Osteoarthritis Case Study

ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING

West Avenue Timawa, Molo, Iloilo City
NCM 114 (RLE)

CARE OF THE OLDER ADULT CLIENT
CASE SCENARIO 2:
OSTEOARTHRITIS
A Case Study Presented to the Department of Nursing of Iloilo Doctor’s College
PRESENTED TO: MRS.

Arvi Tenderly V. Melliza, RN, M.A.N.
(NCM 112 RLE & SKILLS CLINICAL INSTRUCTOR)
PRESENTED BY:
Abenido, Mary Claire Cartera, Riza June
Alayon, Hannah Marie Catubay, Jade
Anatan, Raenacet Claro, Meryll Joy
Camariosa, Shelynar B. Feliciano, Dee D Rhae
Camarista, Coleen Mae C.
(BSN III-G GROUP 1)
NOVEMBER 23, 2021

TABLE OF CONTENTS
I. .. ......................................................................... INTRODUCTION
A. Objectives:
1. General Objective
2. Specific objectives (KSA) format
II. .................................................... NURSING HEALTH HISTORY
III . ....................................................... PHYSICAL EXAMINATION
IV. ..................................... ANATOMY AND PATHOPHYSIOLOGY
V.. ................. DIAGNOSTICS AND LABORATORY PROCEDURE
VI. ................................................................. NURSING PROCESS
VII. ....................................................................... DRUG STUDY
VIII. ............................DISCHARGE PLAN/HEALTH TEACHING
IX. ............................................................. ARTICLE/JOURNAL

I. INTRODUCTION
Osteoarthritis (Degenerative Joint Disease)
OA is a non-inflammatory degenerative disorder of the joints. It is the most common

form of joint disease and is routinely referred to as degenerative joint disease. OA is
classified as either primary (idiopathic), with no prior event or disease related to the OA,
or secondary, resulting from previous joint injury or inflammatory disease, similar to RA
(Papadakis et al., 2015). Unlike most of the disease processes discussed in this
chapter, the pathophysiology of primary OA does not involve autoimmunity or
inflammation. It can occur as an end result of an autoimmune disorder where joint
destruction occurs. Another distinguishing characteristic of OA is that it is limited to the
affected joints; there are no systemic symptoms associated with it. OA often begins in
the third decade of life and
peaks between the fifth and
sixth decades. By 40 years of
age, 90% of the population has
degenerative joint changes in
their weight-bearing joints, even
though clinical symptoms are
usually absent (Papadakis et al.,
2015). Women, especially those
who are Hispanic or
African American, are more
commonly affected. The
incidence of OA increases with
age. It is estimated that over 85% of the general population over 65 years of age has
radiographic changes indicating OA (Cash & Glass, 2015). Although OA is usually
thought of as a disease of aging, it also affects younger patients and results in
significant losses in work-related productivity and higher costs (CDC, 2015).
Risk factors for the disease and its progression include older age, female gender, and
obesity. In addition, certain occupations (e.g., those requiring laborious tasks); engaging
in sport activities; and a history of previous injuries, muscle weakness, genetic
predisposition, and certain diseases can also place patients at risk for joint destruction.
The most prominent modifiable risk factor for OA is obesity. In fact, both quality and
quantity of life are reduced with OA, especially when obesity and OA are combined. A
program of diet and exercise can help minimize symptoms of OA in patients who are
obese (CDC, 2015).
Clinical Manifestations
The main clinical manifestations of OA are pain, stiffness, and functional impairment.
The joint pain is usually aggravated by movement or exercise and relieved by rest. If
morning stiffness is present, it is usually brief, lasting less than 30 minutes. The onset is
routinely insidious, progressing over multiple years.
On physical examination, the affected joint may be enlarged with a decreased range of
motion. Although OA occurs most often in weight-bearing joints (hips, knees, cervical and
lumbar spine), the proxima interphalangeal (PIP) and distal interphalangeal (DIP) joints are
also often involved causing bony enlargements of the DIP (Heberden’s nodes) and PIP
(Bouchard’s nodes) joints. Crepitus may be palpated, especially over the knee. Joint
effusion, a sign of inflammation, is usually mild. No systemic manifestations are found.
OBJECTIVES
A. General Objectives
This study aims to convey familiarity and to provide an effective nursing care to
a patient diagnosed with Osteoarthritis through understanding the patient history, disease
process, achieve and maintain control of symptoms and prevent further complications.
B. Specific Objectives
A. Knowledge
• Define the meaning of Osteoarthritis.
• Know the pathophysiological basis of the Osteoarthritis.
• Determine signs and symptoms and risk factors/causes of Osteoarthritis.
• Determine appropriate nursing care management for client with Osteoarthritis
 Formulate plan of care for clients with Osteoarthritis.
• Provide accurate information about the topic
B. Skills
• Assess client who is experiencing an Osteoarthritis.
• Apply different assessment techniques to determine the patients need
• Evaluate the plan of care needed
• Formulate nursing diagnoses that address the needs of the client experiencing
Osteoarthritis.
• Collaborate with health team member in planning and performing client care
• Document expected outcomes for effectiveness and achievement of care.
C. Attitude
• Build rapport with the client to build trust.
• Respect client decision (race, culture, values and beliefs)
• Maintain confidentiality regarding patient records/information
• Explain the importance of follow up check-up.
• Establish therapeutic relationship with client and family
• Acknowledge client needs using holistic approach
• Display confidence in providing nursing care to the client.

