Case study

Sociodemographic data:

Special unit: dar om kolthom

Patient's name:fathia abd el aziz
Sex: female
Date of admission: 2 years ago
Stay period :admitted since 2 years until death
Age: 71 years old
Level of education: diploma
Marital status: widow
Years of retirement; no occupation
Religious: muslem
Occupation before retirement; house wife
Anthropometric measurement
Weight; about 60 kg
Height; about 160 cm
BMI; weight\height 60\1,6
She is an ideal weight
Vital signs
Respiration; 19 c\m
Pulse; 88 b\m
Temperature; 36,5 c
Blood pressure; 110 \70 mmhg
Present history:
Diagnosis / Present illness: knee osteoarthritis -
Predisposing factors: diabetes mellitus -
 Past history:
Medical:

Diagnosis / Duration: diabetes mellitus -

Surgical
-No surgery performed
Allergy history:No

Family history:No

:Patient's Physical Assessment

1. Respiratory system: no abnormalities
2. Circulatory system: high blood sugar
3. Neurological assessment: inflammation of nerves
4. Gastrointestinal system: constipation , dry mucus membranes
5. Urinary system: polyuria
6. Musclo skeletal system: limited range of motion, difficulty in
movement, muscle stiffness, pain with movement ,and knee joint
pain
7. Skin assessment: shrinks, dry, creases
8. Head / hair: white color
9. Eyes: inflammation, cataract
10. Ears: normal
11. Nose: normal
12. Mouth: dry mucus membranes ,partial loss of teeth
13. Neck: normal
14. Activity and rest: limited mobility ,insomnia
Introduction
Osteoarthritis is a chronic disease of the muscle skeletal system,
without systemic involvement.
It mainly a non inflammatory disease of synovial joints and the
most important cause of disability in old age.
Knee osteoarthritis is the most common type.
Incidence and prevalence
Osteoarthritis is the most common joint disease found in 70 % of
the population over 60 years of age in world wide.
affect on all ages especially age over 40 years.
Radiological evidence of osteoarthritis can be found in over 90%
of the population.
Definition of disease:
a degenerative disease of diarthrodial (synovial) joints characterized
by breakdown of articular cartilage and proliferative changes of
surrounding bones.

Pathophysiology of disease:
It is caused by breakdown of cartilage. Cartilage is the tough elastic
material that covers and protects the ends of bones. In healthy
joints ,cartilage acts as a shock absorber when you put weight on the
joint. The slippery surface of the cartilage allow the bones to move
smoothly.
Bits of cartilage may break off and causes pain and swelling in the
joint between bones ,this pain is called inflammation.
Joint osteoarthritis, the cartilage gradually becomes rough and thin,
and the bone underneath thickens. overtime the cartilage may wear
away entirely, and the bones will rub together.
Classification
Primary OA; etiology is nu known
Secondary OA; etiology is known
Stages of OA
Stage I; doubtful (normal)
Stage II; mild
Stage III; moderate
Stage IV; severe

Etiology:
According to patient (actual)
The client complain from secondary
knee OA as a result of diabetes mellitus
According to literature(ideal)
Primary OA ; etiology is un
known
Secondary OA; etiology is
known which result from;
Trauma
Previous joint disorder
Congenital hip dislocation
Infection; septic arthritis
Metabolic disease(gout)
Endocrine disease ; diabetes
mellitus
Hematologic; hemophilia
 Inflammatory; RA

Risk factors
Age; elderly are more common
Sex; males more than females
Obesity; due to stress on the weight-bearing joints
Genetics
Trauma(daily)
Most affected joints
According to patient(actual) According to literature(ideal)
The client has a type of weight-bearing -weight-bearing joints such as
joint which is knee joint 0A hip,knee,feet and spine
-non weight-bearing joint such as
finger joints

signs and symptoms

According to patient(actual) According to literature(ideal)
The client complain from the following Pain especially when moving a
signs; joint
Leg pain Swelling or bumps
Knee Joint pain Sore and stiffness
Difficulty in movement Joint pain
Limitation of range of motion Deformity
Stiffness Limitation of range of motion
Swelling Hard movement(walk and up
stairs)
Hear grating sound when the
roughened cartilage on the
surface of the bones rubs
together

