1. D EGENERATIVE J OINT D ISEASE Santhia Mirtyl, SN

2. I NTRODUCTION Framework of the body Supports tissues Site of blood cell formation Mineral storage Permits movement by providing points of attachment for muscles

4. P ATHOPHYSIOLOGY Osteoarthritis is characterized by local areas of damage and loss of articular cartilage, new bone formation of joint margins, subchondral bone changes, and variable degrees of mild synovitis and thickening of the joint capsule Sclerosis of bone underneath cartilage Formation of bone spurs (osteophytes) Incidence increases with age and trauma Primary disease is idiopathic

5. P REVALENCE Osteoarthritis is the most common form of arthritis. It affects about 27 million people in the United States. It is a leading cause of disability. Osteoarthritis is more common in people who are older, overweight, or have injured a joint.

6. S YMPTOMS AND SIGNS Pain Stiffness Enlargement of the joint Tenderness Limited motion Deformity

7. D IAGNOSTICS X- rays Serum calcium Serum albumin Ionized calcium Erythrocyte sedimentation rate Magnetic resonance imaging Bone scan.

8. P AIN MANAGEMENT Medical Intervention Pharmacologic therapy Salicylates NSAIDs Prednisone Physical therapy Transcutaneous electric nerve stimulator Surgery Arthroplasy Debridement Osteotomy Pain management Analgesic administration Cutaneous stimulation Heat or cold application Touch Exercise therapy Promote muscle relaxation Encourage positive thinking Medical InterventionNursing Intervention http://www.youtube.com/watch?v=W4 2rwWD6zjw

9. C ASE S TUDY Patient is a 65 year old Caucasian female who is complaining of unbearable bilateral knee pain. She states that her knee pain began in 1999 due to an accidental fall at work when she tripped over a ball. Her knees were repaired and her pain had subsided. She reinjured her knees due to another accidental fall in 2000 and was diagnosed with Bilateral Degenerative Joint Disease. She has a burning muscular pain when she attempts to walk short or long distances. Her symptoms have been maintained through physical therapy, antinflammatory medication such as Selebrex and natacotics such as Percocet. X-rays were completed

10. N URSING D IAGNOSIS Impaired physical mobility related to Bilateral Knee Replacement as evidence by reluctancy to ambulate both legs. Risk of infection related to decreased WBC count as evidence by pertinent lab values. Acute pain related to Bilateral Knee Replacement as evidence by grimacing and guarding of both knees. Risk of fall related to Bilateral Knee Replacement as evidence by past accidental falls in the work place and home.

11. NCLEX Q UESTION A 63 year old female has been an avid runner for the past 45 years. The patient complains of stiffness and unbearable knee pain daily, particularly in the evening which has disrupted her ability to go on her evening runs. Her x-ray and bone scan indicates deterioration of articular cartilage. Her physician suspects that she has symptoms and signs associated with degenerative joint disease. Which one of these objective finding would be presented during a focused assessment? A: Decrease in bone cartilage B: Loss of normal function of the knee C: “Bone to bone aching pain” D: Complete blood count

12. NCLEX Q UESTION Osteoarthritis and Rheumatoid arthritis present similar clinical manifestations. What is not a characteristic of Osteoarthritis? Choose all that apply. A: Osteoarthritis is a systemic disease. B: Women are more likely to be diagnosed with osteoarthritis. C: Osteoarthritis is a severe inflammatory disease D: Pain localized at the joints E: Onset usually after age 50 years of age

13. R ESOURCES Brown, M., TBrown, M., T., Murphy, F., T., Radin, D., M., Davignon, I., Smith, M., D., West, C., R. (2012). Journal of Pain. Tanezumab Reduces Osteoarthritic Knee Pain: Results of a Randomized, Double-Blind, Placebo-Controlled Phase III Trial.Murphy, F., TRadin, D., MDavignon, ISmith, M., DWest, C., R Huether, S. E., & McCance, K. L. (2012).Understanding Pathophysiology (5th ed.). St. Louis, MO: Mosby. John M Eisenberg Center for Clinical Decisions and Communications Science. (2012). Managing Osteoarthritis Pain With Medicines. Rosenthal A., K. (2006). Calcium crystal deposition and osteoarthritis. Rheum Dis Clin North Am. 32(2), 401-12. Rheum Dis Clin North Am. Nursing central