# A nurse is caring for a 65-year-old client with osteoarthritis of the hands. Which nursing intervention should be the priority to help manage the client's pain and maintain joint function?

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## 문제

A nurse is caring for a 65-year-old client with osteoarthritis of the hands. Which nursing intervention should be the priority to help manage the client's pain and maintain joint function?

## 보기

1. Encourage gentle range-of-motion exercises and low-impact activities such as swimming or walking **✔ 정답**
2. Recommend complete bed rest to prevent further joint damage
3. Apply ice packs to the affected joints for 30 minutes every hour
4. Advise the client to take high-dose NSAIDs continuously for maximum pain relief

**정답: 1**

## 해설

Gentle range-of-motion exercises and low-impact activities maintain joint mobility and prevent stiffness in osteoarthritis without exacerbating pain. Other options may worsen symptoms or have risks.

## 심화 해설

Understanding Osteoarthritis and the Rationale for Priority Intervention

Osteoarthritis (OA) is a degenerative joint disease characterized by the progressive breakdown of articular cartilage, leading to pain, stiffness, and functional impairment. In OA of the hands, the carpometacarpal (CMC) joint at the base of the thumb and the distal and proximal interphalangeal (DIP and PIP) joints are commonly affected. The underlying pathophysiology involves a cycle of mechanical stress, low-grade inflammation, and failed repair mechanisms, which results in osteophyte formation and joint space narrowing. The cornerstone of management, as strongly endorsed by the 2019 American College of Rheumatology/Arthritis Foundation Guideline, is a comprehensive non-pharmacologic approach [1][3].

Analysis of the Correct Answer (Option 1)

Encouraging gentle range-of-motion (ROM) exercises and low-impact activities is the priority intervention. This recommendation is classified as a strong recommendation in the management of hand OA [1][3]. The mechanism of benefit is multifactorial. Gentle ROM exercises help maintain joint mobility by stretching the joint capsule and preventing contractures, which are common as patients avoid movement due to pain. Low-impact activities, such as swimming or walking, strengthen the periarticular muscles without subjecting the damaged cartilage to excessive compressive loads. Stronger muscles act as dynamic stabilizers, offloading stress from the joint and reducing pain. A systematic review and meta-analysis further supports the efficacy of non-pharmacological interventions, including exercise, as a first-line strategy for improving pain and physical function in elderly patients with OA [4]. This approach addresses both pain management and the preservation of joint function without the risks associated with pharmacologic agents.

Analysis of Incorrect Answers

**Option 2: Recommend complete bed rest to prevent further joint damage.**

This intervention is contraindicated. Prolonged immobilization leads to muscle atrophy, joint capsule tightening, and increased stiffness, which paradoxically worsens pain and functional decline. The guidelines do not recommend bed rest; instead, they emphasize activity and self-efficacy as critical components of OA management [1]. The goal is to maintain function, not to eliminate all joint loading, as controlled mechanical stress is essential for cartilage nutrition and health.

**Option 3: Apply ice packs to the affected joints for 30 minutes every hour.**

While thermal modalities, including the application of cold, are conditionally recommended for short-term pain relief in hand OA, the specific protocol described here is excessive and potentially harmful [1][3]. Applying ice for 30 minutes every hour can cause skin damage, nerve injury, and excessive vasoconstriction. The standard recommendation for cryotherapy is typically 10 to 20 minutes with a protective barrier, applied several times a day as needed. More importantly, this is an adjunctive, symptom-focused measure, not a priority intervention for maintaining long-term joint function.

**Option 4: Advise the client to take high-dose NSAIDs continuously for maximum pain relief.**

This recommendation directly contradicts current evidence-based guidelines. The 2019 ACR/AF guideline conditionally recommends against the chronic, continuous use of non-selective NSAIDs, including high-dose regimens, in favor of using the lowest effective dose for the shortest necessary duration due to significant gastrointestinal, renal, and cardiovascular risks [1][3]. Pharmacologic therapy is an adjunct to, not a replacement for, a core non-pharmacologic treatment plan. The priority is to initiate management with the safest and most effective long-term strategies, which are exercise and self-management education [1].References (research sources)

- [1]2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and KneeGuidelineSharon L. Kolasinski, Tuhina Neogi, Marc C. Hochberg, Carol A. Oatis, Gordon Guyatt, Joel A. Block (2020) · DOI: 10.1002/acr.24131

- [3]2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and KneeGuidelineSharon L. Kolasinski, Tuhina Neogi, Marc C. Hochberg, Carol A. Oatis, Gordon Guyatt, Joel A. Block (2020) · DOI: 10.1002/art.41142

- [4]Efficacy of non-pharmacological interventions for knee osteoarthritis in the elderly: A systematic review and meta-analysis.Meta-analysis/systematic reviewLiu D, Yu G, Li Y, Song G, Jia Q. (2026) · DOI: 10.1097/md.0000000000048984

## 임상 시나리오

Hand Osteoarthritis: First-Line Exercise PrescriptionStrongly recommended by ACR/AF 2019 Guidelines
The priority intervention is gentle active range-of-motion (ROM) exercises combined with low-impact aerobic activities such as swimming or walking. This approach strengthens periarticular muscles to act as dynamic stabilizers, offloading stress from the damaged cartilage without excessive compressive load.

Exercise should be performed within a pain-free range. Instruct the client to move each affected joint through its full available arc 2-3 times daily. Low-impact aerobic activity should be accumulated to at least 150 minutes per week to improve overall joint health and reduce systemic inflammation.

CautionDo not confuse OA management with acute injury protocols. Complete bed rest is contraindicated as it promotes contractures and muscle atrophy. Heat therapy (e.g., warm paraffin bath) is often preferred over ice for chronic stiffness before exercise, while ice may be reserved for acute flare-ups.

## 핵심 개념

- **Osteoarthritis (OA)** — A degenerative joint disease marked by progressive cartilage breakdown, leading to pain, stiffness, and functional impairment, commonly in hands, knees, and hips.
- **Range of Motion (ROM) Exercises** — Movements that take a joint through its full available arc of motion to maintain flexibility, prevent contractures, and lubricate the joint.
- **Periarticular Muscles** — Muscles surrounding a joint that act as dynamic stabilizers, absorbing shock and reducing mechanical load on the articular cartilage.
- **Osteophyte** — A bony outgrowth or bone spur that forms at joint margins in OA due to attempted repair of damaged cartilage, contributing to pain and deformity.
- **Non-pharmacologic Intervention** — First-line OA treatments including patient education, exercise, weight loss, and thermal modalities, recommended before or alongside medications.

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