Central Luzon Doctors’ Hospital Educational Institution

San Pablo, Tarlac City

CASE STUDY
On
Osteoarthritis

Prepared by:

John Lee Dela Cruz

BSN IV-C

Group 12

Ms. Mary Ann Pangan RN, MSN

Clinical Instructor
 I. Introduction

For the purpose of privacy and confidentiality, the real name of the patient in this Case Study is
withheld and she will referred to as “Mr. A” throughout the entire document.

Mr. A is a 54 year old female and currently residing in Purok Ilang Ilang, Plastado, Gerona,
Tarlac together with her wife. For further evaluation, hence, he was admitted at Central Luzon Doctors’
Hospital with the chief complaint of lower back pain.

Osteoarthritis is a chronic, nonsystemic disorder of joints characterized by degeneration of articular

cartilage. Women and men are affected equally, the incidence increases with age. Cause is still unknown,
most important factor in development is aging, other include obesity and joint trauma. Weight bearing
joints in spine, knees and hip and the terminal interphalangeal joints in fingers are most commonly
affected.

OA is the most common form of arthritis, and the leading cause of chronic disability in the United States.
It affects about 8 million people in the United Kingdom and nearly 27 million people in the United States.

Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. A
variety of causes—hereditary, developmental, metabolic, and mechanical—may initiate processes leading
to loss of cartilage. When bone surfaces become less well protected by cartilage, bone may be exposed
and damaged. As a result of decreased movement secondary to pain, regional muscles may atrophy, and
ligaments may become more lax

The main symptom is pain, causing loss of ability and often stiffness. "Pain" is generally
described as a sharp ache, or a burning sensation in the associate muscles and tendons. OA can cause a
crackling noise (called "crepitus") when the affected joint is moved or touched, and patients may
experience muscle spasm and contractions in the tendons. Occasionally, the joints may also be filled with
fluid. Humid and cold weather increases the pain in many patients

OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips
and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints
appear larger, are stiff and painful, and usually feel worse, the more they are used throughout the day,
thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the
distal interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form,
and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at
the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these
physical changes before they experience any pain.
II. Assessment

Nursing Health History A

Patient: Mr.A

Age: 53 years old Sex: Male

C/S:married Religion: Roman Catholic

I. CHIEF COMPLAINT

Lower back pain

II. HISTORY OF PRESENT ILLNESS

A day prior to admission patient experienced severe lower back pain

which caused him difficulty doing his job.

III. MEDICAL HISTORY (includes dates, complications, if any)

A. PAST Pediatric and Adult Illness:

Mumps Pertusis HPN

Measles  Rheumatic Heart Disease

Chicken Pox  Pneumonia Hepatitis

Rubella Tuberculosis Others

B. Immunization/Test:
 BCG  Hepa B For Pneumonia

DPT Measles Others

OPV Flu

C. Hospitalizations:

He was hospitalized for 5 times due to fever.

D. Injuries:

He had no injuries.

E. Transfusions:

The patient did not receive any blood transfusions.

F. Medications:

Before admission he usually took alaxan for lower backpain.

G. Allergies:

She had reported not having any allergies to either food groups or drugs.

IV. FAMILY HISTORY

Age Family Member Cause of death Disease Present in the Family

L D
* Paternal grandfather old age none
* Paternal Grandmother old age none
* Maternal Grandfather Accident none
Maternal Grandmother none
78 Mother none
79 * Father none
49 Wife none

III. SOCIAL AND PERSONAL HISTORY

Date of Birth: june 26, 1957 Birthplace: Purok Ilang Ilang, Plastado, Gerona,
Tarlac
Educational Attainment: elementary graduate Ethnic Background: Ilocano
Position in the Family: father Language : Ilocan, Kapampangan, Tagalog

A. Residence/ Home Environment

Mr. A and his wife currently reside in Purok Ilang Ilang, Plastado, Tarlac. Their
house is constructed with concrete and wood and stands near the rice fields. They
do have ceiling and adequate light source. According to him, the space is
adequate enough for them.

