All the findings for
the nails are found
to be within
normal.

Head -Symmetrical,
rounded and
noncephalic.
-Head
Symmetrical,
rounded and
noncephalic.
-Head
All of the findings
for the head are
found to be ithin
normal range.
circumference is
45-60 cm.
-head is study
-No palpable
lymph nodes
-No dandruff
-Full range of
motion
circumference is
51 cm

No palpable lymph
nodes
-No dandruff
-Full range of
motion
Eyes -Symmetrical
-Eye lashes are
evenly distributed
-Sclera white
-No discharge
-Pink conjunctiva
-Symmetrical
-Eye lashes are
evenly distributed
-Sclera white
-No discharge
-Pink conjunctiva
All of the findings
for the eyes are
found to be within
normal.

Nose and sinuses -No discharge
-Uniform in odor
-Not tender
-Pink mucosa
-Nasal septum
intact
No discharge
-Uniform in odor
-Not tender
-Pink mucosa
-Nasal septum
intact
The ears finding
are found to be
within normal
range.
Mouth -Pink tone of gums,
tongue and tonsils
Pink tone of gums,
tongue and tonsils
All findings for
mouth are found to
-Moist and slightly
rough tongue
-Absence of lesion
in oral mucosa
-Moist and slightly
rough tongue
-Absence of lesion
in oral mucosa
be in normal

Throat and neck -No palpable
lymph nodes
-No edema
-Neck can move
freely

-No palpable
lymph nodes
-No edema
-Neck can move
freely

All findings are
found normal
Breast and Axilla -Symmetrical
-Absence of
tenderness
-No Masses and
discharge
-Symmetrical
-Absence of
tenderness
-No Masses and
discharge
All findings are
found normal

Chest and
Respiratory system
-Symmetrical
-Bilaterally equal
shoulder height
-regular
-Symmetrical
-rounded and
scapula are equal
horizontal position
All findings are
found normal

Cardiovascular and
peripheral
- Apical pulses are
audible
-No cold
-Presence of apical
pulses
Slightly cold and
Some findings are
abnormal due to
osteoarthritis
extremities and
discolored
extremities
-Capillary refill less
than 2 sec
discolored of
extremities

-Capillary refill less
than 2 sec.

Abdomen and
Gastrointestinal
system
-Symmetrical
-No lesions
-No tenderness
-No masses
-Presence of flatus
-Bowel sounds of
5-30 clicks

Symmetrical
-No lesions
-No tenderness
-No masses
-Presence of flatus
-His bowel
movement is
everyday
All finding are
found normal

Muscoskeletal -Uniform in color
-10fingers and toes
-symmetrical
-No fractures,
dislocations and
deformities
-Slightly different
in color
10fingers and toes
-Presence of
dislocation and
deformities
The findings are
abnormal and
indication of
osteoarthritis



Anatomy and Pathophysiology
Joints can be classified in either functional or structural terms. A functional classification,
based on movement, would categorize joints as follows:
Synarthroses (immovable)
Amphiarthroses (slightly moveable)
Diarthroses (freely moveable)
A structural classification would categorize joints as follows:
Synovial
Fibrous
Cartilaginous
Normal synovial joints allow a significant amount of motion along their extremely
smooth articular surface. These joints are composed of the following:
Articular cartilage
Subchondral bone
Synovial membrane
Synovial fluid
Joint capsule
The normal articular surface of synovial joints consists of articular cartilage (composed
of chondrocytes) surrounded by an extracellular matrix that includes various
macromolecules, most importantly proteoglycans and collagen. The cartilage facilitates
joint function and protects the underlying subchondral bone by distributing large loads,
maintaining low contact stresses, and reducing friction at the joint.
Synovial fluid is formed through a serum ultrafiltration process by cells that form the
synovial membrane (synoviocytes). Synovial cells also manufacture hyaluronic acid (HA,
also known as hyaluronate), a glycosaminoglycan that is the major noncellular
component of synovial fluid. Synovial fluid supplies nutrients to the avascular articular
cartilage; it also provides the viscosity needed to absorb shock from slow movements, as
well as the elasticity required to absorb shock from rapid movements.


