Nursing Clinical Practice Guide
Clinical Scenario: Mr. Johnson, a 68-year-old retired carpenter with a history of knee OA, comes to the clinic. He reports his right knee pain has been getting worse over the past month, especially after he started gardening more frequently. He says, "It's fine in the morning, but by the afternoon, after I've been on my feet, it really aches. I have to sit down and put it up."
Nursing Intervention Strategy:- 1AssessmentPerform a focused musculoskeletal assessment. Use the OPQRST mnemonic (Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Time) to characterize the pain. Assess range of motion, crepitus (grating sensation), joint stability, and presence of bony enlargements. Evaluate his gait and use of any assistive devices.
- 2Nursing DiagnosisChronic Pain related to joint degeneration and Impaired Physical Mobility related to pain and stiffness.
- 3Planning & Implementation• Pain Management: Educate on pharmacologic (acetaminophen, scheduled NSAIDs with food) and non-pharmacologic strategies (application of warm compresses before activity to reduce stiffness, cold packs after activity to reduce inflammation and pain).
• Activity & Joint Protection: Teach energy conservation and pacing techniques. Recommend low-impact exercises (swimming, stationary cycling) to maintain muscle strength without stressing the joint. Discuss the use of a cane for walking to reduce weight-bearing stress.
• Weight Management: Collaborate on a nutrition plan if the client is overweight, as even a small weight loss significantly reduces stress on weight-bearing joints.
- 4EvaluationReassess pain levels using a standardized scale. Observe for improved ability to perform ADLs (Activities of Daily Living) and increased participation in desired activities.
Patient Safety and Precautions:
• Monitor for GI upset or bleeding with chronic NSAID use.
• Caution against overactivity that leads to severe pain, as this can cause further joint damage and inflammation.
• Assess home environment for fall risks, especially if the client has instability or uses assistive devices.
Nursing Procedure & Medication Flow
• Patient Education on NSAIDs: "Take ibuprofen with food or milk to protect your stomach. Do not take it on an empty stomach. Report any black, tarry stools or abdominal pain immediately."
• Assistive Device Fitting: When teaching cane use: The handle should be at the level of the client's wrist crease when standing upright. The cane should be held in the hand opposite the affected knee (e.g., right knee pain = cane in left hand) to provide a wider base of support and unload the painful joint.
A Word from Your Senior Nurse
"Remember, our goal with osteoarthritis isn't to cure it—we can't regrow cartilage yet. Our goal is to help the client manage it effectively so they can live their life with the least amount of pain and the greatest amount of function. Listen carefully to their pain story. That 'pain with activity, relief with rest' pattern is your biggest clue that you're dealing with OA, not an inflammatory arthritis. Teaching clients how to balance activity and rest, and how to protect their joints, is some of the most empowering nursing care we can provide."