S.S.

AGRAWAL COLLEGE OF NURSING

TRAINING COLLEGE AND RESEARCH
CENTER,NAVSARI.

SUB - MEDICAL SURGICAL NURSING

TOPIC – Medical Care plan on Osteoarthritis

SUBMITTED TO, SUBMITTED BY,

MRS.POONAM PATEL MS AVNI PATEL
ASSO. PROFESSOR 2nd YEAR M.SC (N)
SSAGCON,NAVSARI SSAGCON,NAVSARI

DATE OF SUBMISSION
03-7-21

OUTLINE

1
 Introduction
 History collection
 Physical examination
 Investigation
 Pharmacological management
 Theory application
 Nursing process
 Diet
 complication
 Health education
 Home remedies
 Summary
 Conclusion
 Bibliography

INTRODUCTION
2
Name- Patel Avni c.

Class- Second year M.sc Nursing

Topic- Medical care plan on osteoarthritis

Date-03-6-22

Introduction

As a part of our clinical experience in medical surgical nursing,we posted in

civil hospital for training.I selected one patient for my care plan requirement.

HISTORY COLLECTION

3
INFORMATION DATA
Name- Mr. Karsandas A. Nayka
Age- 78 year
Sex- Male
Address- Sardar patel township ,Navsari
Education- B.A
Religion- hindu
Occupation- clerk
Bed number-5
Ward- Male Ortho ward
Medical diagnosis- Osteoarthritis
Surgery- not performed
Date and time of admission-03-7-21

CHIEF COMPLAINT
 Severe joint pain
 Joint stiffness
 Pain at knee and lower back
 Loss of appetite since
 Fatigue

HISTORY OF PRESENT MEDICAL ILLNESS

4
Mr.Sureshbhai having present complaints are:
 Swelling of lower legs
 Moderate shortness of breathing
 Joint pain
 Weakness
 backache
 Fatigue
HISTORY OF PRESENT SURGICAL ILLNESS
No any significant data about present surgical illness.

HISTORY OF PAST MEDICAL ILLNESS

Client having past history of osteoarthritis since 14 year and diabetes mallitus since 3 year
Trauma and accidents-no any history of trauma and external injuries and accidents.
Hospitalization ,operations or special treatment- He had history of previous
hospitalization,but he treated in opd with same problem before 14 year.
Allergies- according to my patient she has not known allergies to any food,drugs and others.

HISTORY OF PAST SURGICAL ILLNESS

No any significant data about past surgical illness history.

FAMILY HISTORY

KEY
Karsandas (78year) Reenaben(65 year)

Male

Darsh(56 year)
Female

patient

FAMILY COMPOSITION

5
 Name of Ag sex Educatio occupatio Incom Relationshipwit Healt
the e n n e h pt h
family status
member
1.Karsanda 78yr male BA clerk 10000 patient ill
s
2.Reenaben 65yr femal illterate housewife - wife healthy
e
3.Darsh 56yr male B.E engineer 1,20,ooo son healthy

FAMILY HISTORY
Mr. Sureshbhai living in a nuclear family.No any hereditary disorder present in their
family.All the members are well cooperate with each other.

PERSONAL HISTORY
Mr Anilbhai is looking poorly nourished,skin colour is yellow,he has a no any bad habit like
alcoholism,smoking,tobacochewing.he is a non vegetarian .
Personal hygiene:
Oral hygiene-once a time
Bath- once in a day daily.
Sleep and rest- 7 hours/day
Elimination:
Bowel per day : regular
Urine frequency: 1600ml/day
Mobility and exercise:
He is not doing exercise.
Environmental History:
Type of house-pakka
Ventilation-good
Water supply-municipality
Electricity-good
Drainage-closed drainage
Cooking-separate kitchen
Location of house-In city

6
Pet animals-No

PHYSICAL EXAMINATION

GENERAL HEALTH:
 Nourishment-poorly nourished
 Body built-normally built
 Health-ill
 Activity-dull
 Facial expression-dull
 Level of consciousness-conscious
Height-4 feet 6 inch
Weight-65kg
Temperature-99 degree c
Pulse-86 beats/min
Respiration-18 breath/min
Blood pressure-120/80mm/Hg

HEAD AND FACE:

