5. Osteoarthritis; joint disorder characterized by degeneration of articular cartilage and formation of bony outgrowths at edges of weight-bearing joints.
   1. Pathophysiology: excessive friction combined with risk factors - thinning of articular cartilage, narrowing of joint space, and loss of joint stability; cartilage erodes, producing shallow pits on articular surface and exposing bone in joint space. Bone responds by becoming denser and harder.
   2. Risk factors:
      1. Aging (>50).
      2. Rheumatoid arthritis.
      3. Arteriosclerosis.
      4. Obesity.
      5. Trauma.
      6. Family history.
   3. Assessment:
      1. Subjective data:
         1. Pain; tender joints.
         2. Fatigability, malaise.
         3. Anorexia.
         4. Cold intolerance.
         5. Extremities: numb, tingling.
      2. Objective data:
         1. Joints:
            1. Enlarge
            2. Stiff, limited movement.
            3. Swelling, redness, and heat around affected joint.
            4. Shiny stretched skin over and around joint.
            5. Subcutaneous nodules.
         2. Weight loss.
         3. Fever.
         4. Crepitation (creaking or grating of joints).
         5. Deformities, contractures.
         6. Cold, clammy extremities.
         7. Lab data: decreased Hgb, elevated WB.
         8. Diagnostic tests: x-ray, thermography, arthroscopy.
   4. Analysis/nursing diagnosis:
      1. Pain related to friction of bones in joints.
      2. Bathing/hygiene self-care deficit related to decreased mobility of involved joints.
      3. Risk for injury related to fatigability.
      4. Impaired physical mobility related to stiff, limited movement.
      5. Impaired home maintenance management related to contractures.
   5. Nursing care plan/implementation:
      1. Goal: promote comfort: reduce pain, spasms, inflammation, swelling
         1. Medications as prescribed.
            1. Nonsteroidal anti-inflammatory agents: aspirin (Ecotrin), acetaminophen (Tylenol), ibuprofen (Motrin), indomethacin (Indocin), corticosteroids, nabumetone (Relafen), naproxen (Naprosyn).
            2. Antimalarials: chloroquine (Aralen), hydroxychloroquine (Plaquenil), to relieve symptoms.
         2. Heat to reduce muscle spasms, stiffness.
         3. Cold to reduce swelling and pain.
         4. Prevent contractures:
            1. Exercise.
            2. Bed rest on firm mattress during attacks.
            3. Splints to maintain proper alignment.
         5. Elevate extremity to reduce swelling.
         6. Rest.
         7. Assistive devices to decrease weight bearing of affected joints (canes, walkers).
      2. Goal: health teaching to promote independence.
         1. Encourage self-care with assistive devices for activities of daily living (ADL).
         2. Activity, as tolerated, with ambulationassistive devices.
         3. Scheduled rest periods.
         4. Correct body posture and body mechanics.
      3. Goal: provide for emotional needs.
         1. Accept feelings of frustration regarding long-term debilitating disorder.
         2. Provide diversional activities appropriate for age and physical condition to promote comfort and satisfaction.
   6. Evaluation/outcome criteria:
      1. Remains independent as long as possible.
      2. No contractures.
      3. States comfort has improved.
      4. Uses methods that are successful in pain control.