osteomyelitis

pathophysiology

• infection of bony tissue

• can lead to chronic reaccurence, loss of function, chronic pain, amputation, or death due to sickness

• bacteria, viruses, parasites, or fungi can cause bone infection

• pathogen stimulated inflammatory responsewhich produced vascular lead and edema of surrounding osft tissue

  • vessels become trombosed and release exudate into bony tissue

    • ischemia and necrosis follow

      • sequestrum forms-—prevents one helaing and causes superimpsed infection

exogenous

• infectious organism enter from outside the body

  • open fracture, surgery, or penetrating trauma

endogenous (hematogenous)

• organisms are carried by the bloodstream from other infections areas in the body

• result from bacteremia, underlying disease, or nonpenetrating trauma

  • UTI leads to spread to lower vertebra

  • long-term IV catheters, hemodialysis

  • Salmonella infections of the GI tract

physical assessment

• bone pain

  • constant, localized, pulsating sensation, worsens with movement

  • no pain if nerve damage occurs due to vascular compromise

• fever

  • higher than 101

  • older adults may not have extreme elecation due to aging and immune system

• swelling erythma and heat

lab assessments

• elevated WBC

• elevated ESR

• blood culture

  • obtained if bactermia is present

  • identifies offending pathogen and treatment

active osteomylitis

• fever; temp usually above 101

• swelling around the affected area

• possible erythema and heat in the affected area

• tenderness of the affected area

• bone pain that is constant, localized, and pulsating; worsening with movement

chronic osteomyleitis

• foot ulcers or bone surgery

• sinus tract formation

• localized pain

• drainage from the affected area, usually due to bone absess

antimicrobal therapy

• at least 4-6 weeks of antimicrobial therapy for acute osteomyelitis

• prolonged therapy for more than 3 months is often needed

  • more than 1 antimicrobial may be required

  • may require home health nurse or SNF to administer medication

  • PIC line may be required

• observe side effect of toxicity

wound care and antimicrobial therapy

• contact precautions for copious wond drainage

• use of antibiotics-—impregnated packed into wounds that require continuous or intermittent irrigation

• hyperbaric oxygen therapy

• pain managment

surgical managment

• incision and drainage

• wound dbridement

• bone excision

  • sequestectomy

    • removes necrotic bone and allows revascularization of tissue

    • often leaves cavitu or bone defect

      • bone graft may be required

• frequent neurovascular assessments

  • evaluate extremes to increase venous return and control swelling