Osteoarthritis and Role of Nurse
Content
Nursing Care
Management 1
Nursing Care
Management
Osteoarthritis and Role of Nurse
[Pick the date]
Student Name:
University Name:
Class Name:
Professor:
Nursing Care
Management 2
Table of Content:
1234567-
Introduction ………………………….3
Pathophysiology ………………………..3
Nursing Care Management ………………5
Community Resources ……………………...6
Evidence based knowledge / article summary…………..8
Conclusion………………….12
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.
Nursing Care
Management 3
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 boneon-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.
Nursing Care
Management 4
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:
Nursing Care
Management 5
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
Nursing Care
Management 6
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
Nursing Care
Management 7
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-theclock 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:
Nursing Care
Management 8
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
Nursing Care
Management 9
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
Nursing Care
Management 10
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
Nursing Care
Management 11
Ontario and McMaster Universities Osteoarthritis Index’, ‘the Health
Assessment Questionnaire’, and ‘the Medical Outcomes Study Short Form 36Item 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 viscosupplements. 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
Nursing Care
Management 12
diverse races and ethnicity. Most drug therapies gave mild-to-moderate pain relief; their longterm 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
Nursing Care
Management 13
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
Nursing Care
Management 14
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/diseasecenter/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-surgeryosteoarthritis-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/diseasesconditions/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/advancedpractice-nursing/care-management
Prevalence of Disabilities and Associated Health Conditions AmongAdults—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 OsteoarthritisRelated 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
Nursing Care
Management 15
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
Management 1
Nursing Care
Management
Osteoarthritis and Role of Nurse
[Pick the date]
Student Name:
University Name:
Class Name:
Professor:
Nursing Care
Management 2
Table of Content:
1234567-
Introduction ………………………….3
Pathophysiology ………………………..3
Nursing Care Management ………………5
Community Resources ……………………...6
Evidence based knowledge / article summary…………..8
Conclusion………………….12
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.
Nursing Care
Management 3
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 boneon-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.
Nursing Care
Management 4
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:
Nursing Care
Management 5
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
Nursing Care
Management 6
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
Nursing Care
Management 7
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-theclock 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:
Nursing Care
Management 8
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
Nursing Care
Management 9
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
Nursing Care
Management 10
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
Nursing Care
Management 11
Ontario and McMaster Universities Osteoarthritis Index’, ‘the Health
Assessment Questionnaire’, and ‘the Medical Outcomes Study Short Form 36Item 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 viscosupplements. 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
Nursing Care
Management 12
diverse races and ethnicity. Most drug therapies gave mild-to-moderate pain relief; their longterm 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
Nursing Care
Management 13
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
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Management 14
Osteoarthritis.Orthopaedic Nursing, 31(2), 98-102. doi:10.1097/nor.0b013e31824fcde4
Arthritis.org,. (2015). Osteoarthritis: Symptoms & Treatment | Arthritis Foundation. Retrieved
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