• Develop teamwork and collaboration to the health care team member
II. NURSING HEALTH HISTORY

BIOGRAPHIC DATA
Name: Mrs. Doring
Age: 66 years old
Gender: female
Marital Status: Married (widow for 20 years)
Occupation: business woman
Religion: N/A
Attending Physician: N/A
Final Diagnosis: Osteoarthritis
Past medical history

-Had knee pain on the right for a few years and has progressively gotten
worse and in the last 6 months, noticed a similar pain on the left.
-Did not undergo any surgery and haven’t experienced any major illness
Present medical history

-Clinically diagnosed for osteoarthritis
-Bilateral knee x-ray finding: Osteophyte formation joint space narrowing
subchondral and cyst.
-Rheumatoid Factor - 14,000WBC/mm3
-Comprehensive Metabolic Panel (CMP) - 19.2 mg/dl
-Erythrocyte Sedimentation Rate (ESR) - 73 mm/hr.
Lifestyle history
-66 years old, nonsmoker and occasionally drinks alcoholic beverages.
-Obese
Drug history
-Taken Flanax as needed for pain management.
-Started medications for pain such as Acetaminophen ( Tylenol)
30mg/tab TID, Capsaicin (Zostrix) cream apply PRN, given also a natural
treatment like fish oil once a day.
III. PHYSICAL EXAMINATION

Physical Examination
Appearance of the patient
 In case of acute fractures, patients may appear anxious and distressed because
of pain. Risk factors predisposing to acute fractures include being elderly.
 Osteoporosis due to chronic corticosteroid use may present with features of cushing's
syndrome such as Buffalo hump, abdominal striae, moon-like faces, and
edematous eyelids.
 Patients may exhibit physical characteristics of other secondary causes
of osteoporosis, such as hyperthyroidism (proptosis, tremor, and restlessness).
Vital Signs
 Temperature =36.8 degree centigrade
 Pulse rate = 83 beats per minute
 Respiration rate =17 cycle per minute
 Blood pressure = 140/90 mmHg.
Skin
 Normal
 Striae may be present if there is chronic corticosteroid use
HEENT
 Normal
 Characteristic moon-like face if excessive corticosteroid use
Neck
 Thyromegaly in case of hyperthyroidism
Abdomen
 Hepatomegaly may be found due to hemochromatosis or alcoholism
 Central obesity
Knee examination
 There is no erythema, bruising and discoloration of the left knee
 There is also no point of tenderness
 Slight budging is seen on the medial aspect of the right knee joint
 Popliteal bulging is seen at right knee posterior aspect.
 Musculature of both knees seems symmetric bilaterally.
 There is no bone deformity.

