A. DEFINITION
Osteomyelitis is an acute or chronic inflammatory process of the bone and its structures secondary to infection with pyogenic organisms.
B. CAUSE
Acute hematogenous osteomyelitis (Note increasing reports of other pathogens in bone and joint infections including community-associated methicillin-resistant Staphylococcus aureus [MRSA, Kingella kingae, and others.)
a. Newborns (younger than 4 mo): S aureus, Enterobacter species, and group A and B Streptococcus species
b. Children (aged 4 mo to 4 y): S aureus, group A Streptococcus species, Haemophilus influenzae, and Enterobacter species
c. Children, adolescents (aged 4 y to adult): S aureus (80%), group A Streptococcus species, H influenzae, and Enterobacter species
d. Adult - S aureus and occasionally Enterobacter or Streptococcus species
Direct osteomyelitis
a. General - S aureus, Enterobacter species, and Pseudomonas species
b. Puncture wound through an athletic shoe - S aureus and Pseudomonas species
c. Sickle cell disease -S aureus and Salmonellae species
C. TYPE OF OSTEOMYELITIS
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 & nbsp;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.
D. PATOPHYSIOLOGY (PATHWAYS)
E. SIGN AND SYMPTOMS
Bone pain
Bone swelling
Fever
Muscle spasm
Local redness
Local warmth
Pain moving a nearby joint
Specific symptoms depend on the bone affected:
• Arm bone pain
• Leg bone pain
• Pelvis bone pain
F. PROCEDURE OF DIAGNOSTIC
Diagnostic procedures may include:
• X-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• Magnetic resonance imaging (MRI) – a diagnostic test which uses magnetic energy to visualize bones and other organs. It is a very sensitive test for early bone infections.
• Radionuclide bone scans - a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.
• Blood tests – includes a complete blood count (CBC), blood culture, and tests of inflammation (known as ESR and CRP).
• Computed tomography scan (Also called CT or CAT scan.)
G. COMPLICATION
Chronic myelitis
Necrosis
Bone necrosis
Blood clots
Sequestra
Bone abscess (type of Abscess)
Abscess
H. MEDICAL MANAGEMENT
Medications
Administration of intravenous (IV) antibiotics, which may require hospitalization or may be given on an outpatient schedule, may be necessary. Intravenous or oral antibiotic treatment for osteomyelitis may be very extensive, lasting for many weeks.
Monitoring of successive x-rays and blood tests
Pain management
Dressing changes- use sterile technique.
Maintain proper body alignment and change position frequently to prevent deformities
Bed rest or restricted movement of the affected area surgery
In some cases, surgical intervention may be necessary to drain infectious fluid, or to remove damaged tissue and bone.
I. NURSING PROCESS
1. Assessment
Things that need to be assessed in patients with portal hypertension are;
Assess for risk factors
Observe for guarded movements
Observe for warmth and swelling, drainage, elevated temperatue
Chronic cases may have minimal temperature elevation
2. Nursing Diagnosis
Risk for Infection
Hyperthermia
Impaired physical mobility
Acute pain
Anxiety
3. Care plan
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
Teach your patients to:
o Eat a variety of fruits and vegetables, which can provide the body with the nutritional support it needs to fight infection and stay healthy.
o 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.
o 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
BIBLIOGRAPHY
Doenges, M., Moorhouse, M., and Murr, A. (2006). Nurses pocket guide: Diagnoses, prioritized interventions and rationales. Philadelphia: F.A. Davis Co.
http://emedicine.medscape.com/article/785020-overview
http://www.wrongdiagnosis.com/o/osteomyelitis/symptoms.htm
http://www.wrongdiagnosis.com/o/osteomyelitis/symptoms.htm?ktrack=kcplink
http://www.childrensmemorial.org/depts/infectious/osteomyelitis.aspx
http://carefirst.staywellsolutionsonline.com/Library/Encyclopedia/85,P00126
http://www.scribd.com/doc/17647441/Osteomyelitis
http://www.scribd.com/doc/36253538/Osteomyelitis-nn
http://www.scribd.com/doc/23560715/pathoPHYSIOLOGY-OF-OSTEOMYELITIS-DIAGRAM
Smeltzer, S., Bare, B., Hinkle, J., and Cheever, K. (2008). Brunner and Suddarth’s textbook of medical-surgical nursing.