osteoarthritis and role of nurse

Nursing Care Management 1

Nursing Care ManagementOsteoarthritis and Role of Nurse

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Table of Content:

1- Introduction ………………………….3

2- Pathophysiology ………………………..3

3- Nursing Care Management ………………5

4- Community Resources ……………………...6

5- Evidence based knowledge / article summary…………..8

6- Conclusion………………….12

7- References……………………13


1- Introduction:

This paper illustrates the “Nursing Care Management” of a patient suffering from a

disease called ‘Osteoarthritis - OA’. It is a generic form of arthritis disease that affects millions

of people around the world, majorly consists of older individuals who face it due to wearing

down of their protective cartilage that is present on the bone end.(Mayoclinic.org, 2015). This

study includes information sourced from there different nursing care management articles.

2- Pathophysiology:

OA - Osteoarthritis is also identified as degenerative joint disease or degenerative

arthritis or osteoarthrosis. It is a group of mechanical abnormalities involving degradation

of joints in human beings that includes articular cartilage and sub-chondral bone. It develops

slowly over many years as this cartilage continues to wear down and forces more painful bone-

on-bone rubbing. Osteoarthritis is usually confined to the

joints, more specifically joints in hands, knees, hips, and

spine. This disease gradually becomes worse as theirno

cure for it existed at the moment in our world.

It is generally stated that if a person remains active,

maintains a healthy weight and followother treatments, this

can help in slowing down the progression of this disease

and help improve pain and joint function.(Arthritis.org,

2015)A combination of individual person’s age, his genetics, the joint injuries, joint overuse,


obesity (BMI), hormones, and weakness in muscles can be addressed as to play an important role

in this disease and are the contributing risk factors in growing this disease within human body.

Osteoarthritis symptoms develop slowly and gradually and worsen over a long time period. This

includes,

Pain: Hurting of Joint during or after

movement.

Tenderness: Joint can be felt tender when one

applies light pressure to it.

Stiffness:One feels Joint stiffness at the time of

morning when one wakes-up or after a long

inactive period.

Loss of flexibility:It becomes difficult to move joint through its full range of motion.

Grating sensation: You may hear or feel anirritating sensation when one uses the joint.

Bone spurs: The extra bits of bone, may felt like hard lumps, they may appear around the

affected joint.

This disease is developed gradually and appears in the body, as the patient may have

spurs on their fingers, or on shoulders, or on elbows, or hips, or on knees, or on ankles. In

osteoarthritis, larger weight-bearing joints such as hips and knees usually have the worst damage;

the severity in patient condition may require a joint replacement surgery such as Knee

replacement etc. at the later stage.Its treatment suggested by physicians starts with patients’

weight loss, then exercise and physiotherapy, and use of analgesics. ('Prevalence of Disabilities

and Associated Health Conditions among Adults—United States, 1999', 2001).


If the pain becomes unbearable joint replacement surgery can be advised. As it is the

most commonly existing form of arthritis, and hence is the leading cause of chronic disability in

the United States it is found that it is affecting approx. 27 million people in the United States.

('Guidelines for the Management of Postoperative Pain after Total Knee Arthroplasty', 2012)

3- Nursing Care Management:

Osteoarthritis medical diagnosis can be prepared with a reasonable certainty based on

patients’ history and clinical examination and lastly the X-rays that confirm the diagnosis by

physician or Doctor.(Zhang et al., 2009). The changes in bones structure can be found in X-ray

that includes narrowing of joint spaces, increase of bone formation around joints, cyst formation

etc. some hi-tech imaging techniques also available nowadays helps to identify details diagnosis.

Radiographic diagnosis results in the diagnosis of a joint fracture joint. There are number of

classification systems that are used for gradation osteoarthritis are ‘Womac Scale’ and another is

‘Kellgren Lawrence Grading Scale’. (Conaghan& Nelson, 2012)

This disease can be categorized into either primary or secondary stage depending on

whether or not there is an identifiable underlying cause. Both primary ‘generalized nodal’ OA

and ‘erosive’ OA are sub-sets of primary OA. Erosive OA is less common, and is more

aggressive inflammatory form of OA which affects hand joints and shows characteristic articular

erosive changes on x-ray.

It is the responsibility of nursing care to properly prepare the patient for diagnosis test.

Once it is carried out and the patient is diagnosed, doctor suggests medication then it is nursing

care provider responsibility to guide the patient about taking medicine and care about diet.


