CASE STUDY: OSTEOARTHRITIS NURSING CARE PLAN PROJECT
Introduction
Osteoarthritis (OA) is a group of medical and mechanical anomalies that involve degeneration of joints such as sub-chondral one and articular cartilage. Osteoarthritis is also referred to as degenerative joint disease or degenerative arthritis. Symptoms of AO may comprise of effusion, locking, bone stiffness, tenderness, as well as joint pain. This Nursing Care Plan (NCP) report evaluates 4 NCPs for Osteoarthritis illustrated in Christopher Collins’ case study, including goals for the condition’s care plan, the assessment, as well as nursing interventions. The objective of the care plan entails focussing on the control and lowering of degeneration of joints, modification of lifestyle, adherence to the therapeutic regimen, as well as complications control and prevention. Osteoarthritis is the most common arthritis form, and the primary cause of chronic disability in the US, with approximately 27 million people affected.
Case Study: Christopher Collins
Christopher Collins is a 54-year-old male who was diagnosed with early-stage Osteoarthritis in the left knee, causing pain and affecting mobility. Surgery was planned to take weight/pressure off the damaged side of the knee joint and therefore relieve pain and also help improve joint function. Five days ago, Christopher was admitted for a left high tibia knee osteotomy. The osteotomy procedure involved the stabilization of the tibia using a plate and screws. Moreover, Antibiotics were administered by the anaesthetist on anaesthetic induction. Consequently, Christopher had a smooth post-operative phase and got discharged two days later. As a result, he was discharged with non-steroidal anti-inflammatory medication for relieving pain, non-weight bearing on crutches and fitted for a supportive knee brace until his planned outpatient review after two weeks.
Situation
Christopher got presented at the ED complaining of pain at the incision site, shivering, and nausea. Additionally, examining the wound site on his left knee revealed a suture, ‘tight’, shinny, and red skin. Moreover, there were numerous small areas where dehiscence was apparent with pus present. Thus Oxygen therapy is initiated.
Background
Christopher was diagnosed with Progressive Macular Hypomelanosis (PMH) despite suffering from asthma since childhood and Osteoarthritis. Several drugs were administered, including NSAID, Ventolin, and Seretide accuhaler. From the test, Christopher did not show any noticeable allergic reaction. Besides, Christopher is a non-smoker and regularly swims 3 to 4 times a week, and sometimes participates in Kayaking.
Nursing Care Plans
According to the Arthritis Foundation (2014), Nursing Care Plan for patients suffering from Osteoarthritis comprise of; easing pain, enhancing comfort processes, averting progressive disability, as well as sustaining optimal functions of the joints. According to Golovach (2017, p. 12), there are four major Nursing Care Plans (NCPs) for Osteoarthritis:
- Chronic Pain and Acute Pain
- Impaired Physical Mobility
- Activity Intolerance
- Risk For Injury
Chronic Pain and Acute Pain
Acute Pain: According to Osteoarthritis Research Society International (2014), acute pain can be described as an emotional and unpleasant sensory experience that arises from actual or potential damage of tissues or is depicted in terms of such damages; slow or sudden commencement of any intensity from moderate to acute with the predictable or expected end of six months
Chronic Pain: Chronic pain is described as an emotional and unpleasant sensory experience that arises from actual or potential damage of tissues, or is depicted in terms of such damages; slow or sudden commencement of any intensity from moderate to acute, to constant or repetitive without a predictable or expected end of over six months (Relyveld et al. 2007, p. 14).
Related Risk Factors
Chronic pain and acute pain can be attributed to the following factors (Spector and MacGregor, 2004, p. 44).
- The patient may experience difficulty in physical mobility
- The patient may be experiencing muscle spasms
- There may be evidence of joints degeneration
- Bones may appear to be deformed
Evidence
The acute and chronic pains may be evidenced by several issues or factors (as evidenced in Christopher’s case) such as (Glyn-Jones et al. 2015, p. 379);
- The patient may appear restless
- Sometimes the patient may even cry
- Guarded and protective behaviour
- The client may show traces of facial grimaces
- The patient may get easily irritable
- The patient may report muscle numbness, tingling, spasms, and pain
- The client may report a decreased capability to perform ADLs as a result of the discomfort
- Some patients may be unable or may refuse to do exercises or rehabilitation programs
- Some patients may appear withdrawn in their moods and behavior
Desired Outcomes
- Christopher is expected to report satisfactory control of pain at levels less than 3 – 4 on a scale of 0 – 10.