 On palpation, the left knee joint is not warm or tender.
 There is mild effusion felt.
 Range of movement of the left knee is full.
 Crepitus on both legs were felt. Pedal pulses were all intact.
Back
 Point tenderness in case of fractures
 Stooped back, "Dowager's hump"
 Kyphoscoliosis
 Shortened spinal column
 Buffalo hump
Genitourinary
 Hypogonadism
Extremities
 Fracture or previously healed fractures may be present
 Peripheral muscle atrophy with chronic corticosteroid use
IV. ANATOMY AND PATHOPHYSIOLOGY

Joints (articulations) are functional junctions between bones. They bind parts of the
skeletal system, make possible bone growth, permit parts of the skeleton to change shape during
childbirth, and enable the body to move in response to skeletal muscle contractions. Joints vary
considerably in structure and function.
Fibrous Joints
Fibrous (fi ′brus) joints lie between bones that closely contact one another.
Cartilaginous Joints
Hyaline cartilage, or fi brocartilage, connects the bones of cartilaginous (kar′′tı˘-lah′jin-us)
joints.
Synovial Joints
Most joints within the skeletal system are synovial (sı˘-no′ve-al) joints, which allow free
movement (diarthrotic). They are more complex structurally than fi brous or cartilaginous
joints.
All joints consist of bone, particularly subchondral bone or the bony plate to which the
articular cartilage is attached. This articular cartilage is a lubricated, smooth tissue that protects
the bone from damage with physical activity. Between the articular cartilage of the bones
forming the joint is a space (called the joint space) that allows for movement. To aid in fluidity,
each joint contains synovial fluid to help lubricate and protect the joint’s movement. With OA,
the articular cartilage breaks down, leading to progressive damage to the underlying bone and
eventual formation of osteophytes (bone spurs) that protrude into the joint space. The result is
that the joint space is
narrowed, leading to
decreased joint movement and
the potential for more damage.
Consequently, the joint can
progressively degenerate.
Understanding of OA
pathophysiology has been
greatly expanded beyond what
was previously thought of as
simply “wear and tear” related
to aging.. In addition to the
degeneration, an infectious
arteritis can occur.
V. LABORATORY AND DIAGNOSTICS
Laboratory test Normal Value Result Significance

Rheumatoid Factor <200 WBC/mm3 14,000WBC/mm3 A white blood cell
count that is higher
than normal may
indicate infectious
arthritis, gout, or
rheumatoid arthritis
Comprehensive 70-99 mg/dL 19.2 mg/dl The CMP measures
Metabolic Panel (CMP) albumin specifically
(the major blood
protein produced by
the liver), as well as the
amount of all proteins
in the blood. Low levels
may indicate liver or
kidney disease or
nutritional problems.
Erythrocyte 0 to 22 mm/hr for men 53 mm/hr An extreme elevation
Sedimentation Rate of the ESR is strongly
(ESR) 0 to 29 mm/hr for associated with serious
women underlying disease,
most often infection,
collagen vascular
disease or metastatic
malignancy.
DIAGNOSIS
Probable diagnosis:
 Osteoarthritis of knees – acute exacerbation of right knee.

Bilateral knee x-ray
 Findings: Osteophyte formation joint space narrowing subchondrial and cyst.

 Impression: Osteoarthritis of both knee joints.
VI. NURSING CARE PLAN
ASSESSMENT NURSING OUTCOME INTERVENTION RATIONALE EVALUATION

DIAGNOSIS IDENTIFICATION
SUBJECTIVE: Acute pain SHORT TERM INDEPENDENT: Expected patient

related to GOAL: - RELIEVING - assess the outcomes may
“My knees are
swelling, and PAIN patient’s level include:
in pain, it’s After 4 hours of
immobilization of pain,
giving me an
nursing evaluate the 1. Reports
oppressive
sensation and Rationale: intervention the patient’s decreased level of
seemingly patient will response to pain
without an end Acute Pain an verbalize relief therapeutic
making me do unpleasant measures, and a. Uses multiple
of pain,
less chores sensory and adequate make every approaches to
and emotional neurovascular effort to reduce pain
activities”… experience relieve the
as verbalized
function, b. Uses
associated with improved pain and
by the patient medication as
actual or discomfort
mobility, and needed to control
potential tissue
absence of discomfort
damage, or - MAINTAINING - The nurse
complications
OBJECTIVE: described in ADEQUATE monitors the
c. Elevates
terms of such LONG TERM: PERIPHERAL neurovascular
Mild swelling damage. status of the extremity to
on her right
TISSUE
After 24 hours involved body control edema
knee PERFUSION
part and discomfort
of nursing
Unable to intervention, and notifies
d. Moves with
ambulate all the patient will: the primary
by herself provider greater comfort
1. Reports promptly of
2. Exhibits normal
decreased level any
peripheral tissue
of pain indications of
perfusion
diminished
a. Uses multiple tissue a. Exhibits normal
approaches to perfusion. color and
reduce pain temperature of
- IMPROVING
PHYSICAL skin
b. Uses - The primary
medication as MOBILITY provider will
b. Has normal
needed to prescribe the
capillary refill
weight-
control bearing limits response