B. Occupation:

Mr. A is currently a jeepney driver at Gerona.

C. Financial Support System:

Mr. A mostly gets their finances from his work as a jeepney driver which is
sufficient to provide their daily expenses.

D. Habits (tobacco/alcohol use, others)

Mr. A drinks alcohol occasionally and smokes ½ pack of cigarette per day.

E. Diet (meal distribution, others):

 Mr. A eats three times a day. He is fond of eating vegetables, itlog and usual
barrio dishes which they can get from their backyard and sometimes eats meat
occasionally.

F. Physical Activity/Exercise, if any:

His work as a driver is his form of exercise.

G. Brief Description of Average Day:

Mr. A usually wakes up around 4 am. Around six am he then starts his usual
work. He takes his meal at regular time and take a nap in the afternoon. He usually
sleeps around 8 pm.

IV. PHYSICAL EXAMINATION FINDINGS

1. SKIN

Area/ Feature to assess Technique Key Findings

Color Inspection Brown complexion
Lesions Inspection and Absence of lesion
Palpation
Moisture Palpation dry.

Texture Palpation Smooth and even.

Mobility and Turgor Palpation Returns immediately to its normal position when
pinched, no tenting noted.

2. HAIR
Area/Feature to assess Technique Key findings
Color and Distribution Inspection Hair is black and well distributed.
Texture and Oiliness Palpation Fine texture and smooth to touch.
Infestation Inspection No infestation.

3. SCALP

Area/Feature to assess Technique Key findings

Scaliness and scars Inspection No scars and scaliness.
Tenderness, Lesions, Palpation Absence of lesion, tenderness and lumps; smooth and
lumps, masses intact.

4. SKULL

Area/Feature to assess Technique Key findings

Shape and symmetry Inspection Symmetrical.
Contour, Masses, Palpation Smooth, non-tender and free from masses and
Depression and depression.
Tenderness

5. FACE

Area/Feature to assess Technique Key findings

Facial Feature Inspection Proportion to the gross body structure.
Edema and Masses Inspection No tender areas, masses, edema or deformities.
Palpation

6. EYES

Area/Feature to assess Technique Key Findings

Size Inspection Round and symmetrical

Sclera Inspection White, moist and glossy

Iris & pupil Inspection Iris are equal in size and pupils
are rounded about 2mm equal in
both eyes and symmetrically
responsive to light

Visual Acuity When the patient looks straight

ahead, she can see objects in the
outside edge and periphery. Both
eyes are coordinated and move in
a union with parallel alignment.
The patient shows evidence of in
 clear sight of objects with proper
identification and distinction.

7. EARS

Area/Feature to assess Technique Key findings

External and internal ear Inspection Symmetrical with upper attachment at eye corner
level, there is absence of cerumen or any discharge.

Firm, smooth and free from lesions and pain.

Palpation
Auditory acuity Inspection The numbers whispered to both ears with one ear
occluded at a time were heard clearly.

8. NOSE AND SINUSES

Area/Feature to assess Technique Key findings

Nose Inspection and Located symmetrically, proportion to the face.
Palpation Presence of nasal flaring. The nasal bridge is aligned,
and is without swelling, bleeding, lesion or masses.

Nasal cavities Inspection Mucosa is pink without swelling.

Nasal sinuses Palpation There is no pain or discomfort felt upon palpating the
frontal and maxillary sinuses.

9. MOUTH AND PHARYNX

Area/Feature to assess Technique Key findings

Lips Inspection Slightly dark in color, quite dry but no ulcers present.
Gums Inspection Gums are pink, smooth and moist. There is absence
of swelling, inflammation, or bleeding.
Teeth Inspection Incomplete teeth and presence of cavities
Tongue Inspection Pinkish. Dorsal and ventral surface are both smooth
and mobile.
Palate Inspection Palates are concave and pink. Soft palate is smooth
and hard palate has ridges.
Tonsils Inspection Tonsils are symmetrical and there is no swelling.

