OSTEOMYELITIS

I. Definition

 Is an infection of the bone that is pyogenic which maybe chronic or acute

 This results from a combination of trauma and an acute infection anywhere in the body
 This can spread to the bone marrow, cortex and periosteum

II. Causes
 Staphylococcus aureus
 Streptococcus pyogenes
 Pneumococcus
 Pseudomonas aeroginosa
 E. coli

Risk factors

 Those who are poorly nourished

 Elderly and children
 Diabetic
 Patients with rheumatoid arthritis
 Patients that have been hospitalized for long time
 Patients who had surgery on a joint that is previously operated on
 Those who had concurrent sepsis
 Those who have prolonged wound drainage
 Those who have marginal incisional drainage o wound dehiscence
 Those who require evacuation of post-op hematomas

III. Clinical manifestations

 Swelling
 Pain
 Heat
 Restricted movement
 Fever
 Malaise
 Discharge of pus
 V. Pathophysiology

Risk factors

Mode of entrance of microorganisms

Organisms find a culture sit in hematoma from

recent trauma or in a weakened
area and spread directly to the bone

increase WBC

infection

inflammation and immunologic response

 pus formation
tension builds within the rigid medullary cavity  fever
 swelling
pus is forced to the haversion canal  pain
forming subperiosteal abcess
 malaise
 restricted
decrease blood supply
movement
bone necrosis

stimulates the periosteum to create a new bone(involucrum)

the old bone(sequestrum) become a medium for microorganism growth

chronic osteomyelitis

VI. Diagnostic procedures

 Blood culture
 Blood studies
 MRI
 Bone X-ray
 CT scan
 Bone biopsy

VII. Medical management, pharmacologic management, surgical management

a. Medical management
Administration of IVF
 Dressing changes- use sterile technique
Maintain proper body alignment and change position frequently to prevent deformities.
 Immobilization of affected part.
Foods rich in protein and vitamin C
 Increase fluid intake ( for fever )

b. Pharmacologic management

b.1 Drug name: Paracetamol

Classification: Analgesic

Mechanism of action:

Produces analgesia by blocking generation of pain impulses. This action is probably caused
by inhibition of prostaglandin synthesis; it may also be caused by inhibition or action of other othe
synthesis or action of other substances that sensitize pain receptors to mechanical or chemical
stimulation. It relieves fever by central action in the hypothalamic heat-regulating center.

Nursing responsibilities:

> Explain to patient about the drug.

b.2 Drug name: Ciprofloxacin hydrochloride

Classification: Antibacterial

Mechanism of action: Interferes with DNA replication in susceptible bacteria preventing cell
reproduction

Nursing responsibilities:

 Explain to patient about the drug.

 Advise him/her to call his healthcare provider to report any adverse effect before discontinuing the
drug on his own.
 Tell the patient that the success of antibiotic treatment depends on adhering to the complete
regimen
Advise him/her to call his healthcare provider to report any adverse effect before discontinuing the
drug on his own.

c. Surgical management
Incision and drainage
Sequestrectomy
Saucerization
 Myocutaneous flaps/skin grafting
Amputation

VIII. Nursing diagnosis

1. Acute pain maybe r/t inflammation and tissue necrosis

Nursing Responsibilities:

Perform a comprehensive assessment of pain to include location, characteristics, onset/duration,

frequency, quality, severity and precipitating/aggravating factors.
Monitor vital signs- usually altered in acute pain.
Administer analgesics as indicated. Notify physician if regimen is inadequate to meet pain control
goal.
The affected part maybe immobilized with a splint to decrease pain and muscle spasm.
The joints above and below the affected part should be gently placed through the range of motion.
The wounds themselves are frequently very painful and must be handled with great care and
gentleness.
Elevation reduces swelling and associated discomfort.
Monitor the neurovascular status of the affected extremity.
Teach techniques for reducing pain perception because this may be useful.

2. Impaired physical mobility associated with pain, immobilization devices and weight-bearing
limitations

Nursing Responsibilities:

Restrict patient strictly in doing unnecessary activities.

Explain to patient the rationale for the activity restrictions.
Encourage patient to participate in activities of daily living within the physical limitations to
promote general well being.

3. Risk for extension of infection: bone abscess formation

Nursing Responsibilities:

Monitor the patient’s response to antibiotic therapy.

Observe the intravenous site for evidence of phlebitis or infiltration.
If surgery was necessary, measures are taken to ensure adequate circulation ( wound suction to
prevent fluid accumulation, elevation of the area to promote venous drainage, avoidance of pressure
on grafted area) to maintain needed immobility and to comply with weight-bearing restrictions.
Monitor the general health and nutrition of the patient.