discomfort and the use of
protective c. Demonstrates
c. Elevates devices intact sensory and
extremity to (orthoses), if motor function
control edema necessary
and discomfort d. Demonstrates
- MONITORING reduced swelling
d. Moves with AND - The nurse
greater comfort MANAGING monitors the
POTENTIAL patient for
2. Exhibits
COMPLICATIO signs of DVT
normal NS as described
peripheral previously and
tissue perfusion promptly
reports
a. Exhibits
findings to the
normal color
primary
and provider for
temperature of management.
skin
b. Has normal
capillary refill
response
c. Demonstrates
intact sensory
and motor
function
d. Demonstrates
reduced
swelling
ASSESSMENT NURSING OUTCOME INTERVENTION RATIONALE EVALUATION

DIAGNOSIS IDENTIFICATION
SUBJECTIVE: Impaired SHORT TERM INDEPENDENT: Expected patient

physical GOAL: outcomes may
“I have this feeling of - Check for - Understand
mobility related include:
difficult to carry myself After 2-4 hours functional level the particular
to decreased of mobility.
and to move everywhere I
of nursing level, guides a. Reports
want to go and even in my
range of
the design of
garden, I used to sit in my motion, muscle intervention the absence of pain
best possible
stool rather that weakness, lack patient will
management b. Uses
stooping”… as verbalized or improper use verbalize
plan. medication as
by the patient of ambulatory adequate
devices. needed to control
neurovascular - Determines
- Evaluate discomfort
function, strengths or
Rationale: patient’s ability
OBJECTIVE: improved insufficiency c. Elevates
to perform
mobility, and Activities of and may give
Impaired extremity to
Respiration rate =17 absence of information
Daily Living control edema
cycle per minute Blood Physical regarding
complications efficiently and and discomfort
pressure = 140/90 Mobility is safely on a recovery.
mmHg. characterized LONG TERM: daily basis. d. Moves with
by inability to
Relatively sedentary greater comfort
move After 8 hours of
- Identifying
Unable to ambulate all purposefully nursing - Assess for e. Demonstrates
barriers to
by herself within the intervention, impediments
mobility (e.g., intact sensory and
physical the patient will: to mobility
chronic motor function
environment,
arthritis
including bed a. Reports
versus stroke
mobility, absence of pain
versus pain)
transfers, and
b. Uses guides design
ambulation,
medication as of an optimal
inability to
treatment
perform action needed to
plan.
as instructed, control
limited ROM, discomfort
and reluctance - Assess the - This
to attempt c. Elevates strength to assessment
movement extremity to perform ROM provides data
control edema to all joints. on extent of
and discomfort any physical
problems and
d. Moves with guides
greater comfort therapy.

Testing by a
e. Demonstrates physical
intact sensory therapist may
and motor be needed
function
VII. DRUG STUDY

Classification Side Effects
Indications and Special Nursing
Drug Name and Mechanism Contraindications and Adverse Precautions Responsibilities
of Action Effects
Generic Name: Classifications: Indications:  Nausea Avoid drinking  Verify doctor’s

Naproxen Nonsteroidal Treatment and alcohol while order
Anti- management for on this
 Constipation  Assess onset,
Inflammatory pain and medication to
Drugs (NSAID) inflammation in reduce the risk type, location,
duration of
osteoarthritis  Abdominal of GI irritation
or bleeding. pain.
Trade/ Brand pain
 Monitor
Name:
 Heartburn blood
Flanax pressure of
patient
 Dizziness
 Take with
Contraindications: food or milk to
Mechanism of Hypersensitivity to  Headache prevent GI
Dosage: Actions: naproxen, and bleeding.
Reduces other NSAIDs  Report
(1500 mg/day)  GI Bleeding
inflammatory immediately if
response, fever, headache, rash,
and intensity of  Diarrhea black or tarry
pain. stools,
bleeding, and
 Gastritis
Route: persistent
headache occurs.
(Oral)
Frequency and
Timing:
(Twice a Day)
Classification
Indications and Side Effects and Special Nursing
Drug Name and Mechanism Contraindications Adverse Effects Precautions Responsibilities
of Action
Generic Classifications: Indications: Relieve  Vomiting Use ketoprofen  Verify doctor’s

