Osteomyelitis - UPDATED

8/7/2019 Osteomyelitis - UPDATED

1/26

OsteomyelitisOsteomyelitis


2/26

DEFINITIONDEFINITION

y Osteomyelitis is a serious bone infection, usually caused byanother external tissue infection visible on the skin's

surface. Osteomyelitis is usually caused by the bacteria

staphylococcus aureus, or staph infection. Other bacterial

organisms and fungi can cause osteomyelitis as well. It may

be acute , occurring within days or weeks, or chronic ,

staying for months or years. Osteomyelitis can happen to

anyone of any age and may affect any bone. Approximately

50% of cases occur in preschool-aged children. Young

children primarily experience acute hematogenousosteomyelitis because of the rich vascular supply in their

growing bones. Bacteria usually cause bone infection by

infecting an open fracture (broken bone with open skin

wound).


3/26

You may also get osteomyelitis after a bone operation.

Germs from another infection may also get to your

bone by traveling through the blood. Anything thatcauses a weak immune system or poor blood flow may

increase your risk for having osteomyelitis.


4/26

OsteomyelitisOsteomyelitis ComplicationsComplications

y Death of bone or osteonecrosis

Infection of the bone can hinder the

circulation of the blood inside the bone,

which leads to death of the bone. Thebone will heal after surgery has removed

small areas of bone which is dead. If a

section of the bone is large and has died,the patient might need to have the limb

amputated in order to stop the migrating

of the infection.


5/26

RISK/PREDISPOSING FACTORSRISK/PREDISPOSING FACTORS

y Diabetes

y Hemodialysis

y Injected drug use

y Poor blood supply

y Recent trauma


6/26

MANIFESTATIONMANIFESTATION

SYMPTOMS OF OSTEOMYELITISSYMPTOMS OF OSTEOMYELITISy Muscle spasm

y Muscle weakness or atrophy in later

stagesy Pain radiating to the buttocks, legs, and

feet

y Pain made worse with coughing, straining,or laughing

y Severe low back pain

y Tingling or numbness in legs or feet


7/26

Septic ArthritisSeptic Arthritis

Infections in bones can migrate

to adjacent joints

y Growth impairment

Children normally have osteomyelitis in

the areas that are soft and referred to as

the growth plates which are located at

both ends of the long bones of the legs

and arms. In these infected bones,

growth that is normal can be disturbed.


8/26

Cancer of the skinCancer of the skin

If osteomyelitis results in a sore that is

open and draining pus, the skin

surrounding it is at a high risk of creatingsquamous cell cancer.


9/26

DIAGNOSTIC STUDIESDIAGNOSTIC STUDIES

1. Bone scan

During this test, a small amount of Technetium-99

pyrophosphate, a radioactive material, is injected intravenously into the

body. If the bone tissue is healthy, the material will spread in a uniform

fashion. However, a tumor or infection in the bone will absorb the

material and show an increased concentration of the radioactive

material, which can be seen with a special camera that produces the

images on a computer screen. The scan can help your doctor detect

these abnormalities in their early stages, when X-ray findings may only

show normal findings.


10/26

y 2. Bone Biopsy

Another effective test for osteomyelitis is a bone biopsy.

Your doctor will remove a small section of bone to be sent

to a lab to confirm the bacteria. Knowing the exact bacteria

in the infection, or the exact strain of staph bacteria, will

allow the doctor to prescribe the best antibiotics.


11/26

3.Blood tests

When testing the blood, measurements are taken

to confirm an infection: a CBC (complete blood

count), which will show if there is an increased

white blood cell count; an ESR (erythrocyte

sedimentation rate); and/or CRP (C-reactive

protein) in the bloodstream, which detects andmeasures inflammation in the body.


12/26

PathophysiologyPathophysiology


13/26

MANAGEMENTMANAGEMENT

Medical management for clients with

Osteomyelitis are as follows:

y

Analgesics - This medicine is given to fight or prevent an infection

caused by bacteria. Always take your antibiotics exactly as ordered

by your caregiver. Keep taking this medicine until it is completely

gone, even if you feel better. Stopping antibiotics without your

caregiver's OK may make the medicine unable to kill all of the

germs.Never"save" antibiotics or take leftover antibiotics that

were given to you for another illness.


14/26

y Pain medicine:You may be given medicine to take at

home to take away or decrease pain. Your doctor will

tell you how much to take and how often to take it.

Take the medicine exactly as directed by your doctor.

Do not wait until the pain is too bad before taking your

medicine. The medicine may not work as well at

controlling your pain if you wait too long to take it. Tell

your doctor if the pain medicine does not help, or if

your pain comes back too soon.


15/26

SURGERYSURGERY

y Incision and Drainage of bone abscess.

y

Sequestrectomy- removal of dead, infected bone and cartilage.

y Bone grafting is recommended after repeated infections.

y Limb amputation-This is a last resort. Surgeons can amputate the

limb that is affected so as to halt the infection from further

spreading.


16/26

Acute Pain related to inflammationAcute Pain related to inflammation


17/26


18/26

Hyperthermia related toHyperthermia related to

bacterial infectionbacterial infection


19/26


20/26

Discharge PlanningDischarge Planningy Medications

y Teach patient and SO about the medication purpose,

dosage, route, and possible side effects of all prescribed

medications.

y Teach patient and SO to keep a written list of the

medicines the patient take, the amounts, and when and

why he takes them.

y Advise them to not use any medicines, over-the-counter

drugs, vitamins, herbs, or food supplements without firsttalking to the doctor.


21/26

y Advise them to always take the medicine as directed by

the doctor. Call your caregiver if you think yourmedicines are not helping or if you feel you are having

side effects.

y Advise them that if they are taking medicine that makes

them drowsy, do not drive or use heavy equipment.


22/26

ExerciseExercise

y Advise patient to do ROM exercises as tolerated to

promote joint flexion and avoid stiffness.

y Provide safety measures to the clients environment to

avoid further injury.

y Advise client to do some light exercises like walking(if

able) to promote good circulation.


23/26

TreatmentTreatment

y Advise SO to give support to the patient while

undergoing treatment regimen.

y Educate client and SO about the treating regimen being

implemented.

y Encourage cooperation and compliance of patient and

SO to the treatment regimen.


24/26

Health TeachingHealth Teaching

y Advise SO to help client in self-care if client is unable to

address self-care needs

y Educate client on ROM exercises to be used.

y Educate client and SO on proper wound cleaning and

timely dressing changes.

y Advise client and SO to wash hands after wound

cleaning to prevent spread of infection

y Advise client to take care of your skin and feet if you

have diabetes. You may do this by checking and washingyour skin and feet everyday.


25/26

Ongoing AssessmentOngoing Assessment

y Ensure that client and SO is well educated about

current condition

y Ensure that client has fully understood all health

teachings done and also the proper home care regimen

y Ensure that the client has a scheduled follow-up check-

up to update health care personnel about condition.


26/26

DietDiet

y Advise client to eat healthy foods from all of the five

food groups: fruits, vegetables, breads, dairy products,

meat and fish.

y Teach client that eating healthy foods may help you feel

better, have more energy, and help you heal faster.

y Advise client that it may be easier to eat smaller meals

more often

Documents

Osteomyelitis - UPDATED