- After the interventions, Christopher will be expected to use pharmacological and non-pharmacological pain-relieving approaches
- The client is expected to show some increase in comfort like baseline levels for HR, BP, respiration, as well as a relaxed tone of the muscles or posture of the body.
- The client will participate in desired exercise and activities without an increase in the levels of pain.
Nursing Interventions and Rationale for Chronic Pain and Acute Pain
| Nursing Interventions | Rationale | ||||||||||||||||||||||
| Assessing how the client describes the pain
| The patient may report pain in the cervical vertebrae, lower lumbar spine. Knees, hips, arms, and fingers (Sinusas 2012, p. 49) Consequently, pain is typically triggered by activities and relieved by rests; aching and joint pains may be present when the patient is resting. The pain may as well manifest in the form of an ache that progresses to a sharp pain when the affected part is brought to bear full weight or full Range of Motion (ROM). Therefore, the patient may experience severe, painful muscle spasm, and paresthesias. | ||||||||||||||||||||||
| Assessing the patient’s prior experiences with pain and pain relief. | The patient may have a tried-and-true plan to execute then OA becomes aggravated. Attention should be given to executing this nursing care plan, with few adjustments where necessary, when the pain turns out to be acute. | ||||||||||||||||||||||
| Identifying elements or actions that appear to aggravate severe incidences or precipitate a chronic situation. | Pain may be linked to particular motions, particularly repetitive movements of the joints that are involved. | ||||||||||||||||||||||
| Determining whether the patient has reported all of the forms of pain he/she is undergoing.
| Clients who have become accustomed to living with chronic pain may learn to tolerate basal levels of discomfort and only reports those discomforts that exceed these “normal” levels (Kalunian, 2014). The care provider is not getting an accurate picture of the client’s status if this pain is not reported. The nurse may need to be sensitive to nonverbal cues that pain is present. | ||||||||||||||||||||||
| Determining how the patient reacts to chronic pain. | The patient may find it challenging to cope with an advancing and devastating disease. | ||||||||||||||||||||||
Create a pain relief regimen plan based on the patient’s recognized relieving and aggravating dynamics. Therefore, instruct the patient to perform the following:
Instruct the patient to take prescribed analgesics and anti-inflammatory drugs. Additionally, enlighten the patient on the side effects of the medications.
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Impaired Physical Mobility
Impaired Physical Mobility refers to the constraint in the purposeful, independent physical movement of the body or one or more part of the body.
Related Risk Factors
Factors that are attributed to Impaired Physical Mobility may entail (Yucesoy et al. 2015, p. 267).
- Body and muscle fatigue
- Muscle and joint pains
- Stiff Joints
- Muscle weakness
- Constrained movement of joints
Evidence
Impaired Physical Mobility may be evidenced by:
- Patient feeling reluctant to move
- Patient refusing to transfer, ambulate or perform ADLs
- Patient experiences a limited range of motion
- A patient may experience a decrease in muscle strength
Desired Outcomes
After the implementation of the proposed nursing interventions, the patient is expected to:
- Perform physical activities autonomously and within the limits of the restrictions of the activities.
- Show the use of adaptive changes that enhance transfer and ambulation.
- Exhibit complication-free mobility, as illustrated by regular patterns of the bowel, lack of thrombophlebitis, clear sound of breathing, as well as intact skin (Cutolo 2015, p. 616).
