Case study - Knee osteoarthritis: Nursing

Nurse Mary works at a family practice clinic and is caring for Ryker, a 70-year-old male with a history of osteoarthritis who presents to the office for worsening bilateral knee pain. In collaboration with the registered nurse, RN Ron, Nurse Mary goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Ryker’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Mary recognizes important cues, including Ryker’s vital signs, which are temperature 97.2 F or 36.2 C, heart rate 98 beats per minute, respirations 22 breaths per minute, blood pressure 115/74 mmHg, and oxygen saturation 98 percent on room air. He currently rates his pain as 6 on a 0 to 10 numeric scale.

Nurse Mary notes RN Ron’s assessment revealed Ryker has swelling, tenderness to palpation, and a decreased range of motion, or ROM, in both of his knees.

Nurse Mary: I noticed you had quite a bit of pain when RN Ron touched your knees. Can you tell me more about your knee pain?

Ryker: I used to really enjoy taking walks several times a day, but over the last few years my knees have felt so stiff when I wake up, and they hurt so much when I'm walking. So, I haven’t been walking much. It just keeps getting worse. I’ve been gaining a bit of weight too since I haven’t been walking as much as I used to.

Nurse Mary: Is there anything that makes the pain feel better?

Ryker: Usually sitting down and resting makes the pain go away. I try acetaminophen sometimes which helps a little, I guess.

Next, Nurse Mary analyzes these cues. She reviews the electronic health record, or EHR, and notes Ryker’s BMI is calculated as 31 kg/m2 and that before retiring, he was a firefighter for many years.

Nurse Mary knows that osteoarthritis is a degenerative disease that occurs when there’s a gradual destruction of the cartilage that covers the end of each bone found in most joints, like the knees.

She also knows this can occur due to factors such as being overweight; experiencing prolonged mechanical wear and tear, like with occupations involving heavy physical activity; along with the production of proinflammatory mediators. Together, these processes result in joint tissue destruction and narrowing of the joint space, causing the bones to rub against each other.