Nursing Guide to Osteoarthritis: Nursing Diagnosis, Interventions, & Care Plans

Osteoarthritis Definition

Osteoarthritis (OA), the most common form of arthritis, is a degenerative joint disease marked by the progressive breakdown of cartilage within joints. This deterioration results in pain, stiffness, and reduced mobility, primarily affecting weight-bearing joints such as the hips, knees, spine, and hands.

Although OA is most prevalent among individuals aged 50 and older, it can also develop in younger individuals, particularly those with a history of joint injuries or other contributing risk factors (Arthritis Foundation, n.d.; Mayo Clinic, 2021). Globally, millions are affected, with the condition disproportionately impacting older adults and women. In the U.S., OA affects over 32.5 million adults (Mayo Clinic, 2021).

Etiology

OA results from a combination of mechanical stress, biological aging, and systemic factors. Key contributing factors include:

Aging 

The risk increases with age, typically presenting after age 50.

Injuries 

Joint injuries, including fractures or ligament tears, may predispose individuals to OA, even if healed.

Repetitive Stress 

Overuse due to occupation or sports can contribute to cartilage wear.

Obesity 

Excess weight adds stress to joints and promotes inflammation due to fat-derived proteins.

Genetics 

A family history of OA can increase susceptibility.

Metabolic Disorders 

Conditions such as diabetes contribute to cartilage damage by increasing systemic inflammation and weakening joint structures.

Diagnostic Criteria 

OA is diagnosed through clinical evaluation, imaging, and laboratory tests, which help confirm the condition and exclude other potential causes. This includes:

Clinical History 

• A thorough assessment is conducted to evaluate symptoms, prior injuries, and any functional limitations experienced by the individual.

Physical Examination 

• This includes an evaluation of joint tenderness, swelling, range of motion, and any visible deformities.

Imaging Studies 

• X-rays are used to detect joint space narrowing, cartilage loss, and the presence of bone spurs.
• MRI scans provide a detailed view of cartilage and soft tissue damage, offering additional insights into joint health.

Lab Tests 

• Joint fluid analysis may be performed to rule out other conditions, such as gout or rheumatoid arthritis (Mayo Clinic, 2021).

Common Signs and Symptoms

OA symptoms develop gradually and worsen over time. Recognizing signs early can improve management. Signs include:

• Persistent joint pain, often worsening after activity.
• Morning stiffness or stiffness after inactivity.
• Swelling and tenderness around affected joints.
• Limited range of motion.
• Crepitus (grating or crackling sensation) during joint movement.

Red Flags 

Red flags signal the need for urgent intervention to prevent complications, such as:

• Severe, persistent joint pain unrelieved by usual measures.
• Sudden, significant swelling or redness, which may indicate secondary infection or inflammatory arthritis.
• Joint instability, such as buckling or giving way, which increases the risk of falls.

Potential Complications

OA can lead to significant secondary issues beyond joint damage, including:

• Chronic pain and disability which limits mobility and significantly impairs the ability to perform daily activities.
• Comorbidities such as obesity and cardiovascular disease are common in individuals with OA, particularly those with reduced physical activity.
• Falls and fractures become more likely due to instability and muscle weakness, particularly in individuals with lower body OA (Arthritis Foundation, n.d.).
• Psychological effects, including depression, anxiety, and sleep disturbances, which frequently arise from persistent pain and reduced mobility.

Treatments 

Pharmacological 

There is currently no cure for OA. However, medications are commonly used to alleviate pain, reduce inflammation, and improve overall joint function, including:

• Acetaminophen (Tylenol®): Commonly used to manage mild pain.
• Opioids: May be used in the short term for severe cases.
• Ibuprofen (Advil®, Motrin®) and celecoxib (Celebrex®): Reduce both pain and inflammation but require monitoring for gastrointestinal side effects.
• Intra-articular corticosteroid injections, such as triamcinolone [Kenalog®]): Can alleviate localized inflammation.
• Duloxetine (Cymbalta®): Treats chronic musculoskeletal pain, including OA-related knee pain.
• Platelet-rich plasma (PRP): Offers experimental relief of joint pain and dysfunction, though it is not FDA-approved for OA (Arthritis Foundation, n.d.).

