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The increased pain is interfering with her daily routines and may prohibit her from participating in her moderate daily exercise

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She complains of her knee being achy in the morning and also some discomfort with movement. She also has a history of overuse and prior injuries to to her right knee. There is +1 edema and decreased ROM to the right knee. She is also overweight with a BMI of 30.

-Obesity

-Excessive wear and tear

-Gender

Pain 3/10

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She is overweight. This is the single most modifiable risk factor of osteoarthritis. By eating a heart healthy diet (low salt, low cholesterol), she may be able to manage her weight more effectively. Limiting fast food for lunch is a start. Talk about meal prep and health options.

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First choice: Acetaminophen! (analgesics)- for mild to moderate pain; can cause hepatic toxicity

NSAIDS - mild to moderate pain; can cause nephrotoxicity, GI bleeding; be careful if patient is on anticoagulation.

Opioids - moderate to severe pain; can cause nausea, constipation (give stool softener), confusion

Topicals: Intra-articular corticosteriods (steroid injections), Intra-articular hyaluronans (acts as lubricant/shock absorber), topical NSAIDS, Topical capsaicin

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ESR and C reactive protein can help check for inflammation. With Osteoarthritis, there will be inflammation of the surrounding tissues due to the lack of cartilage and a narrowed joint space.

Liver enzymes: acetaminophen can cause hepatoxicity

CBC (hgb/hct): NSAIDs can cause GI bleeding

BUN/CR/GFR: NSAIDs can cause nephrotoxicity

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Xray will assess for any type of fracture

CT or MRI will get a more detailed picture of the surrounding tissues/joint.

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Hypertension may occur if using chronic NSAIDS; can alter renal function, reduce sodium excretion and lead to fluid retention.

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Administer prescribed medications to assist with pain relief. Offer nonpharmacological therapy as well.

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Modify exercise to low weight bearing exercises; try swimming, for example.

Swimming is a non-weight bearing form of exercise that can still achieve cardio results as well as muscle building.

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Should the patient have an arthroplasty done, patient will follow orders as far as weight-bearing.

PT/OT will work with patient to get them back to their normal activity/exercise regimen; no deep knee bends post arthroplasty

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Patient may have an unsteady gait; use fall precautions; may need assistive devices.

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Heat, Ice (to help with pain/swelling)

Elevate extremity

Take stool softener if sedentary and if taking opioids.

Monitor liver enzymes (Acetaminophen), and Kidney function (NSAID use)

Physical Therapy/Occupational Therapy to assist with movement/safety/exertion

Energy conservation: fatigue is common and managing energy is important to be safe

Glucosamine: supplement to help rebuild cartilage and synovial fluid

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Report chest pain, abdominal pain, abnormal bleeding, and blood in the stool or emesis; these are all signs of NSAID toxicity or MI

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Review what is noted under the Medication Education Section above.

Ensure patient is taking medications as prescribed and review the side effects of each.