osteomyelitis

Radionuclide bone scans

(gallium and indium) are helpful in diagnosis and are usually positive in the area of infection. Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be used to help identify the extent of the infection

Indirect entry osteomyelitis

(hematogenous) of microorganisms most frequently affects growing bone in boys younger than 12 years old and is associated with their higher incidence of blunt trauma. Adults with genitourinary and respiratory tract infections marked by vascular insufficiency disorders (e.g., diabetes mellitus) are at higher risk for the spread of a primary infection via the blood to the bone. As highly vascular bones, the pelvis, tibia, and vertebrae, are the most common sites of infection.

Osteomyelitis wound care- dressings

-Dressings are used to absorb drainage from wounds and debride dead tissue from the wound bed. - dry, sterile dressings; dressings saturated in saline or antibiotic solution; wet-to-dry dressings; and dressings applied with negative-pressure wound therapy. -Sterile technique is essential when changing the dressing. -Handle soiled dressings carefully to prevent transfer of bacteria to other areas of the wound. -Discard dressings appropriately to prevent spread of infection to other patients.

adverse reactions of prolonged antibiotic therapy for osteomyelitits

-These reactions include hearing deficit, impaired renal function, and neurotoxicity. -Reactions associated with cephalosporins (e.g., cefazolin) include hives, severe or watery diarrhea, blood in stools, and throat or mouth sores. -Tendon rupture (especially the Achilles tendon) can occur with use of the fluoroquinolones (e.g., ciprofloxacin, levofloxacin [Levaquin]).

Antibiotic Treatment of chronic osteomyelitis

-extended use of antibiotics. -Acrylic bead chains containing antibiotics may also be implanted at this time to help combat the infection. -After debridement of the dead, infected tissue, the wound may be closed, and a suction irrigation system is inserted. -Intermittent or constant irrigation of the area with antibiotics may also be initiated.

Surgical treatment of Chronic Osteomyelitis

-surgical removal of the poorly perfused tissue and dead bone and the limb or surgical site is often protected with casts or braces. -Postoperatively negative-pressure wound therapy (vacuum-assisted wound closure) may be used. -If orthopedic prosthetic devices are a source of chronic infection, they must be removed. -Muscle flaps or skin grafts provide wound coverage over the dead space (cavity) in the bone, only after infection is resolved. Bone grafts may help to restore blood flow. Amputation if bone destruction is extensive. Amputation should improve quality of life and may save the patient's life if systemic complications are developing.

The overall goals are that the patient with osteomyelitis will

1-have satisfactory pain and fever management, 2-not experience any complications associated with osteomyelitis, 3-Adhere to the treatment plan, and 4-maintain a positive outlook on the outcome of the disease.

NDs osteomyelitis

Acute pain related to inflammatory process secondary to infection Ineffective health maintenance related to lack of knowledge regarding long-term management of osteomyelitis Impaired physical mobility related to pain, immobilization devices, and weight-bearing limitations

pathophysiology of beggining osteomyelitis

After gaining entry into/via the blood, microorganisms grow and pressure increases because of the nonexpanding nature of most bone. This increasing pressure eventually leads to ischemia and vascular compromise of the periosteum. The infection spreads through the bone cortex and marrow cavity, causing cortical devascularization and necrosis

why is osteomyelitis hard to treat?

Antibiotics or white blood cells (WBCs) have difficulty reaching the sequestrum through the blood. Thus sequestrum may become a reservoir for microorganisms that spread to other sites, including the lungs and brain. If the sequestrum does not resolve on its own or is not debrided surgically, a sinus tract may develop. Chronic, purulent cutaneous drainage from the tracts results.

sequestrum

Bone death occurs as a result of ischemia. The area of dead bone eventually separates from the surrounding living bone, forming sequestrum (dead bone).

diagnostic labs for osteomyelitis

Bone or soft tissue biopsy is the definitive way to identify the causative microorganism. The patient's blood and/or wound cultures are frequently positive for the presence of microorganisms. Elevated WBC count and erythrocyte sedimentation rate (ESR) may also be found. Although elevated ESR is usually seen in chronic infective processes, elevated C-reactive protein (CRP) may also suggest acute infection.

Health Promotion for patients with osteomyelitis

Control other current infections Persons at risk are immunocompromised, have diabetes, orthopedic prosthetic devices, vascular insufficiencies Encourage to call HCP about local signs- bone pain, fever, swelling, and restricted limb movement

prevention of complications related to bedrest for osteomyelitis

Good body alignment and frequent position changes promote comfort and prevent complications related to immobility Flexion contracture of the affected lower extremity is common as the patient frequently positions leg in a flexed position to promote comfort. Footdrop can develop quickly due to Achilles tendon contracture if the foot is not correctly supported in a neutral position by a splint or boot. A tight splint or dressing may also compress and injure the peroneal nerve.

SD- perception, nutrition, activity, cog, coping

Health perception-health management: IV drug and alcohol abuse, malaise Nutritional-metabolic: Anorexia, weight loss, chills Activity-exercise: Weakness, paralysis, muscle spasms around affected area Cognitive-perceptual: Local tenderness over affected area, increase in pain with movement of affected area Coping-stress tolerance: Irritability, withdrawal, dependency, anger

O2 therapy for chronic Osteomyelitits

Hyperbaric oxygen with 100% oxygen may be given as an adjunct therapy in refractory cases of chronic osteomyelitis. It stimulates new bone growth and healing in the infected tissue.