7
  Hair-Black
 Scalp-dandruff present,no injury,
 Skull-normal in shape
 Face – no edema
 Sinuses-no swelling,tenerness
EYES:
 Eye brow-symmetrical
 Eyelashes-no any infection
 Eye lid-no edema
 Eye ball-euqally reaction to the light
 Conunctiva-pale
 Sclera-yellowish
 Lens-opaque
 Vision-normal
EAR:
 External ear- no discharge
 Tympanic membrane-normal
 Hearing acuity-normal
 Drainage from ear-no discharge ,pus
 Hearing aid-not used
NOSE:
 Location- centrally located
 Nasal deviation-not found
 Bleeding-no
 Patency of the nostrils-patented
 Condition of nasal mucosa-pale in colour
 Flaring nostrils-not presented
 Inflammation-not found
 Nasal polyps-not found
MOUTH:
 Lips-dry
 Oral cavity-pale mucous membrane of oral cavity
 Teeth-normal
 Tounge-slightly dry and coated tounge
 Vocal cord,uvula and tonsils-not enlarged and inflammed
 Speech disorder-not presented
NECK:
 Movement-full and smooth range of movement
 Jugular vein-not enlarged

8
  Condition of thyroid-no enlargement of thyroid gland
CHEST:
 Respiratory rate-18 breath/min
 Depth of respiration –normal depth
 Quality of respiration- dyspnoea in lying position
CHEST INSPECTION:
- Lateral diameter is wider than anterior posterior diameter
- Sternum is located at the midline
- Even expansion of the chest during breathing
- No intercostals retraction
CHEST PALPATION:
- No tenderness,lump or depression along the ribs.
Percussion
- Deep resonant sound heard all over the lungs.
Auscultation
- Breath sounds are heard in all areas of the lungs
- Inspiration longer than expiration
- No rhonchi,wheezing sounds was presented

HEART
 Pulse rate-74 beats/min
 Character of pulse-normal
 Blood pressure-110/80mm/hg
 Varicosities-absent
 Visible external jugular veins-absent
 Systolic or diastolic murmur-absent

ABDOMEN
 Size and shape of abdomen-normal size and shape of abdomen
 Inspection-no lesion
 Palpation-no any organomegaly
 Shifting dullness-present
 Distended abdominal veins-absent
 Fluid thrill-absent
 Abdominal girth-33 inch
 Bowel sound-present

9
GENITAL AREA
 Lesion or tumors of rectal area-not found
 Abnormalities of genito urinary area-not found

EXTREMITIES
 Motor strength and mobility-slightly reduced
 Enlargement and stiffness of joint-not present
 Range of motion-active

LOCAL EXAMINATION IN STANDING POSITION

 Anterior-Both hip extended and adducted.knee and ankle at neutral position.
 There is genu varus deformity of the left leg
 There is muscle wasting at the left thigh and left calf
 There is apparent shortening of the left lower limb.
 There is no scar,no swelling
LATERAL-There is no deformity,scar,swelling
POSTERIOR-There is no swelling on the popliteal fossa,no scars

LOCAL EXAMINATION IN SUPINE POSITION

 ANTERIOR-Hips : Both are flexed at 30 degree
 Knees- Both are flexed at 5 degree
 Ankle- Both are at neutral position.
 There is muscle wasting at the left thigh and left calf.
 There is apparent shortening of the left lower limb
 LATERAL- There is no deformity scars,swelling.
 There is tenderness over the medial joint line of left knee

MOVEMENT KNEE JOINT RIGHT LEFT

 Crepitus was felt and heard upon moving the left knee joint movment right(active)
Right(Passive) extension 0 0 ,Flexion 00-1100

NEUROLOGICAL EXAMINATION
 Sensory examination is intact on both sides of the lower limb.
 Motor examination- patient able to dorsiflexion and plantarflexion for left ankle joint.

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COMFORT,SLEEP AND REST
 Location of pain-both extremities

INVESTIGATION

PARAMETER RESULT NORMAL VALUE REMARK

WBC 3 4.0-10.0 Increase
15-3 10 / ul
RBC 3,86 106/ul 4.0-6.0 Increase
HGB 8.2g/dl 13.0-16.0 Increase
HCT 31% 37-48 Decrease
MCV 80gr/dl 80-97 Normal
MCH 25pg 26.5-33.5 Decrease
MCHC 31fl 31.5-35 Normal
PLT 341 103u/l 150-500 Normal
PCT O,19% 0.15-0.50 Increase
NEUTROPHIL 70,5% 52-75 Normal
LYMPHOCYTE 20,9% 20,000-40,000 Normal
MONOCYTES 5,5 103/uL 2.00-8.00 Normal
EOSINOPHIL 2,7 1.00-3.00 Normal
BASOPHIL 0.03 0.00-01.0 Normal
ESR 45mm/hr 0-12 Increase
CRP 7.2mg/l <5.o Increase