10. NECK

Area/Feature to assess Technique Key findings

Symmetry and Inspection and The patient’s neck is mobile and proportion to the
Masculature Palpation gross body structure. The trachea is in its normal
midline position. There is absence of neck vein
engorgement, masses, or scars.
Lymph nodes Palpation The lymph nodes are normal in size and shape. No
pain felt upon palpation.

11. THORAX AND LUNGS

A. POSTERIOR THORAX

Area/Feature to assess Technique Key findings

Lesions Palpation Posterior thorax is free from tenderness and lesion.
Breath sounds Auscultation Absence of rales.

B. ANTERIOR THORAX

Area/Feature to assess Technique Key findings

Symmetry, Rhythm Inspection Thorax rises and falls in unison with respiratory
cycle.
Sound Auscultation Absence of rales.

12. HEART

Area/Feature to assess Technique Key findings

Heart sound Auscultation No murmur, clear.
Point of maximal Auscultation PMI was located on the 4th to 5th intercostal space left
impulse(PMI) midclavicular line or the apical area.
Heart beat Auscultation 81 cardiac cycle/min.

13. ABDOMEN

Area/Feature to assess Technique Key findings

General appearance of the Inspection The 4 quadrants and 9 regions were correctly
abdomen identified
Sound Auscultation Decreased bowel sounds
Percussion The abdomen has a dull sound
Tenderness Palpation Tenderness on RUQ, smooth.

14. UPPER and LOWER EXTREMITIES

Area/Feature to assess Technique Key findings

Extremities Inspection and Peripheral pulses were strong and palpable.
palpation Extremities are proportion to the gross body
structure, normal in color and mobile. All body parts
are present. Peripheral IV access at right arm with no
signs of phlebitis and infiltration.
Radial pulse rate at 81bpm.

15.GENITAL: Unable to perform.

16. NAILS
Area/Feature to assess Technique Key findings
Color, shape and texture Inspection and Transparent, smooth and convex with a 160˚ nail bed
Palpation angle.
Capillary refill Palpation and 1-2 sec.
Inspection
Lesion Inspection No lesion

V. REVIEW OF SYSTEM: Conducted on July 29, 2010

General Description:

Weight Loss: Fatigue: Anorexia:

Night Sweats: Weakness:

Skin

Itch: Bruising:

Rash: Bleeding:

Lesions: Color Change:

Eyes:
 Pain: Itch: Vision Loss:

Diplopia: Blurring: Excessive Tearing:

Glasses/Contact Lenses:

Ears:

Ear aches Discharge Tinnitus Hearing Loss

Nose:

Obstruction Epistaxis Discharges

Throat and Mouth:

Sore Throats Bleeding Gums Tooth Aches

Neck:

Swelling Dysphagia Hoarseness Others:

Chest:

Cough Sputum: (Amount & character) Hemoptysis

WheezePain on respiration Dyspnea

Breast: Lumps Pain Bleeding Discharged

CVS:

Chest Pain Palpitation Dyspnea on Exertion Edema

PND Orthopnea Others:

GIT:

Food Intolerance Heartburn Nausea Jaundice

 Vomiting Epigastric Pain Bloating Excessive Gas

Constipation Chance in BM Melena

GU:

Dysuria Nocturia Retention Polyuria Dribbling

Hematuria Flank Pain

Male: Penile Discharged Lesion Testicular Pain Others

Extremities:

Joint Pains Varicose veins Claudication

Edema Stiffness Deformities

Neuro:

Headaches Dizziness Memory Loss Fainting

Numbness Tingling Paralysis: (location) Paresis: (location)

Seizures Others:

Mental Health Status:

Anxiety Depression Insomnia

Sexual Problems Fear

VI. CLIENT PROFILE (July 29, 2010)

Nursing Health History B

A. General Description of the Client

Mr. A has a large body built, signs of discomfort were noticed and complaints
of mild pain. He is oriented to time, places and persons. He is attentive and cooperative when asked. His
speech is even and moderately paced with appropriate words in a calm and understandable voice.

