Final Osteoarthritis

8/12/2019 Final Osteoarthritis

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Introduction

Osteoarthritis is the most common form of arthritis, affecting millions of people around

the world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective

cartilage on the ends of your bones wears down over time.

While osteoarthritis can damage any joint in your body, the disorder most commonly

affects joints in your hands, neck, lower back, knees and hips.

Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis

treatments can slow the progression of the disease, relieve pain and improve joint

function.

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and

symptoms of osteoarthritis include:

Pain.Your joint may hurt during or after movement.

Tenderness.Your joint may feel tender when you apply light pressure to it.

Stiffness.Joint stiffness may be most noticeable when you wake up in the

morning or after a period of inactivity.

Loss of flexibility.You may not be able to move your joint through its full range

of motion.

Grating sensation.You may hear or feel a grating sensation when you use the

joint.

Bone spurs.These extra bits of bone, which feel like hard lumps, may form

around the affected joint.


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Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints

deteriorates over time. Cartilage is a firm, slippery tissue that permits nearly frictionless

joint motion. In osteoarthritis, the slick surface of the cartilage becomes rough.

Eventually, if the cartilage wears down completely, you may be left with bone rubbing on

bone.

Factors that increase your risk of osteoarthritis include:

Older age.The risk of osteoarthritis increases with age.

Sex.Women are more likely to develop osteoarthritis, though it isn't clear why.

Bone deformities.Some people are born with malformed joints or defective

cartilage, which can increase the risk of osteoarthritis.

Joint injuries.Injuries, such as those that occur when playing sports or from an

accident, may increase the risk of osteoarthritis.

Obesity.Carrying more body weight puts added stress on your weight-bearing

joints, such as your knees.

Certain occupations.If your job includes tasks that place repetitive stress on a

particular joint, that joint may eventually develop osteoarthritis.

Other diseases.Having diabetes, underactive thyroid, gout or Paget's disease of

bone can increase your risk of developing osteoarthritis.

Osteoarthritis is a degenerative disease that worsens over time. Joint pain and

stiffness may become severe enough to make daily tasks difficult. Some people are

no longer able to work. When joint pain is this severe, doctors may suggest joint

replacement surgery.


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I choose this topic, because it is the most common form of arthritis and one of the

leading causes of pain, stiffness, joint deformity, loss of joint mobility and disability

worldwide. In this study, I can help people especially elderly to be aware in this

kind of condition and the same time, they know how to manage.


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Learning Objectives

Comprehend and recognize salient points that are important to remember when

dealing with patient who manifested degenerative disease: Its nature, causes,

symptoms, clinical manifestation, management, and prognosis. This is to enhance the

student and other health care providers awareness, knowledge and understanding of it

in order to promote health, prevent the disease and help manage patient with them.

Specific Objectives:

-Present introduction of the studied disease.

-Present the obtained initial database of the patient.

-Present the nursing history including the past and present illness of the patient.

-Identify the anatomy and physiology of the disease.

-Explain the assessment and cognitive findings.

-Interpret the laboratory results.

-Outline the drug study

-State the discharge planning

Profile of the Patient


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A, Personal Data:

Patient name: L.M

Age: 75 years old Gender: Female

Status: Widow Religion: Catholic

Address: 4-C Mabilis St., Pinyahan Quezon City

Birthday: April 6, 195 Birthplace: Visayas

Educational Attainment: High School Graduate

Language/Dialect spoken: Tagalog, Bisaya, English

Work: Retired

No of children: 7

B. Vital Information:

Vital signs: T: 36.6, BP: 130/70, PR:84, R:18,

Weight: 63Kg Height: 5

Date admitted: November 18,2013

Reason for Admission: Degenerative Osteoarthritis

Past, Present and Family History


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Past Illness History

The patient L.M a 78 yrs old female. She had 7 normal spontaneous delivery. In her

50s she was diagnosed with hypertension and taking maintenance medication.

Family History

There is no known inherited condition present in both paternal and maternal family.

Present Illness History

A month ago before the admission, LM experienced inability to mobilize her legs

especially the right one. She also recalled and claimed that its approximately a year

that she has been suffering from immobility. She cited that pain start getting worst.

Then they decided to seen a physician, the physician advised the patient to be

admitted on that day.


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Gordons Functional Health Pattern

System Normal Findings Actual Findings Remarks

General

Appearance

-Appears as its age

-In good hygience

-Appearance

appropriate on his

age

-Alert and active

-Appears happy

-Cooperative

-Appears well

nourished

-Can speak and can

express what he

wanted.

-Body hair is fine

and thinly

distributed

-Appears as its age

-In good hygience

-Appearance

appropriate on his

age

-Alert and active

-Appears happy

-Cooperative

-Appears well

nourished

-Can speak and can

express what he

wanted.

-Body hair is fine

and thinly

distributed

The general

appearance of the

patient is

appropriate to the

age and found to

be normal.

Vitals signs -RR: 20-30 cpm

-Heart rate: 30-

110pbm

Temperature:36.5-

-RR: 18 cpm

-Heart rate: 84

pbm

Temperature: 36.6

All the findings for

the vitals signs are

found to be within

normal range.