Name: Nonsteroidal pain, tenderness, with extreme order
Ketoprofen Anti- swelling, and caution in
 Headache  Assess patient’s
SR Inflammatory stiffness caused by patients with
Drugs osteoarthritis history of GI skin regularly for
signs of rash or
 Irritability bleeding or
ulcer disease other
because hypersensitivity
 Nervousness reaction.
Trade/ Brand NSAIDs, such as
ketoprofen,  Instruct patient
Name: Orudis
 Seizures increase risk of to take
Contraindications: GI bleeding and ketoprofen with
Hypersensitivity to ulceration. food or after
Mechanism of ketoprofen or its  Asthma meals to prevent
Actions: Reduces components. GI upset.
inflammatory  Advise her to
 Respirator
Dosage: symptoms and take drug with a
100mg/caps relieves pain. It full glass of water
ule also causes local  Indigestion and to avoid lying
vasodilation with down for 15 to 30
pain and minutes
 Edema
swelling. afterward to
prevent GI
 Hypertension irritation.
Route:
Oral  If GI distress
occurs, withhold
drug and notify
prescriber
immediately.
Frequency
and Timing:
BID
8:00, 6:00
Classification
of Action
Generic Classifications: Indications:  Palpitations Caution  Verify doctor’s

Name: Antiulcer agent Provide short term patient to order
Famotidine treatment of avoid alcohol
 Dry mouth  Assess patient’s
active duodenal and smoking
epigastric or
ulcer during
abdominal pain.
 Taste famotidine
therapy  Monitor daily
alteration
because it pattern of bowel
Trade/ Brand
 Abdominal activity, stool
Name: Pepcid irritates the
pain stomach and consistency.
can delay  Assess for
 Nausea
Contraindications: ulcer healing. confusion in
Hypersensitivity to elderly.
Mechanism of famotidine, or its  Diarrhea  Advise patient
components. to report if she
Actions:
develops pain,
Dosage:
 Confusion has trouble
20mg/tablet Inhibits gastric
swallowing.
acid secretion to
 Report
helps prevent  Bronchospasm persistent
peptic ulcers symptoms of
from forming heartburn, acid
Route: and helps heal indigestion,
existing ones. sour stomach
Oral
Frequency
and Timing:
BID
8:00, 6:00
Classification and
Drug Name Mechanism of Contraindications Adverse Effects Precautions Responsibilities
Action
Generic Classifications: Indications:  Skin itching Wash hands  Verify doctor’s

Name: Nonsteroidal Anti- after each order
Use to relieve  Rash
Piroxicam Inflammatory application
pain, tenderness,  Blurred  Assess patient’s
0.5% Agents unless it is the
swelling, and level of pain
vision hand that is
stiffness caused
 Local being treated.  Keep away
by osteoarthritis
Trade/ Brand Mechanism of irritation from the eyes
Name: Actions: and mucosal
Feldene Inhibits  Erythema surfaces.
prostaglandin  Dermatitis  Do not apply to
synthesis and any sites
affected by
release through a Contraindications:
open skin
Dosage: reversible inhibition Hypersensitivity to
lesions,
30g of the cyclo- piroxicam
dermatoses or
oxygenase enzyme
infection.
which relieve pain
 If local
and reduce swelling
Route: irritation
affecting joints and
Topical develops, the
muscles when
use of the gel
rubbed into the
should be
skin over the
Frequency discontinued.
affected area.
and Timing:
(Not
mention)
Classification and
Mechanism of
Drug Name Contraindications Adverse Effects Precautions Responsibilities
Action
Generic Name: Classifications: Indications:  Abdominal If the patient  Verify doctor’s

