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Osteomyelitis

Osteomyelitis. Marcus Josiah M. Reyes, SN-UST Batch 2010 Section 8 RLE 4. Osteomyelitis. A severe infection of the bone and surrounding tissues (Maher, Salmond, & Pellino, 2002).

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Osteomyelitis

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  1. Osteomyelitis Marcus Josiah M. Reyes, SN-UST Batch 2010 Section 8 RLE 4

  2. Osteomyelitis • A severe infection of the bone and surrounding tissues (Maher, Salmond, & Pellino, 2002). • Can occur in any age, but common to children younger than 12 years of age. Males have higher incidence than females (Maher, et al, 2002).

  3. Three Ways of Infection (Maher, et al, 2002) • Hematogenous • Through the bloodstream • Contiguous focus • Extension from adjacent tissue infection • Direct infection into the bone

  4. HematogenousOsteomyelitis • Predominantly occur in children, middle-aged, and older adults (Maher, et al, 2002). • There is usually a single organism that enters a bone via the bloodstream from a site of infection (most commonly S. aureus) (Maher, et al, 2002). • Common sources of infection: UTI, skin infection, URTI, and acute otitis media (Maher, et al, 2002).

  5. HematogenousOsteomyelitis • Involves rich red marrow (Maher, et al, 2002). • In children and infants: the long bones

  6. Osteomyelitis 2⁰ to Contiguous Infection • Onset is insidious (Maher, et al, 2002). • Infection spreads to adjacent bone through the soft tissue (Maher, et al, 2002). • Greater risk for clients with Diabetes Mellitus and severe atherosclerosis (Maher, et al, 2002).

  7. Direct Bone Infection • Microbes gain entry to the bone through open fractures, penetrating wounds, or contamination in a surgical procedure (Maher, et al, 2002). • Implanted items may also cause infection (Maher, et al, 2002).

  8. Pathophysiology(Smeltzer, Bare, Hinkle, & Chever, 2008)

  9. Manifestations (Smeltzer, et al, 2008) • If hematogenous, common sepsis manifestations: • Chills • High fever • Rapid pulse • General Malaise

  10. Manifestations (Smeltzer, et al, 2008) • At first, systemic sx may overshadow the local signs • Constant, pulsating pain that intensifies with movement • Swollen and tender area of infection • Chronic Osteomyelitis presents continuously draining sinus or recurrent inflammation

  11. Diagnostics ( Maher, et al, 2002) • CBC • ESR • Blood Cultures • Superficial Cultures • Biopsy • X-Rays • Radionuclide Bone Scans • MRI

  12. Prevention (Smeltzer, et al, 2008) • If with current infection, postpone orthopaedic surgery • Strict aseptic technique during orthopaedic surgery • Prophylactic antibiotics • Urinary catheters and drains are removes as soon as possible

  13. Management (Smeltzer, et al, 2008) • Pharmacologic • IV Antibiotic Therapy for 3-6 weeks • Then, oral ATB for 3 months • Direct application • Surgical • Surgical Debridement • Sequestrectomy • Saucerization • Internal fixation or external supportive devices

  14. Nursing Management(Maher, et al, 2002) • Infection • IN ATBs, as ordered • Hand Washing • Strict Asepsis • Monitoring of ATB compliance • Health Education • Infection Control • Infection Prevention • ATB administration

  15. Nursing Management (Maher, et al, 2002) • Pain • Deep Breathing Exercises • Splinting • Analgesics, as ordered

  16. Nursing Management(Maher, et al, 2002) • Impaired Physical Mobility and Activity Tolerance • Complete Bed Rest • Diversional Activities • Active ROM exercises to unaffected areas • Passive ROM exercise to affected area, approved by the MD • Assistive Devices

  17. Nursing Management(Maher, et al, 2002) • Anxiety • Active Listening • Stress Reduction (relaxation, guided imagery) • Diversional Activities • Health Education regarding illness

  18. Nursing Management(Maher, et al, 2002) • Knowledge Deficit: Disease and Medication • Health Education to the patient and family

  19. Resources: • Maher, A., Salmond, S., & Pellino, T. (2002). Orthopaedic Nursing 3rd Ed. PA: W.B. Saunders Company • Smeltzer, S., Bare, B., Hinkle, J., & Chever, K. (2008). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 11th Ed. PA: Lippincott Williams & Wilkins

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