Musculoskeletal disorders (Osteomyelitis)

osteomyelitis

100

what is osteomyelitis 

Severe infection of  bone, bone marrow, and surrounding soft tissue

200

what is the most common organisms to cause osteomyelitis?

Most common microorganism is Staphylococcus aureus, but can be caused by variety of organisms

300

indirect entry (hematogenous) of osteomyelitis 

•Young boys

•Blunt trauma

•GU and respiratory infections

•Vascular insufficiency disorders

400

direct entry of osteomyelitis 

•Via open wound

Foreign body presence

500

pathophysiology of osteomyelitis 

•Microorganisms grow → increase  pressure in bone → ischemia and vascular compromise

•Infection spreads through bone → cortex devascularization and necrosis

acute osteomyelitis

100

clinical manifestations of acute osteomyelitis 

•Infection of < 1 month in duration

•Local manifestations

•Pain that worsens with activity; is unrelieved by rest

•Swelling, tenderness, warmth

•Restricted movement

200

systemic manifestions 

•Fever

•Night sweats

•Chills

•Restlessness

•Nausea

•Malaise

•Drainage (late)

300

interprofessional care of acute osteomyelitis 

•Aggressive, prolonged IV antibiotic therapy (Gentamicin) 

•Cultures or bone biopsy 

•Surgical debridement and decompression

•IV antibiotics via CVAD

•May be started in hospital, continued at home/ skilled nursing facility

•IV antibiotics 4-6 weeks or longer

•Variety of antibiotics, depending on microorganism

chronic osteomyelitis

100

what is chronic osteomyelitis 

•Infection lasting  > 1 month or has failed to respond to initial  antibiotic treatment

•Continuous and persistent or process of exacerbations and remissions

200

clinical manifestations of chronic osteomyelitis 

•Systemic manifestations reduced

•Local signs of infection more common

•Pain, swelling, warmth

•Granulation tissue turns to scar tissue → avascular →  ideal site for microorganism growth → cannot be penetrated by antibiotics

300

what are long term and mostly rare complications of osteomyelitis 

•Septicemia

•Septic arthritis

•Pathologic fractures

•Amyloidosis (abnormal protein builds up in tissues and organs leading to organ failure)

400

dx studies of osteomyelitis 

•Bone or soft tissue biopsy 

•Blood and/or wound cultures

•WBC count

•Erythrocyte sedimentation rate (ESR)

•C reactive protein

•X-rays/ MRI/ CT scans

•Bone scans

500

interprofessional care of chronic osteomyelitis 

•Surgical removal

•Extended use of antibiotics

Acrylic bead chains containing antibiotics

Intermittent or constant  antibiotic irrigation of bone

•Casts or braces

•Negative-pressure wound therapy

•Hyperbaric oxygen therapy

•Removal of prosthetic devices

•Muscle flaps, skin grafts, bone grafts

•Amputation

nursing assessment

100

subjective data 

•Past health history

•Bone trauma, open fracture, open or puncture wounds, other infections

•Medications

•Use of analgesics or antibiotics

•Surgery or other treatments

Bone surgery

•IV drug and alcohol abuse, malaise

•Anorexia, weight loss, chills

•Weakness, paralysis, muscle spasms

•Local tenderness, increase in pain

Irritability, withdrawal, dependency, anger

200

objective data 

•Restlessness, high spiking temperature, night sweats

•Diaphoresis, erythema, warmth, edema

•Restricted movement, wound drainage, spontaneous fractures 

•↑ WBC, + cultures, ↑ ESR,  presence of sequestrum and (dead bone)

300

nursing diagnoses 

•Acute pain

•Ineffective health management

•Impaired physical mobility

400

planning for osteomyelitis 

•Have satisfactory pain and fever management

•Do not experience any complications associated with osteomyelitis

•Adhere to treatment plan

Maintain a positive outlook on outcome of disease

nursing implementation

100

health promotion of osteomyelitis 

•Control other current infections

•Persons at risk

•Are immunocompromised

•Have diabetes, orthopedic prosthetic devices, vascular insufficiencies

•Encourage to call HCP about local signs

200

acute care of osteomyelitis 

•Immobilization and careful handling of affected limb

•Assess and treat pain

•Dressing care - sterile technique

Proper positioning/support of extremity

300

acute care/ medications 

•Patient teaching adverse and toxic reactions to antibiotic therapy (Gentamicin, Cipro, Levaquin)

•Ototoxicity, impaired renal function, neurotoxicity

•Hives, severe or watery diarrhea, bloody stools, throat and mouth sores

•Tendon rupture

Monitor peak and trough levels

•Lengthy antibiotic therapy can cause an overgrowth of Clostridium difficile 

•Patient and family are often frightened and discouraged

•Continued psychologic and emotional support 

400

nursing implementation 

•Ambulatory Care

•Patient/caregiver teaching regarding antibiotic administration and management of CVAD

•Wound care/dressing changes

Physical and psychological support

500

evaluation of osteomyelitis 

•The patient will

•Have satisfactory pain management

•Follow treatment regimen

•Verbalize confidence in ability to implement treatment plan

•Demonstrate increase in mobility/ range of motion