Osteoarthritis: Pathophysiology, Clinical Manifestations, and Evidence-Based Treatment

This essay provides an in-depth discussion on the pathophysiology, clinical manifestations, and evidence-based treatment of osteoarthritis. It also explores the nursing process and holistic considerations for managing this chronic joint condition. The essay is suitable for students studying healthcare or nursing.

Running Head: OSTEOARTHRITIS
0
Osteoarthritis
Essay
student

OSTEOARTHRITIS
1
Table of Contents
Introduction.................................................................................................................................................2
Knowledge and discussion......................................................................................................................2
Pathophysiology..................................................................................................................................2
Clinical manifestations........................................................................................................................3
Evidence-based treatment....................................................................................................................3
Nursing process.......................................................................................................................................4
Application of nursing process................................................................................................................5
Holistic consideration..............................................................................................................................8
Conclusion...................................................................................................................................................8
References.................................................................................................................................................10

OSTEOARTHRITIS
2
Introduction
Osteoarthritis (OA) is the most common chronic joint condition. With OA, the cartilage
of bone disrupts down, triggering the bones contained by the joint to rub with each other. This
may lead to pain, stiffness, and other related symptoms. OA arises most frequently in older
individuals, though it can happen in grown-ups of any age (Bombelli, 2012). As discussed in the
case study Mrs Halpern is had total hip arthroplasty and had a history of osteoarthritis and
obesity. In this particular assessment report the pathophysiology, clinical manifestation, and
evidence-based treatment will be discussed. The understanding of the nursing process in this case
and the application of the nursing process and the holistic considerations will also be mentioned.
Knowledge and discussion
Pathophysiology
Osteoarthritis is traditionally considered a wear and tear disorder that caused as people
age. The pathogenesis of this health conditions includes the degradation of the bone cartilages
and remodeling of the bones because of an active reaction of chondrocytes present in the
articular cartilage and the also the inflammatory body cells in the nearby tissues. The enzyme
released from these Cartilages breakdown the collagen and proteoglycans, terminating the
articular cartilage of bones. The experience of the fundamental subchondral bones leads to
sclerosis and reactive remodeling alterations those results in the creation of the osteophytes and
cysts of bones (Vincent, Conrad, Fregly, & Vincent, 2012).

OSTEOARTHRITIS
3
Clinical manifestations
Osteoarthritis commonly affects the small joints of the hips, feet, keens, and hands. The
patients usually experience insidious, long lasting and gradually worsening symptoms that
relieved by rest. Long lasting OA might lead to deformity and the decreased variety of
movement (Bijlsma, Berenbaum, & Lafeber, 2011). Signs of OA involves localized enlargement
also called joint effusion, joint malalignment, crepitus, fixed deformity, and muscle wasting. As
mentioned in the case study Mrs Rose has also been experiencing the symptoms of OA such as
increased weight, pain in the hip, and facing difficulty to mobilize and doing activities of daily
lives (Felson, 2009).
Evidence-based treatment
There are different types of treatment options are available that can be helpful in the case
of Mrs Rose such as conservative methods, medical treatments, and surgical treatments. In all
type of treatments, nurses play a key role in the successful implementations of the treatment
strategies. The nursing process plays an important role in providing quality health care to the
patient (Broyles, et al., 2017).
Medical treatment
The usual analgesics and the topical NSAID, Cymbalta, and corticosteroids are
considered as the frontline medicinal management of this health condition along with the
conservative measures (Brown, Edwards, Seaton, & Buckley, 2015). It has been recommended
to use the intra-articular steroid injections instead of oral analgesics for the successful treatment
(Roubille, Martel-Pelletier, & Pelletier, 2013). These medicines can be helpful in the case of Mrs
Rose to reduce her pain, although the patient has also been prescribed with IV antibiotic