Caltrate Plus Vitamins & Prevention and distension is using a order
Minerals treatment of large amount
Supplements osteoporosis,  Abdominal of calcium or  Administer
calcium and using it for a with food and
pain a full glass of
vitamin D long time,
water to help
Trade/ Brand deficiency.  Constipation there’s need
to check the drug
Name:
patient's absorption
 Diarrhea blood on a  Make sure the
Mechanism of regular basis. patient is not
Actions: Provides taking other
 Flatulence
calcium which is drug with
Dosage:
responsible for Contraindications: same drug
1 tablet strengthening Hypersensitivity to  Nausea components
bones and active ingredients to avoid drug
providing or its other overdose.
 Vomiting
structural components
integrity. Calcium  Hypercalcemia

Route:
is formulated with
Oral
Vitamin D and
other minerals that  Hypercalciuria
are bone
beneficial.
Frequency and
Timing:
OD
8:00
Classification
of Action
Generic Name: Classifications: Indications:  Excessive thirst Make sure  Verify doctor’s
Vitamin B Multivitamins Prevention and the patient is order
 Skin conditions
complex Supplement treatment of not taking
vitamin B  Blurry vision other drug  Assess patient
deficiency.  Nausea with same for signs of
drug vitamin
Trade/ Brand  Vomiting deficiency
components
Name:  Diarrhea before and
of vitamin B
Nephro-Vite periodically
 Skin flushing complex to
avoid drug during therapy
 Abdominal
overdose  Assess
cramps nutritional
that may
Contraindications: status through
lead to nerve
Dosage: Mechanism of Hypersensitivity to 24-hr diet
damage
1000mg/tablet Actions: its drug recall.
Vitamin B components
complex helps
prevent
Route:
infections and
Oral
helps support or
promote cell
Frequency and health, growth of
Timing: red blood cells,
and proper nerve
OD function
8:00
Side Effects
Classification and Indications and Special Nursing
and Adverse
Drug Name Mechanism of Action Contraindications Precautions Responsibilitie
Effects s
Generic Name: Classifications: Indications:  Dry mouth Use cautiously  Verify doctor’s
Orphenadrine/ Muscle Relaxant/ Orphenadrine use to patient with order
Paracetamol Analgesics, to relieve pain and impaired
 Nausea  Monitor
discomfort caused kidney or liver
Antipyretics patient’s vital
by muscle injuries. function and
(Drug Combination)  Constipation respiratory signs
Paracetamol is
dysfunction.
used to treat or  Monitor
Trade/ Brand
prevent pain and  Palpitation serum
Name: Norflex
reduce fever. glucose, and
renal
Mechanism of  Weakness function.
Actions:  Monitor
Orphenadrine acts in daily
 Headache
Dosage: the central nervous pattern of
35mg/ system to produce bowel
muscle relaxant  Drowsiness activity,
450mg 2 Contraindications: stool
tablets effects. Paracetamol Hypersensitivity to consistency.
decreases fever orphenadrine and  Agitation  Administe
paracetamol r after
through inhibiting the
meal to
effects of pyrogens  Tremor prevent GI
on the hypothalamic upset.
Route:
heat regulating  Immediately
Oral  Blurred
centers and by report if
hypothalamic action vision hypersensiti
leading to sweating vit y reaction
occurs.
and vasodilation.
Frequency and
Timing:
TID
PRN
VIII. DISCHARGE PLAN/HEALTH TEACHING

Go to physical therapy as directed:
A physical therapist teaches you exercises to help improve movement and strength, and to
decrease pain in your joints. The exercises also help lower your risk for loss of function. A
physical therapist may move an area with his or her hands. For example, he or she may move
your leg in certain ways to treat osteoarthritis in your hip.
Manage your symptoms:

