Osteomyelitis 000

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Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

Musculoskeletal

Disorders


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Osteomyelitis


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Osteomyelitis

Severe infection of the

Bone

Bone marrow

Surrounding soft tissue

Caused by a variety of microorganisms

Most common infecting microorganism


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Etiology and Pathophysiology

Antibiotics in conjunction with surgical

treatments have decreased mortality rate

and complications

Infecting microorganisms can invade by

Indirect entry

Direct entry


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Direct Entry

Can occur at any age

Open wound where microorganisms can

gain entry to body

May also occur in presence of foreign

body


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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


7/43Copyright 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

Direct Entry

Once outside bone

Sequestrum may

Revascularize and then undergo removal bynormal immune process

Be surgically removed through debridement ofnecrotic bone

If necrotic sequestrum is not resolved, it maydevelop a sinus tract resulting in chronic,purulent cutaneous drainage



Indirect Entry

Frequently affects growing bone in boys



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

Fig64-1



Clinical ManifestationsAcute Osteomyelitis

Initial infection

Infection of


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Clinical Manifestations

of Chronic Osteomyelitis

Chronican infection that persistsfor longer than 1 month

Infection that has failed to respondto initial course of antibiotictherapy

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 causativemicroorganism

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 afterstart 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 softtissue 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


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Collaborative Care

Acute Osteomyelitis

Antibiotic therapy may be continued forat home for _ to _ _____ or as long as

_ __ _ ______ Variety of antibiotics may be prescribed

Penicillin, nafcillin (Nafcil)

Neomycin, vancomycin Cephalexin (Keflex)

Cefazolin (Ancef)


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Collaborative Care

Chronic Osteomyelitis

Adults with chronic osteomyelitis may beprescribed 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


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Nursing Care

Toxic effects:

Aminoglycosides - Nephrotoxic, ototoxic, optic neuritis, fluidretention

Cephalosporins and Quinolonesjaundice, colitis,

photosensitivity, crystalluria


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Nursing Care/Patient Teaching

Measure

Preventive measures:

Monitor _ _ _; Keep patient well hydrated toprevent ____________ or __________

Avoid direct sunlight, wear sunscreen

Monitor urinary function, hearing, vision Assess for signs of yeast infections in genitourinary

and mouth


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Collaborative Care


Surgical treatment for chronic

osteomyelitis

Removal of poorly vascularized tissue anddead bone

Extended use of antibiotics

Antibiotic-impregnated polymethylmethacrylate bead chains may also be

implanted


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Collaborative Care


After debridement, wound may be closed

and a suction irrigation system inserted

Intermittent or constant irrigation ofaffected bone with antibiotics

Protection on limb or surgical site with

casts or braces

Negative pressure to draw wound together


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Collaborative Care


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


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Collaborative Care


Bone grafts may help restore blood flow

Amputation may be indicated if


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Collaborative Care

Long-term and mostly rare complications

Septicemia

Septic arthritis

Pathologic fractures Amyloidosis


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Nursing Assessment

Important health information

Past health history Bone trauma, open fracture, open or puncture

wounds, other infections

Medications Surgery or other treatments


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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


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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


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Nursing Diagnoses

Acute pain

RT Inflammatory process secondary to

infection

AEB Guarding, moaning, crying,

restlessness, altered muscle tone, decreased

activity; Statement of pain


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Nursing Diagnoses

Ineffective therapeutic regimen

management

RT Lack of knowledge regarding long-term

management of osteomyelitis

AEB Verbalization of concern anduncertainty about procedures and skills

needed for home care


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Other Nursing Diagnosis Labels

Fear, Anxiety

Powerlessness, Hopelessness


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Planning

Overall goals

Have satisfactory pain and fever control

Not experience any complications associatedwith osteomyelitis

Cooperate with treatment plan

Maintain a positive outlook on outcome of

disease


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Nursing Implementation

Health promotion

Control infections already in body

Susceptible adults

Instruct susceptible adults and their families

on local and systemic manifestations


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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 usingpharmacologic and non-pharmacologic

strategies


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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


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Instruct patient to avoid activities that

increase circulation and swelling and serve asstimuli to spread infection

Exercise, ____ application

Dressings to absorb exudate from drainingwounds


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Teach patient potential adverse and toxicreactions with prolonged and high-dose

antibiotic therapy

Lengthy antibiotic therapy can result in anovergrowth of


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Patient and family often frightened anddiscouraged

Continued psychologic and emotional

support is an integral part of nursingmanagement


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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


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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 intechnique

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Osteomyelitis 000