X-RAY
AP VIEW
 Narrowing of medial joint space
 Subchondral sclerosis
 Osteophytes
LATERAL VIEW
 Narrowing of patellar space
SERUM URIC ACID- 11.2mg/dl

11
PHARMACOLOGICAL MANAGEMENT

Sr no Drug Dose Route Frequency Action

1 Acetaminophen 650 mg Oral BD Analgesic
2 Diclofenac 50 mg TDS TDS Analgesic
sodium
3 Ibuprofen 400mg Oral BD NSAID
4 Sprifermin- 100mcg Oral OD
Merck

12
Drug name Dose,route Mechanism of Indication contraindication Side effect Nursing
action responsibilities
Tab Acetaminophen 650gm The exact Backache -severe hepatic Severe diarrhoea -asess the
mechanism is Arthritis impairement . patient
Route unknown.it Toothache hypersensitivity Nausea. condition.
Oral may reduce Menstrual - monior the
Vomiting.
the cramps hemodynamic
production of Muscular Stomach pain. status
prostaglandid ache Itching or skin -assess for
in the brain. fever rash. allergic
Headache. reaction
Dizziness. -maintai IO
chart.
Fits.
-maintain
rights of
patients.

13
Drug name Dose,route Mechanism Indication contraindication Side effect Nursing
of action responsibilities
Tab 400gm The exact Backache -severe hepatic Severe diarrhoea. -asess the
Ibuprofen mechanism is Arthritis impairement Nausea. patient
Route unknown.it Toothache hypersensitivity condition.
Vomiting.
Oral may reduce Menstrual - monior the
the cramps Stomach pain. hemodynamic
production of Muscular Itching or skin status
prostaglandid ache rash. -assess for
in the brain. fever Headache. allergic
Dizziness. reaction
-maintai IO
Fits.
chart.
-maintain
rights of
patients.

14
15
NURSING THEORY
 Roy adaptation
 Orem self-care deficit theory
 Abdellah theory
 Hendersons theory

THEORY APPLICATION
Mr. Karsandas is having weakness, constipation, decreased urine output and difficulty in
walking & breathing difficulty and unable to do his daily activity so I’m going to apply to
orems self care deficit theory on patient care.

Information of patient

Name- Mr. Karsandas A. Nayka

Age- 78 year
Sex- Male
Address- Sardar patel township ,Navsari
Education- B.A
Religion- hindu
Occupation- clerk
Bed number-5
Ward- Male Ortho ward
Medical diagnosis- Osteoarthritis
Surgery- not performed
Date and time of admission-

ASSUMPTIONS
 Human beings require continuous ,deliberate inputs to themselves and their
environment to remain alive and function according to their capacity.
 Human agency is exercised in the form of care for self and others in identifyig and
meeting needs.
 Mature human beings experience privations in the form of limitations for action and
care for of clustered tasks and alloself and others involving life sustaining and
function regulating inputs.

16
  Human agency is exercised in discovering developing and transmitting ways and
means to identify needs and make input to self and others.
 Groups of human beings with structured relationship of clustered tasks and allocate
responsibilities for providing care to group members who experience privations for
making required deliberate input to self and others.

PRIORITY OF NURSING PROBLEM ACCORDING TO OREMS THEORY OF

SELF CARE DEFICIT

 Prevent or manage the development threats

 Maintenance of health status
 Awareness and management of the disease process
 Adherence to the medical regimen
 Awareness of potential problem
 Modify self image
 Adjust life style to accommodate health status changes

UNIVERSAL SELF CARE REQUISITES

 Air : Breath without difficulty,no pallor cynosis
 Water:Fluid intake is sufficient .Edema present over ankles.Turgor normal for the age.
 Food: Food intake is not adequate
 Elimination: Voids and elimination bowel without difficulty
 Activity/Rest: Frequent rest is required due to pain.
Pain not completely relieved.
Activity level has come down.
 Social interaction: Communicate well with neighbours and calls the daughter by
phone,need for medical care is communicted to the daughter.
 Prevention of hazards: Need instruction on care of joints and prevention of falls.
Need instruction on improvement of nutritional status.
 Promotion of nonmalcy:Has good relation with daughter.

