osteoarthritis and role of nurse

Nursing CareManagement 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

ReferencesAntonelli, 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/osteo

arthritis.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

Hss.edu,.(2015). Nursing. Retrieved 30 March 2015, from

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-20014749

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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