- Stay active. Physical activity may reduce your pain and improve your ability to do daily
activities. Avoid activities that cause pain. Ask your healthcare provider what type of exercise
would be best for you.
- Maintain a healthy weight. This helps decrease the strain on the joints in your back, hips,
knees, ankles, and feet. Ask your healthcare provider what a healthy weight is for you. He or
she can help you create a weight loss plan if you are overweight.
- Use heat or ice on your joints as directed. Heat and ice help decrease pain, swelling, and
muscle spasms. For heat, use a heating pad on a low setting for 20 minutes, or take a warm
bath. For ice, use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel before
you place it on your joint. Use ice for 15 minutes every hour.
- Massage the muscles around the joint. Massage helps relieve pain and stiffness. Your
healthcare provider or a physical therapist can show you how to do this. If you have hip OA,
another person may need to help you massage the area.
- Use a cane, crutches, or a walker if directed. These help protect and relieve pressure on
your ankle, knee, and hip joints. You may also be prescribed shoe inserts to decrease pressure
in your joints.
- Wear flat or low-heeled shoes. This will help decrease pain and reduce pressure on your
ankle, knee, and hip joints.
IX. ARTICLE/JOURNAL
INTERNATIONAL:
Recommendations for the Reporting of Harms in Manuscripts on
Clinical Trials Assessing Osteoarthritis Drugs: A Consensus
Statement from the European Society for Clinical and Economic
Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal
Diseases (ESCEO)
Background: There is strong evidence of under-reporting of harms in manuscripts on

randomized controlled trials (RCTs) compared with the volume of raw data retrieved from
these trials. Many guidelines have been developed to tackle this, but they have failed to
address some important issues that would allow for standardization and transparency. As a
consequence, harms reporting in manuscripts remains suboptimal.
Objective: The European Society for Clinical and Economic Aspects of Osteoporosis,
Osteoarthritis and Musculoskeletal Diseases (ESCEO) aimed to deliver accurate
recommendations for better reporting of harms in clinical trials manuscripts on anti-
osteoarthritis (OA) drugs. These could help to better inform clinicians on harms recorded in
RCTs and further help researchers conducting meta-analyses.
Methods: Using the outcomes of several systematic reviews on the safety of anti-OA drugs,
we summarized the ways in which harms have been reported in OA RCT manuscripts to date.
Next, we drafted some recommendations and initiated a modified Delphi process that
involved a panel of clinicians and clinical researchers to build an expert consensus on
recommendations from the ESCEO for the reporting of harms in future manuscripts on RCTs
assessing anti-OA drugs.
Results: These recommendations emphasize that all treatment-emergent adverse events (AEs)
should always be taken into account for harms reporting, with no frequency threshold, and
describe how specific AEs should be reported; they also provide a list of the most relevant
organ systems to be considered according to each class of drug for reporting of harms within
the results section of a manuscript. Irrespective of the drug, the ESCEO recommends that total,
severe and serious AEs and withdrawals due to AEs should always be reported; guidance on
the reporting of specific events pertaining to each category is provided. The ESCEO also
recommends the reporting of information on drug effect on biological parameters, with
specific guidance.
Conclusions: These recommendations may contribute to improve transparency in the field of

safety of anti-OA medications. Pharmaceutical companies developing drugs for OA, and
researchers conducting clinical trials, are encouraged to comply with them when reporting
harms-related results in manuscripts on RCTs. The ESCEO also encourages journals to refer to
the ESCEO recommendations in their instructions to authors for the publication of
manuscripts on trials of anti-OA medications.
REFERENCES:
Honvo, G., Bannuru, R. R., Bruyère, O., Rannou, F., Herrero-Beaumont, G., Uebelhart, D., Cooper, C., Arden, N., Conaghan, P. G.,
Reginster, J. Y., Thomas, T., & McAlindon, T. (2019). Recommendations for the Reporting of Harms in Manuscripts on Clinical
Trials Assessing Osteoarthritis Drugs: A Consensus Statement from the European Society for Clinical and Economic Aspects of
Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Drugs & aging, 36(Suppl 1), 145–159.
https://doi.org/10.1007/s40266-019-00667-8
NATIONAL:
Correlation between Family APGAR scores and health-related quality of

