Osteomyelitis 000

Musculoskeletal Disorders
Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Osteomyelitis
Osteomyelitis
Severe infection of the

Bone Bone marrow Surrounding soft tissue
Caused by a variety of microorganisms

Most common infecting microorganism
Etiology and Pathophysiology

Antibiotics in conjunction with surgical
treatments have decreased mortality rate and complications Infecting microorganisms can invade by
Indirect entry Direct entry
Direct Entry
Can occur at any age Open wound where microorganisms can
gain entry to body May also occur in presence of foreign body

Direct Entry
Sequestrum continues to be an infected
island of bone, surrounded by pus Difficult for blood-borne antibiotics or white blood cells (WBCs) to reach sequestrum Sequestrum can move out of bone and into soft tissue
Direct Entry
Once outside bone Sequestrum may

Revascularize and then undergo removal by normal immune process Be surgically removed through debridement of necrotic bone
If necrotic sequestrum is not resolved, it may develop a sinus tract resulting in chronic, purulent cutaneous drainage
Indirect Entry
Frequently affects growing bone in boys
<12 years old ---Why???
Most common sites of indirect entry
Distal femur Proximal tibia Humerus Radius
Indirect Entry
Adults with increased risk Vascular disorders Genitourinary and respiratory infections Spread infection from blood to bone Vascular-rich bone sites

Pelvis Tibia Vertebrae

Development of Osteomyelitis
Fig 64-1
Clinical Manifestations
Acute Osteomyelitis
Initial infection
Infection
of <1 month in duration Both systemic and local
Clinical Manifestations Acute Osteomyelitis

Systemic
Local Constant bone pain that worsens with activity Swelling, tenderness, warmth at infection site Restricted movement of affected part Later signs: drainage from sinus tracts
Clinical Manifestations of Chronic Osteomyelitis

Chronic an infection that persists for longer than 1 month Infection that has failed to respond to initial course of antibiotic therapy Systemic signs ______
Signs and Symptoms Constant bone pain Swelling Tenderness Warmth at site Continuous Drainage
Diagnostic Studies
Bone or soft tissue biopsy Definitive way to determine causative microorganism Patients blood and/or wound culture Frequently positive for presence of microorganism Lab Studies WBC Erythrocyte sedimentation rate (ESR)
Radiologic Studies
Radiologic signs Usually do not appear until 10 days to weeks after start of clinical symptoms Radionuclide bone scans Helpful in diagnosis and usually positive in areas of infection Magnetic resonance imaging (MRI)
Computed tomography (CT) Help identify extent of infection, including soft tissue involvement
Collaborative Care Acute Osteomyelitis

Vigorous and prolonged intravenous (IV)
antibiotic therapy
Treatment of choice for acute osteomyelitis As long bone ischemia has not occurred Cultures or bone biopsy should be done if possible
Delaying antibiotic treatment may require
surgical debridement and decompression


Patients are often discharged to home care
or skilled nursing facility (SNF) with IV antibiotics delivered via


Antibiotic therapy may be continued for
at home for _ to _ _____ or as long as _ __ _ ______ Variety of antibiotics may be prescribed

Penicillin, nafcillin (Nafcil) Neomycin, vancomycin Cephalexin (Keflex) Cefazolin (Ancef)

Collaborative Care Chronic Osteomyelitis

Adults with chronic osteomyelitis may be
prescribed oral therapy + fluoroquinolone for 6 to 8 weeks instead of IV antibiotics Oral antibiotics may be given after acute IV therapy to ensure resolution of infection Monitoring patients response
Nursing Care
Toxic effects: Aminoglycosides - Nephrotoxic, ototoxic, optic neuritis, fluid retention
Cephalosporins and Quinolones jaundice, colitis, photosensitivity, crystalluria
Nursing Care/Patient Teaching

Measure
Preventive measures: Monitor _ _ _; Keep patient well hydrated to prevent ____________ or __________ Avoid direct sunlight, wear sunscreen Monitor urinary function, hearing, vision Assess for signs of yeast infections in genitourinary and mouth

Surgical treatment for chronic
osteomyelitis

Removal of poorly vascularized tissue and dead bone Extended use of antibiotics Antibiotic-impregnated polymethyl methacrylate bead chains may also be implanted

After debridement, wound may be closed
and a suction irrigation system inserted Intermittent or constant irrigation of affected bone with antibiotics Protection on limb or surgical site with casts or braces Negative pressure to draw wound together

Hyperbaric oxygen therapy with 100%
oxygen as adjunct therapy
Stimulate circulation and healing
Orthopedic prosthetic devices, if source of
infection must be removed Muscle flaps, skin grafting provide wound coverage over dead space (cavity) in bone

Bone grafts may help restore blood flow
Amputation may be indicated if

Collaborative Care
Long-term and mostly rare complications

Septicemia Septic arthritis Pathologic fractures Amyloidosis
Nursing Assessment
Important health information
Past health history
Bone trauma, open fracture, open or puncture wounds, other infections
Medications Surgery or other treatments