4- Community Resources:

‘Healthcare’,can be defined as the diagnosis of disease, its treatment, and its prevention

or any other physical and mental deficiency in human beings. Health care is provided by

practitioners in many different health professions such as, dentistry, or midwifery (obstetrics), or

medicine, or nursing, or pharmacy etc.(WHO.int, 2015)this can be stated as the work done in

providing primary, secondary, and tertiary care, as well as in public health sector. Nowadays the

delivery of modern health care depends on groups of trained professionals and paraprofessionals

coming together as interdisciplinary teams and nursing staff is one of them. Others that can be

included in this sector are medicine, physiotherapy, dentistry, midwifery, and community health

workers etc. that provide systematicpersonal and population-based preventive and rehabilitative

care services.

While the definitions of the different types of health care that depends on the different

cultures, geo-political scenario, organizational and their disciplinaryviews, there appears to be

some consensus that primary care constitutes the first element of a continuing health care

process, which may include provision of secondary and tertiary levels of care.Healthcare exists

either in public or private sectors. The Care Management Department at “NYU Langone Medical

Center – New York”enables and encourages high-quality, effective, and educational approach to

service delivery in the community of New York. The hospital’s nursing care is considered one of

the best in the city of New York. The team engaged here works daily tasks in professional

manner. The nursing staff is responsible forbalancing an empathic behavior towards patient and

family interaction with the knowledge of healthcare. They also serve as individuals who can

change and adapt continually to improve the process of care management that is beneficial for


patients. The hospital encourages staff involvement in improving, educating, and developing

high standards of care and treatment. The hospital has a Care Management Department that is

structured with a model that confirms responsiveness as per need of the Medical Center and the

clinical utilization and discharge needs of patients. The key to success in nursing management is

the availability of highperforming and integrated team of Nurse Care Managers. Further efforts

are ongoing for the addition of team building techniques with leadership skills and commitment

towards a shared vision statement. (Nursing.med.nyu.edu, 2015).

Hospital for Special Surgery New

York provides best care and highly advanced

technology to perform arthroscopic surgery

for osteoarthritis of the knee. They have

highly skilled and considerate nursing staff

that works for the treatment and caring of

patients.(Hospital for Special Surgery,

2015). Nursing staff at HSS hospital works for all aspects for patients for example from

educating patients about their illness conditions and procedures, to assistHSSsurgeons in

conducting most advanced hi-tech surgical procedures, with a round-the-clock physical clinic,

and emotional, and educational support system for patients and their families. Nursing staff here

are the talented professionals who are chosen to bring their superior training, creativity, vision,

and skills to hospital as they are committed to delivering the world’s best patient care. (Hss.edu,

2015)


5- Evidence based knowledge / article summary:

The article,“Assessing for Risk and Progression of Osteoarthritis: The Nurse's Role” is

written jointly by Antonelli, Mary Carol RN, CRNP; Starz, Terence W. MD published in AJN,

American Journal of Nursing in their March 2012 Volume 112, Issue 3 on page S26–S31.

This articleshows the primary and secondary risk factors for osteoarthritis (OA). This

disease pathophysiology and epidemiology, and its evidence-based approaches to slowing down

disease progression. Lastly, Nurses role in encountering OA in primary care and other settings.

(Antonelli& Starz, 2012).

The article describes that Osteoarthritis-OA is a complex disease involving

biomechanical, genetic, and environmental processes. Genetics and aging are considered to be

the most substantial contributors and risk factors to the primary form of the disease whereas;

obesity and injury are the common secondary factors. There’s no approved disease-modifying

medicine or other cure interferencesare nowadays present in the market, evident measures can be

seen to have a positive impact on pain, on routine functions, and improvement in quality of life

in people suffering with osteoarthritis.

Animportant problem in concentratingrisk and progression of Osteoarthritis is the broad

spectrum of clinical features that depend in part on demographic factors and the joint

affected.With aging, the individual face changes in the hyaline cartilage matrix and decreases in

its water content that influence its biomechanical properties and reduce its shock-absorbing

capacity. Genetic factors play a key role in the development of Osteoarthritis whereas the

influence of heredity varies in different joints. No specific genes for predicting osteoarthritis


have been identified till today. Genes that regulate the synthesis of the various components of

cartilage instead of coding for specific structural proteins offer the greatest promise.