life of Filipino elderly patients with knee osteoarthritis
Objectives: This study aims to describe the clinical profile of Filipino patients with knee
osteoarthritis (OA) and correlate their health-related quality of life (HrQoL) with perceived
family support.
Methods: This is a cross-sectional, analytical study of patients seen at the Philippine General
Hospital Arthritis Clinic diagnosed with knee OA using the American College of Rheumatology
classification criteria. Questionnaires for the Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC) v.3.1 and Family APGAR (Adaptation, Partnership, Growth,
Affection and Resolve) were self-administered. Pearson's correlation, analysis of variance and
Bonferroni tests were applied.
Results: Ninety patients with 3 : 1 female-to-male ratio, mean age of 70.14 years qualified for
the study. Mean body mass index was 23.3. Mean duration of symptoms was 5.9 years. Fifty-
three considered their family to be highly functional, 28 moderately dysfunctional and nine
severely dysfunctional. Analysis showed that Family APGAR is moderately and inversely
correlated with pain (r = -0.3373; P = 0.0002), stiffness (r = -0.3642; P = 0.0004), function (r = -
0.3646; P = 0.0004) and total WOMAC scores (r = -0.3880; P = 0.0002). Likewise, there were
significant differences of total WOMAC scores in the pain, stiffness and function subscales (P
= 0.0076, P = 0.0032, P = 0.0165 and P = 0.0159, respectively) between patients in highly
functional and severely dysfunctional families, and between highly and moderately functional
families. As Family APGAR scores increased, there was significant decrease in all WOMAC
subscales.
Conclusion: We described the clinical profile of 90 elderly patients with knee OA and the
relationship of HrQoL to Family APGAR scores. This paper concludes that higher Family
APGAR scores in this population correlated with better HrQoL.
References:
Lim, A. T., Manching, J., & Penserga, E. G. (2012). Correlation between Family APGAR
scores and health-related quality of life of Filipino elderly patients with knee
osteoarthritis. International journal of rheumatic diseases, 15(4), 407–413.
https://doi.org/10.1111/j.1756-185X.2012.01757.x

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ILOILO DOCTOR’S COLLEGE

BACHELOR OF SCIENCE IN NURSING

NCM 114 (RLE)

A Case Study Presented to the Department of Nursing of Iloilo Doctor’s College

PRESENTED TO: MRS.

(BSN III-G GROUP 1)

NOVEMBER 23, 2021

III . ....................................................... PHYSICAL EXAMINATION

IV. ..................................... ANATOMY AND PATHOPHYSIOLOGY

V.. ................. DIAGNOSTICS AND LABORATORY PROCEDURE

VI. ................................................................. NURSING PROCESS

VII. ....................................................................... DRUG STUDY

VIII. ............................DISCHARGE PLAN/HEALTH TEACHING

IX. ............................................................. ARTICLE/JOURNAL

OA is a non-inflammatory degenerative disorder of the joints. It is the most common

• Display confidence in providing nursing care to the client.

II. NURSING HEALTH HISTORY

Past medical history

Present medical history

III. PHYSICAL EXAMINATION

 There is no erythema, bruising and discoloration of the left knee

 There is also no point of tenderness

 Popliteal bulging is seen at right knee posterior aspect.

 Musculature of both knees seems symmetric bilaterally.

 There is no bone deformity.

 On palpation, the left knee joint is not warm or tender.

 There is mild effusion felt.

 Range of movement of the left knee is full.

IV. ANATOMY AND PATHOPHYSIOLOGY

V. LABORATORY AND DIAGNOSTICS

Laboratory test Normal Value Result Significance

 Osteoarthritis of knees – acute exacerbation of right knee.

 Findings: Osteophyte formation joint space narrowing subchondrial and cyst.

VI. NURSING CARE PLAN

ASSESSMENT NURSING OUTCOME INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Acute pain SHORT TERM INDEPENDENT: Expected patient

control bearing limits response

ASSESSMENT NURSING OUTCOME INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Impaired SHORT TERM INDEPENDENT: Expected patient

greater comfort therapy.

VII. DRUG STUDY

Generic Name: Classifications: Indications:  Nausea Avoid drinking  Verify doctor’s

Generic Classifications: Indications: Relieve  Vomiting Use ketoprofen  Verify doctor’s

Generic Classifications: Indications:  Palpitations Caution  Verify doctor’s

Generic Classifications: Indications:  Skin itching Wash hands  Verify doctor’s

Generic Name: Classifications: Indications:  Abdominal If the patient  Verify doctor’s

integrity. Calcium  Hypercalcemia

VIII. DISCHARGE PLAN/HEALTH TEACHING

Manage your symptoms:

Background: There is strong evidence of under-reporting of harms in manuscripts on

Conclusions: These recommendations may contribute to improve transparency in the field of

Correlation between Family APGAR scores and health-related quality of

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