17
 NURSING PROCESS

NURSING DIAGNOSIS
1.Chronic pain related to joint degeneration as evidenced by refusal or inability to participate
in ongoing exercise or rehabilitation programme.
2. Impaired physical mobility related to restricted joint movement as evidenced by decreased
muscle strength.
3.Activity intolerance related to decrease muscle tone as evidenced by limitation of
movement.
4.Self care deficit related to musculoskeletal impairement decreased strength/endurance as
evidenced by inability to manage their self care activities.
5.Deficient knowledge related to information misinterpretation as evidenced by inaccurate
follow through of instructions.
6.Risk for injury related to altered mobility

18
19
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Chronic pain Client will report Assess the Assessed the patient
After providing all the
patient says,” I’m related to joint satisfactory pain patient pain level. pain level by pain
nursing care clients
degeneration as control. scale. (6/10) level of pain will be
having pain
evidenced by reduce some extent.
extremities. refusal or inability Provide comfortable
to participate in position to the Provided semi fowler
ongoing exercise patient. position to the patient.
or rehabilitation
Objective data: programme

By pain scale Provide comfort Provided hot

device position to the application to the
6/10 patient. patient for reduce

Provide diversional Provided music

therapy to the patient therapy to the patient.

Administer Administer analgesic

medication as per (Inj,Ibuprofen), 75mg,
doctors order. iv as per doctors order.

20
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Impaired physical Client will Assess the Assessed the patient
After providing all the
patient says,” I’am mobility related to perform physical patient posture pain level by pain
nursing care clients
restricted joint activity and gait. scale. (6/10) physical mobility
not able to do my
movement as independently improve some what..
work evidenced by Provided semi fowler
decreased muscle Assess range of motion position to the patient.
strength. in all joints
Encouraged siting in a
Objective data: chair with a raised seat
Encourage siting in a
and firm support
chair with a raised
By physical
seat and firm support
Encouraged the client to
examination ambulate with assisitvie
Encourage the client to device
ambulate with assisitvie
(impaired device

Administerd analgesic
mobility) Administer
(Inj,Ibuprofen), 75mg,
medication as per
iv as per doctors order.
doctors order.

21
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Activity Client will report Assess the physical Assessed the physical
activity level and activity level and After providing all the
patient says,” I’am intolerance related a measureble
nursing care clients
to decrease muscle increase in mobility of the client. mobility of the client.
not able to do my activity level improve
tone as evidenced activity somewhat.
work by limitation of intolerance. Assess the need for Assessed the need for
movement. ambulation aids ambulation aids

Encourage the client to Encouraged the client to

Objective data: ambulate with assisitvie ambulate with assisitvie
device device
By physical
Encourage active Encouraged active
examination range of motion range of motion
exercise exercise

(Activity level)
Assess the clients Assessed the clients
nutritional status nutritional status

22
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Self care deficit related Client will Assess the physical Assessed the physical
activity level and activity level and After providing all the
patient says,” I’am to musculoskeletal demonstrate
nursing care clients
impairement decreased technique mobility of the client. mobility of the client.
not able to do my strength/endurance as activity level improve
changes to meet somewhat.
work evidenced by inability self care needs Assess the need for Assessed the need for
to manage their self ambulation aids ambulation aids
care activities.
Encourage the client to Encouraged the client to
Objective data: ambulate with assisitvie ambulate with assisitvie
device device
By physical
Allow patient Allowed patient
examination sufficient time to sufficient time to
complete tasks to complete tasks to
the fullest extent the fullest extent of
(Musculoskeleta of ability. ability.

l examination)
Consult with Consuletant with
rehabilitation rehabilitation
specialist( occupat specialist( occupati
ional therapist) onal therapist)

23
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Deficient knowledge Client will Assess the physical Assessed the physical
activity level and activity level and After providing
patient says,” I don’t related to information verbalize
knowledge about
misinterpretation as understanding of mobility of the client. mobility of the client.
know how this evidenced by condition client get
conditions/progno somewhat knowledge
disease occur inaccurate follow sis, and potential Assess the need for Assessed the need for regarding disease
through of instructions. complications. ambulation aids ambulation aids condition.

Encourage the client to Encouraged the client to

Objective data: ambulate with assisitvie ambulate with assisitvie
device device
By asking
Allow patient Allowed patient
frequent sufficient time to sufficient time to
complete tasks to complete tasks to
question. the fullest extent the fullest extent of
of ability. ability.