OSTEOARTHRITIS
4
The surgical treatment is quite effective in different cases of OA. It is recommended if
both conservative and medicinal treatment fails to cure the patient. It is considered when the
symptoms start impacting the normal work life of the patient (Beswick, Wylde, Gooberman-Hill,
Blom, & Dieppe, 2012). The surgical treatment has already provided to Mrs Rose and the
progress is observed accept the pain in the hip area
The conservative treatment includes education the patient about the health condition they
are suffering from such as joint protection advise, and focusing on the daily exercise and
strengthening (Felson, 2009) as discussed in the case study Mrs rose has a history of obesity,
therefore, she needs to reduce the weight
Nursing process
The nursing process is the complete plan of nurses that is used to provide high-quality
care to the patient with different health conditions. Mrs Rose has been facing issues of pain and
lack of ability to perform daily work. She is 65 years old women; therefore she must be respected
and dealt with empathy. In order to provide favorable health interventions, therapeutic
communication should be built with the patient. Here the role of nurses takes to play as they
spent a lot of time with the patient compared to other health care members (Grotle, et al., 2010).
The nursing process, in this case, will include different steps such as assessment of the patient for
vital signs, identifications of the main problem Mrs rose is facing, planning of the implementing
the interventions, implementation of the approach and evaluation of the effectiveness of the
approach. The nursing process is helpful to provide the complete treatment in the case of Mrs
Rose as OA is the chronic illness that needs a holistic approach that can help the patient to gain
complete recovery.

OSTEOARTHRITIS
5
Application of the nursing process
The complete nursing process or care plan includes assessment, problem identification,
planning, implementation, and evaluation.
Assessment
The vital sign of Mrs Rose has been recorded as stable. However, she is reluctant to
mobilize and perform normal daily life activities due to hip pain (Brown, Edwards, Seaton, &
Buckley, 2015). After the one day of operations, she has dual bellovac drains in situ, her wound
portion is surrounded by the dressing, and her urinary catheter excretion is satisfactory (Brand,
Ackerman, & Tropea, 2014).
Problem identification or diagnosis
There is acute hip pain, that occurs due to the hip movement, lack of knowledge related
to the osteoarthritis and the treatment to stop additional damage. Impaired bodily mobility,
associated with the activity and weight bearing practices. Risk of infections is there to the leg
wound. The risk of ineffective perfusion of tissues, right leg, and associated vascular disruption
edema is also there. The continuous pain may also cause stress or depression (McKenzie, &
Torkington, 2010).
Expected outcomes
Manage the adequate comfort level after the surgery as demonstrated by her ability to
move effortlessly, within the boundaries, and verbal description of the comfort. Remain
uninfected to any infectious agent. The pain associated with the hip will be reduced and she will
be able to perform daily life works.

OSTEOARTHRITIS
6
Planning an implementations
OA management is the holistic approach that comprises a multidisciplinary team, and the
patient is involved in the decision-making process. Effective communication and team
management must happen between the patient, doctors, allied health services, and nurses
(Brembo, Kapstad, Eide, Månsson, Van Dulmen& Eide, 2016). When planning for the OA
nursing intervention for Mrs Rose the PDSA tool can be helpful for the nurses. PDSA is plan do
study and act, it is commonly run as the time-based cycle, where every step is examined before
the next cycle. The pain associated with the hip should be assessed a minimum hourly
throughout the first one to two days after the surgery and thereafter if required. Use of The
patient-controlled analgesia can be instructed and its effectiveness should be monitored. Mrs
Rose must be helped with changing positions at least every two hours; the use of overhead
trapeze can be used to shift the patient position frequently (Creedon, & Weathers, 2011). The
sequential compression device and antiembolic stocking should be maintained as recommended;
removing it for nearly one hour. Assist the patient to move out of bed at least three times a day,
and the abduction of the affected hip should be maintained with the pillow. The passive ROM
exercise or the unaffected extremities should be performed every shift. Other exercises like
frequent quadriceps setting and the planter and feet dorsiflexion should be encouraged. The
surgical site must be assessed frequently, and any signs of increased bleeding or inflammations
should be recorded. The temperature should also be assessed at regular intervals or 4 hours. Mrs
Rose should also be assessed for pulses, colour, sensation in the right foot hourly for the first
days, and after that in every 120 minutes for one day then 4 hours. The patient pain level should
also be assessed daily (Swearingen, & Wright, 2019).
Evaluation