Acute Care nursing interventions for osteomyelitis

Immobilization and careful handling of affected limb Assess and treat pain Dressing care - sterile technique Proper positioning/support of extremity

opportunistic infections related to long term antibiotic therapy

Lengthy antibiotic therapy can also cause an overgrowth of Candida albicans and Clostridium difficile in the genitourinary and GI tracts, especially in immunosuppressed and older patients. Instruct the patient to report any changes in the oral cavity (e.g., whitish, yellow, curdlike lesions) or the genitourinary cavity (e.g., perianal itching or diarrhea).

Osteomyelitis pain contril

Muscle spasms may cause minor to severe pain. Nonsteroidal antiinflammatory drugs (NSAIDs), opioid analgesics, and muscle relaxants may be prescribed for patient comfort. Encourage nondrug approaches to pain management (e.g., guided imagery, relaxation breathing).

Ostomyelitis

Osteomyelitis is a severe infection of the bone, bone marrow, and surrounding soft tissue. Although Staphylococcus aureus is a common cause of infection, a variety of microorganisms may cause osteomyelitis.

SD- PMH, Meds, Surgery

Past health history: Bone trauma, open fracture, open or puncture wounds, other infections (e.g., streptococcal sore throat, bacterial pneumonia, sinusitis, skin or tooth infection, chronic urinary tract infection) Medications: Use of analgesics or antibiotics Surgery or other treatments: Bone surgery

Ambulatory Care of osteomyelitis nursing interventions

Patient/caregiver teaching regarding antibiotic administration and management of CVAD Wound care/dressing changes Physical and psychologic support

Antibiotic therapy for acute osteomyelitis

Patients are often discharged to home care or a skilled nursing facility with IV antibiotics delivered via a central venous access device (CVAD). These include centrally inserted catheters, peripherally inserted central catheters (PICCs), and implanted ports. IV antibiotic therapy may initially be started in the hospital and continued in the home for 4 to 6 weeks or as long as 3 to 6 months.

Objective Data osteomyelitis

Restlessness, high spiking temperature, night sweats Diaphoresis, erythema, warmth, edema Restricted movement, wound drainage, spontaneous fractures ↑ WBC, + cultures, ↑ ESR, presence of sequestrum and involucrum

Long-term and mostly rare complications of osteomyelitis

Septicemia Septic arthritis Pathologic fractures Amyloidosis

imaging studies for osteomyelitis

Signs of osteomyelitis usually do not appear on x-rays until 10 days to weeks after the appearance of clinical symptoms. By this time, the disease will have progressed. Compared to x-rays, CT scan may be more helpful in assessing the extent of infection. Especially in the acute phase, MRI may be more sensitive than CT in detecting bone marrow edema, which is an early indication of osteomyelitis.

preventing adverse reactions to prolonged antibiotic therapy for osteomyelitis

Teach the patient the possible adverse and toxic reactions associated with prolonged and high-dose antibiotic therapy Peak and trough blood levels of most antibiotics should be monitored to avoid adverse effects.

involucrum.

The part of the periosteum that continues to have a blood supply forms new bone called...

Direct entry osteomyelitis

can occur at any age when an open wound (e.g., penetrating wounds, fractures) allows microorganisms to enter the body. Osteomyelitis may also be related to a foreign body such as an implant or an orthopedic prosthetic device (e.g., plate, total joint prosthesis).

Antibiotics for Osteomyelitis

depends on organism- penicillin, nafcillin (Nafcil), neomycin, vancomycin, cephalexin (Keflex), cefazolin (Ancef), cefoxitin (Mefoxin), gentamicin (Garamycin), and tobramycin (Nebcin). In adults with chronic osteomyelitis, oral therapy with a fluoroquinolone (ciprofloxacin [Cipro]) for 6 to 8 weeks may be prescribed instead of IV antibiotics. Oral antibiotics may also be given after acute IV therapy is completed to ensure the infection is resolved.

Systemic manifestations of acute osteomyelitis

include fever, night sweats, chills, restlessness, nausea, and malaise. Later signs include drainage from cutaneous sinus tracts and/or the fracture site.

Systemic manifestations of chronic osteomyelitis

may be reduced. Local signs of infection become more common, including constant bone pain as well as swelling and warmth at the infection site. Over time, granulation tissue turns to scar tissue. This avascular scar tissue provides an ideal site for continued microorganism growth because it cannot be penetrated by antibiotics.

Chronic osteomyelitis

refers to a bone infection that lasts longer than 1 month or an infection that has failed to respond to initial course of antibiotic treatment. Chronic osteomyelitis may be a continuous, persistent problem (a result of inadequate acute treatment) or a process of exacerbations and remissions

Acute osteomyelitis

the initial infection or an infection of less than 1 month in duration. Clinical manifestations of acute osteomyelitis are both local and systemic. Local manifestations include constant bone pain that worsens with activity and is unrelieved by rest; swelling, tenderness, and warmth at the infection site; and restricted movement of the affected part.