Consult with Consuletant with

rehabilitation rehabilitation
specialist( occupat specialist( occupati
ional therapist) onal therapist)

24
25
DIET

1. Oily fish

Oily fish contain lots of healthful omega-3 fatty acids. These polyunsaturated fats have anti-
inflammatory properties so they may benefit people with osteoarthritis.

People with osteoarthritis should aim to eat at least one portion of oily fish per week. Oily
fish include:

 sardines

 mackerel

 salmon

 fresh tuna

Those who prefer not to eat fish can take supplements that contain omega-3 instead, such as
fish oil, krill oil, or flaxseed oil.

26
Other sources of omega-3 includeTrusted Source chia seeds, flaxseed oil, and walnuts. These
foods can also help to fight inflammation.

2. Oils

In addition to oily fish, some other oils can reduce inflammation. Extra virgin olive oil
contains high levels of oleocanthal, which may have similar properties to nonsteroidal anti-
inflammatory drugs (NSAIDs).

Avocado and safflower oils are healthful options and may also help to lower cholesterol.

3. Dairy

Milk, yogurt, and cheese are rich in calcium and vitamin D. These nutrients increase bone
strength, which may improve painful symptoms.

27
Dairy also contains proteins that can help to build muscle. People who are aiming to manage
their weight can choose low-fat options

4. Dark leafy greens

Dark leafy greens are rich in Vitamin D and stress-fighting phytochemicals and antioxidants.
Vitamin D is essential for calcium absorption and can also boost the immune system, helping
the body to fight off infection.

Dark leafy greens include:

 spinach

 kale

 chard

 collard greens

28
5. Broccoli

Broccoli contains a compound called sulforaphane, which researchers believe could slow the
progression of osteoarthritis.

This vegetable is also rich in vitamins K and C, as well as bone-strengthening calcium

6. Green tea

Polyphenols are antioxidants that experts believe may be able to reduce inflammation and
slow the rate of cartilage damage. Green tea contains high levels of polyphenols

29
7. Garlic

Scientists believe that a compound called diallyl disulfide that occurs in garlic may work
against the enzymes in the body that damage cartilage.

8. Nuts

Nuts are good for the heart and contain high levels of calcium, magnesium, zinc, vitamin E,
and fiber. They also contain alpha-linolenic acid (ALA), which boosts the immune system.

COMPLICATION

30
 Rapid, complete breakdown of cartilage resulting in loose tissue material in
the joint (chondrolysis).
 Bone death (osteonecrosis).
 Stress fractures (hairline crack in the bone that develops gradually in response to repeated
injury or stress).
 Bleeding inside the joint.
 Infection in the joint.
 Deterioration or rupture of the tendons and ligaments around the joint, leading to loss of
stability.
 Pinched nerve (in osteoarthritis of the spine).

HEALTH EDUCATION

No. 1: Control Weight

If you are at a healthy weight, maintaining that weight may be the most important thing you can
do to prevent osteoarthritis. If you are overweight, losing weight may be your best hedge against
the disease.

31
Obesity is clearly a risk factor for developing osteoarthritis. Data from the first National Health
and Nutrition Examination Survey (NHANES), a program of studies designed to assess the
health and nutrition of Americans, showed that obese women were nearly four times as likely as
non-obese women to have osteoarthritis. The risk for obese men was nearly five times greater
than for non-obese men.

No. 2: Exercise
If the muscles that run along the front of the thigh are weak, research shows you have an
increased risk of painful knee osteoarthritis. Fortunately, even relatively minor increases in the
strength of these muscles, the quadriceps, can reduce the risk.
If fear of joint pain after exercise keeps you from exercising, try using heat and cold on painful
joints or take pain relievers. Doing so may make it easier to exercise and stay active. The safest
exercises are those that place the least body weight on the joints, such as bicycling, swimming,
and other water exercise. Light weight lifting is another option, but if you already have
osteoarthritis, first speak with your doctor.

Avoid Injuries or Get Them Treated

Suffering a joint injury when you are young predisposes you to osteoarthritis in the same joint
when you are older. Injuring a joint as an adult may put the joint at even greater risk.

 Avoid bending knees past 90 degrees when doing half knee bends.
 Keep feet as flat as possible during stretches to avoid twisting knees.
 When jumping, land with knees bent.
 Do warm-up exercises before sports, even less vigorous ones such as golf.
 Cool down after vigorous sports.
 Wear properly fitting shoes that provide shock absorption and stability.
 Exercise on the softest surface available; avoid running on asphalt and concrete.

