Med-Surg · chapter 13 · Musculoskeletal System
Osteoarthritis
The 13 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Joint damage management
Though joint damage cannot be reversed or cured, symptoms can usually be managed effectively with a combination of pharmacological and lifestyle interventions.
Inflammatory cartilage breakdown
The pathophysiology of OA is somewhat unknown, but it appears to involve inflammation that results in the breakdown of joint cartilage over time.
Cartilage thinning and swelling
OA causes the cartilage to gradually become thinner, and as the cartilage layer wears down, more pressure is placed on the bones. The joint responds by increasing production of the synovial fluid for more lubrication, but this can cause swelling of the joint cavity.
Bone changes and pain
The bone tissue underlying the damaged articular cartilage also responds by thickening and causing the articulating surface of the bone to become rough or bumpy. As a result, joint movement results in pain and inflammation.
Osteoarthritis risk factors
Certain factors have been linked to an increased risk of developing OA, including advanced age, family history of OA, female sex, history of joint injury, obesity, overuse of joints (e.g., from sports or repetitive motions), and sedentary lifestyle.
Primary clinical manifestation
The main clinical manifestation of OA is joint pain, which is often more apparent during activity or at the end of the day.
Subjective assessment focus
It is important to obtain a subjective report from the patient about their symptoms. Specifically, the nurse should ask about any joint pain or stiffness, as this may indicate the presence of OA.
Imaging for diagnosis
Certain imaging tests such as x-ray or magnetic resonance imaging (MRI) can be used to visualize the joint space and determine the presence of cartilage breakdown and changes in the bone associated with OA.
Joint fluid testing
This procedure involves the insertion of a needle into the joint space to remove fluid, which is then tested for infection or crystals.
Pain control nursing care
Most of the nursing care for patients with OA centers around providing pain control and ensuring patient comfort. This includes administering analgesics as ordered by the provider and implementing comfort measures such as heat or cold application, position changes, and range of motion (ROM) exercises.
Monitoring worsening symptoms
When caring for a patient with OA, the nurse will monitor closely for symptoms indicating that the condition is becoming more severe or requires more intensive treatment. In addition to patient-reported joint pain, the nurse should regularly assess for joint swelling or tenderness.
Independence and adaptive devices
The nurse should help the patient create a plan of care that emphasizes independence and allows for the patient to perform as many personal care activities and ADLs as possible to increase their quality of life. The nurse could consult occupational therapy for adaptive devices to help the patient perform their ADLs.
Nonpharmacological interventions
These include weight loss, regular physical activity and exercise, ROM exercises, use of assistive devices (e.g., braces, shoe inserts), use of adaptive devices (e.g., elevated toilet seats, hygiene devices), physical and occupational therapy, and relaxation and stress-reduction techniques.
Terms to know
- osteoarthritis (OA)
- The most common form of arthritis, osteoarthritis (OA), is a degenerative joint disorder that involves the wearing down of joint cartilage and tissue over time.
- bone spur
- Other common clinical manifestations of OA include joint stiffness, most often occurring first thing in the morning or after long periods of immobility; limited joint range of motion or flexibility; muscle weakness; joint instability (e.g., knee “giving out”); “grating” sensation with joint movement, which may be accompanied by a “popping” or “clicking” sound; a bony projection that develops along bone edges, known as a bone spur; and joint swelling.
- Joint aspiration
- Joint aspiration, also known as arthrocentesis, is another diagnostic test that may be indicated in some cases.
- active movements
- ROM exercises can be classified as active or passive; active movements are achieved voluntarily by patients, without assistance, while passive movements are performed by the nurse or other practitioners because patients are unable or not permitted to move the body parts themselves.
- passive movements
- ROM exercises can be classified as active or passive; active movements are achieved voluntarily by patients, without assistance, while passive movements are performed by the nurse or other practitioners because patients are unable or not permitted to move the body parts themselves.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
At 0900, a patient with osteoarthritis reports that joint pain makes personal care difficult and says, "I want to keep doing things for myself." Which care-plan entry best addresses this concern?
- Emphasize ROM exercises and regular physical activity to support joint movement.
- Provide emotional support as the patient adjusts to needing assistance with personal care.
- Focus on pain relief with prescribed analgesics and heat or cold application before personal care.
- Support participation in as many ADLs as possible and consult occupational therapy about adaptive devices.
Answer: Support participation in as many ADLs as possible and consult occupational therapy about adaptive devices.
Supporting participation in ADLs and exploring adaptive devices directly addresses the patient's goal of maintaining independence. Pain management, exercise, and emotional support are appropriate components of care, but those entries do not explicitly plan how the patient will continue performing personal care.
At 1400, a patient with osteoarthritis reports taking NSAIDs more often because joint pain persists. Which entry should the nurse include in the education plan to address the medication-safety concern?
- Explain that OA symptoms can be managed even though joint damage cannot be reversed.
- Discuss physical activity and ROM exercises as additional approaches to managing OA.
- Review how NSAIDs relieve mild to moderate joint pain and reduce inflammation.
- Explain the link between NSAID overuse and increased gastrointestinal bleeding risk.
Answer: Explain the link between NSAID overuse and increased gastrointestinal bleeding risk.
The section specifically links NSAID overuse to increased gastrointestinal bleeding risk and directs nurses to educate patients about this adverse effect. The other entries describe relevant OA teaching, but they do not address the safety risk raised by taking NSAIDs more often.
At 1900, a nurse is documenting an end-of-shift evaluation for a patient receiving OA pain medication and comfort measures. Which reassessment entries support documenting that the current plan of care is effective? Select all that apply.
- Patient reports that the knee continues to give out intermittently.
- Patient reports less joint pain than at the beginning of the shift.
- Affected joint has increased range of motion compared with the earlier assessment.
- Affected joint has less swelling than on the earlier assessment.
- Patient reports that stiffness after prolonged sitting remains unchanged.
Answer: Patient reports less joint pain than at the beginning of the shift., Affected joint has increased range of motion compared with the earlier assessment., Affected joint has less swelling than on the earlier assessment.
Pain relief, decreased swelling, and increased ROM are outcomes the section identifies as evidence that the patient is improving. Unchanged stiffness and continuing knee instability are OA manifestations, but these entries do not demonstrate improvement in response to care.
Where every quote comes from
Section 13.2 Osteoarthritis of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.