Exam 3 - Osteomyelitis Flashcards
severe infection of the bone, bone marrow, and surrounding soft tissue
osteomyelitis
most common organism for osteomyelitis
Staphylococcus aureus
*educate: keep your nails short
indirect entry (hematogenous) risk factors
blunt trauma
GU, respiratory infection marked by vascular insufficiency disorder (infection spreads to the bone)
boys < 12 y/o
most common sites of osteomyelitis
vascular bones
- pelvis
- tibia
- vertebrae
direct entry risk factors
*most common
open wounds
foreign body present (including artificial joints, plates, etc)
bone death occurs as a result of ___
ischemia
dead bone is aka
sequestrum
thin membrane on the outside of your bones
periosteum
part of the periosteum that continues to have blood supply forms new bone called ___
involucrum
if sequestrum does not resolve on its own or debrided a sinus tract develops. What occurs with a sinus tract?
chronic, purulent cutaneous drainage from the tract
acute osteomyelitis last how long
< 1 month
*initial infection
local s/sx of osteomyelitis
pain, worsens with activity; unrelieved by rest swelling tenderness warmth restricted movement
systemic s/sx of osteomyelitis
fever night sweats chills restlessness nausea malaise drainage (late)
how long does chronic osteomyelitis last
> 1 month
fails to respond to abx treatment; process of exacerbation and treatment
granulation tissue turns into
scar tissue > avascular > ideal site for microorganism growth > cannot penetrate abx
long term and most rare complications
septicemia
septic arthritis
pathologic fractures
amyloidosis
Dx studies for osteomyelitis
bone, soft tissue injury (definitive way to Dx) blood, wound culture WBC ESR CRP CXR, MRI, CT scan bone scan
how long does it take for osteomyelitis to show on an XR?
10 days to weeks
how long for IV abx therapy
4-6 weeks or as long as 3-6 months
how are IV abx give at home
PICC (peripherally inserted central catheter)
port
CVAD (central venous access device; central line)
IV abx used for osteomyelitis
PCN naficillin( Nafcil) neomycin vancomycin Keflex cefazolin (Ancef) cefoxitin (Mefoxin) gentamycin (Garamycin) tobramycin (Nebcin)
PO abx used for chronic osteomyelitis or given after IV abx therapy
cipro
*6-8 weeks
bone grafts may help restore __ __
blood flow
what can develop d/t achilles tendon contracture if the foot is not properly supported in a neutral position by splint or boot
footdrop
what can occur to pts taking fluoroquinolone (cipro, levo)
tendon rupture
side effects of cefazolin (Ancef)
hives
severe, watery diarrhea
blood in stool
throat, mouth sores
lengthy abx use can cause an overgrowth of what?
candida albicans
c. diff
hematogenous osteomyelitis
d/t blood infection
contagious-focused ostemomyelitis
d/t contaminated bone surgery r/t hardware, open fracture, traumatic injury
osteomyelitis with vascular insufficiency
d/t decrease perfusion: common in DM and PVD
commonly affects the feet
any diabetic foot ulcer more than __ cm in diameter is highly suspicious for osteomyelitis
2 cm
are systemic s/sx constant with chronic osteomyelitis?
No, they may be reduced but local s/sx such as constant pain, swelling, warmth at site may be present.
should elective orthopedic sx be performed if the pt currently has an infection?
No, increased risk for osteomyelitis
surgical interventions to help reduce risk for osteomyelitis
prophylactic abx pre-op
abx 24 hr post op
D/C foley, drains ASAP
aseptic wound care
MRI can detect ___ ___ ___ which is an early indication of osteomyelitis
bone marrow edema
which 2 scans are most helpful to identify the extent of infection
MRI
CT
sx treatment for chronic osteomyelitis includes extended abx use and which type of surgery?
sequestrectomy
what occurs during a dequestrectomy?
removal of enough involucrum to enable the surgeon to remove sequestrum
irritation does not extend beyond __ week and uses a ___ physiologic saline solution
1 week
sterile saline solution
which technique is essential when changing dressing r/t osteomyelitis
sterile
what labs must be monitored to avoid adverse abx reaction
peak
trough