Eat Right
Although no specific diet has been shown to prevent osteoarthritis, certain nutrients have been
associated with a reduced risk of the disease or its severity. They include:
Omega-3 fatty acids. These healthy fats reduce joint inflammation, while unhealthy fats can
increase it. Good sources of omega-3 fatty acids include fish oil and certain plant/nut oils,
including walnut, canola, soybean, flaxseed/linseed, and olive.
Vitamin D. A handful of studies has shown that vitamin D supplements decreased knee pain in
people with osteoarthritis. Your body makes most of the vitamin D it needs in response to
sunlight. You can get more vitamin D in your diet by eating fatty fish such as salmon, mackerel,
tuna, sardines, and herring; vitamin D-fortified milk and cereal; and eggs.

HOME REMEDIES
Osteoarthritis (OA) is a degenerative disease. Treatment relies on a combination of
conventional medicine and lifestyle changes. Medications can treat pain, but there can be side
effects when you take these long-term. Home remedies, lifestyle changes, and natural

32
remedies can help manage OA pain with fewer side effects. Certain methods may even
prevent OA from getting worse.

Hot and cold compresses

When it comes to pain, hot and cold compresses may be very beneficial. They don’t cause the
long-term side effects that medications might. Heat is helpful for joint stiffness, and cold
compresses are best for joint pain.

Compresses can reduce muscle

Epsom salt bath

Epsom salt baths can provide allover relief, especially for joint pain. The magnesium in
Epsom salt may help with inflammation and pain. You can buy Epsom salt from a drugstore.
These baths are safe enough to take as often as you’d like for 30 minutes at a time. Use 2
cups of Epsom salt in a bath of warm water at a temperature of about 102°F (38

33
Topical ointments and creams

You may want to try topical versions as an alternative to oral over-the-counter (OTC)
medications like acetaminophen and ibuprofen. These gels and creams may contain aspirin or
analgesics to numb the pain. You can apply them directly to the affected joints. These
products can work well for areas that are near the skin surface, such as your knees.

Another topical home remedy is capsaicin. Capsaicin is a compound made from hot chili
peppers. It works best when you apply it to painful joints three to four times per day. To
avoid accidental eye exposure, wash hands after each use.

You may also want to try other ointments like Tiger Balm or horse liniment. Talk to your
doctor before experimenting with any of these products.

Support devices

Various types of assistive devices can offer added support without the need for medications.
The exact devices you choose depend on the affected joints. Options include:

 braces

 canes

 grabbing or gripping tools

 knee taping (be sure to have your doctor or physical therapist show you first)

 shoe inserts

34
SUMMARY
In this assignment I had included the following topic:

 Introduction
 History collection
 Physical examination
 Investigation
 Pharmacological management
 Theory application
 Nursing process
 Diet
 complication
 Health education
 Home remedies
 Summary
 Conclusion
 Bibliography

35
CONCLUSION
Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide.
It occurs when the protective cartilage that cushions the ends of the bones wears down over
time. Although osteoarthritis can damage any joint, the disorder most commonly affects
joints in your hands, knees, hips and spine..

36
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1. Black J.M & Matassarin E(1997),MEDICAL SURGICAL NURSING:Clinical

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2. Smeltzer S.C.&Bare,B(2003) BRUNNER & SUDDARTHS TEXTBOOK OF

MEDICAL SURGICAL NURSING (10th edition).

3. Brunner & siddharts, ‘’ TEXTBOOK OF MEDICAL SURGICAL NURSING’’

Jaypee Brothers medical publishers(p) LTD,13th edition

4.F.A.Davis,”DRUG GUIDE FOR NURSES,” 9th edition, Nursing Robert Martone

Publication.

5.Javed Ansari and Davinder Kaur, ‘’TEXTBOOK OF MEDICAL SURGICAL

NURSING- 1’’, first edition, pee vee publication, 2015

6.Ksum Samant,"MEDICAL SURGICAL NURSING," 3rd edition, Vora medicak

Publication.

7.Kochuthresiamma Thomas," MEDICAL SURGICAL NURSING -I," 1st edition,

Jaypee publication.
8.Ross and Wilson’’ANATOMY AND PHYSIOLOGY,” 12TH edition, jaypee

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Publication.

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