B. Health Perception- Health Management Pattern

He believes that health is important because if illness persists a person will not be
able to do daily activities.

C. Nutritional Metabolic Pattern

 He does not have any known allergies to any foods or drugs. He is fond of eating
vegetables and fish. He usually eat meat and meat products occasionally

D. Elimination Pattern .

Mr. A voids almost 4-6 times a day, defecates once a day.

E. Activity- Exercise Pattern

He considered his work as his form of exercise.

F. Sleep-Rest Pattern

Mr A usually wakes up around 4 o clock in the morning and sleeps around 8 in the evening.
He usually takes a nap in the afternoon.

G. Cognitive-Perceptual Pattern

He was oriented to time, place and person. He was able to communicate well and
accommodate questions.

H. Sexuality-Reproductive Pattern

He is sexually active and has 5 children.

I. Coping –Stress Tolerance Pattern

He consulted a medical practitioner hoping that it can help her regain her health. He also
took medicines to temporarily relieve her pain, and performed her usual activities as not to feel that she’s
sick.

L. Value- Belief Pattern

Mr. A believes on scientifically based health assistance. Every Sunday he goes to mass.
VII. LABORATORY July 20,2010

Routine Blood Count (RV) (RV)

WBC 7.82 4.23 - 9.07x10^3/uL RBC 4.72 4.63 - 6.08x10^3/uL

Neutro% 43.4 34.0 - 67.9 HGB 14.1 13.7 - 17.5g/dL

Lympho% 43.2 21.8 - 53.1 HCT 40.6 40.1 - 51.0%

Mono% 9.1 5.3 - 12.2 MCV 86 79.0 - 92.2fL

Eo% 3.7 0.8 - 7.0 MCH 29.9 25.7 - 32.2pg

Baso% 0.6 0.2 - 1.2 MCHC 34.7 32.3 - 36.5g/dL

Neutro# 3.39 1.78 - 5.38x10^3/uL RDW-CV 12.3 11.6 - 14.4 %

Lympho# 3.78 1.32 - 3.57x10^3/uL RDW-SD 37.9 35.1 - 43.09fL%

Mono# 0.71 0.30 - 0.82x^3/uL PLT 324 163 - 337x10^3/uL

Eo# 0.24 0.04 - 0.54x^3/uL

Baso# 0.05 0.01 - 0.08 x^103/uL

Fasting blood sugar

Glucose 6.7 mmol/ L 4.1 – 5.9 mmol/ L

Cholesterol 6.0 mmol/ L >5.2 mmol/ L

Triglycerides 2.26 mmol/ L >1.69 mmol/ L

Urea Nitrogen 3.5 mmol/ L 3.7 – 7.71 mmol/ L

Creatinine 73 mmol/ L 71 – 133 mmol/ L

Urine analysis

Transparency Slightly turbid

Color Yellow
Occult blood Negative
Bilirubin Negative
Urobilirubin 0.2 EU/DL
Ketone Negative
Protein Negative
Nitrate Negative
Glucose Negative
1
Reaction 7.0
SP gravity 1.015
Leukocytes Negative
Pus cells 0 – 2/ HPF
RBC 0- 1/ HPF
Epithelial Cells Few
A phosphates Few
A urates Few

