2-29-08 Mrs.

Renfroe

Osteomyelitis
• Infection of the bone by three modes:

o Extension of soft tissue

o Direct bone contamination

o Hematogenous (blood borne) tem

At risk Patients

• Poorly nourished

• Elderly

• Obese

• Impaired immune system

• Chronic illness

• Long term corticosteroid us

Deep Sepsis

• Stage 1

o Acute fulminating

• Stage 2

o Delayed onset

• Stage 3

o Late onset

o 2 or more years after surgery

Clinical manifestations

• Blood borne

o Chills

o Fever
 o Rapid pulse

o Malaise

• Direct contact

o Swollen

o Warm

o Painful

o Tender to touch

• Chronic

o Draining sinus

o Recurrent periods of pain

o Inflammation

o Swelling

Diagnostic Findings

• Early x-ray shows soft tissue swelling

• Two weeks x-ray shows irregular calcification and bone necrosis

• Bone scans

• MRI

• Labs show elevated leukocytes, and elevated SED rate, C&S

o If it is chronic condition might not show elevated WBC

Treatment

• Prevention

• Orthopedic surgery

o Incision &Drainage, antibiotic beads inserted

• Prophylactic antibiotics

• Postoperative wound care

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o Handle these patients very carefully

o STERILE TECHNIQUE

• Diet high in vitamin C and protein

• Prevent anemia

• Provide good nutrition and hydration

Medical Management

• Antibiotic therapy

o Vancomycin-will probably see PICC lines

• Supportive measures

o Ace bandage, splint, etc.

• Immobilization

o They will initially be on bedrest, they don’t want to promote the spread
of the infection

• Wet soaks

o May help to relieve pain

• Surgical debridement

• Sequestrectomy

Nursing Interventions

• Pain relief

• Physical mobility

o Move the area very gently

o Restrict activity due to bone weakness, protect bone

o Use passive ROM

o Restrict weight bearing

• Controlling infection

o IV antibiotics
 o Use aseptic techniques, phlebitis is common

• Teaching self-care

Nursing Care

• Most important thing is to control the infection (DON’T SPREAD THE

INFECTION THAT THEY HAVE), then pain

Septic Arthritis
• Inflammation of the synovial tissues in a joint as the result of a pyogenic
bacterial infection.

• Joints become infected by:

o Hematogenous

o Direct trauma

o Surgical instrumentation

• Contributing factors

o Previous trauma

o Joint replacement

o Coexisting arthritis

o Diminished resistance

• Causitive Organism

o S. aureus streptococci and Gram negative organisms

Clinical Manifestations

• Warm, painful, swollen joints

• Decreased ROM

• Systemic

o Chill

o Fever

o Leukocytosis
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Risk Factors

• Diabetes

• Rheumatoid Arthritis

• Advanced age

Assessment and Diagnostic Findings

• Examination

• Aspiration and culture of synovial fluid

• CT scan

• MRI

• Bone scan

Management

• Prompt treatment is essential and may save a joint prosthesis

• Broad spectrum antibiotics are started promptly

• Monitor synovial fluid for a decrease in WBC

• Joint aspiration

• Arthrotomy and arthroscopy

• Support and immobilize joint

• Pain management

• Nutrition

• Progressive ROM

• Education

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