Nurse Teaching on Complications of Unresolved Osteoarthritis
Nurse educated the patient and caregiver on the complications of unresolved osteoarthritis as follows:
- Damage to the cartilage: Osteoarthritis involves damage to the articular cartilage that covers the ends of bones and allows the bones to glide over each other. Articular cartilage minimizes the friction between the joints and makes the movement easier and pain free. Chronic unresolved osteoarthritis leads to complete lysis of the articular cartilage resulting in loose tissue material. Also, total shrinking of the joint space between the bone surfaces can occur, resulting in bone on bone situation, with extreme pain and tenderness.
- Bone spurs: Damaged bone ends rubbing against each other can result in formation of small, pointed, extra pieces of bone that can be felt as a lump near the joint involved.
- Damage to the support structures in & around joint: Support structures in and around the joints, such as, ligaments and tendons, contribute significantly to the strength and stability of the joint. Chronic unresolved inflammatory activity in the joint can weaken & damage the support structures leading to poor stability of the joint involved.
- Increased fall risk: Damage to the support structures around the joint from chronic inflammatory activity in the joint can result in poor stability of the joint. This can contribute to increased risk for falls and accidents.
- Nerve damage: Inflamed joints can exert pressure on the nerves running close to the joint involved, leading to neuropathy. Individuals can present with signs and symptoms of neuropathy, such as, nerve pain, altered sensation, tingling& numbness along the area of distribution of the involved nerve, sharp radiating burning pain along the distribution of the nerve, and weakness of muscles supplied by the involved nerve.
- Limited range of motion: The pain and swelling can lead to stiffness and limitation in the range of motion (ROM) of the involved joints.
- Compromised independence on ADL/IADL performance: The pain and tenderness with limitation of range of motion in the joints involved can lead to reduced ability and independence on ADL/IADL performance. This can contribute to overall compromised activity and caregiver dependent states.
- Increased risk for clot formation: Reduced activity of the individual with limited ROM of the involved joints, especially of lower extremities, lead to increased pooling of blood in the limb. This can increase the risk for clot formation in the deeper veins of the limb, thus contributing to development of deep vein thrombosis (DVT) and associated complications.
- Bone fracture: Chronic exposure of the bone and joint to inflammation and injury leads to severe damage to the structure of bone, thus weakening the framework, resulting in fracture of the bone.
- Bone death and infection: Chronic inflammatory activity in the joint with swelling can compromise blood supply to the joint. Blood supply to any tissue is important for nutrient and oxygen supply. Reduced blood supply to the joint can lead to compromised nutrient and oxygen supply to the bone ends involved. Over a period of time, compromised nutrient and oxygen supply can result in bone death and increased risk for infection.
- Septicemia: The infection in the bone can enter the blood and spread to distant body sites, resulting in septicemia and consequent complications.
- Anxiety and sleep disturbance: Poor pain control with unresolved arthritis can lead to exacerbation of anxiety and poor quality sleep. Reduced sleep hours and grossly interrupted sleep pattern can lead to daytime sedation and poorly managed stress.