OSTEOARTHRITIS

INTRODUCTION

OSTEOARTHRITIS

A type of arthritis caused by INFLAMMATION, BREAKDOWN, AND EVENTUAL LOSS OF CARTILAGE IN THE JOINTS. Also known as degenerative arthritis Osteoarthritis is a disease characterized by DEGENERATION OF CARTILAGE AND ITS UNDERLYING BONE within a joint as well as bony overgrowth.

INTRODUCTION

The breakdown of these tissues eventually leads to PAIN AND JOINT STIFFNESS. The joints most commonly affected are the KNEES, HIPS, AND THOSE IN THE HANDS AND SPINE. The specific causes of osteoarthritis are unknown, but are believed to be a result of BOTH MECHANICAL AND MOLECULAR EVENTS IN THE AFFECTED JOINT.

INTRODUCTION

Disease onset is gradual and usually begins after the AGE OF 40. THERE IS CURRENTLY NO CURE FOR OA . Treatment for OA focuses on RELIEVING SYMPTOMS AND IMPROVING FUNCTION, and can include a combination of patient education, physical therapy, weight control, and use of medications.

OSTEOARTHRITIS

ANATOMY AND PHYSIOLOGY

Joints can be classified as synovial, fibrous, or combination joints, based on the presence or absence of a synovial membrane and the amount of motion that occurs in the joint. Normal synovial joints allow a significant amount of motion along their extremely smooth articular surface. These joints are composed of the following:

Articular cartilage Subchondrial bone

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 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 the major protein component of synovial fluid, hyaluronic acid (also known as hyaluronate) .

Synovial fluid is supplies nutrients to the avascular 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.

S IGNS AND SYMPTOMS

Signs and symptoms of Osteoarthritis

Pain and stiffness Swelling Reduced range of motion and loss of use of the joint Cracking and creaking

Loss of flexibility
Bone spurs

S IGNS AND SYMPTOMS

Pain. Your joints may ache, or the pain may feel burning or sharp. For some people, the pain may come and go. Constant pain or pain while you sleep may be a sign that your arthritis is getting worse.

Stiffness. When you have arthritis, getting up in the morning can be hard. Your joints may feel stiff and creaky for a short time, until you get moving. You may also get stiff from sitting. Swelling. swelling in joints, making them feel tender and sore.

S IGNS AND SYMPTOMS

Reduced range of motion and loss of use of the joint. As your arthritis gets worse, you may not be able to fully bend, flex, or extend your joints. Or you may not be able to use them at all. Cracking and creaking. Your joints may make crunching, creaking sounds. This creaking may also occur in a normal joint. But in most cases, it doesn't hurt and doesn't mean that there is anything wrong with the joint. Loss of flexibility. You may not be able to move your joint through its full range of motion. Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.

S IGNS AND SYMPTOMS

Pain and stiffness in the joints are the most common symptoms. The pain is often worse after exercise and when you put weight or pressure on the joint. If you have osteoarthritis, your joints probably become stiffer and harder to move over time. You may notice a rubbing, grating, or crackling sound when you move the joint. The phrase "MORNING STIFFNESS" refers to the pain and stiffness you may feel when you first wake up in the morning. Stiffness usually lasts for 30 minutes or less. It is improved by mild activity that "warms up" the joint.

S IGNS AND SYMPTOMS

During the day, the pain may get worse when you're active and feel better when you are resting. After a while, the pain may be present when you are resting. It may even wake you up at night. Some people might not have symptoms, even though x-rays show the changes of OA

Signs and tests

A physical exam can show:

Joint movement may cause a cracking (grating) sound, called crepitation Joint swelling (bones around the joints may feel larger than normal) Limited range of motion

Tenderness when the joint is pressed

Normal movement is often painful

D IAGNOSTIC T EST

X-ray MRI Joint aspirations or Arthrocentesis

X-rays will provide a two-dimensional image of the overall structure of your knee. It is helpful in identifying loss of joint space, arthritis, abnormal bone shapes such as bone spurs or bone cysts, fractures, and degeneration (wear and tear) on the joint.

MRIs (magnetic resonance imaging)will provide more detailed information and will help to evaluate the soft tissues in and around your knee joint (muscles, tendons, ligaments, menisci, other connective tissues). It can identify ligament and meniscal damage, and help to determine the extent of your injury, the displacement and degree of your tear, fluid on your knee, a discoid meniscus and/or other associated conditions

Joint aspiration (arthrocentesis) involv es withdrawing and analyzing fluid from your knee via needle and syringe to determine the cause of your joint swelling and the type of arthritis.

N URSING D IAGNOSIS AND N URSING I NTERVENTION

1. Pain Acute / Chronic related to distention of tissue by the accumulation of fluid / inflammatory process, Liquor joints.

NURSING INTERVENTIONS:

Assess pain; note the location and intensity of pain (scale 0-10). Write down the factors that accelerate and signs of non-verbal pain. Give the hard mattress, small pillow. Elevate bed when a client needs to rest / sleep. Help the client take a comfortable position when sleeping or sitting in a chair. Depth of bed rest as indicated.

N URSING D IAGNOSIS AND N URSING I NTERVENTION

Monitor the use of a pillow. Help clients positions. to frequently change

Help the client to a warm bath at the time of waking. Help the client to a warm compress on the sore joints several times a day. Monitor temperature compress.

N URSING D IAGNOSIS AND N URSING I NTERVENTION

Give a massage.Encourage the use of stress management techniques such as progressive relaxation bio-feedback therapeutic touch, visualization, self hypnosis guidelines imagination, and breath control.Engage in activities of entertainment that is suitable for individual situations. Give the drug before activity / exercise that is planned as directed. Assist clients with physical therapy.