OSTEOARTHRITIS
7
Mrs Rose can be returned to the orthopedic unit after her surgical treatment. She might
become confused and disoriented thoughts the initial 1 to 2 days after the operations, however,
her thought process and orientation will be clear gradually. Her family members should remain
with her in order to provide her additional emotional support. One week after the surgery the
patient is transferred to the extended care unit, and she is able to use the walker for ambulation
(Robbins, & Kulesa, 2012). The home care nurses should visit her in her home for regular
assessment after discharge. The pain assessment should be done on a regular basis by using
assessment questionnaires such as hip and knee questionnaires. The pain assessment scale is used
which cantinas number from 0 to ten. O mean there is no sign of pain and ten mean the patient is
experiencing extreme pain. The tools like Visual analogue scale, PROMIS, and numeric Pain
rating system can be a great option for pain measurement (Hawker, Mian, Kendzerska, &
French, 2011). After the success full implementation of the nursing interventions and treatments,
the patient has expressed her symptoms and report that she has very little pain which occurs
while she moves and she was scored 2 out of ten. Her other vital sign like breathing, temperature,
and respiration and the vital signs were stable.
Critical thinking
The patient preoperative signs showed that she had a history of obesity, that can be a
problem to manage the low pressure on the hips and the patient might also face difficulty in
walking on her own. It is also mentioned that she is living on the third floor of a building so there
is a risk of fall if she will to walk down or go upstairs. The patient may also experience issues
like sleeplessness and irritation and social isolation.

OSTEOARTHRITIS
8
Holistic consideration
Complete nursing care includes a holistic approach that includes the physical, spiritual,
cultural, or emotional support for the patient (Lucas, 2009). As mentioned in the case study Mrs
Rose is an old woman who cannot perform the daily life work on her, therefore the physical
support should be provided to her. The increased pressure nm the hip and feet might increase the
chances of hip injury, therefore, the nurses should educate the patient about how to manage the
everyday tasks. The high protein and calcium food should be included in her daily life to
strengthen the muscles. The nurse should also deal with her more empathetically and
respectfully. The nurses should help the nurses to take medicines at the recommended time and
doses (Parsons, Godfrey, & Jester, 2009). They should also consider avoiding the infections to
her foot and hip area. She has been facing issues related to the increased weight, therefore, the
nurses should implement some exercise in her daily routine. The patient had any surgery recently
frequently developed the negative thought that may hinder the recovery process (Fransen,
McConnell, Hernandez‐Molina, & Reichenbach, 2014). The patient might feel like they cannot
be treated due to their age and weight, therefore the nurses should also provide emotional support
by building therapeutic communications with the patient. This might help the patient to discuss
their actual situation to the nurses. Different communication skills like touch method, active
listening, empathy, and involving the patient in the decision-making process are helpful in the
recovery process (Brembo, et al., 2016).
Conclusion
Osteoarthritis is one of the main issues of joint condition. In osteoarthritis the cartilage of
the bone is broken down, ultimately results in extreme pain. The patient in the case study has

OSTEOARTHRITIS
9
undergone a total hip arthroplasty for OA. The OA includes degradation bones cartilages and the
remodeling of bones which occurs due to the response of chondrocytes exists in the articular
cartilages. It commonly affects the small joints and the patient may face long-lasting symptoms.
Medical treatment includes the use of NSAID, Cymbalta, and corticosteroids. Conservative
treatment includes patient education and total hip Surgery is performed as a last option. The
nursing process includes patient assessment, identification of main problems like pain, planning,
and implementation of the intervention, and evaluation of the interventions. The holistic
approach should include building a therapeutic relationship and applying the recommended
exercises in the patient’s daily life.

