Osteomyelitis Finally 2

8/2/2019 Osteomyelitis Finally 2

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Osteomyelitis..


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Created By :-

Ashwag Hammed.

Naseem Hassan.

Balsam Mohammed. Maria Mohammed.

Ebtehal zweed.

Salsabil Abdullah. Areej Al-motery.


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Objectives :-

Definition of Osteomyelitis.

Classification of Osteomyelitis.

Causes of Osteomyelitis.

Risk factors of Osteomyelitis. Signs & symptoms ofOsteomyelitis.

Investigations ofOsteomyelitis.

Treatments and nursingmanagement of Osteomyelitis.

Complications of


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Definition:- Osteomyelitis is the medicalterm for an infection in a bone.

Osteomyelitis is an acute orchronic bone infection.


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Classifications:-

Host immune status :

Type A: Normal immune status.

Type B: Some degree ofimmunocomprimised status primarygrafting.Type C: Significant immunocomprimised

status.

Type I :- Medullary osteomyelitis.- Does not necessarily require bone


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Cont ..

- Type I :- medullary Osteomyelitis.- does not necessarily require bone grafting.

- Type II :- superficial Osteomyelitis affecting outer

surface of bone.- bone exposure second to soft-tissue loss, or an

adjacent soft tissue abscess abutting cortex.

- Type III :

- well marginated sequestration of cortical bone.- can be excised w/ creating instability.

- Type IV:- permeative destructive lesion causing

instability.


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Conditions which may classifyas a compromised healer include :

Diabetes. Use of steroids. Poor nutrition. Extensive scarring. Use of tobacco products. Cancer.

Previous radiation therapy. Organ failure. Chronic lymphedema. Old age.


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Pathophysiology:-

Osteomyelitis can occur as a result of Hematogenousseeding, spread of infection to bone, or directinoculation of infection into the bone as a result oftrauma or surgery.

Hematogenous Osteomyelitis is usuallymonomicrobial, while Osteomyelitis due to contiguousspread or direct inoculation is usually polymicrobial.

In long bone Hematogenous Osteomyelitis, mostcommon site of infection is in the metaphysis. Majorblood vessel to long bones usually penetrates thebone then travels towards both ends, forming

metaphysical vascular loop.


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Causes:-

Most cases of Osteomyelitis are caused by:

(staphylococcus bacteria).

Germs can enter a bone in a variety ofways, including:

Via blood stream. From a nearby infection. Severe

puncture wounds

Direct contamination. This may occur


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Risk factors:-

Bone fracture Any condition that causes a weakening of

the immune system such as: Diabetes. Organ transplant. Chemotherapy. AIDS.

Kidney failure. Intravenous drug abuse. Joint replacement. Peripheral neuropathy. Peripheral vascular disease.

Sickle cell anemia.


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Signs and Symptoms:-

Bone pain. Fever. General discomfort, uneasiness, or ill-feeling

(malaise).

Local swelling, redness, and warmth.

Other symptoms that may occur withthis disease :

Chills. Excessive sweating. Low back pain. Swelling of the ankles, feet, and legs.


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Investigations:-

A physical examination shows bone tendernessand possibly swelling and redness. Tests may include: Blood cultures.

Bone biopsy (which is then cultured). Bone scan. Bone x-ray. Complete blood count (CBC).

C-reactive protein (CRP). Erythrocyte sedimentation rate (ESR). MRI of the bone. Needle aspiration of the area around affected

bones.


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Laboratory and Imaging:-

CBC :

(WBC 18,000, 68% segs, 7% bands,

20% Lymphs, 5% monos, H/H 13/40, Plt.

260,000).

ESR : 60.

CRP : 15.


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Cont ..

q

X-rays: X-rays can reveal damage to your bone.

q Computerized tomography (CT) scan:creating detailed cross-sectional views of a

person's internalStructures.

q Magnetic resonance imaging (MRI): MRIs can

produce exceptionally detailed images of bonesand the soft tissues that surround them.

q Bone biopsy: it can reveal what particular typeof germ has infected your bone.


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Treatments:-The most common treatments forosteomyelitis are antibiotics.

MEDICATIONS :

Doctor can choose an antibiotic thatdepend on the type of infection.-The antibiotics are usuallyadministered through a vein at least six

weeks.- Side effects may include nausea,vomiting and diarrhea.


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Surgery:Depending on the severity of the infection.

surgery may include one or more of the followingprocedures :

Drain the infected area:Opening up the area

around the bone and allow surgeon to drain any pus orfluid that has accumulated in response to the infection.

Remove diseased bone and tissue: It'scalled debridement, the surgeon removes as much of

the diseased bone and taking a small margin of healthybone to ensure that all the infected areas have beenremoved.

Another procedures:-

Remove any foreign objects.


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Nursing management :-

Nursing Assessment:-

Important health information:

Past health historyMedicationsSurgery or other treatments.

Subjective data:IV drug use, malaise.Anorexia, weight loss, chills.Weakness, paralysis, muscle spasms.Local tenderness over affected area.


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Objective data:

General: Restlessness, high, spikingtemperature, night sweats.

Integumentary: Diaphoresis,erythema, warmth, edema atinfected bone.

Musculoskeletal: Restrictedmovement, wound drainage,spontaneous fractures.


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Nursing Diagnoses :-

Acute pain:Inflammatory process secondary toinfection.crying, restlessness, altered muscle tone,

decreased activity. Impaired physical mobility:

Pain, immobilization devices, weight-bearing limitations.Inability or unwillingness to changepositions.

Ineffective therapeutic regimenmanagement:

Lack of knowledge regarding long-term


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Nursing Interventions :-1-control the patient's pain withprescribed analgesics and nonpharmacologic techniques.

2-monitor his response to antibiotictherapy.

3- observe the patient's I.V. site forsigns of complications.

4- monitor the area of infection and

neurovascular status (if an extremities


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5- apply gentle range-of-motion

exercises to the joints above and belowthe affected site.

6- unless contraindicated, providenutritional support in the form of ahigh-protein diet.

7- teach your patient how to takeprescribed antibiotics and how torecognize possible adverse reactions.


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Teach your patients to :-

1-Eat a variety of fruits and vegetables.

2- Stop smoking.

3- Continue antibiotic treatment asprescribed.


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Planning :-

Over all goals :-

Have satisfactory pain and fever control.

Cooperate with treatment plan.

Maintain a positive outlook on outcome ofdisease.


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Complications:-

Bone death (osteonecrosis).

Septic arthritis: In some cases,

infection within bones can spreadinto a nearby joint.

Impaired growth. In children

Skin cancer.

Amputation.


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Any Questions... ?!


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Osteomyelitis Finally 2

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