Osteomyelitis
58 likes31,938 views
Osteomyelitis is an infection and inflammation of bone and bone marrow that is usually painful. It is most commonly caused by bacteria such as Staphylococcus aureus. Risk factors include diabetes, sickle cell disease, HIV/AIDS, and intravenous drug use. Symptoms may include fever, pain, swelling, and limited range of motion near the infected bone. Diagnosis involves x-rays, scans, blood tests, and culture of wound or blood samples. Treatment involves long-term intravenous antibiotics as well as possible surgery to debride infected tissue. Nursing care focuses on pain management, preventing infection spread, maintaining mobility, and educating the patient.
Osteomyelitis
- 1. OSTEOMYELITIS Presented by: Ms. Avelin D’Souza 1st year M.Sc. Nursing5/30/20161
- 2. Osteomyelitis is an infection and inflammation of the bone and bone marrow. Osteomyelitis is an infectious usually painful inflammatory disease of bone often of bacterial origin that may result in the death of bone tissue. – Merriam Webster. Definition 5/30/20162
- 3. The overall prevalence is 1 case per 5,000 children. Neonatal prevalence is approximately 1 case per 1,000. The incidence of vertebral osteomyelitis is approximately 2.4 cases per 100,000 population. Direct trauma and contiguous focus osteomyelitis are more common among adults and adolescents than in children. Vertebral osteomyelitis is more common in persons older than 45 years Incidence 5/30/20163
- 4. Structure and function of the skeletal system There are 206 bones in the human body, divided into four categories: • Long bones (e.g., femur) • Short bones (e.g., metacarpals) • Flat bones (e.g., sternum) • Irregular bones (e.g., vertebrae) Anatomy and physiology 5/30/20164
- 5. Bone is composed of cells, protein matrix, and mineral deposits. The cells are of three basic types—osteoblasts, osteocytes, and osteoclasts. Covering the bone is a dense, fibrous membrane known as the periosteum. The periosteum nourishes bone and allows for its growth; it also provides for the attachment of tendons and ligaments. The periosteum contains nerves, blood vessels, and lymphatics. Cont.… 5/30/20165
- 6. 1. Suppurative osteomyelitis a) Acute suppurative osteomyelitis b) Chronic osteomyelitis Primary (no preceding phase) Secondary suppurative (follows an acute phase) Classification 5/30/20166
- 7. 1. Non-suppurative osteomyelitis Diffuse sclerosing Focal sclerosing (condensing osteitis) Proliferative periostitis (periostitis ossificans, Garré's sclerosing osteomyelitis) Osteoradio necrosis Cont.… 5/30/20167
- 8. Staphylococcus aureus Staphylococcus epidermidis Streptococcus viridens Escherichia coli Mycobacterium tuberculosis Pseudomonas 5/30/20168 Etiology
- 9. Certain conditions and behaviors that weaken the immune system increase a person's risk for osteomyelitis, including: Diabetes (most cases of osteomyelitis stem from diabetes) Sickle cell disease HIV or AIDS Rheumatoid arthritis Intravenous drug use Alcoholism Long-term use of steroids Hemodialysis Poor blood supply Recent injury 5/30/20169 Cont.…
- 10. Fever, irritability, fatigue Nausea Tenderness, redness, and warmth in the area of the infection Swelling around the affected bone Lost range of motion Clinical Manifestations 5/30/2016 10
- 11. When the infection is blood borne, the onset is usually sudden, occurring often with the clinical manifestations of septicemia Chills High fever Rapid pulse General malaise 5/30/201611 Cont.…
- 12. X-Ray Radioisotope bone scans Blood studies Wound and blood culture studies Level of C-reactive protein MRI and CT scan Assessment and Diagnostic Findings 5/30/201612
- 13. The initial goal of therapy is to control and halt the infective process. Pharmacologic therapy Vigorous and prolonged IV antibiotic therapy is the treatment of choice for acute osteomyelitis as long as bone ischemia has not yet occurred. As soon as the culture specimens are obtained, IV antibiotic therapy begins first in the hospital then is continued at home for 4-6 weeks or as long as 3-6 months The antobiotics include Vancomycin, Neomycin, Gentamycin, Tobramycin, Cefazolin Medical Management 5/30/201613
- 14. Hyperbaric oxygen therapy: 100% oxygen may be administered as an adjunct therapy in refractory cases of chronic osteomyelitis. This therapy is thought to stimulate circulation, healing in the infected area. Cont.… 5/30/201614
- 15. Surgical management: Debridement. A sequestrectomy (removal of enough involucrum to enable the surgeon to remove the sequestrum) Amputation Cont.… 5/30/201615
- 16. Assessment: Subjective data: Important health history Functional health patterns Objective data: General Integumentary Musculoskeltal Nursing process 5/30/201616
- 17. Nursing Diagnoses Based on the nursing assessment data, nursing diagnoses for the patient with osteomyelitis may include the following: •Acute pain related to inflammation and swelling •Impaired physical mobility related to pain, use of immobilization devices, and weight-bearing limitations •Risk for extension of infection: bone abscess formation •Deficient knowledge related to the treatment regimen Cont.… 5/30/201617
- 18. Relieving pain The affected part may be immobilized with a splint to decrease pain and muscle spasm. The nurse monitors the 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 analgesics and other pain reducing techniques Nursing Interventions 5/30/201618
- 19. Improving physical mobility Treatment regimens restrict activity. The bone is weakened by the infective process and must be protected by immobilization devices and by avoidance of stress on the bone. The patient must understand the rationale for the activity restrictions. The joints above and below the affected part should be gently placed through their range of motion. The nurse encourages full participation in ADLs within the physical limitations to promote general well-being. Cont.… 5/30/201619
- 20. Controlling the infectious process The nurse monitors the patient’s response to antibiotic therapy and observes the IV access site for evidence of phlebitis, infection, or infiltration. With long-term, intensive antibiotic therapy, the nurse monitors the patient for signs of superinfection (e.g., oral or vaginal candidiasis, loose or foul-smelling stools). If surgery was necessary, the nurse takes measures to ensure adequate circulation (wound suction to prevent fluid accumulation, elevation of the area to promote venous drainage, avoidance of pressure on grafted area), to maintain needed immobility, and to comply with weight-bearing restrictions. The nurse changes dressings using aseptic technique to promote healing and to prevent cross-contamination. The nurse continues to monitor the general health and nutrition of the patient. A diet high in protein and vitamin C ensures a positive nitrogen balance and promotes healing. The nurse encourages adequate hydration as well. Cont.… 5/30/201620
- 21. Long bone osteomyelitis is difficult to treat and is responsible for significant morbidity and expense. The goal of treatment is to arrest its spread and repair the damage it has caused. Appropriate treatment includes culture-directed antibiotic therapy and operative debridement of all necrotic bone and soft tissue. Conclusion 5/30/201621
- 23. Brunner & Siddharth, ‘Textbook of Medical surgical nursing’, Volume 1, 11th edition, Wolters Kluwer publication, New Delhi 2009, pg. 2060 - 2065. Lewis et al, ‘Medical Surgical Nursing’, 7th edition, Elsevier publication 2007 New Delhi, pg. 1668 – 1672 Lippincott, ‘Manual of Nursing Practise’, 10th edition, Wolters Kluwer publication, New Delhi 2010, pg. 1144 - 1145 http://www.uptodate.com/contents/overview-of-osteomyelitis-in- adults www.slideshare.com www.mayoclinic.org/diseasesconditions/osteomyelitis/basics/.../co n-20025518 Reference 5/30/201623
- 24. 5/30/201624
- 25. 5/30/201625