Osteoarthritis NCLEX Review

This NCLEX review will discuss osteoarthritis.

As a nursing student, you must be familiar with osteoarthritis along with how to care for patients who are experiencing this condition.

These type of questions may be found on NCLEX and definitely on nursing lecture exams.

Don’t forget to take the osteoarthritis quiz.

You will learn the following from this NCLEX review:

• Definition of osteoarthritis
• Overview
• Signs and Symptoms
• Nursing Interventions
• Treatment

NCLEX Lecture on Osteoarthritis

NCLEX Review on Osteoarthritis

What is osteoarthritis? It is the most common type of arthritis that develops due to the deterioration of the articular cartilage. Remember articular cartilage is hyaline cartilage.

When this happens it leads to bone break down because the bones within the joint start to rub upon one another.  This will cause changes inside and outside of the bone. The inside of the bone will start to experience abnormal hardening (sclerosis), and the outside of the bone will experience osteophytes formation (bone spurs).

OA is from “wear and tear” on the body rather than from on overactive immune system, which is the cause in rheumatoid arthritis (it affects the synovium NOT hyaline cartilage in RA).

What is bone cartilage? Bone cartilage is a rubbery, smooth tissue found within the joint that covers the end of each bone. It acts as a protective mechanism for movement by providing this slick surface for the bones to slide and glide during movement. In addition, it absorbs shock from movement.

What happens in Osteoarthritis?

The top layer of cartilage begins to breakdown and wear away. This leads to a loss of joint space within the joint, which allows the bones to grate upon each other. Therefore, there is no longer this environment that allows for easy gliding of bones during movement without friction. This leads to eroding of the bone and osteophyte formation. Furthermore, pieces of cartilage and bone can break off and float around in the joint space. All of this leads to extreme stiffness and pain.

Key Points about Osteoarthritis to Remember:

OA is also called degenerative joint disease and remember it is the CARTILAGE NOT synovium.

It happens and worsens overtime.

It tends to most commonly occur in the hands, knees, hips, and spine (majorly the weight-bearing joints which experience a lot of stress) and it does NOT affect other systems in the body and it’s unsymmetrical (a patient can have OA in both correlating joints or just one). Remember  RA is symmetrical….it must be found in the correlating joint.

Causes:

• Occurs in older age 40+
• Increased risk if patient has had repeated joint injuries
• Jobs that are strenuous
• Overweight
• Genetics

There is no cure. It gets worse overtime and damage can’t be reversed (cases vary mild to severe).

Managed with lifestyle changes (exercise/losing weight), medication, surgery (hip/knee joint replacement or bone realignment “osteotomy’, arthroscopic).

No conclusive test to diagnose OA. Must evaluate patient’s signs and symptoms and rule out other forms of arthritis such as gout, rheumatoid arthritis.  X-ray imaging may be helpful (remember a x-ray ONLY shows bones, it doesn’t show cartilage)

• X-ray may show: sclerosis of bones, decreased joint space, osteophytes/bone fragments in the joint space, osteophytes (bone spur) formation.

Signs and Symptoms of Osteoarthritis

“Osteo”

Outgrowths that are bony, especially on the hands due to bone spur formation (*remember the names of the nodes and where they are found):

• Heberden’s Node (most common): found on the distal interphalangeal joint (joint closest to the finger nail)
• Bouchard’s Node: found on the proximal interphalangeal joint (middle finger joint)

Sunrise Stiffness (morning) LESS than 30 minutes (Remember RA is greater than 30 minutes)…pain will be the worst at the end of day from overuse than compared to morning time

Tenderness when touching the joint site with bony overgrowths (joints will be BONY and HARD), NOT warm or boggy as with RA

Experience grating (crepitus) of the bones when moving/flexing joint from bones rubbing together and joint pain with activity which goes away with rest

Only the joints: Asymmetrical/Uneven , limited to joints (joint site will be hard and bony, NO warmth or boggy synovitis with red inflammation) along with limited mobility, not system wide, (no fever, anemia, fatigue, systemic inflammation…just the joints)

Nursing Interventions for Osteoarthritis:

Pain assessment: patient’s perception of the disease, effects of the disease on the patient’s activities of daily living, nonpharmalogical and pharmacological approaches

Therapy: physical exercise is one of the most effective treatments for OA….may help create more lubrication to the cartilage allowing the pain and stiffness to decrease, strengthen muscles, help patient lose weight, feel better mentally

Do NOT exercise painful, irritated joint but let it rest

Exercise: this is the last thing most patients want to do but limiting activity and not exercising leads to more pain, increased joint damage, increased weight, and decreased mental health.

• Types:
  • Low impact: walking, water aerobics
  • Strengthen training (lifting weights which helps strengthen muscles around the joint)
  • Range of motion exercises (ROM): improves the mobility of the joint and decreases stiffness
• AVOID: high impact exercise that will increase the stress on weight bearing joints, such as running/jogging, jump rope, or any type of exercise where both feet are off the ground.

Heat and cold compresses

Importance of weight loss (BMI <25)

Physical therapy and occupation therapy (using assistance devices to decrease weight bearing stress, exercise etc.), local support groups, structuring day to prevent overuse of joints

Medications:

Intra-articular injections: corticosteroids…more effective than oral: reduces the inflammation of the inflamed tendons and ligaments. Note: this is temporary relief of no more than a month or two.

Glucosamine: improve symptoms and function

Pain relief: topical creams, Tylenol, NSAIDs (GI bleeding/ulcers), controlled substances (opioids if severe)

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