N URSING D IAGNOSIS AND N URSING I NTERVENTION

2. Impaired Physical Mobility related to skeletal deformities, pain, discomfort, decreased muscle strength

Monitor the level of inflammation / pain in joints Maintain bed rest Schedule of activities to provide a rest period of continuous and uninterrupted nighttime sleep.

N URSING D IAGNOSIS AND N URSING I NTERVENTION

Assist clients with range of motion active / passive and resistive exercise and isometric if possible. Slide to maintain an upright position and sitting height, standing, and walking. Provide a safe environment, for example, raise the chair / toilet, use a high grip and tub and toilet, the use of mobility aids / wheelchairs rescue. Collaboration physical therapist / occupational and specialist vasional.

N URSING D IAGNOSIS AND N URSING I NTERVENTION

3.Chronic pain related to joint deterioration.

Provide rest for involved joints. Excessive use aggravates the symptoms and accelerates degeneration. Advise the patient to avoid activities that precipitate pain. Apply heat as directed to relieve muscle pain and stiffness. Teach the patient correct posture and body mechanics

N URSING D IAGNOSIS AND N URSING I NTERVENTION

Advise the patient to sleep with rolled terry cloth towel under the neck to relieve cervical pain. Provide patient with crutches, braces, or cane when indicated to reduce-weight bearing stress on hips and knees. Encourage patient to wear corrective shoes and metatarsal support for foot disorders.

Encourage patient to lose weight to decrease stress on weight-bearing joints

N URSING D IAGNOSIS AND N URSING I NTERVENTION

Teach the patient range-of-motion exercises to maintain join mobility. Refer patient to physical and occupational therapy.

TREATMENT

MEDICATIONS:

*acetaminophen (Tylenol) *Painkillers (analgesics) *Paracetamol *Nsaids -aspirin, ibuprofen, and naproxen. *Opium

TREATMENT

Other medications or supplements that you may use include:

Corticosteroids injected right into the joint to reduce swelling and pain Over-the-counter remedies such as glucosamine and chondroitin sulfate Capsaicin (Zostrix) skin cream to relieve pain

Artificial joint fluid (Synvisc, Hyalgan) can be injected into the knee to relieve pain for 3 - 6 months

TREATMENT

SUPPORTIVE TREATMENTS:

*Transcutaneous electrical nerve stimulation (TENS)

*Hot or cold packs

(sometimes cryotherapy) called thermotherapy or

*Manual therapy
*Assistive devices

TREATMENT

LIFESTYLE CHANGES

Staying active and getting exercise helps maintain joint and overall movement. Water exercises, such as swimming, are especially helpful. Other lifestyle recommendations include:

Applying heat and cold Eating a healthy, balanced diet

Getting rest
Losing weight if you are overweight Protecting the joints

TREATMENT

ALTERNATIVE TREATMENTS

*Acupuncture

SURGERY

Severe cases of OA might need surgery to replace or repair damaged joints. Surgical options include: Arthroscopic surgery to trim torn and damaged cartilage Changing the alignment of a bone to relieve stress on the bone or joint (osteotomy) Surgical fusion of bones, usually in the spine (arthrodesis) Total or partial replacement of the damaged joint with an artificial joint (knee replacement, hip replacement, shoulder replacement, ankle replacement, elbow replacement)

PATHOPHYSIOLOGY

D ISCHARGE PLANNING

Medicines:

Pain medicine: You may need medicine to take away or decrease pain.

Learn how to take your medicine. Ask what medicine and how much you should take. Be sure you know how, when, and how often to take it. Do not wait until the pain is severe before you take your medicine. Tell caregivers if your pain does not decrease.

D ISCHARGE PLANNING

Pain medicine can make you dizzy or sleepy. Prevent falls by calling someone when you get out of bed or if you need help.
Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not working as expected. Tell him if you are allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs you take. Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists.

D ISCHARGE PLANNING

Physical therapy:

You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function

D ISCHARGE PLANNING

Activity:

Avoid motions and activities that cause strain on your joints, such as jogging and heavy lifting. If your joints are very painful, rest or limit your activities until your symptoms improve. You may need to use crutches, a cane, or a walker to help decrease stress and strain on your joint.

D ISCHARGE PLANNING

Self-care:

Lose weight: This helps decrease the strain on the joints in your back, hips, knees, ankles, and feet. Talk to your primary healthcare provider about the best way to lose weight. Sleep on a firm mattress: Sleep on your back with a pillow under your knees to decrease pain in your back. You can also put pillows between your knees if you sleep on your side.

D ISCHARGE PLANNING

Heat: Use a heating pad on a low heat setting to decrease joint pain and swelling. Heat brings blood to the sore area to relax the muscles. Do not sleep on the heating pad as it can burn you. A warm bath will also help your joints. Sit in a warm bath for 15 to 20 minutes every hour as long as you need to. Massage: Massaging the muscles around the joint may relieve pain and stiffness. Avoid cold: Cold temperatures may cause more pain in the affected joint. You may want to wear thermal underwear or avoid outdoor activity in cold weather.

D ISCHARGE PLANNING

Wear flat or low-heeled shoes: This will help decrease the pain of arthritic toes and feet. Lowheeled shoes decrease strain on the ankle, knee, and hip joint.

D ISCHARGE PLANNING

Contact your primary healthcare provider if:

You have a fever. Your joint is red and tender. You have questions or concerns about your condition or care.

Seek care immediately if:

You have severe pain. You have increased swelling, pain, or redness of your joint.

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