Osteomyelitis
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Osteomyelitis
Definition: Infection of the bone and surrounding tissues, most commonly caused by Staphylococcus Aureus. It can be either acute or chronic. This disorder usually occurs as a result of an infection in one part of the body that is transported through the bloodstream to a bone in a distant location.
Also Known As: •
Hematogenous Osteomyelitis
Incedence •
Osteomyelitis affects about 2 in 10,000 people.
•
Acute osteomyelitis is rare in children. It's estimated that one in every 1,000 children under the age of one will develop acute osteomyelitis. The condition is even less common in children over one, with one in every 5,000 children affected. For example, it's estimated that between 30% and 40% of people with diabetes, who experience a puncture injury to the foot, will develop osteomyelitis. One in every 200 people with sickle cell anaemia (a hereditary blood condition) will develop osteomyelitis in any given year.
• •
Risk Factors •
Trauma
•
Diabetes
•
Hemodialysis
•
Splenectomy
•
Advanced age - ↓Immune function
•
Poor circulation
Manifestation •
Pain and/or tenderness in the infected area
•
Swelling and warmth in the infected area
•
Fever
•
Nausea, secondarily from being ill with infection
•
General discomfort, uneasiness, or ill feeling
•
Drainage of pus through the skin
Additional symptoms that may be associated with this disease include: •
Excessive sweating
•
Chills
•
Lower back pain (if the spine is involved)
•
Swelling of the ankles, feet, and legs
•
Changes in gait (walking pattern that is a painful, yielding a limp)
Types 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 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.
• Stages of Osteomyelitis
PATHOPHYSIOLOGY OF OSTEOMYELITIS SEKELETAL SYSTEM
Risk Factors: -trauma -diabetes -hemodialysis -splenectomy -advanced age
ETIOLOGY/CAUSE:
Newborns (younger than 4 mo) -
S. aureus, Enterobacter species, and group A and B Streptococcus species - Children, adolescents (aged 4 y to adult) S. aureus (80%), group A Streptococcus species, H. influenzae, and Enterobacter species Enterobacter or Streptococcus
Molecular Gross/Anatomical if compensation Changes: fails Physical Compensatory Mechanisms Neutrophil invasion Changes: great losses Vascular Pus spread congestion to vascular channel Small vessel Increase intraosseous thrombosis pressure Edema Decreased blood flow inflammation exudation of polymorphonuclear
leukocytes increased erythrocytes increased W BC
Bacterial invasion ( hematogenous, loval extension , trauma)
Laboratory Clinical Pathophysiologic Complications: Manifestations Exams: Manifestation ) : on Bone sclerosis or( S/S deformity Increased Effect CRP oncompliment Bodily Function: reactive Organ CBC Multiple proteinFailure ↓ cardiac Increased Bone Death scan output erythrocyte ↓ impaired cellular sendimentatiion ESR rate metabolism ESR ischemic Bone lesion necrosis biopsy or culture systemic infection lysis of the bone cell the skin Drainage of pus through
Pain and/or tenderness in the infected area
Swelling and warmth in the infected area
Fever
Nausea, secondarily from being ill with infection
Pathophysiology
Osteomyelitis tends to occlude local blood vessels, which causes bone necrosis and local spread of infection. Infection may expand through the bone cortex and spread under the periosteum, with formation of subcutaneous abscesses that may drain spontaneously through the skin. In vertebral osteomyelitis, paravertebral or epidural abscess can develop. If treatment of acute osteomyelitis is only partially successful, low-grade chronic osteomyelitis develops. Diagnostic Studies CBC- WBC may be elevated (indicates presence of active infection). ESR (erythrocyte sedimentation rate) - may be elevated (indicates inflammatory process). Bone Scan (indicates infected bone). Bone lesion biopsy or culture (may reveal the causative organism).
Management Medical management for clients with Osteomyelitis are as follows: •
Analgesics as prescribed.
•
Antibiotics as prescribes.
•
Dressing changes- use sterile technique.
•
Maintain proper body alignment and change position frequently to prevent deformities.
•
Immobilization of affected part.
Surgery if needed: •
Incision ad Drainage of bone abscess.
•
Sequestrectomy- removal of dead, infected bone and cartilage.
•
Bone grafting is recommended after repeated infections.
Common Nursing Diagnoses for Clients with Osteomyelitis: • Risk for Infection
• Hyperthermia • Impaired physical mobility • Acute pain • Anxiety
Nursing Resposibilities for client with Osteomyelitis: •
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 highprotein diet
•
teach your patient how to take prescribed antibiotics and how to recognize possible adverse reactions.
Patients with osteomyelitis need to take care of themselves to improve their chances of fighting infection. Teach your patients to: •
Eat a variety of fruits and vegetables, which can provide the body with the nutritional support it needs to fight infection and stay healthy.
•
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.
•
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.
Illustration:
References: Medical-Surgical Nursing by Josie Quiambao-Udan, RN, MAN http://www.nlm.nih.gov/medlineplus/ency/imagepages/9712.htm http://www.nhs.uk/conditions/Osteomyelitis/Pages/Introduction.aspx www.merck.com Lemone, Page 1267 Professional Guide to Diseases (Eighth Edition), 2005
Definition: Infection of the bone and surrounding tissues, most commonly caused by Staphylococcus Aureus. It can be either acute or chronic. This disorder usually occurs as a result of an infection in one part of the body that is transported through the bloodstream to a bone in a distant location.
