Osteomyelitis

Definition: Infection of the bone and surrounding tissues, most commonly caused by
Staphylococcus Aureus. It can be either acute or chronic. This disorder usually occurs
as a result of an infection in one part of the body that is transported through the
bloodstream to a bone in a distant location.

Also Known As:

 Hematogenous Osteomyelitis

Incedence
 Osteomyelitis affects about 2 in 10,000 people.
 Acute osteomyelitis is rare in children. It's estimated that one in every 1,000
children under the age of one will develop acute osteomyelitis.
 The condition is even less common in children over one, with one in every 5,000
children affected.
 For example, it's estimated that between 30% and 40% of people with diabetes,
who experience a puncture injury to the foot, will develop osteomyelitis. One in
every 200 people with sickle cell anaemia (a hereditary blood condition) will
develop osteomyelitis in any given year.

Risk Factors

 Trauma

 Diabetes

 Hemodialysis

 Splenectomy
 Advanced age
- ↓Immune function

 Poor circulation

Manifestation

 Pain and/or tenderness in the infected area

  Swelling and warmth in the infected area
 Fever
 Nausea, secondarily from being ill with infection
 General discomfort, uneasiness, or ill feeling
 Drainage of pus through the skin

Additional symptoms that may be associated with this disease include:

 Excessive sweating
 Chills
 Lower back pain (if the spine is involved)
 Swelling of the ankles, feet, and legs
 Changes in gait (walking pattern that is a painful, yielding a limp)

Types

There are three main types of osteomyelitis:

 Acute osteomyelitis, where the bone infection develops within two weeks
of an initial infection, injury or the onset of an underlying disease.
 Sub-acute osteomyelitis, where the bone infection develops
within one ot two months of an initial infection, injury or onset of an
underlying disease.
 Chronic osteomyelitis, where the bone infection develops two months or
more after an initial infection, injury or onset of an underlying disease.

Stages of Osteomyelitis
 PATHOPHYSIOLOGY OF OSTEOMYELITIS

SEKELETAL Risk Factors:

SYSTEM -trauma
-diabetes
-hemodialysis
-splenectomy
-advanced age
ETIOLOGY/CAUSE: -decrease immune function
- Newborns (younger than 4 -poor circulation
mo)
S. aureus, Enterobacter
species, and group A and B
Streptococcus species
- Children, adolescents (aged
4 y to adult) S. aureus (80%),
group A Streptococcus
species, H. influenzae, and Bacterial invasion
Enterobacter species ( hematogenous, loval
- Adult S. aureus and extension , trauma)
occasionally Enterobacter or
Streptococcus species

Neutrophil invasion

Compensatory Mechanisms

Molecular Changes:

Gross/Anatomical Physical Changes:

Pus spread to vascular channel Vascular congestion
Increase intraosseous pressure Small vessel thrombosis
Decreased blood flow Edema
exudation of polymorphonuclear leukocytes inflammation
increased erythrocytes
increased WBC

if compensation fails
great losses
 Pathophysiologic Manifestation on Effect on Bodily Function:

↓ cardiac output
↓ impaired cellular metabolism
ischemic necrosis
systemic infection
lysis of the bone cell

Complications:

Multiple Organ Failure

Death

Clinical Manifestations ( S/S ) : Laboratory Exams:

Increased CRP compliment reactive protein
Increased erythrocyte sendimentatiion rate ESR CBC
Drainage of pus through the skin Bone scan
Pain and/or tenderness in the infected area ESR
Swelling and warmth in the infected area Bone lesion biopsy or culture
Fever
Nausea, secondarily from being ill with infection

Bone sclerosis or deformity

Pathophysiology
Osteomyelitis tends to occlude local blood vessels, which causes bone necrosis and
local spread of infection. Infection may expand through the bone cortex and spread
under the periosteum, with formation of subcutaneous abscesses that may drain
spontaneously through the skin. In vertebral osteomyelitis, paravertebral or epidural
abscess can develop.

If treatment of acute osteomyelitis is only partially successful, low-grade chronic

osteomyelitis develops.

Diagnostic Studies

CBC- WBC may be elevated (indicates presence of active infection).

ESR (erythrocyte sedimentation rate) - may be elevated (indicates inflammatory
process).
Bone Scan (indicates infected bone).
Bone lesion biopsy or culture (may reveal the causative organism).

Management
Medical management for clients with Osteomyelitis are as follows:

 Analgesics as prescribed.
 Antibiotics as prescribes.
 Dressing changes- use sterile technique.
 Maintain proper body alignment and change position frequently to prevent
deformities.
 Immobilization of affected part.
Surgery if needed:

 Incision ad Drainage of bone abscess.

 Sequestrectomy- removal of dead, infected bone and cartilage.
 Bone grafting is recommended after repeated infections.

Common Nursing Diagnoses for Clients with Osteomyelitis:

• Risk for Infection

• Hyperthermia
 • Impaired physical mobility

• Acute pain

• Anxiety

Nursing Resposibilities for client with Osteomyelitis:

 control the patient's pain with prescribed analgesics and

nonpharmacologic techniques
 monitor his response to antibiotic therapy
 observe the patient's I.V. site for signs of complications
 monitor the area of infection and neurovascular status (if an extremity
is involved)
 apply gentle range-of-motion exercises to the joints above and below
the affected site
 unless contraindicated, provide nutritional support in the form of a high-
protein diet

 teach your patient how to take prescribed antibiotics and how to

recognize possible adverse reactions.

Patients with osteomyelitis need to take care of themselves to improve their

chances of fighting infection. Teach your patients to:

 Eat a variety of fruits and vegetables, which can provide the body with
the nutritional support it needs to fight infection and stay healthy.
 Stop smoking. Smoking slows blood flow to the hands and feet,
making it more difficult for the body to fight infection. Provide your
patient with smoking cessation materials if he needs help.
 Continue antibiotic treatment as prescribed. Advise him to call his
health care provider to report any adverse effects before discontinuing
the drug on his own. The success of antibiotic treatment depends on
following the complete regimen.
Illustration:
References:
Medical-Surgical Nursing by Josie Quiambao-Udan, RN, MAN
http://www.nlm.nih.gov/medlineplus/ency/imagepages/9712.htm
http://www.nhs.uk/conditions/Osteomyelitis/Pages/Introduction.aspx
www.merck.com
Lemone, Page 1267
Professional Guide to Diseases (Eighth Edition), 2005