Nursing Assessment
Subjective data

IV drug use, malaise Anorexia, weight loss, chills Weakness, paralysis, muscle spasms Local tenderness over affected area, increase in pain in affected area
Nursing Assessment
Objective data General: Restlessness, high, spiking temperature, night sweats Integumentary: Diaphoresis, erythema, warmth, edema at infected bone Musculoskeletal: Restricted movement, wound drainage, spontaneous fractures
Nursing Diagnoses
Acute pain

RT Inflammatory process secondary to infection AEB Guarding, moaning, crying, restlessness, altered muscle tone, decreased activity; Statement of pain
Nursing Diagnoses
Impaired physical mobility RT Pain, immobilization devices, weightbearing limitations AEB Inability or unwillingness to change positions
Nursing Diagnoses
Ineffective therapeutic regimen
management

RT Lack of knowledge regarding long-term management of osteomyelitis AEB Verbalization of concern and uncertainty about procedures and skills needed for home care
Other Nursing Diagnosis Labels
Fear, Anxiety Powerlessness, Hopelessness
Planning
Overall goals

Have satisfactory pain and fever control Not experience any complications associated with osteomyelitis Cooperate with treatment plan Maintain a positive outlook on outcome of disease
Nursing Implementation
Health promotion

Control infections already in body Susceptible adults

Instruct susceptible adults and their families on local and systemic manifestations
Acute intervention
Immobilization and non-weight bearing on affected limb will decrease pain Limb should be handled carefully to avoid excessive manipulation and decrease pain Manage patients pain level using pharmacologic and non-pharmacologic strategies
Acute intervention (contd)
Patient is frequently on bed rest in early stages of acute infection
Good body alignment and frequent position changes prevent complications associated with immobility and promote comfort
Flexion contracture is a common sequela of osteomyelitis

Acute intervention (contd) Patient frequently positions affected extremity in a flexed position to promote comfort Contracture may then progress to deformity ___ ____ can develop quickly in lower extremity if foot is not supported in a neutral position by a splint or if there is excessive pressure from a splint
Acute intervention (contd) Instruct patient to avoid activities that increase circulation and swelling and serve as stimuli to spread infection
Exercise, ____ application
Dressings to absorb exudate from draining wounds

Teach patient potential adverse and toxic reactions with prolonged and high-dose antibiotic therapy Lengthy antibiotic therapy can result in an overgrowth of

Patient and family often frightened and discouraged Continued psychologic and emotional support is an integral part of nursing management
Ambulatory and home care

IV antibiotics can be administered to patient in a skilled nursing facility or home setting If at home

Patient and family must be instructed on correct care and management of venous access device Must also be taught how to administer antibiotic
Ambulatory and home care Importance of continuing antibiotics after symptoms have subsided should be stressed Periodic nursing visits provide support and decrease anxiety Frequent dressing changes for open wounds May require supplies and instruction in technique

Osteomyelitis 000

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Osteomyelitis 000

Uploaded by

Copyright:

Available Formats

Musculoskeletal Disorders

Bone Bone marrow Surrounding soft tissue

Caused by a variety of microorganisms

Etiology and Pathophysiology

Indirect entry Direct entry

gain entry to body May also occur in presence of foreign body

<12 years old ---Why???

Most common sites of indirect entry

Distal femur Proximal tibia Humerus Radius

Pelvis Tibia Vertebrae

of <1 month in duration Both systemic and local

Clinical Manifestations Acute Osteomyelitis

Clinical Manifestations of Chronic Osteomyelitis

Collaborative Care Acute Osteomyelitis

Delaying antibiotic treatment may require

surgical debridement and decompression

Collaborative Care Acute Osteomyelitis

or skilled nursing facility (SNF) with IV antibiotics delivered via

Collaborative Care Acute Osteomyelitis

at home for _ to _ _____ or as long as _ __ _ ______ Variety of antibiotics may be prescribed

Penicillin, nafcillin (Nafcil) Neomycin, vancomycin Cephalexin (Keflex) Cefazolin (Ancef)

Collaborative Care Chronic Osteomyelitis

Cephalosporins and Quinolones jaundice, colitis, photosensitivity, crystalluria

Nursing Care/Patient Teaching

Collaborative Care Chronic Osteomyelitis

Collaborative Care Chronic Osteomyelitis

Collaborative Care Chronic Osteomyelitis

oxygen as adjunct therapy

Stimulate circulation and healing

Orthopedic prosthetic devices, if source of

Collaborative Care Chronic Osteomyelitis

Long-term and mostly rare complications

Septicemia Septic arthritis Pathologic fractures Amyloidosis

Past health history

Bone trauma, open fracture, open or puncture wounds, other infections

Medications Surgery or other treatments

Other Nursing Diagnosis Labels

Fear, Anxiety Powerlessness, Hopelessness

Control infections already in body Susceptible adults

Patient is frequently on bed rest in early stages of acute infection

Flexion contracture is a common sequela of osteomyelitis

Exercise, ____ application

Dressings to absorb exudate from draining wounds

You might also like