Non-Pharmacological 

Non-drug therapies are essential for managing OA long-term. Therapies include:

Exercise

• Tailored programs include strengthening exercises and low-impact aerobics such as swimming, cycling, and balance exercises to reduce fall risk.

Weight Management

• Losing even small amounts of weight reduces joint stress significantly; one-pound loss decreases joint pressure by four pounds (Mayo Clinic, 2021).

Physical Therapy

• Techniques are used to stabilize joints, improve range of motion, and reduce pain.

Heat and Cold Therapy

• Heat therapy is beneficial for reducing stiffness and improving joint flexibility.
• Cold therapy is more effective for acute inflammation or swelling.

Assistive Devices

• Braces, orthotics, and canes minimize joint stress and improve mobility.

Complementary Therapies

• Complementary therapies such as acupuncture, massage, or meditation may work alongside other treatment options.

Surgical

• Surgery may be necessary for severe cases that do not respond to other treatments.

Joint Replacement Surgery

• This is most commonly performed on the hips and knees to restore joint function and relieve severe pain.

Joint Fusion

• Joint fusion stabilizes the joint by fusing bones together and is reserved for cases where joint preservation is not an option.

Nursing Management 

Assessment and Interventions 

Pain Management

• Administer prescribed analgesics and monitor for side effects.
• Teach the use of hot/cold therapy for localized relief.
• Encourage low-impact activities to reduce stiffness and improve mobility.

Fall Prevention

• Conduct home safety assessments and recommend modifications, such as grab bars and non-slip flooring.
• Teach balance-enhancing exercises and proper use of assistive devices.

Mobility and Function

• Monitor range of motion and muscle strength.
• Collaborate with physical therapists to create individualized activity plans.
• Recommend adaptive devices to enhance independence.

Psychosocial and Cultural Considerations

Psychosocial Support

• Offer resources for managing depression and anxiety, such as counseling or support groups.
• Encourage participation in social and community activities to reduce isolation.

Cultural Considerations

• Incorporate dietary preferences into weight management strategies.
• Address cultural attitudes toward exercise and medication use.

Home Management 

Self-care for Osteoarthritis 

• Teach joint exercises, emphasizing proper warm-up and cool-down routines.
• Recommend anti-inflammatory diets, such as the Mediterranean diet, for joint health, emphasizing foods like fatty fish, leafy greens, and nuts. Provide guidance on incorporating these dietary changes into daily routines.
• Suggest maintaining optimal blood sugar levels through regular glucose monitoring, adherence to prescribed diabetes medications, and meal planning. Emphasize that stable blood sugar levels can reduce inflammation and slow cartilage damage.

Safety Measures

• Teach proper lifting techniques to avoid joint strain.
• Recommend tools like long-handled devices to reduce repetitive joint stress.

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2028

Content Contributor

The content for this course was written by Sherry D. Haszto, M.S.N., R.N.
Sherry is a nursing professional with over 21 years of experience. She has earned an Associate Degree in Nursing from Randolph Community College, a Bachelor of Science in Nursing from the University of North Carolina at Greensboro, and a Master of Science in Nursing from Walden University. Her background includes work in oncology and hematology, home healthcare, hospice and palliative care, healthcare education, nursing consultation, performance improvement, and quality assurance. Sherry is committed to supporting patient care and healthcare education, focusing on enhancing patient outcomes and maintaining quality standards in all aspects of her work.

References

• Arthritis Foundation. (n.d.). Osteoarthritis. Retrieved January 21, 2025, from https://www.arthritis.org/diseases/osteoarthritis
• Mayo Clinic. (2021). Osteoarthritis. https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925