Bacteria Moderate

PATHOLOGY AND PHYSIOLOGY

MODIFIABLE NON MODIFIABLE

FACTORS FACTORS
• Injury • AGE
• obesity • SEX
• RACE

Articular cartilage
becomes rough, frayed
and cracked

THE SURFACE OF THE

CARTILAGE BREAKS DOWN
AND WEARS AWAY

BONES BEGINSTO RUB TOGETHER

Joint cartilage and

PAIN
underlying deteriorates
STIFFNESS
resulting in micorfractures
SPURS
LOSS MAY
Articular
OF GROW
boneAT THE
cartilage
MOTION
of subchondral
BITSBONE
becomes RUBS
OF BONE
rough AND
and
SURFACE
OFEACH
JOINT OF THE JOINT
CARTILAGE
cracked OTHER
BREAKS OFF
LOSS OF ELASTICITY
Cues Nursing Scientific Planning Intervention Rationale Evaluation
Diagnosis Explanation

S> “masakit ang Impaired bed Tissue destruction After 30 minutes Determine pt. To assess After 30 minutesof
likod ko pag mobility r/t pain cause inability to of nursing level of mobility functional ability nursing
gumagalaw ako move from one interventions, intervention,
mula sa pagkahiga bed position to patient will be patient identified
ko” another due to able to identify techniques to
Encourage to take This prevent
manifestation of techniques to enhance bed
deep breaths, atelectasis and
the disease enhance bed mobility like
cough, reposition pneumonia
condition mobility. practicing the range
O> self, drink
of motion
adequate fluids
 always lying
flat on bed
 with limited
Teach proper Immobility and
movements
 assisted when range of motion muscle weakness
moving by the and self care from connective
spouse activities tissue changes
 unable to sit up contribute to
in bed contractures
 with pain in the
lower back;
pain scale: 4/10

Assist pt. in his To promote

activities optimal level of
function

Being in vertical
Periodically position reduces
position the the work of the
patient on upright heart and also
sitting position as improves lung
tolerated compliance

Involve client’s To assist in

learning ways of
SO in care managing
problems of
immobility.

If movement
To relieve pain
intensifies pain,
administer
analgesics as
ordered
 CUES NURSING SCIENTIFIC PLANNING INTERVENTION RATIONALE EXPECTED
DIAGNOSIS EXPLANATION OUTCOME
S: Constipation Decrease in normal After 8 hours 1. Identify contributing > Establish baseline After 8 hours of
“Nahihirapan related to frequency of of giving factors associated with data. proper nursing
akong immobility. defecation appropriate constipation. intervention
dumumi.” accompanied by nursing patient was able to
difficulty or intervention the 2. Auscultate characteristics >This reflects bowel identify ways to
O: incomplete passage patient will of the abdominal sounds. activity. increase peristaltic
>weak of stool and passage increase movement.
inappearance of excessively hard, peristaltic 3. Promote adequate fluid >Promotes passage of
dry stool due to movement. intake including high fiber soft stools
>reports of decreased in fruit juices.
abdominal peristalsis.
pain or 4. Encourage exercise >Stimulates
cramping within limit. contractions of the
intestines.

>decreased 5. Provide privacy and >So that the client can

bowel sounds routinely schedule time for response to urge.
defecation.

6. Administer stool >Used to soften stools

softeners as ordered by the for easy defecation.
physician.
 Drug Name Dosage Classification Action Indication Contra- Side Adverse Nursing Responsibilities
Indication Effects Effect
Celecoxib 200 mg 1 Nonsteroidal Inhibitor To relieve signs Hypersensitivity Nausea, gastric >Administer with meals,
tab OD Anti- and and symptoms reaction to drugs vomiting, ulceration foods or milk to minimize
inflammatory primarily of osteoarthritis. dizziness, ,kidney GI adverse effect.
Drugs inhibits headache failure,ble
(NSAIDs) this eding and
isoform of ulcers in >Instuct the patient to
cyclooxyg the avoid sudden change in
enase stomach movement.
and
intestine
>Inform the client that
nausea, vomiting,
dizziness and headache
can be experience and not
to be worried because
these are only the drug’s
side effects