Furthermore, with age, sex, and genetics factors, a number of secondary factors such as load

distribution of body affect the joints. The relationship between obesity, joint pain, functional

impairment, and physical activity levels is very complex. Nowadays in United States

obesityaffects 33.8% of adults that age 20 yearsor old. 30% of women in population having body

mass indexes (BMIs) less than 25 will expect to have knee osteoarthritis during their lives

detected any stage of life.Light or moderate physical activity and exercise that do not cause pain

or injury do not increase the risk of osteoarthritis. This disease can be cured by controlling pain

and maintaining functional activity.Another non-pharmacologic therapy relief has been observed

via self-management, education, exercise, and acupuncture and weight loss technique.

The article also communicates the evolving role of the nurse in managing Osteoarthritis

risks and progression in patients. In the case of primary care of patients, then teachingand

researching on the topic, and similar other related tasks. Such as evaluation that includes targeted

history and physical examination along with laboratory and joint imaging studies to establish the

patient diagnosis. Educating patients about this disease, risk management for medicines and

other activities such as physiotherapy etc. care coordination between patient and health care

professionals such as physicians or doctors. And other compliance plans that includes proper

medicine use by patients, weight loss techniques and exercise to control this disease.

It is expected that a projected increase in osteoarthritis may be prevalent in US in near

future hence the role of nursing staff becomes more critical. They must be trained and

professionally sound to assist patients in need. An acute shortage of these practitioners exists in

US as there are roughly 500 nurse members of the Association of Rheumatology Health


Professionals, a division of the ACR, and 415 physicians were in rheumatology training in 2009.

Nurses assist in diagnosing and assessing the disease functional and its psychosocial

impacts.They help to provide medication and painmanagement, they monitor disease progress,

and share disease information with patients, and coordinate care with other providers (physical,

occupational, and psychosocial therapists. Their understanding of the clinical expressions and the

diagnostic criteria for osteoarthritis provide the footing for these activities.

Studies reveal that in primary care settings illustrate that nurses are key assessors of and

coordinators in managing their osteoarthritis patients’ care. There are programs and protocols

designed specifically for OA that define screening tools for uniformly collecting patient data,

they provide models for treatment, and promote the integration of interventions among various

health care providers. Self-report instruments such as,‘the Western Ontario and McMaster

Universities Osteoarthritis Index’, ‘the Health Assessment Questionnaire’, and ‘the Medical

Outcomes Study Short Form 36-Item Health Survey’ are validated tools that can provide

important information for assessing outcomes in this disease. Nurses help patients in accepting

their disease and encourage them to dynamically participate in the care process which is

essential. It is also important to identify patients who are hiding their symptoms from health care

professionals and trying to self-manage their problems. In addition to all of these responsibilities,

orthopedic nurses also keenly engage themselves in pre and postoperative care.

Another article, “Pharmacologic Management of Osteoarthritis-Related Pain in Older

Adults”is written by Reid, M. Carrington MD, PhD; Shengelia, Rouzi MD; Parker, Samantha J.

AB published in AJN, American Journal of Nursing in their March 2012Volume 112, Issue 3on

page S38–S43.(Reid, Shengelia& Parker, 2012).


This article describes that pain is a very common, disturbing and shatteringsymptom of

osteoarthritis in older adults. The article shows data on the efficacy and safety of commonly used

oral, topical, and intra-articular drug therapies in US population. It was found in several different

researches through databases that most studies have focused on knee osteoarthritis and reported

only its short-term outcomes. Also, treatment and cure efficacy was found to vary by drug class;

the smallest effect was observed with acetaminophen and the largest with opioids and visco-

supplements. The active ingredients in medicines, ‘Acetaminophen’ and topical agents had the

best safety profiles, whereas oral non-steroidal anti-inflammatory drugs and opioids had the

worst. Little data were available on patients’ ages 75 years old and older and for patients from

diverse races and ethnicity. Most drug therapies gave mild-to-moderate pain relief; their long-

term safety and efficacy and their effects in diverse populations (particularly older adults) remain

undetermined.

A third article here under consideration is, “Osteoarthritis: The Patient's

Experience”written by Joy Jacobson published in AJN, American Journal of Nursing in

theirMarch 2012 issue Volume 112, Issue 3 on p S12. Here the writer has described a patient

‘Kathy Geller’ life experience that is about her having a chronic Osteoarthritis illness.(Jacobson,

2012).This article sharethe life experience of Kathy Geller who is an exercise therapist and has

lived her past 13 years of life with osteoarthritis disease. The writer mentioned about what she

discussed about the financial and emotional costs of the disease.

