# A nurse is caring for a 68-year-old client with osteoarthritis of the knees. Which nursing intervention should be the priority to help manage the client's pain and maintain joint function? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541075 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a 68-year-old client with osteoarthritis of the knees. Which nursing intervention should be the priority to help manage the client's pain and maintain joint function? ## 보기 1. Encourage complete bed rest to prevent further joint damage 2. Teach the client to perform gentle range-of-motion exercises daily **✔ 정답** 3. Apply ice packs to the affected joints for 30 minutes every hour 4. Advise the client to take over-the-counter NSAIDs without consulting the physician **정답: 2** ## 해설 Gentle range-of-motion exercises maintain joint flexibility, reduce stiffness, and prevent muscle atrophy, effectively managing osteoarthritis pain and function. Other options like bed rest or excessive NSAIDs can worsen symptoms or cause harm. ## 심화 해설 Understanding the Priority: Exercise as First-Line Management For a client with knee osteoarthritis (OA), the priority nursing intervention is to teach and encourage gentle range-of-motion exercises. This is not merely a suggestion for general wellness; it is the cornerstone of conservative, non-pharmacological management as supported by high-level evidence. A Cochrane systematic review confirms that land-based therapeutic exercise provides significant benefits for people with knee OA, specifically in reducing joint pain and improving physical function [2][4]. The goal is to break the pain-inactivity cycle, where pain leads to reduced movement, which in turn causes muscle weakness and joint stiffness, ultimately worsening pain. Why the Other Options Are Incorrect - Option 1 (Complete bed rest) is contraindicated. Immobilization leads to muscle atrophy and joint stiffness, which destabilizes the knee and increases long-term disability. The evidence strongly favors active movement to maintain function [2][4]. - Option 3 (Ice packs for 30 minutes every hour) is an inappropriate application of cryotherapy. While cold therapy can temporarily relieve acute inflammation, applying ice for 30 minutes every hour poses a risk for skin and nerve damage. This intervention does not address the underlying need to maintain joint mobility and muscle strength. - Option 4 (Advise OTC NSAIDs without consulting a physician) is outside the scope of nursing practice and unsafe. A nurse cannot advise a client to initiate a new medication regimen without a provider's order, especially in an older adult who may have contraindications such as renal impairment or gastrointestinal bleeding risk. Pain management is multimodal, but pharmacologic advice requires a prescriber. The Physiologic Basis for Exercise in OA The therapeutic effect of exercise is grounded in joint physiology. Articular cartilage is avascular and relies on the compression and decompression of movement to receive nutrients from synovial fluid and expel metabolic waste. Gentle range-of-motion exercises facilitate this process, nourishing the cartilage and maintaining its health. Furthermore, strengthening the quadriceps and hamstring muscles through isometric or low-impact exercise offloads the knee joint. A recent study on elderly patients with knee OA demonstrated that an isometric exercise intervention directly reduced knee pain perception, highlighting the link between muscle conditioning and analgesia . Stronger periarticular muscles act as shock absorbers, decreasing the mechanical stress placed directly on the damaged cartilage. Translating Evidence to Nursing Practice The priority nursing action is client education on a safe, daily exercise regimen. This aligns with international guidelines that identify exercise therapy as a dominant non-pharmacological intervention for knee OA [4]. A scoping review of randomized controlled trials reinforces that non-pharmacological approaches, including structured exercise, are central to managing chronic degenerative joint disorders like knee OA . The nurse must translate this evidence by teaching the client specific, low-impact activities such as straight-leg raises, quadriceps sets, or seated knee extensions. The focus is on consistency and proper technique to avoid overloading the joint, with the goal of reducing pain and preserving functional independence.References (research sources) - [2]Exercise for osteoarthritis of the knee: a Cochrane systematic reviewMeta-analysis/systematic reviewMarlene Fransen, Sara McConnell, Alison R. Harmer, M. van der Esch, Milena Simić, Kim L. Bennell (2015) · DOI: 10.1136/bjsports-2015-095424 - [4]Exercise for osteoarthritis of the kneeResearch articleMarlene Fransen, Sara McConnell, Alison R. Harmer, M. van der Esch, Milena Simić, Kim L. Bennell (2015) · DOI: 10.1002/14651858.cd004376.pub3 ## 임상 시나리오 Knee OA: ROM Exercise as First-Line PriorityBreaking the pain cycle through daily movement For knee osteoarthritis, the priority nursing intervention is teaching daily gentle range-of-motion exercises. This is the cornerstone of non-pharmacological management, proven to reduce pain and improve physical function by strengthening supporting muscles and maintaining joint mobility. The goal is to interrupt the pain-inactivity cycle, where pain leads to reduced movement, causing muscle atrophy and stiffness that worsen pain. Consistent, low-impact activity is essential; a Cochrane review confirms land-based exercise provides significant benefit. CautionNever recommend complete bed rest, as immobilization accelerates joint damage. Avoid prolonged cryotherapy exceeding 20 minutes per application to prevent skin or nerve injury. Do not advise OTC NSAIDs without a provider's order, as this is outside the nursing scope of practice. ## 핵심 개념 - **Osteoarthritis (OA)** — A degenerative joint disease characterized by cartilage breakdown, causing pain, stiffness, and reduced function, commonly in weight-bearing joints like knees. - **Range-of-Motion (ROM) Exercises** — Gentle movements that take a joint through its full available motion to maintain flexibility, reduce stiffness, and prevent contractures. - **Pain-Inactivity Cycle** — A cycle where joint pain leads to reduced movement, causing muscle weakness and stiffness, which in turn worsens pain and further limits activity. - **Cryotherapy** — The therapeutic application of cold (e.g., ice packs) to reduce acute inflammation, swelling, and pain; requires careful timing to prevent tissue damage. - **Non-pharmacological Intervention** — First-line management strategies for chronic conditions like OA that do not involve medications, such as exercise, weight management, and patient education. ## 같은 주제 문제 - [A nurse is assessing a 65-year-old client with osteoarthritis of the knees. 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