Also Known As: •
Hematogenous Osteomyelitis
Incedence •
Osteomyelitis affects about 2 in 10,000 people.
•
Acute osteomyelitis is rare in children. It's estimated that one in every 1,000 children under the age of one will develop acute osteomyelitis. The condition is even less common in children over one, with one in every 5,000 children affected. For example, it's estimated that between 30% and 40% of people with diabetes, who experience a puncture injury to the foot, will develop osteomyelitis. One in every 200 people with sickle cell anaemia (a hereditary blood condition) will develop osteomyelitis in any given year.
• •
Risk Factors •
Trauma
•
Diabetes
•
Hemodialysis
•
Splenectomy
•
Advanced age - ↓Immune function
•
Poor circulation
Manifestation •
Pain and/or tenderness in the infected area
•
Swelling and warmth in the infected area
•
Fever
•
Nausea, secondarily from being ill with infection
•
General discomfort, uneasiness, or ill feeling
•
Drainage of pus through the skin
Additional symptoms that may be associated with this disease include: •
Excessive sweating
•
Chills
•
Lower back pain (if the spine is involved)
•
Swelling of the ankles, feet, and legs
•
Changes in gait (walking pattern that is a painful, yielding a limp)
Types 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 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.
• Stages of Osteomyelitis
PATHOPHYSIOLOGY OF OSTEOMYELITIS SEKELETAL SYSTEM
Risk Factors: -trauma -diabetes -hemodialysis -splenectomy -advanced age
ETIOLOGY/CAUSE:
Newborns (younger than 4 mo) -
S. aureus, Enterobacter species, and group A and B Streptococcus species - Children, adolescents (aged 4 y to adult) S. aureus (80%), group A Streptococcus species, H. influenzae, and Enterobacter species Enterobacter or Streptococcus
Molecular Gross/Anatomical if compensation Changes: fails Physical Compensatory Mechanisms Neutrophil invasion Changes: great losses Vascular Pus spread congestion to vascular channel Small vessel Increase intraosseous thrombosis pressure Edema Decreased blood flow inflammation exudation of polymorphonuclear
leukocytes increased erythrocytes increased W BC
Bacterial invasion ( hematogenous, loval extension , trauma)
Laboratory Clinical Pathophysiologic Complications: Manifestations Exams: Manifestation ) : on Bone sclerosis or( S/S deformity Increased Effect CRP oncompliment Bodily Function: reactive Organ CBC Multiple proteinFailure ↓ cardiac Increased Bone Death scan output erythrocyte ↓ impaired cellular sendimentatiion ESR rate metabolism ESR ischemic Bone lesion necrosis biopsy or culture systemic infection lysis of the bone cell the skin Drainage of pus through
Pain and/or tenderness in the infected area
Swelling and warmth in the infected area
Fever
Nausea, secondarily from being ill with infection
Pathophysiology
Osteomyelitis tends to occlude local blood vessels, which causes bone necrosis and local spread of infection. Infection may expand through the bone cortex and spread under the periosteum, with formation of subcutaneous abscesses that may drain spontaneously through the skin. In vertebral osteomyelitis, paravertebral or epidural abscess can develop. If treatment of acute osteomyelitis is only partially successful, low-grade chronic osteomyelitis develops. Diagnostic Studies CBC- WBC may be elevated (indicates presence of active infection). ESR (erythrocyte sedimentation rate) - may be elevated (indicates inflammatory process). Bone Scan (indicates infected bone). Bone lesion biopsy or culture (may reveal the causative organism).
Management Medical management for clients with Osteomyelitis are as follows: •
Analgesics as prescribed.
•
Antibiotics as prescribes.
•
Dressing changes- use sterile technique.
•
Maintain proper body alignment and change position frequently to prevent deformities.
•
Immobilization of affected part.
Surgery if needed: •
Incision ad Drainage of bone abscess.
•
Sequestrectomy- removal of dead, infected bone and cartilage.
•
Bone grafting is recommended after repeated infections.
Common Nursing Diagnoses for Clients with Osteomyelitis: • Risk for Infection
• Hyperthermia • Impaired physical mobility • Acute pain • Anxiety
Nursing Resposibilities for client with Osteomyelitis: •
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 highprotein diet
•
teach your patient how to take prescribed antibiotics and how to recognize possible adverse reactions.
Patients with osteomyelitis need to take care of themselves to improve their chances of fighting infection. Teach your patients to: •
Eat a variety of fruits and vegetables, which can provide the body with the nutritional support it needs to fight infection and stay healthy.
•
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.
•
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.
Illustration:
References: Medical-Surgical Nursing by Josie Quiambao-Udan, RN, MAN http://www.nlm.nih.gov/medlineplus/ency/imagepages/9712.htm http://www.nhs.uk/conditions/Osteomyelitis/Pages/Introduction.aspx www.merck.com Lemone, Page 1267 Professional Guide to Diseases (Eighth Edition), 2005
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