Diagnosis
According to patient(actual) According to literature(ideal)
When I performed discussion with client, History
I have been found; History of signs and symptoms
History And its duration
History of signs and symptoms and I Family history
found knee joint pain, difficulty in Medical history
movement, limitation of range of motion, Surgical history
and stiffness Lifestyle history
Medical history; diabetes mellitus 10 Physical examination
years ago Inspection; observe for signs and
Physical examination symptoms appeared
Inspection; pain in knee joint , stiffness , Palpation; palpate affected joints
difficulty in movement for any swelling pain and
Palpation ; tenderness of knee joint tenderness
Percussion ; when deep tendon reflex Percussion; deep tendon reflex
performed , the client had limited range Diagnostic investigations
of motion Lab tests
Diagnostic investigations Blood test
Lab investigation Endocrine function test
Blood test biopsy from synovial fluid
Blood sugar CSF culture
Radiological investigations Radiological investigations
x-ray x-ray; narrowing of joint space
due to loss of cartilage
CT scan
MRI
Bone cysts
arthroscopy

Complications:
According to patient(actual)
No any complications appeared
According to literature(ideal)
1-The muscles that hold the joint
in place weaken because they are
not being used
2-overtime, the joint losses its
shape and does not work at all
 Management :
According to patient(actual) According to literature(ideal)
Medical Medical
-the client had been taken the following -Take analgesic drugs;
drugs;- acetaminophen to relieve mild to
-Neurovit (vitamin B1,B6,B12); tablets moderate arthritis pain
for diabetes -creams and gels to remove
-Tymer(sterile,ophthalamic solution) 2 temporary pain
drops per day -non steroidal anti- inflammatory
-diamicron;2 tablets daily morning and1 drugs (NSAIDS) such as aspirin
in evening Surgical
-arthroscopy
-osteotomy
-arthroplasty(joint replacement)

Role of nurse through three levels of

prevention:-
1-primary prevention(prevent onset of disease)
A-Health promotion
-diet
Increase calcium intake
Increase vitamins intake such as ( vitamin B1- B6 B12)
Increase dietary food such as(eggs milk milk products)
Decrease fat intake
Low salt diet
Decrease sugar intake

-Exercise
Regular exercise
Avoid straining on bone and joints
Avoid excessive range of motion

-Sleep and rest

Sleep 6-8 hours every day
One or two naps every day
Change position

B-Health Education
-Help client to identify the following
Definition- causes and sings &symptoms of disease
Healthy life style
Expose to sunlight frequently
Advice client to eat high fiber diet such as ( fruit &
vegetables )
Teach client to perform regular exercises without
straining on bones and joint
Teach about importance of personal hygiene specially
foot hygiene

C-Specific protection
Take analgesic
Take local creams and gels
2-Secondary prevention
A-early diagnosis: as before
B-early treatment
-Modification life style habits : as before

3-Tertiary prevention
A-avoid complication
Complete course of treatment
Regular follow up
Tell the doctor if appear any signs of complication
Avoid lifting heavy objects
Avoid straining on bones & joint
B-Rehabilitation
-Physical
Learn client types of medication routs &side effects
-Social
Learn how to prevent recurrence of disease
-Psychological
Teach client how to deal with her disease and give
support

Outline
-socio-demographic data
-physical assessment
-introduction
-incidence & prevalence
-definition
-pathophysiology
-classification
-stages
-causes
-risk factors
-sings & symptoms
-most effected joint
-diagnosis
-complication
-treatment
-role of nurse
-nursing care plan
-reference

Outline
-introduction
-incidence & prevalence
-definition
-pathophysiology
-causes
-risk factors
-sings & symptoms
-most effected joint
-diagnosis
-complication
-treatment
-role of nurse
-nursing care plan
-reference