As she turned 63 she had her intra-articular injections in both of her hips;she takes

periodic cortisone injections in various other joints and injections of hyaluronic acid in both

knees for improving her quality of life. She had used many different drugs that are non-steroidal


anti-inflammatory, visited orthopedists and rheumatologists with worn knee and wrist braces,

and had customized orthotics made. She had also go through physical therapy, occupational

therapy, and had many operations: such as joint arthro-plasty and tendon transfer on both

thumbs, shoulder surgery, surgery on her right wrist because of a triangular fibrocartilage

complex and on her left foot to repair a shredded anterior tibialis tendon. She had taken epidural

injections for severe low-back pain. The pain forced her to curtail her work life substantially. She

finally describes that, “Stroke gets front-page news, but people don't die of osteoarthritis all at

once. Your life is whittled away.”

6- Conclusion:

‘Nurse’ plays a navigator role in patient’s care management as he / she help patients

through a complicated maze of procedures involving screening, diagnosis, treatment, and

ongoing self-management, as well as the financial challenges that are faced by patients. Nurse

has the ability to help

decide how people

must learn, as they are

able to educate about

medicine safety etc.as

there’s no cure for

osteoarthritis, the available medications help to relieve pain, when needed. The doctor may

recommend physical therapy (PT) or occupational therapy (OT) to help improve strength and

function. When the pain becomes unbearable and frequent or mobility of an individual is


hampered and daily activities become difficult, surgery may be considered. At all stages of

health care, a nurse plays vital role to communicate and assist.

7- References

References

Antonelli, M., & Starz, T. (2012).Assessing for Risk and Progression of

Osteoarthritis.Orthopaedic Nursing, 31(2), 98-102. doi:10.1097/nor.0b013e31824fcde4

Arthritis.org,. (2015). Osteoarthritis: Symptoms & Treatment | Arthritis Foundation. Retrieved

30 March 2015, from

http://www.arthritis.org/arthritis-facts/disease-center/osteoarthritis.php

Conaghan, P., & Nelson, A. (2012).Osteoarthritis. Abingdon: Health Press.

Guidelines for the Management of Postoperative Pain after Total Knee Arthroplasty.(2012).

Knee SurgRelat Res, 24(4), 201. doi:10.5792/ksrr.2012.24.4.201

Hospital for Special Surgery,.(2015). Arthroscopic Surgery for Osteoarthritis of the Knee.

Retrieved 30 March 2015, from http://www.hss.edu/conditions_arthroscopic-surgery-

osteoarthritis-knee.asp#.VRlvZPyUe8A

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http://www.hss.edu/Nursing.asp#.VRlwOfyUe8A

Jacobson, J. (2012). Osteoarthritis.Orthopaedic Nursing, 31(2), 84.

doi:10.1097/nor.0b013e31824fcd04

Mayoclinic.org,.(2015). Osteoarthritis Definition - Diseases and Conditions - Mayo Clinic.

Retrieved 30 March 2015, from

http://www.mayoclinic.org/diseases-conditions/osteoarthritis/basics/definition/con-

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Nursing.med.nyu.edu,.(2015). Care Management. Retrieved 30 March 2015, from

http://nursing.med.nyu.edu/nursing-nyu-langone/departments-and-unit-profiles/advanced-

practice-nursing/care-management

Prevalence of Disabilities and Associated Health Conditions AmongAdultsâ€”United States,

1999. (2001). JAMA, 285(12), 1571. doi:10.1001/jama.285.12.1571-jwr0328-3-1

Reid, M., Shengelia, R., & Parker, S. (2012). Pharmacologic Management of Osteoarthritis-

Related Pain in Older Adults.Orthopaedic Nursing, 31(2), 109-114.

doi:10.1097/nor.0b013e31824fce26

Who.int,.(2015). WHO | Health systems. Retrieved 30 March 2015, from

http://www.who.int/topics/health_systems/en/

Zhang, W., Doherty, M., Peat, G., Bierma-Zeinstra, M., Arden, N., &Bresnihan, B. et al.

(2009).EULAR evidence-based recommendations for the diagnosis of knee

osteoarthritis.Annals Of The Rheumatic Diseases, 69(3), 483-489.

doi:10.1136/ard.2009.113100

osteoarthritis and role of nurse

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