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Osteomyelitis

Eric Umban

Anatomy and Physiology  The Skeleton The adult human skeleton has a total of 206 bones, excluding the sesamoid bones (1). The appendicular skeleton has 126 bones, axial skeleton 60 bones, and auditory ossicles six bones. Each bone constantly undergoes modeling during life to help it adapt to changing biomechanical forces, as well as remodeling to remove old, microdamaged bone and replace it with new, mechanically stronger bone to help preserve bone strength.

scapulae) Irregular bones (sacrum. coccyx) . mandible. etc.) Short bones (carpal. 2. humerus. Long bones (clavicle. 4.Four general categories bones: 1. tarsal bone) Flat bones (skull. radius. 3.

Function of Bone -the bones of the skeleton provide structural support for the rest of the body -permit movement and locomotion by providing levers for the muscles -protect vital internal organs and structures -provide maintenance of mineral homeostasis and acid-base balance -serve as a reservoir of growth factors and cytokines. and provide the environment for hematopoiesis within the marrow spaces .

and rounded epiphyses above the growth plates. The diaphysis is composed primarily of dense cortical bone. . whereas the metaphysis and epiphysis are composed of trabecular meshwork bone surrounded by a relatively thin shell of dense cortical bone. or diaphysis. flared.The long bones are composed of a hollow shaft. cone-shaped metaphyses below the growth plates.

 Osteomyelitis osteo-derived from the osteon.means marrow  itis.means inflammation Greek word . meaning bone  myelo.

It is an acute or chronic inflammatory process of the bone and its structures secondary to infection with pyogenic organisms. duration and anatomic location of the infection . It can be usefully sub classified on the basis of the causative organism(pyogenic bacteria or mycobacteria ) the route. .Simply means an infection of the bone or bone marrow.

Extension of the soft tissue infection (incisional infection or vascular ulcer) 2. Hematogenous (blood borne) spread form other sites of infection . open fracture. Direct bone contamination from bone surgery. or traumatic injury 3.The bones becomes infcted by one the three modes: 1.

possibly from subclinical (non apparent) trauma. Also at risk are patient with impaired immune system. those with chronic illness and those receiving long term corticosteroid therapy. elderly or obese. . Postoperative surgical wound infections occur within 30 days after surgery. Patient who are risk for osteomyelitis include those who are poorly nourished . Osteomyelitis resulting from hematogenous spread typically occurs in a bone area of trauma or lowered resistance. They are classified as incisional or deep .

Bone infections are more difficult to eradicate than soft tissue infection because the infected bone becomes walled off. . Natural body immune responses are blocked. Osteomyelitis may become chronic and may affect the patient's quality of life. and there is less penetration by antibiotics .

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Etiology Bacteria Staphylococcus Aureus Streptococcus Gonococcus Cocciloides Treponema .

Risk Factor   Long term use of corticosteroids Obese    Elderly Poorly nourished Postoperative surgical wound      Trauma Weak immune system Immunocompromised patient Diabetes Poor blood supply .

results from the skin infection of adjacent tissue .infectious organism enter from the outside of the body Endogenous. open fracture) Trauma to the bone Category of Osteomyelitis Exogenous.Causes    Direct or indirect invasion of an organism into the bone Break in the skin (break make cause abrasion.organism carried by a blood circulation from other area of the infection in the body Contigious.

Sign and Symptoms:  Elevated WBC    Limited ROM Bone pain on affected site Irritability    Elevated ESR Swelling Redness .

Modifiable Factor: Age Gender Bacterial invasion or infection on the wound Hematogenous spread of infection to the bone Organism invade the bone tissue and initiate and inflammation response .Modifiable Factor: Lifestyle Punctured wound Non.

Fever. Leukocytosis. and Pus formation Exudates contribute to grow Pressure develops at the site causing pain Exudates extends into the medullary cavity and under the periosteum Sequestrum then osteoblastic response Vascular Engorgement due to inflammation Compromised blood flow Involucrum . Inflammation.

6. 7. 3.Diagnostic Test: 1. 4. 2. 5. Bone biopsy MRI CT-scan Ultrasound Culture and sensitivity CBC X-ray .

2. 5.3NaCl) Laboratory Test Medication (Paracetamol) Diet and Nutrition Debridement .Medical Intervention: 1. IVF (D5 0. 3. 4.

Sequestrectomy 2. Amputation . Muscle Flap 4.Surgical Management: 1. Bone graft 3.

Administering oral antibiotics 9. Proper disposal of drainage 10. Encourage on relaxation and distractive techniques 6. Open draining wounds 8. Avoids complication of impaired mobility 4. Increasing clients comfort 3. Maintain cool and clean environment 5.Nursing Management: 1. Provide information regarding to the disease 7. Prevention for deformity or injury 2. Emphasize importance of clean wound according to its disease .

Nursing Diagnosis 1. Impaired physical mobility 5. Risk for peripheral neurovascular dysfunction 2. Acute pain 4. Risk for Infection 3. Impaired skin integrity .