Osteomyelitis.The initial goal of therapy is to control and halt the infective process.

The initial goal of therapy is to control and halt the infective process.

1. Osteomyelitis إعداد الطالب اثير عبد احمد اشراف ا.د. حسين هادي عطية

2. Learning objectives: Explain the pathophysiology and classification of osteomyelitis. Identify the clinical manifestations of osteomyelitis. Discuss the medical management of osteomyelitis. Describe the role of nursing in the nursing management of patients with osteomyelitis.

3. Osteomyelitis Osteomyelitis is an infection of bone that can be either acute (lasts less than 4 weeks) or chronic (lasts more than 4 weeks). Osteomyelitis is an infection of the bone that results in inflammation, necrosis, and formation of new bone.

4. Classification of Osteomyelitis 1. Hematogenous osteomyelitis (i.e., due to bloodborne spread of infection) 2. Contiguous-focus osteomyelitis, from contamination from bone surgery, open fracture, or traumatic injury (e.g., gunshot wound) 3. Osteomyelitis with vascular insufficiency, seen most commonly among patients with diabetes and peripheral vascular disease, most commonly affecting the feet.

5. Pathophysiology

6. Pathophysiology More than 50% of bone infections are caused by Staphylococcus aureus. Other pathogens include the Gram-positive organisms streptococci and enterococci, followed by Gram-negative bacteria, including pseudomonas

7. Patients who are at high risk for osteomyelitis: Older adults and those who are poorly nourished or obese. Impaired immune systems. Chronic illnesses (e.g., diabetes, rheumatoid arthritis). Receiving long-term corticosteroid therapy or immunosuppressive agents. Iv drugs users.

8. Clinical Manifestations 1. A fever, as well as local signs of inflammation, such as tenderness, redness, heat, rapid pulse, general malaise 2. Pulsating pain that intensifies with movement as a result of the pressure of the collecting purulent material (i.e. drainage) 3. The infected area becomes painful, swollen, and extremely tender. 4. Ulceration, drainage, and localized pain are typical signs and symptoms of chronic osteomyelitis.

9. Assessment and Diagnostic Findings A. Acute osteomyelitis Early x-ray findings demonstrate soft tissue edema. Radioisotope bone scans, particularly the isotope-labeled white blood cell (WBC) scan, and MRI help with an early definitive diagnosis. Blood studies reveal leukocytosis and an elevated ESR. Wound and blood culture studies are performed, although they are only positive in 50% of cases.

10. Assessment and Diagnostic Findings B. Chronic osteomyelitis Large, irregular cavities, raised periosteum, sequestra , or dense bone formations are seen on x-ray. The ESR and the WBC count are usually normal. Anemia, associated with chronic infection, may be evident. Cultures of blood specimens and drainage from the sinus tract are frequently unreliable for isolating the organisms involved. An open bone biopsy is indicated

11. Therapeutic Measures 1. Long-term antibiotic therapy (4–6 weeks) is the treatment of choice for patients with osteomyelitis. 2. Surgery to remove necrotic bone tissue or replace it with healthy bone tissue can also be needed. A sequestrectomy (removal of enough involucrum to enable the surgeon to remove the sequestrum) is performed. 3. Amputations are reserved for patients who have massive infections that have not responded to one or more of the conventional treatments

12. Therapeutic Measures Medical Management The initial goal of therapy is to control and halt the infective process. General supportive measures (e.g., hydration, diet high in vitamins and protein, correction of anemia) are instituted. The area affected with osteomyelitis is immobilized to decrease discomfort and to prevent pathologic fracture of the weakened bone.

13. Nursing Process The Patient With Osteomyelitis Assessment 1. Assesses the patient for risk factors (e.g., older age, diabetes, long-term corticosteroid therapy) and for a history of previous injury, infection, or orthopedic surgery. 2. The gait may be altered as the patient avoids pressure and movement of the area 3. Physical examination reveals an inflamed, markedly edematous, warm area that is tender.

14. Nursing Process The Patient With Osteomyelitis Nursing Diagnoses 1. Acute pain related to inflammation and edema. 2. Impaired physical mobility related to pain, use of immobilization devices, and weight-bearing limitations. 3. Risk for infection: bone abscess formation. 4. Deficient knowledge related to the treatment regimen.

15. Nursing Process The Patient With Osteomyelitis Nursing Interventions. 1. Relieving pain The affected part may be immobilized with a splint to decrease pain and muscle spasm. Monitors the skin and neurovascular status of the affected extremity. The wounds are frequently very painful, and the extremity must be handled with great care and gentleness. Elevation reduces swelling and associated discomfort. Pain is controlled with prescribed analgesic agents and other pain-reducing techniques.

16. Nursing Process The Patient With Osteomyelitis Nursing Interventions 2. Improving physical mobility Treatment regimens restrict weight-bearing activity. The joints above and below the affected part should be gently moved through their range of motion. Encourages full participation in ADLs within the prescribed physical limitations to promote general well-being.

17. Nursing Process The Patient With Osteomyelitis Nursing Interventions 3. Controlling the infectious process Monitors the patient’s response to antibiotic therapy. Observes the IV access site for evidence of phlebitis, infection, or infiltration. Monitors the patient for signs of superinfection (e.g., oral or vaginal candidiasis, lose or foul-smelling stools). Monitors the patient for the development of additional sites that are painful or sudden increases in body temperature.

18. Nursing Process The Patient With Osteomyelitis Nursing Interventions 3. Controlling the infectious process If surgery is necessary, the nurse takes measures to ensure adequate circulation to the affected area (wound suction to prevent fluid accumulation, elevation of the area to promote venous drainage, avoidance of pressure on the grafted area). Maintain needed immobility, and to ensure the patient’s adherence to weight-bearing restrictions. The nurse changes dressings using aseptic technique.

19. Nursing Process The Patient With Osteomyelitis Nursing Interventions. 4. Knowledge of treatment regimen. Teach the patient and family the importance of strictly adhering to the therapeutic regimen of antibiotics and preventing falls or other injuries that could result in bone fracture. Teach the patient how to maintain and manage the IV access and IV administration equipment in the home. The nurse provides instruction on aseptic dressing and warm compression techniques.

20. Nursing Process The Patient With Osteomyelitis Evaluation 1. Experiences pain relief. 2. Increases in safe physical mobility. 3. Shows absence of infection 4. Adheres to therapeutic plan