Osteomyelitis
a severe infection of the bone, bone marrow, and surrounding soft tissue
Staphylococcus aureus
most common infecting organism
Indirect entry of infecting agents is often related to
blunt trauma
Most common sites of indirect entry in children
distal femur, proximal tibia, humerus, and radius
adult comorbidities associated with osteomylitis are
DM, vascular disorders, GU infections & respiratory infections
Direct entry osteomyelitis is often associated with
open wounds (penetrating wounds, fractures)
Sequestra
a fragment of necrosed bone that has become separated from the surrounding tissue
Involucrum
covering of newly formed bone enveloping sequestrum in infection of the bone
Acute osteomyelitis
refers to the initial infection or an infection of less than 1 month in duration
Systemic manifestations of acute osteomyelitis
fever, night sweats, chills, restlessness, nausea, & malaise
Local manifestations of osteomyelitis include
bone pain, swelling, tenderness, warmth and restricted movement
Local bone pain is not relieved by____and worsens with ________
rest; activity
Chronic osteomyelitis refers to bone infection that persists for
longer than one month or an infection that has failed to respond to treatment
Bone or soft tissue biopsy is
the definitive way to determine causitive microorganism
Blood or wound cultures may be
positive for microorganism
WBC may be
elevated
ESR may be
elevated
Normal WBC
4000-11000
Normal ESR
<15-30
Treatment for acute osteomyelitis is
IV antibiotics
Short course of antibiotics may last
4-6 weeks
Longer courses of antibiotics may take as long as
3-6 months
Instruct patients taking gentamicin to notify physician if these symptoms appear:
visual, hearing, or urinary problems
What status should be assessed before starting gentamicin?
hydration
In adults with chronic osteomyelitis, oral therapy of what may be perscribed?
fluoroquinolone
What is another name for flouroquinolone
ciprofloxan (Cipro)
How long is the course of oral Cipro?
6-8 weeks
How is the patients response to medication monitored?
Bone scans and ESR
Surgical treatment for chronic osteomyelitis includes?
removal of tissue and dead bone
Why is tissued removed?
because it is poorly vascularized
What might be implanted to help fight the infection?
antibiotic impregnated polymethl-methacrylate beads chains
What may be used to draw the wound together after surgery?
negative pressure or Wound VAC
When is hyperbaric oxygen therapy used?
refractory cases of chronic osteomyelitis
Is amputation a possibility?
Yes esp. with extensive bone destruction
Complications of long term osteomyelitis include:
septicemia, septic arthritis, pathologic fx, and amyloidosis
Health Hx asessment:
bone trauma, open fx, puncture wounds, strep throat, bac. pneumonia, tooth infection, skin infection, UTI, sinusitis
Three priority nursing Dx:
acute pain, ineffective therapeutic regimen mgmt, impaired physical mobility
At risk patients include:
immunocompromised, orthopedic prosthetics, vascular insufficiencies
Pain control options:
NSAIDs, opioids, muscle relaxants
Types of dressings:
dry, sterile, saline or antibiotics dressings, and wet to dry
Technique when changing dressing
sterile