NUR 317 Exam 5 - Osteomyelitis

Osteomyelitis

• Severe infection of bone, bone marrow, and surrounding soft tissue

• Most common microorganism is Staphylococcus aureus, but can be caused by variety of organisms

Indirect entry osteomyelitis

• Usually one organism

• Hematogenous – seeding from source of infection

• Blunt trauma

Direct entry osteomyelitis

• Usually more than one organism

• Via open wound

• Foreign body presence

Acute osteomyelitis local manifestations

• Pain that worsens with activity and is unrelieved by rest

• Swelling

• Restricted movement

Acute osteomyelitis systemic manifestations

• Fever

• Night sweats

• Chills

• Restlessness

• Nausea

• Malaise

• Drainage (late)

Chronic osteomyelitis clinical manifestations

• Infection lasting more than 1 month

  • Or – has failed to respond to initial antibiotic treatment

• Continuous and persistent or process of exacerbations and remissions

• Local manifestations become more common

• Systemic manifestations become less common

• Scar tissue develops

Osteomyelitis diagnostic studies

• Bone or soft tissue biopsy

• Blood and/or wound cultures

• WBC count

• Erythrocyte sedimentation rate (ESR)

• C reactive protein

• X-rays/ MRI/ CT scans

• Bone scans

Acute osteomyelitis interprofessional care

• IV antibiotic therapy

• Surgical debridement and decompression

• IV antibiotics:

  • For 4-6 weeks or longer

  • Antibiotics may be continued at home or may need

• Variety of antibiotics depending on microorganism

  • Not all SNF’s accept all medications

  • Oxacillin, clindamycin, vancomycin, ceftriaxone, ciprofloxacin, linezolid

Chronic osteomyelitis interprofessional care

• Surgical removal

• Antibiotics

• Acrylic bead chains

• Intermittent or constant antibiotic irrigation of bone

• Negative pressure wound therapy

• Hyperbaric O2

• Amputation

Osteomyelitis subjective data

• Past health history

  • Bone trauma, open fracture, open or puncture wounds, other infections

• Medications

  • Use of analgesics or antibiotics

• Surgery or other treatments

  • Bone surgery

• IV drug and alcohol abuse, malaise

• Anorexia, weight loss, chills

• Weakness, paralysis, muscle spasms

• Local tenderness, increase in pain

• Irritability, withdrawal, dependency, anger

Osteomyelitis objective data

• Restlessness, high spiking temperature, night sweats

• Diaphoresis, erythema, warmth, edema

• Restricted movement, wound drainage, spontaneous fractures

• Labs – WBC, cultures, ESR

• X-ray – sequestrum, involcurum

Osteomyelitis overall goals

• Satisfactory pain and fever management

• No complications associated with osteomyelitis

• Adherence to treatment plan

• Maintain a positive outlook on outcome of disease

Osteomyelitis acute care

• Mobility – bedrest, repositioning

• Assess and treat pain

• Dressing care

• Proper positioning/support of affected limb

• Antibiotic therapy (potentially high dose)

  • Educate on side effects

  • May need to monitor peak and trough levels

Osteomyelitis complications and associated conditions

• Septicemia

• Septic arthritis

• Pathologic fractures

• Amyloidosis

Osteomyelitis

• Continued psychologic and emotional support

  • Patient and family are often frightened and discouraged

• Collaboration with MSW

• If patient going home vs SNF:

  • Long term antibiotic administration

    • Teaching regarding antibiotic administration

    • Teaching regarding management of CVAD

  • Wound care/dressing changes