CH 39 Osteomyelitis & Gout

osteomyelitis

bacterial infection of the bone

• pts with sickle cell anemia are more prone

• ↑ risk of pathological fractures

clinical presentation of osteomyelitis

• (CNS) chills, fever, malaise

• localized tenderness, erythema, edema, ↓ ROM

• assess if there has been recent infections

3 types of osteomyleitis

hematogenous, contiguous, and chronic

hematogenous osteomyelitis

type of OM where symptoms come on quickly and is mostly seen in kids (due to ↑ vascularity to growing bones)

contiguous osteomyelitis

type of OM that results from trauma or surgery

• more likely to acquire if pt has pressure ulcer

• people w/diabaetes mellitus and PVD are ↑ risk for this type of OM

chronic osteomyelitis

type of OM classified by amount of time (longer than 6-8 weeks) w/lack of response to meds

• bone that’s affected is dead, black, and necrotic

• pt has icnresaed risk of gangrene w/this type

how is OM diagnosed?

• CBC

• ESR (identifies inflammation)

• CRP lab

• draw blood cultures (but only 50% of pts are positive for blood cultures)

• aspirate fluid from area and do a culture to find type of bacteria

why are CTs and MRIs more effective at diagnosing OM than Xray?

because Xrays may be normal at first, but CTs/MRIs show early problems in bone and surrounding soft tissue

treatment of OM

• Antibiotics (by IV for 2-6 weeks, followed by oral antibiotics)

• debridement of necrotic tissue

• drainage of excess fluid

• follow up appointments every 3 months for 2 years to ensure no complications develop

• if OM is due to infected prosthesis it may need to be removed

• pain management

• maybe hyperbaric O2 treatment

• standard precautions

S&S of OM

• bone pain (constant, localised, puslating)

• sensations become worse w/movement

• fever

• area around bone is swollen/tender

• chronic OM = less likely to show fever, swelling, and erythema

• ESR is normal early on

• ↑ WBC

Gout

affects the metatarsal pharangeal joint of the big toe

hyperuricemia

lots of uric acid which causes inflammation

tophi

uric acid crystals that form in SubQ tissue

presentation of gout

• redness

• warmth

• swelling of joint

discomfort starts during the night or early morning

risk factors for gout

• diet high in red meat/seafood (because it has purines, which has a lot of uric acid)

• lots of alcohol

• yoyo dieting (diet, lose weight, put weight back on, repeat)

• genetics

• those who’ve had chemo (because it affects all cells in the body)

major complication of hyperuricemia

kidney stones

diagnosis of gout

• rule out other joint conditions (like OA or RA)

• run 24hr uric acid level

• hyperuricemia may not be present, so can’t be sole diagnostic test

• but gold standard is aspiration of joint to show uric acid crystals

gout treatment

• manage acute attacks/prevent further attacks

• begin meds early to prevent joint damage

• pain management w/NSAIDs or colchicine

how is ibuprofen classified?

NSAID

therapeutic actions of NSAIDs

relief of RA, OA, mild to moderate pain, fever reduction, and general inflammation control

pharmacological actions of NSAIDs

inhibits prostaglandin synthesis by blocking COX-1 and COX-2 receptor sites, leading to antiinflammatory effects, analgesia, and antipyretic effects

AEs of NSAIDS

CNS

• headache

• dizziness

• somnolence (drowsiness)

• fatigue

• body rash

GI

• dyspepsia (upset stomach)

  • if person is medicating (ex antacids) due to GI side effects from drug, that’s NOT NORMAL

• constipation

Hematological

• bleeding risk

• bone marrow suppression

• MI or stroke

how are NSAIDs administered?

orally or IV

therapeutic use of colchicine

only used to treat gout

pharmacological action of colchicine

decreases inflammation produced specifically by gout, by inhibiting leukocyte migration and activity

patient education for colchicine

• take med with food to lessen GI side effects

• if diarrhea occurs, take antidiarrheal agent

• if GI distress occurs, stop immediately and notify provider

• **also notify provider if bleeding, bruising, or sore throat occur

• do not eating grapefruit/drink grapefruit juice because it can

• prevent gout by avoiding alcohol/foods high in purine, drinking water, and maintaining healthy weight

AEs of colchicine

• thrombocytopenia

• suppressed bone marrow

• rhabdomyolysis (more likely to occur w/long term, low dose therapy, for pts who take statins, or for pts who have impaired kidneys/liver)

GI

• mild GI distress, which may progress to GI toxicity

• abdominal pain

• diarrhea

• nausea/vomiting

contraindications of colchicine

severe renal, cardiac, hepatic, or GI dysfunction

how is colchicine administered?

orally