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OSTEOMYELITIS It is an infection in the bone that results in inflammation, necrosis, and formation of new bone.

Causes Most cases of osteomyelitis are caused by staphylococcus bacteria Germs can enter a bone in a variety of ways, including: Via the bloodstream germs in other parts of your body From a nearby infection severe puncture wounds can carry germs deep inside your body. Direct contamination this may occur if you have broken a bone so severely that part of it is sticking out through your skin. Clinical Manifestations The symptoms of osteomyelitis can include: 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)

Normal Structure and Function of the Musculoskeletal System There are 206 bones in the adult body. It includes the bones of the skeleton and the cartilages, ligaments, and other connective tissue that stabilize or connect the bones.

In addition to supporting the weight of the body, bones work together with muscles to maintain body position and to produce controlled, precise movements. Main Functions It provides support for the body Store minerals and lipids Produce blood cells Protect body organs Provide leverage and movement Bone Structure Each bone in the skeleton contains two forms of tissue: a. Compact (dense) bone that is relatively solid and spongy (cancellous) bone that forms an open network of struts and plates, which is found on the external surface b. Spongy bone it is located inside the bone Bone development and growth Bones begin to form in a mother's womb about six weeks after fertilization, and portions of the skeleton do not stop growing until about the age of 25. Most bones originate as hyaline cartilage, which is converted gradually to a bone through a process of ossification. Other elements of the musculoskeletal system Joints where two bones interconnect. Each joint reflects a compromise between stability and range of motion. Tendons these attach muscle to bone Ligaments these attach bone to bone Skeletal Muscles these contracts to pull on tendons and move the bones of the skeleton it also maintains posture and body position, support soft tissues, guard entrances and exits to the digestive and urinary tracts, and maintain body temperature. Nerves it controls the contraction of skeletal muscles, interprets sensory information, and coordinates the activities of the body's organ systems Cartilage a firm gel-like substance which is a type of connective tissue

Pathophysiology PREDISPOSING FACTOR > Age elderly PRECIPITATING FACTOR > Nutrition > Immuno-compromised > Medication: Long-term corticosteriod > Post operative surgical infection

Soft Tissue Infection

Direct bone contamination

Hematogenous spread

Warm

Pain and tender

Inflammation

septicemia

Vascularity

O: Fever S: Chills

Rapid pulse

General malaise

Swollen

Edema

Thrombosis

Occlusion of BV

Ischemia

Necrosis

Abscess formation

(Pressure) Pulsating pain (Sequetrum)

Not easily liquefy and drain Extends to the periosteum

Infection up to adjacent soft tissue and joints

does not heal

Involucrum forms Athralgia

Osteomyelitis

Management Medical management 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 and drainage of bone abscess Sequestrectomy removal of dead, infected bone and cartilage. Bone grafting is recommended after repeated infections.

Nursing Care Monitor the neurovascular status of the affected extremity Elevation reduces swelling and associated discomfort Pain is controlled with prescribed analgesics and other pain-reducing techniques Must be protected by immobilization devices and avoidance of stress on the bone The patient must understand the rationale of activity restrictions Encourage patient to have a full participation in ADLs within the physical limitations to promote general well-being Monitor the patients response to antibiotic therapy Observes the IV access for evidence of phlebitis, infection, or infiltration, With long term intensive antibiotic therapy (monitors the patient for sign of infection like oral or vaginal candidiasis, loose or fouling-smelling stool) If surgery is necessary (take measures to ensure adequate circulation to the affected area (wound suction to prevent accumulation, elevation of the area to promote venous drainage, avoidance of pressure on the grafted area) to maintain needed immobility, and to ensure the patients adherence of to weight bearing restrictions. Changes dressings using aseptic technique (to promote healing and to prevent cross-contamination) Diet high in protein and Vitamin C (promotes a positive nitrogen balance and healing) Encourage adequate hydration as well

Explanation of Pathophysiology The pathphysiology begins with the different factors that contribute to the development of the disease.

If a patient had an open wound, the disease process starts with the invasion of microorganisms in the said lesion. The infection spreads to the bone via blood stream. The infectious organism invades the bone tissue and initiates an inflammatory response. The inflammatory response leads to the development of edema and increased vascularity in the area. Leukocytes migrate to the site, and inflammatory exudates collects at the site and forms an abscess. Due to the vascular engorgement that develops, the vessels in the area thrombose and the blood flow to the site is compromised. As the site of infection expands and the exudate continues to grow, pressure develops at the site causing pain and leading to ischemia of the bone and eventually necrosis. The exudates extend into the medullary cavity and under the periosteum, stripping the periosteum off the bone and further compromising the vascular supply of underlying bone tissue. The necrotic bone that develops forms an area referred to as sequestum. It is separated from the surrounding bone that is still living that provides an area for bacteria to continue to live. In response to bone destruction and disruption of the periosteum, the body initiates an intense osteoblastic activity. The osteoblasts stimulate the growth of new bone, which surrounds and encloses the area of dead bone. The new bone which surrounds the sequestrum is referred to as involucrum

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