{
  "name": "Osteoarthritis",
  "slug": "osteoarthritis",
  "url": "https://nursingplex.com/care-plans/osteoarthritis",
  "category": "Musculoskeletal",
  "summary": "Degenerative joint disease; pain control, joint protection and activity balance.",
  "nursing_diagnoses": [
    "Chronic pain",
    "Impaired physical mobility",
    "Self-care deficit"
  ],
  "overview": [
    "Osteoarthritis is progressive loss of articular cartilage with subchondral bone change, osteophyte formation and secondary synovial inflammation. It is a wear-and-repair disorder of mechanically loaded joints — knees, hips, spine, and the small joints of the hands.",
    "The clinical signature is asymmetric joint pain that worsens with use and improves with rest, morning stiffness lasting under 30 minutes, and crepitus. That short stiffness separates it from rheumatoid arthritis, where stiffness lasts longer than an hour and joints are involved symmetrically with systemic features.",
    "Management is layered: weight loss and exercise first, then acetaminophen and topical NSAIDs, then oral NSAIDs, intra-articular injections and finally joint replacement. Nurses spend most of their teaching time on the counterintuitive truth that appropriate exercise reduces pain rather than worsening damage."
  ],
  "key_facts": [
    {
      "label": "Stiffness rule",
      "text": "OA stiffness lasts under 30 minutes after rest; RA stiffness exceeds an hour in the morning."
    },
    {
      "label": "Hand findings",
      "text": "Heberden nodes at distal interphalangeal joints and Bouchard nodes at proximal interphalangeal joints."
    },
    {
      "label": "Weight impact",
      "text": "Each pound lost removes about four pounds of load from the knee."
    },
    {
      "label": "First-line drugs",
      "text": "Acetaminophen and topical NSAIDs; oral NSAIDs need GI, renal and cardiac caution in older adults."
    },
    {
      "label": "Exercise",
      "text": "Low-impact aerobic activity, quadriceps strengthening and aquatic therapy reduce pain and improve function."
    },
    {
      "label": "Heat vs cold",
      "text": "Heat before activity for stiffness; cold after activity for swelling and acute pain."
    }
  ],
  "nursing_priorities": [
    "Relieve joint pain with the safest effective regimen.",
    "Preserve and improve mobility and function.",
    "Protect joints from further mechanical stress.",
    "Support weight management.",
    "Prevent falls and maintain independence."
  ],
  "assessment": {
    "subjective": [
      "Pain location, pattern with activity and rest, and effect on sleep",
      "Duration of morning stiffness and gelling after inactivity",
      "Functional limits: stairs, rising from a chair, opening jars, walking distance",
      "Current medications, supplements and prior injections",
      "Mood, isolation and fear of movement"
    ],
    "objective": [
      "Joint swelling, bony enlargement, deformity and Heberden or Bouchard nodes",
      "Range of motion, crepitus and joint alignment",
      "Gait pattern, use of assistive devices and ability to rise from sitting",
      "Muscle strength, especially quadriceps, and evidence of atrophy",
      "Weight, BMI and skin condition over pressure areas",
      "Radiographic joint space narrowing and osteophytes when available"
    ],
    "related_factors": [
      "Cartilage degeneration and subchondral bone remodeling",
      "Obesity and repetitive mechanical loading",
      "Prior joint injury or occupational overuse",
      "Aging, genetics and female sex after menopause",
      "Muscle weakness reducing joint protection"
    ]
  },
  "goals": [
    "The client will report pain at or below 3/10 with the prescribed regimen.",
    "The client will perform prescribed range-of-motion and strengthening exercises daily.",
    "The client will walk an agreed distance or complete daily activities with reduced difficulty.",
    "The client will use assistive devices and joint-protection techniques correctly.",
    "The client will achieve an agreed weight-loss target if overweight."
  ],
  "interventions": [
    {
      "title": "Pain relief",
      "points": [
        "Give acetaminophen on a schedule and topical NSAIDs to affected joints; reserve oral NSAIDs for inadequate relief.",
        "Monitor NSAID use for GI bleeding, hypertension, edema and rising creatinine in older adults.",
        "Apply moist heat before exercise and cold packs after activity or during flares.",
        "Time analgesia about 30–60 minutes before therapy sessions or planned activity."
      ]
    },
    {
      "title": "Mobility and exercise",
      "points": [
        "Encourage low-impact aerobic exercise: walking, cycling, swimming and water aerobics.",
        "Teach quadriceps and hip strengthening, which directly reduce knee pain.",
        "Balance activity with rest; use the two-hour rule — pain lasting more than two hours after exercise means it was too much.",
        "Coordinate physical and occupational therapy for gait training and device fitting."
      ]
    },
    {
      "title": "Joint protection",
      "points": [
        "Teach large-joint use for lifting, sliding rather than carrying, and two hands instead of one.",
        "Recommend adaptive equipment: raised toilet seats, jar openers, long-handled reachers, shower chairs.",
        "Fit a cane for the hand opposite the affected joint and check height at the wrist crease.",
        "Encourage supportive cushioned footwear and avoiding prolonged kneeling, squatting and stair climbing."
      ]
    },
    {
      "title": "Weight, safety and surgery",
      "points": [
        "Refer for dietitian support and set realistic incremental weight-loss goals.",
        "Assess home fall hazards: rugs, cords, lighting, grab bars and stair rails.",
        "Prepare patients considering arthroplasty for prehabilitation, expectations and postoperative precautions.",
        "Screen for depression and social isolation, which worsen perceived pain and reduce activity."
      ]
    }
  ],
  "patient_teaching": [
    "Movement lubricates the joint — appropriate exercise reduces pain and does not accelerate damage.",
    "Take acetaminophen on schedule rather than waiting for severe pain, and stay within daily limits.",
    "Report black stools, stomach pain, swelling or reduced urine output on NSAIDs.",
    "Use heat before activity and cold after; 15–20 minutes at a time with a barrier on the skin.",
    "Lose weight gradually; even 5–10% reduces knee pain measurably.",
    "Glucosamine and chondroitin have mixed evidence — discuss before spending money on supplements."
  ]
}