>Prepare a kidney basin

for possible vomiting
 Drug Name Dosage Classification Action Indication Contra- Side Adverse Nursing Responsibilities
Indication Effects Effect
Lyrica 100 mg 1 Anticonvulsant Binds Management of Hypersensitivity Dizziness, headache Monitor VS
cap OD/ with high neuropathic pain to any somnolenece, blurred
lunch affinity to associated with component of dry mouth vision, Advise to take medication
the alpha diabetic the product, peripheral diplopia, with or without food
delta site peripheral including edema, constipati
in CNS neuropathy lactose. asthenia, on Do not stop drug
tissues. ataxia, abruptly
Binding Lactation confusion,
may be Do not perform activities
involved that require mental
in alertness
pregabalin
s Advise to report any
antinocice
unexplained muscle pain,
ptive and
anti weakness or tenderness
seizure
effects
 Drug Name Dosage Classification Action Indication Contra- Side Adverse Nursing Responsibilities
Indication Effects Effect
Cozaar 100 mg/ Antihypertensiv Completel Antihypertensiv Use during URTI, asthenia, • Monitor patients
tab OD e, angiotensin y blocks e alone or in second and third dizziness, fatigue, BP.
Losartan potassium II receptor the combination trimesters of cough , headache, • Monitor patients
blocker angiotensi with other pregnancy due to diarrhea, insomnia who are also
n AT1 antihypertensive possible injury sinus edema, taking diuretics
receptor drugs and death to disorder, chest pain for symptomatic
located in developing fetus. nasal hypotension.
vascular Use in children congestion, • Assessmpatients
smooth less than 6 y/o. dyspepsia renal function
muscle heartburn, • Tell patient to
and the pain avoid salt
adrenal substitutes
glands,
thus
blocking
the
vosoconstr
ictor and
aldosteron
e secreting
effectd of
angiotensi
n II . thus
BP is
reduced
 Drug Name Dosage Classification Action Indication Contra- Side Adverse Nursing Responsibilities
Indication Effects Effect
Rosuvastatin 20 mg/ Anti- hyperlipi A fungal an adjunct to hypersensitivity, Nausea, dyspnea,
calcium tab demic metabolite diet in the impaired hepatic dyspepsia, pneumoni Administer drug at bed
that treatment of function, diarrhea, a time
inhibits elevated total alcoholism, renal vomiting, constipati •
the cholesterol, impairment, rhinitis, on, Monitor patient closely
enzyme mixed advanced age, sinusitis, for signs of muscle injury,
(HGM- dyslipidemia, hypothyroidism cough, especially higher doses
CoA) that atherosclerosis, •
catalyzes Provide comfort measures
the first to deal with headache,
muscle cramps, or
step in the nausea
•
cholestero
Offer support and
l synthesis encouragement to deal
pathway, with disease, diet, drug
resulting therapy
in a
decrease
In serum
cholestero
l, serum
LDLs
(associate
d with
increased
risk of
coronary
artery
disease)
and either
an
increase
or no
change in
serum
HDLs
(associate
d with
decreased)
 Drug Name Dosage Classification Action Indication Contra- Side Adverse Nursing
Indication Effects Effect Responsibilities
Hydrochlorothiazid 25 mg 1 Diuretic, Inhibits Hypertension Contraindicated Nausea, Orthostatic • Check for
e tab OD thiazide reabsorpti as sole therapy with allergy to anorexia, hypotension rashes and
on of or in thiazides, vomiting, dry Photosensitivi temperature
sodium combination sulfonamides; mouth, ty, rash, elevation daily
and with other fluid or polyuria purpura, • Assess for
chloride in antihypertensi electrolyte exfoliative confusion
distal ves imbalance; renal dermatitis, • Assess fluid
renal disease (can lead hives, volume status
tubule, to azotemia); alopecia • Monitor
increasing liver disease electrolytes
the (risk of hepatic
excretion coma); anuria.
of sodium,
chloride,
and water
by the
kidney.