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
Changes:

Vascular congestion
Small vessel thrombosis
Edema
inflammation

Pus spread to vascular channel

Increase intraosseous pressure
Decreased blood flow

if compensation fails
great losses
Molecular Changes:

exudation of
polymorphonuclear
leukocytes:

increased erythrocytes

increased WBC

ETIOLOGY/CAUSE:
1. Newborns (younger than 4
mo):
S. aureus, Enterobacter
species, and group A and B
Streptococcus species
2. Children, adolescents (aged
4 y to adult):
S. aureus (80%),
group A Streptococcus
species, H.
influenzae, and
Enterobacter species
Enterobacter or
Streptococcus
Bacterial invasion (
hematogenous, loval
extension , trauma)
Pathophysiologic Manifestation on
Effect on Bodily Function:
cardiac output
impaired cellular metabolism
ischemic necrosis
systemic infection
lysis of the bone cell
Clinical Manifestations ( S/S ) :
Increased CRP compliment
reactive protein
Increased erythrocyte
sendimentatiion rate ESR
Drainage of pus through the skin
Pain and/or tenderness in the
infected area
Swelling and warmth in the
infected
area
Fever
Nausea, secondarily from being ill
with infection
Laboratory Exams:
CBC
Bone scan
ESR

Bone lesion biopsy or culture

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.

Nursing Diagnoses

Risk for Infection

Hyperthermia
Impaired physical mobility
Acute pain
Anxiety

Nursing Intervention

control the patient's pain with

prescribed analgesics and
nonpharmacologic techniques
Perform tepid sponging if the
temperature is above 40c
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.

References:
Medical-Surgical Nursing by Josie
Quiambao-Udan, RN, MAN
http://www.nlm.nih.gov/medlineplus/ency/i
magepages/9712.htm
http://www.nhs.uk/conditions/Osteomyeliti
s/Pages/Introduction.aspx
www.merck.com
Lemone, Page 1267
Professional Guide to Diseases (Eighth
Edition), 2005
Edited by-Belinda Josephine,Aseana
College of Health Sciences