What is a comprehensive nursing diagnosis for a patient with osteoarthritis, considering their medical history and comorbidities?

Nursing Diagnosis for Osteoarthritis

The primary nursing diagnoses for a patient with osteoarthritis are Chronic Pain related to joint degeneration and inflammation, Impaired Physical Mobility related to joint stiffness and pain, and Activity Intolerance related to decreased muscle strength and joint instability. 1

Primary Nursing Diagnoses

1. Chronic Pain

• Related to: Progressive joint degeneration, cartilage breakdown, and inflammatory processes in affected joints 1
• Evidenced by: Patient reports of joint pain worsened by movement, stiffness after periods of immobility (gelling), and pain that substantially affects quality of life 1, 2
• Assessment focus: Pain intensity, location (commonly knee, hip, hand, back), duration, aggravating factors (weight-bearing activities), and impact on daily functioning 1, 2

2. Impaired Physical Mobility

• Related to: Joint pain, stiffness, reduced range of motion, muscle weakness (particularly quadriceps weakness in knee OA), and decreased joint stability 1, 3
• Evidenced by: Difficulty performing activities of daily living, limited joint range of motion, gait disturbances, and reluctance to move affected joints 1, 3
• Assessment focus: Functional limitations in self-care activities, need for assistive devices, joint stability, and proprioception deficits 1

3. Activity Intolerance

• Related to: Muscle weakness, deconditioning from reduced physical activity, pain with movement, and poor cardiovascular fitness 1
• Evidenced by: Fatigue with minimal exertion, decreased endurance, and avoidance of physical activities 1, 3
• Assessment focus: Exercise capacity, muscle strength (especially quadriceps), aerobic fitness level, and sedentary behavior patterns 1, 4

Secondary Nursing Diagnoses

4. Deficient Knowledge

• Related to: Misconceptions about OA being inevitably progressive and untreatable, lack of understanding about available treatment options 1
• Evidenced by: Patient verbalization of misconceptions, non-adherence to recommended core treatments, inappropriate expectations about disease progression 1, 4
• Assessment focus: Patient's understanding of OA pathophysiology, awareness of treatment options, and beliefs about exercise safety 1

5. Imbalanced Nutrition: More Than Body Requirements (if applicable)

• Related to: Excess caloric intake relative to metabolic needs and decreased physical activity 1, 4
• Evidenced by: Body mass index >25 kg/m², weight exceeding ideal body weight for height and frame 1, 4
• Assessment focus: Current weight, BMI, dietary patterns, and willingness to engage in weight loss interventions 1, 5

6. Self-Care Deficit

• Related to: Pain, joint stiffness, and decreased range of motion limiting ability to perform activities of daily living 1, 3
• Evidenced by: Difficulty with dressing, bathing, grooming, or instrumental activities like cooking and housework 1, 3
• Assessment focus: Specific self-care deficits, need for assistive devices (tap turners, dressing aids, walking sticks), and potential for occupational therapy referral 1

7. Risk for Falls

• Related to: Joint instability, muscle weakness, altered gait, pain with weight-bearing, and use of pain medications that may cause dizziness 1, 6
• Assessment focus: Gait stability, balance, home safety hazards, footwear adequacy, and need for mobility aids 1, 6

8. Disturbed Sleep Pattern (if applicable)

• Related to: Joint pain interfering with sleep, difficulty finding comfortable positions 1
• Evidenced by: Patient reports of difficulty falling asleep or staying asleep due to pain, daytime fatigue 1
• Assessment focus: Sleep quality, pain patterns at night, and impact on daytime functioning 1

9. Anxiety or Ineffective Coping (if applicable)

• Related to: Chronic pain, functional limitations, fear of disability progression, and impact on quality of life 1
• Evidenced by: Patient verbalization of worry about future disability, mood changes, social withdrawal 1
• Assessment focus: Presence of depression or anxiety symptoms, coping mechanisms, and need for psychosocial support 1

Critical Assessment Considerations for Comorbidities

When formulating nursing diagnoses, assess for comorbidities that compound OA effects and influence treatment selection: 1

• Cardiovascular disease: Impacts NSAID safety and exercise prescription 1, 4
• Hypertension: Requires monitoring with NSAID use 1
• Gastrointestinal bleeding risk: Necessitates gastroprotection with NSAIDs 1
• Chronic kidney disease: Contraindicates or requires dose adjustment of NSAIDs 1
• Heart failure: Limits NSAID use due to fluid retention risk 1
• Diabetes: May be worsened by corticosteroid injections 5
• Depression/anxiety: Requires integrated mental health management 1

Common Pitfall to Avoid

Do not formulate nursing diagnoses in isolation from the comprehensive, multimodal treatment plan required for OA. The nursing diagnosis must directly link to interventions addressing core treatments (exercise, weight loss, education) and adjunctive therapies (pain management, assistive devices, self-management strategies), not just symptom documentation. 1 Each diagnosis should guide specific, measurable nursing interventions that prioritize functional outcomes and quality of life over mere pain scores. 1, 3