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37.5

Nutritional Status -Normal weight of

39 to 79.

-Normal height of

40-52 inches.

-Eat balances diet

and exercise.

-Patient weight is

6.6 kg.

-Height of 5 feet

-Patient eats 3

times a day.

The Nutritional

status is not

normal since the

patient doesnt

have balance diet

and loves to eat.

Neurologic status -Oriented to

people, time and

place.

-Calm behavior

-Attitude of

behavior.

Oriented to people,

time and place.

-Calm behavior

-Attitude of

behavior.

All the findings in

neurological status

are found to be

appropriate.

Skin -Skin color ranges

from pale to dark

brown or black. No

odor and no skin

lesions.

-Skin should be

soft warm, moist

with good turgor.

-light brown, no

lesions, with

slightly edema.

-Slightly soft

-Warm to touch

-Skin is intact

-smooth and even

-body hair is fine

All of the findings

for the skin are

found to be within

normal.


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-Boy hair is fine

and thinly

distributed.

and thinly

distributed.

Hair -Even distribution

-Hair color is black.

-No masses

-Clean and neat

-Characteristics of

hair is elastic and

lustrous and silky.

-Well distributed

-No lesions

-No masses

-Clean and neat

-Silky , elastic,

lustrous

All of the findings

of the hair are

found to be ithin

normal.

Nail -Pinkish nail bed

-Concave shape

-Nails clean and

well trimmed

-Color of the nail

back to original

color after 1-2

-Pinkish nail bed

- Slightly Concave

shape

-Nails clean and

well trimmed

-Color of the nail

back to original

color after 1-2

All the findings for

the nails are found

to be within

normal.

Head -Symmetrical,

rounded and

noncephalic.

-Head

Symmetrical,

rounded and

noncephalic.

-Head

All of the findings

for the head are

found to be ithin

normal range.


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circumference is

45-60 cm.

-head is study

-No palpable

lymph nodes

-No dandruff

-Full range of

motion

circumference is

51 cm

No palpable lymph

nodes

-No dandruff

-Full range of

motion

Eyes -Symmetrical

-Eye lashes are

evenly distributed

-Sclera white

-No discharge

-Pink conjunctiva

-Symmetrical

-Eye lashes are

evenly distributed

-Sclera white

-No discharge

-Pink conjunctiva

All of the findings

for the eyes are

found to be within

normal.

Nose and sinuses -No discharge

-Uniform in odor

-Not tender

-Pink mucosa

-Nasal septum

intact

No discharge

-Uniform in odor

-Not tender

-Pink mucosa

-Nasal septum

intact

The ears finding

are found to be

within normal

range.

Mouth -Pink tone of gums,

tongue and tonsils

Pink tone of gums,

tongue and tonsils

All findings for

mouth are found to


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-Moist and slightly

rough tongue

-Absence of lesion

in oral mucosa

-Moist and slightly

rough tongue

-Absence of lesion

in oral mucosa

be in normal

Throat and neck -No palpable

lymph nodes

-No edema

-Neck can move

freely

-No palpable

lymph nodes

-No edema

-Neck can move

freely

All findings are

found normal

Breast and Axilla -Symmetrical

-Absence of

tenderness

-No Masses and

discharge

-Symmetrical

-Absence of

tenderness

-No Masses and

discharge

All findings are

found normal

Chest and

Respiratory system

-Symmetrical

-Bilaterally equal

shoulder height

-regular

-Symmetrical

-rounded and

scapula are equal

horizontal position

All findings are

found normal

Cardiovascular and

peripheral

- Apical pulses are

audible

-No cold

-Presence of apical

pulses

Slightly cold and

Some findings are

abnormal due to

osteoarthritis


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extremities and

discolored

extremities

-Capillary refill less

than 2 sec

discolored of

extremities

-Capillary refill less

than 2 sec.

Abdomen and

Gastrointestinal

system

-Symmetrical

-No lesions

-No tenderness

-No masses

-Presence of flatus

-Bowel sounds of

5-30 clicks

Symmetrical

-No lesions

-No tenderness

-No masses

-Presence of flatus

-His bowel

movement is

everyday

All finding are

found normal

Muscoskeletal -Uniform in color

-10fingers and toes

-symmetrical

-No fractures,

dislocations and

deformities

-Slightly different

in color

10fingers and toes

-Presence of

dislocation and

deformities

The findings are

abnormal and

indication of

osteoarthritis


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Anatomy and Pathophysiology

Joints can be classified in either functional or structural terms. A functional classification,

based on movement, would categorize joints as follows:

Synarthroses (immovable)

Amphiarthroses (slightly moveable)

Diarthroses (freely moveable)

A structural classification would categorize joints as follows:

Synovial

Fibrous

Cartilaginous

Normal synovial joints allow a significant amount of motion along their extremely

smooth articular surface. These joints are composed of the following:

Articular cartilage

Subchondral bone

Synovial membrane

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 facilitates

joint function and protects the underlying subchondral bone by distributing large loads,

maintaining low contact stresses, and reducing friction at the joint.