Diagnostic Procedure and laboratory
Test Normal Result Result Interpretation
X-ray of chest No Fracture R/O Fracture No active
parenchymal
infiltrates seen.
The heart is
moderately
enlarged by CT
ratio (0.15) Aorta
is calcified.
Diaphragm and
sulci are intact.
ECG Rhythm (-)
QRS Axis (-)
PR Interval (-)
QT Interval (-)
QRS Duration (-)
Rate (-)
Atrial (-)
Ventricular (-)
Rhythm (-)
QRS Axis (-)
PR Interval (-)
QT Interval (-)
QRS Duration (-)
Rate (-)
Atrial (-)
Ventricular (-)
Sinus Rhythm Left
axis deviation
Hematology CBC
Hemo- 120-160
Hct-.32-.43
RBC -4.0-5.0
WBC- 4.0-10.0
Segmenters-0.55-
0.65
Lymphocytes .25-
.35
Eosinophils-.02-.04
Monocytes-0.3-
0.06
Basophils-0.00-
0.01
MCV-80-100
MCH-26-37
MCHC-32-36
RDW-11.0-15.0
Platelet-130-400
Prothrombin Time
10.6-13.6
APTT -25.3-32.3
Clotting Time-2-7
129
0.35
4.24
7.71
0.56

0.40

0.04
0.07

0.00

83.5
30.4
36
14.11
290
11.7

26.4
3
Normal
Normal
Normal
Normal
Normal

Infection

Normal
Infection

Normal

Normal
Normal
Normal
Normal
Normal
Normal

Normal
Normal
Bleeding Time-2-4
Urine Color-amber
Transparency-
turbid
SPGravity 1.010
Sugar-(-)
Protein-(-)
RBC-0-1
Puscell-1-3
Epithelium cell-
moderate
Light yellow
Slightly tubid

1.010
(-)
(-)
1
2

moderate
Normal
Normal

Normal
Normal
Normal
Normal
Normal

Normal










Course in the ward
Problem Treatment Results
Immobility of right leg Total Knee Anthroplasty
(right) under SA
Successful and no
complication
Pain Morphine 1 mg IV Reduce the pain
Swelling of the leg (Right) Apply cold compress for
10 minutes TID over right
knee
Reduce swelling











Discharge Planning
When client is to be discharge from the hospital, nursing care is still continued. With
sufficient support at home, most client recover gradually. During home visits, the
clients physical status and progress towards recovery is assessed. The clients
understanding of therapeutic regimen is also assessed and previous teaching is
reinforced.












Introduction
Fracture are common; the average person has two during a lifetime. They occur
when the physical force exerted on the bone is stronger than the bone itself.
Your risk of fracture depends, in part, on your age. Broken bones are very
common in childhood, though children's fractures are generally less complicated
than fractures in adults. As you age, your bones become more brittle and you are
more likely to suffer fractures from falls that would not occur when you were
young.
There are many types of fractures, but the main categories are displaced, non-
displaced, open, and closed. Displaced and non-displaced fractures refer to the
way the bone breaks.
A bone injury that results in more than 2 separate bone components is known as
a comminuted fracture. Some comminuted fractures have specific names such
as 'butterfly fragment' or 'segmental fracture'.
Butterfly fragment example - Metacarpal
Comminuted fracture resulting from 2 oblique fractures forming a 'butterfly
fragment' (shape of a butterfly wing)
Butterfly fragment example - Metacarpal
Comminuted fracture resulting from 2 oblique fractures forming a 'butterfly
fragment' (shape of a butterfly wing)
Causes;
High-energy collisions, such as an automobile or motorcycle crash, are
common causes of tibial shaft fractures. In cases like these, the bone can
be broken into several pieces (comminuted fracture).
Sports injuries, such as a fall while skiing or running into another player
during soccer, are lower-energy injuries that can cause tibial shaft
fractures. These fractures are typically caused by a twisting force and
result in an oblique or spiral type of fracture.
The most common symptoms of a Comminuted fracture are:
Pain
Inability to walk or bear weight on the leg
Deformity or instability of the leg
Bone "tenting" the skin or protruding through a break in the skin
Occasional loss of feeling in the foot
Fracture are most easily diagnosed by an X-ray. An X-ray helps the doctor figure
out how the pieces is a comminuted fracture are arranged so they can treat it
properly.
Often, the best way to treat comminuted fracture may be to pin the pieces during
surgery so they can form back together. It may also be treated with a cast but
sometimes that is not enough. Either way, the fracture need to be immobilize.
We choose this topic, because fracture is the most common accident in people
especially when you get older. In this study, we can help people to be aware to
this kind of fracture (comminuted), by knowing the cause symptoms and to
manage i

Pathophysiology
First,
Changes in articular cartilage

Second
Soft tissue changes

Third
Progressive wear and tear on cartilage leads to thinning of point surface and
ulceration into bone

Fourth
Leads to inflammation of the joint and increased flow and hypertrophy of
subchondral bone

Last
New cartilage and bone formation at joint margins results in oeteophytosis, altering
the size and shape of bone


Case Study
(Degenerative Osteoarthritis)





Presented by:
Pentz, Jennylyn B.
BSN 3Y2-2C




Presented to:
Ms. Maria Sheila B. Mujemulta, RN, MAN
December 5,2013