Introduction

Osteomyelitis

- is an infection in a bone that results in inflammation, necrosis and formation of new bone.
- infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue - osteomyelitis can also begin in the bone itself if an injury exposes the bone to germs.

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.

Osteomyelitis is classified as:

Hematogenous ostemyelitis- due to bloodborne spread of

infection. Contiguous-focus osteomyelitis- from contamination from bone surgery, open fracture, traumatic injury.

Osteomyelitis with vasular insufficiency seen most commonly among patient with diabetes and peripheral vascular disease,most affecting the feet.

Signs and symptoms

Fever or chills Irritability or lethargy in young children Pain in the area of the infection Swelling, warmth and redness over the area of the infection Low back pain swelling of ankles, legs and feet. Sweating due to fever or chills, particularly night sweats.

Pain deep within the bone, usually an ache or throbbing sensation.

Increased pain when pressure is applied around the area of injury or when the patient is standing,

The area adjacent to a fracture or surgery site becomes swollen and inflamed.
The skin around the affected area turns red and/or pus drains from the wound

Diagnostic finding

X-ray finding - to demonstrate soft tissue edema. In about 2-3

weeks areas of periosted elevation and bone necrosis are evident.

Radioisotope bone scan - particularly the isotope-labeled WBC

scan.
MRI - Magnetic resonance imaging (MRI). Using radio

waves and a strong magnetic field, MRIs can produce exceptionally detailed images of bones and the soft tissues that surround them.

Lab Tests

Bone Scan - to identify areas of infection.

Bone biopsy - is the gold standard for diagnosing

osteomyelitis, because it can also reveal what particular type of germ has infected the bone

Medications

Nursing diagnosis

acute pain related to inflammation and swelling

impaired physical mobility related to pain, immobilization devices and load weight limits

Risk for Infection

Nursing interventions

Focus care on controlling infection, protecting the bone from injury, and providing support. Encourage the patient to verbalize his concerns about his disorder. Encourage the patient to perform as much self-care as his conditions allows. Help the patient identify care techniques and activities that promote rest and relaxation and encourage him to perform them. Use strict aseptic technique when changing dressings and irrigating wounds. Provide a well-balanced diet to promote healing.

Support the affected limb with firm pillows.

Nursing interventions

Provide complete cast care. Administer prescribed analgesics for pain. Look for sudden malpositioning of the affected limb, which may indicate fracture. Explain all the test and treatment procedures.

Nursing Interventions

Immobilization with a splint the affected area to reduce pain and muscle spasms. Joints above and below the affected area should be made so that still can be moved according to the range yet gently.. Elevate the affected area to reduce swelling and discomfort. Monitor the affected extremity neurovascular status. Do pain management techniques such as massage, distraction, relaxation, hypnosis to reduce pain perception and collaboration with medical for providing analgesic. Protect bones by means of immobilization and avoid stress on the bone because bones become weak due to the infection process.

The End