Osteomyelitis Presentation (1)

8/3/2019 Osteomyelitis Presentation (1)

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DEFINITION(osteo-derived from the Greek

word osteon, meaning bone, myelo-

meaning marrow, and -itis meaninginflammation)

simply means an infection of thebone or bone marrow.


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OTHER TERMSBrodie abscess

Chronic recurrent multifocalosteomyelitis

SAPHO Syndrome

Garres sclerosing osteomyelitis

Hematogenous Osteomyelitis


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CAUSATIVE AGENTSAGE GROUP MOST COMMON ORGANISMS

Newborns (younger than 4months) S. aureus, Enterobacter species group

A and B Streptococcus species

Children (4 months to 4 years) S. aureus,

group A Streptococcus species, Haemophilus influenzae

Enterobacter species

Children, Adolescents (4 years to adult) S. aureus (80%) group

A Streptococcus species,

H. influenzae

Enterobacter species

Adult S. aureus

occasionally Enterobacter

Streptococcus species

Sickle cell anemia patients Salmonella species


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RISK FACTORS those who are poorly nourished

elderly

obese

other patient at risk include those with impaired

immune system, those with chronic illnesses

(diabetes, rheumatoid arthritis)

and those receiving long term corticosteroid therapy

or immunosuppressive agents


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TYPES OF OSTEOMYELITIS

Acute osteomyelitis

Sub-acute

osteomyelitis

Chronic osteomyelitis


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PATHOPHYSIOLOGYPredisposing factors:vascular insufficiency disorders genitourinary

infectionsrespiratory infections IV drug useImmune-compromising diseaseshistory of blood- stream infections

Indwelling prosthetic devices

Open wounds/fractures

Microorganisms lodge into an area where circulation slows


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PATHOPHYSIOLOGYMicroorganisms grow

Increase pressure

Vascular CompromiseIschemia

Infection through the bone cortex and marrow

Ischemia of the periosteum

Cortical devascularization


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PATHOPHYSIOLOGYNecrosis

Formation ofnew bone

sequestra Separation ofdevitalized

bone from living bone

Involucrum

Continuous to be aninfected island

Difficulty to reach byblood borne antibiotics


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PATHOPHYSIOLOGYEnlarged Sequestrum

Development of sinus tract

Turns to scar tissue

Site for continuedmicroorganism growth

Remission andexacerbation

Sequestrum move out tothe soft tissue

Revascularized

Removal by the normalimmune process

HEALING


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PATHOPHYSIOLOGY

Excessive vascular insifficiency

Loss of organ function

AMPUTATION


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Sign and Symptoms:

Diagnostic Finding:

Acute Osteomyelitis;

x-ray findings

Radioisotope bone scans , Isotope-labeled white blood cell

(WBC) scan, Magnetic Resonance ImagingWound and blood culture

Chronic Osteomyelitis;

X-ray findingsBone Scan

ESR


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Management:

Surgery if needed:

Incision ad Drainage of bone abscess.Sequestrectomy

Debridement


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Nursing Resposibilities for client with Osteomyelitis:

Monitors the neurovascular status of the affected extremity Elevation reduces swelling and associated discomfort Pain is controlled with prescribed analgesics and other pain-reducing

techniques The patient must understand the rationale of for the activity of

restriction Encourage patient to have a full participation in ADLs within the

physical limitationsMonitor the patients response to antibiotic therapyObserves the IV access

If surgery is necessary (take measures to ensure adequate circulation tothe affected area (wound suction to prevent accumulation, elevation ofthe area to promote venous drainage, avoidance of pressure on thegrafted area) to maintain needed immobility, and to ensure the patientsadherence of to weight bearing restrictions.

Changes dressings using aseptic technique

Diet high in protein and Vitamin C


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Thank you

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Osteomyelitis Presentation (1)