Nursing Interventions and Rationales for Impaired Physical Mobility
This report proposes several nursing interventions and the rationale behind them that could help in minimizing and preventing Impaired Physical Mobility for our case study:
| Nursing Interventions | Rationale |
| Assessing the patient’s gait and posture | Assessment of indicators of the reduced capability to move and ambulate independently is critical in devising appropriate interventions. Sovani and Grogan (2013, p. 37) state that some of these indicators include bearing weight unevenly, limping, shortened steps, shoulders hunching, and unstable gait. |
| Assessing the patient’s weight | There is a need to assess the patient’s eight since excessive and uneven weight distribution may stress the painful joints. According to Hinman (2010), excessive weight may add stress to painful joints (p. 1192). |
| Assessing how the patient is comfortable with and understanding of how to use adaptive devices
| The right and correct use of adaptive equipment for ambulation can enhance movement and minimize the risks of falling. However, Momoeda (2020) notes that some patients avoid the use of adaptive devices since they believe they attract attention to their perceived disability. |
| Assessing the patient’s critical signs of impaired physical mobility after physical activity | High BP, respiratory rates, as well as HR, may be risk factors of increased discomfort and effort when performing tasks. Sovani and Grogan (2013, p. 27) state that HBP, as well as other cardiac diseases, could lead to obesity which could, in turn, act as a risk factor for Osteoarthritis. |
| Encouraging the patient to intensify physical and proposed activities | Engaging in physical activities at home is effective in sustaining joints, autonomy and functions. Hence, Sonoo and colleagues (2019) assert that there must be a balance between performing the adequate activity to keep them mobile and not overburdening the joints. |
Activity Intolerance
Activity intolerance refers to small physiological and physiologic energy can is needed to endure or complete a required or desired task.
Risk Factors for Activity intolerance
Activity intolerance may be attributed to:
- Joints pain
- A decrease in muscular tone
Evidence
A patient may show or experience activity intolerance through:
- Experiencing muscle fatigue
- Experiencing muscle atrophy and limited movement
Desired Outcome
Proper implementation of the proposed nursing interventions may result in several desirable outcomes including;
- Patients will use recognized approaches to promote activity intolerance
- Patients will report a considerable improvement in activity intolerance
Nursing Interventions and Rationales for Activity Intolerance
| Nursing Intervention | Rationale |
| Assessing the patient’s nutritional status | Sufficient energy reserves are required for physical and physiological activities. Sonoo and other authors note that physical and physiological activities are essential for the control of Osteoarthritis (2019). |
| Assessing the significance of ambulation aids like walkers and canes for ADLs | Tan and others (2016, p. 586) point out that assistive ambulation devices help patients in mobility by assisting them to overcome their limitations. |
| Assisting with ADLs while evading patient dependency | Helping patients with ADLs permits them to conserve their energy. Cheung and others (2014, p. 169) assert that careful balancing of assistance provision and facilitation of progressive endurance will promote the patients’ self-esteem and activity tolerance. |
Risk for Injury
The risk for injury is defined as vulnerability to injury due to environmental conditions that interact with a person’s defensive and adaptive resources, which may compromise there health.
The risk for injury can be attributed to the following risk factors (Both et al. 2017, p, 191);
- Pain
- Decreased function of bones
- Change in mobility
Desired Outcomes
- The patient is expected to be injury-free
- The patient is expected to devise ways of avoiding injuries.
Nursing Interventions and Rationale for Risk for Injury
| Nursing Intervention | Rationale |
| Assisting patients with passive and active ROM isometrics and exercises as advised | Assisting patients with ROM helps them in maintaining and enhancing muscle strength, functions of the joint, as well as activity endurance (Yu and Hunter 2015, p. 17) |
| Encouraging patients to lose weight to reduce stress on joints bearing weight | Excessive weight on joints adds: contribute to additional stress on the joints, accelerating the deterioration of joint cartilages (Cheung et al. 2014, p. 167). |
| Instructing patients to use adaptive mobility devices like crutches, canes, and walkers as prescribed | Maly and colleagues posit that the use of adaptive mobility devices will help keep the joints mobile, thereby promoting safety, and maintaining a high-quality life (2006, p. 97). |
Conclusion
Osteoarthritis (OA) is a form of arthritis which leads to degeneration of joints such as sub-chondral and articular cartilage. Four NCPs for the disease have been discussed, and they include risk for injury, activity intolerance, impaired physical mobility, and Chronic Pain and Acute Pain. Under each NCP, several issues have been highlighted including risk factors, evidence of the disease, nursing interventions and rationales for each care plan, and desired outcome after the implementation of the interventions. The disease mostly occurs in older adults and has two main types: Idiopathic (primary) OA and Secondary OA. Idiopathic OA primarily affects older women, usually above 65 years, while secondary OA mostly affects men. Regular monitoring and testing for the disease is recommended.
References
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