OSTEOARTHRITIS
10
References
Beswick, A. D., Wylde, V., Gooberman-Hill, R., Blom, A., & Dieppe, P. (2012). What
proportion of patients reports long-term pain after total hip or knee replacement for
osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ
Open, 2(1), e000435.
Bijlsma, J. W., Berenbaum, F., & Lafeber, F. P. (2011). Osteoarthritis: an update with relevance
for clinical practice. The Lancet, 377(9783), 2115-2126.
Bombelli, R. (2012). Osteoarthritis of the Hip: Classification and Pathogenesis The Role of
Osteotomy as a Consequent Therapy. Springer Science & Business Media.
Brand, C. A., Ackerman, I. N., & Tropea, J. (2014). Chronic disease management: improving
care for people with osteoarthritis. Best Practice & Research Clinical
Rheumatology, 28(1), 119-142.
Brembo, E. A., Kapstad, H., Eide, T., Månsson, L., Van Dulmen, S., & Eide, H. (2016). Patient
information and emotional needs across the hip osteoarthritis continuum: a qualitative
study. BMC health services research, 16(1), 88.
Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2015). Lewis's Medical-surgical Nursing:
Assessment and Management of Clinical Problems. Elsevier Health Sciences.
Broyles, B. E., Reiss, B. S., Evans, M. E., McKenzie, G., Pleunik, S. & Page, R. (2017).
Pharmacology in nursing (2nd Australian & New Zealand ed.). South Melbourne,
Australia: Cengage Learning Australia

OSTEOARTHRITIS
11
Creedon, R., & Weathers, E. (2011). The impact of nurse prescribing on patients with
osteoarthritis. British journal of community nursing, 16(8), 393-398.
Felson, D. T. (2009). Developments in the clinical understanding of osteoarthritis. Arthritis
research & therapy, 11(1), 203.
Fransen, M., McConnell, S., Hernandez‐Molina, G., & Reichenbach, S. (2014). Exercise for
osteoarthritis of the hip. Cochrane Database of Systematic Reviews, (4).
Grotle, M., Garratt, A. M., Klokkerud, M., Løchting, I., Uhlig, T., & Hagen, K. B. (2010).
What's in team rehabilitation care after arthroplasty for osteoarthritis? Results from a
multicenter, longitudinal study assessing structure, process, and outcome. Physical
therapy, 90(1), 121-131.
Hawker, G. A., Mian, S., Kendzerska, T., & French, M. (2011). Measures of adult pain: Visual
analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain
questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade
scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and
constant osteoarthritis pain (icoap). Arthritis care & research, 63(S11), S240-S252.
Lucas, B. (2009). Osteoarthritis: management and treatments. Nurse Prescribing, 7(1), 7-12.’
McKenzie, S., & Torkington, A. (2010). Osteoarthritis Management options in general
practice. Australian family physician, 39, 622-625.
Parsons, G. E., Godfrey, H., & Jester, R. F. (2009). Living with severe osteoarthritis while
awaiting hip and knee joint replacement surgery. Musculoskeletal Care, 7(2), 121-135.

OSTEOARTHRITIS
12
Robbins, L., & Kulesa, M. G. (2012). The state of the science in the prevention and management
of osteoarthritis. HSS Journal®, 8(2), 151-158.
Roubille, C., Martel-Pelletier, J., & Pelletier, J. (2013). Osteoarthritis treatments: where do we
stand at the moment. Medicographia, 35(2), 172-180.
Swearingen, P. L., & Wright, J. (2019). All-in-one Nursing Care Planning Resource: Medical-
surgical, Pediatric, Maternity, and Psychiatric-mental Health. Elsevier Health Sciences.
Vincent, K. R., Conrad, B. P., Fregly, B. J., & Vincent, H. K. (2012). The pathophysiology of
osteoarthritis: a mechanical perspective on the knee joint. PM&R, 4(5), S3-S9.