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Synovial fluid is formed through a serum ultrafiltration process by cells that form the

synovial membrane (synoviocytes). Synovial cells also manufacture hyaluronic acid (HA,

also known as hyaluronate), a glycosaminoglycan that is the major noncellular

component of synovial fluid. Synovial fluid supplies nutrients to the avascular articular

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.


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Diagnostic Procedure and laboratory

Test Normal Result Result Interpretation

X-ray of chest No Fracture R/O Fracture No active

parenchymal

infiltrates seen.

The heart is

moderately

enlarged by CT

ratio (0.15) Aorta

is calcified.

Diaphragm and

sulci are intact.

ECG Rhythm (-)

QRS Axis (-)

PR Interval (-)

QT Interval (-)

QRS Duration (-)

Rate (-)

Atrial (-)

Ventricular (-)

Rhythm (-)

QRS Axis (-)

PR Interval (-)

QT Interval (-)

QRS Duration (-)

Rate (-)

Atrial (-)

Ventricular (-)

Sinus Rhythm Left

axis deviation

Hematology CBC


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Hemo- 120-160

Hct-.32-.43

RBC -4.0-5.0

WBC- 4.0-10.0

Segmenters-0.55-

0.65

Lymphocytes .25-

.35

Eosinophils-.02-.04

Monocytes-0.3-

0.06

Basophils-0.00-

0.01

MCV-80-100

MCH-26-37

MCHC-32-36

RDW-11.0-15.0

Platelet-130-400

Prothrombin Time

10.6-13.6

APTT -25.3-32.3

Clotting Time-2-7

129

0.35

4.24

7.71

0.56

0.40

0.04

0.07

0.00

83.5

30.4

36

14.11

290

11.7

26.4

3

Normal

Normal

Normal

Normal

Normal

Infection

Normal

Infection

Normal

Normal

Normal

Normal

Normal

Normal

Normal

Normal

Normal


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Course in the ward

Problem Treatment Results

Immobility of right leg Total Knee Anthroplasty

(right) under SA

Successful and no

complication

Pain Morphine 1 mg IV Reduce the pain

Swelling of the leg (Right) Apply cold compress for

10 minutes TID over right

knee

Reduce swelling


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Introduction

Fracture are common; the average person has two during a lifetime. They occur

when the physical force exerted on the bone is stronger than the bone itself.

Your risk of fracture depends, in part, on your age. Broken bones are very

common in childhood, though children's fractures are generally less complicated

than fractures in adults. As you age, your bones become more brittle and you are

more likely to suffer fractures from falls that would not occur when you were

young.

There are many types of fractures, but the main categories are displaced, non-

displaced, open, and closed. Displaced and non-displaced fractures refer to the

way the bone breaks.

A bone injury that results in more than 2 separate bone components is known as

a comminuted fracture. Some comminuted fractures have specific names such

as 'butterfly fragment' or 'segmental fracture'.

Bu tterf ly fragmen t example - Metacarpal

Comminuted fracture resulting from 2 oblique fractures forming a 'butterfly

fragment' (shape of a butterfly wing)

Bu tterf ly fragmen t example - Metacarpal

Comminuted fracture resulting from 2 oblique fractures forming a 'butterfly

fragment' (shape of a butterfly wing)

Causes;


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High-energy collisions, such as an automobile or motorcycle crash, are

common causes of tibial shaft fractures. In cases like these, the bone can

be broken into several pieces (comminuted fracture).

Sports injuries, such as a fall while skiing or running into another player

during soccer, are lower-energy injuries that can cause tibial shaft

fractures. These fractures are typically caused by a twisting force and

result in an oblique or spiral type of fracture.

The most common symptoms of a Comminuted fracture are:

Pain

Inability to walk or bear weight on the leg

Deformity or instability of the leg

Bone "tenting" the skin or protruding through a break in the skin

Occasional loss of feeling in the foot

Fracture are most easily diagnosed by an X-ray. An X-ray helps the doctor figure

out how the pieces is a comminuted fracture are arranged so they can treat it

properly.

Often, the best way to treat comminuted fracture may be to pin the pieces during

surgery so they can form back together. It may also be treated with a cast but

sometimes that is not enough. Either way, the fracture need to be immobilize.

We choose this topic, because fracture is the most common accident in people

especially when you get older. In this study, we can help people to be aware to

this kind of fracture (comminuted), by knowing the cause symptoms and to

manage i


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Pathophysiology

First,

Changes in articular cartilage

Second

Soft tissue changes

Third

Progressive wear and tear on cartilage leads to thinning of point surface and

ulceration into bone

Fourth

Leads to inflammation of the joint and increased flow and hypertrophy of

subchondral bone

Last

New cartilage and bone formation at joint margins results in oeteophytosis, altering

the size and shape of bone


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Case Study

(Degenerative Osteoarthritis)

Presented by:

Pentz, Jennylyn B.

BSN 3Y2-2C

Presented to:

Ms. Maria Sheila B. Mujemulta, RN, MAN

December 5,2013


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Final Osteoarthritis