F - Wk9 Osteomyelitis

Question 1

Whats osteomyelitis?
How long do the symptoms last?

Answer 1

1. inflammation of the bone and its associated structures
2. Usually caused by an infection.

Acute: up to 1 mth
Chronic: > 1 mth

Question 2

What are the causes of osteomyelitis?

Answer 2

1. Staph aureus infection
   - skin bacteria
2. Mycobacterium tuberculosis,
   Pseudomonas aeruginosa,
   Streptococcus spp.,
   Salmonella spp.,
   Pasteurella spp.

Less common: viruses, parasites & fungi

Question 3

Risk factors for osteomyelitis?

Answer 3

1. Local - trauma and open wounds.

Systemic
2. weak immune system
- can be because of an HIV infection

3. poor circulation
   - uncontrolled diabetes or peripheral vascular disease
4. Bacterial infections at other sites of the body
   - ears, tonsils, teeth, sinuses, lungs, and genitourinary tract
5. IV drug use
6. periodontal (gum) disease
   - spread to jaw bone
7. indwelling central catheter
8. prosthetic joint
   - can be infected during surgery -> spread to surrounding bone

Question 4

What is the pathology of osteomyelitis?

Answer 4

Due to direct or indirect invasion of bones by the causative pathogen.

Direct invasion:
1. trauma or surgery
- eg: open fracture after an accident, the bone may get exposed to the outside environment, coming in direct contact with bacteria

Indirect invasion:
2. From a distant infection through the bloodstream = hematogenous spread

3. From a nearby infection
   - eg cellulitis
   - infection of the dermis layer of the skin
   = contiguous spread.

Once pathogens reach the bone by any route -> proliferate & initiate inflammatory response -> destruction of the bone

Question 5

What are the complications of osteomyelitis?

Answer 5

Acute phase: usually resolves within a few weeks

Chronic:
1. affected bone sometimes becomes necrotic and separates from the healthy part of the bone = sequestrum

Acute & chronic:
2. inflammation may involve the periosteum, lifting it up away from the compact bone

3. can also spread further to involve a nearby joint, knee or hip joint + overlying muscle, skin & blood -> bacteremia & sepsis
4. septic arthritis or pathologic fractures at the site of infection
5. if it involves bones of the skull or spine -> spinal cord compression, meningitis, or brain abscess.

Question 6

What are the signs and symptoms of osteomyelitis?

Answer 6

1. bone pain, redness, swelling, warmth
2. restricted movement around the site of infection.

systemic signs:
3. fever, malaise, nausea,
4. restlessness
5. night sweats, chills.

Question 7

How to diagnose osteomyelitis? READ

Answer 7

Lab tests:
1. CBC
- increase in WBCs
- elevated erythrocyte sedimentation rate or ESR & C-reactive protein CRP

2. Imaging tests
   - X-ray, CT scan, MRI, and radionuclide bone scans
   - thickening of the cortical bone & periosteum
   - elevation of the periosteum
   - loss of the normal trabecular architecture of the bone or osteopenia, = loss of bone mass
3. bone biopsy
4. histopathologic exam & culture
   - confirm diagnosis & identify pathogen responsible for the infection

Question 8

Treatment of acute osteomyelitis?

Answer 8

1. IV administration of antibiotics
2. surgical debridement if needed.
3. Irrigation of the area with antibiotics
4. acrylic bead chains containing antibiotics
   - implanted into infected bone to eradicate the infection

Question 9

Whats the treatment of chronic osteomyelitis?

Answer 9

1. incision and drainage
2. wound debridement
3. sequestrectomy
   surgical removal of dead tissue
4. extended antibiotics therapy & hyperbaric oxygen therapy
   - enhance bone and soft tissue healing

Severe cases of chronic osteomyelitis:
5. amputation of the affected limb
6. bone graft

Question 10

Whats the nursing care for patients with osteomyelitis?

Answer 10

Priority goals of care: eradicate infection & monitor for complications.

1. Establish contact precautions
2. Assess vitals
   - level of pain
3. Administer the prescribed analgesics
   - non-pharmacologic pain management techniques like progressive muscle relaxation or rhythmic breathing
4. Assist them into a comfortable position
   - maintain good body alignment to prevent problems like flexion contractures and foot drop
   - gently immobilize affected extremity
5. IV access & administer the prescribed fluids and antibiotics

Question 11

What is the client and family teaching you will provide?

Answer 11

1. Explain how osteomyelitis can develop when bacteria or other microorganisms get inside the bone
2. Review treatment plan
   - reassure them that the home health nurse will visit daily to assess surgical wound, administer IV antibiotics & monitor progress
   - if they have central venous access device -> teach them how to care for the device properly to prevent infection.
3. Maintaining general health
   - eat a balanced diet rich in vitamins, minerals, and protein
   - managing any chronic, underlying conditions.

if they have diabetes or peripheral vascular disease
5. inspect their legs and feet daily, to take measures to avoid injury
- let HCP know if they develop any wounds, ulcers, or other breaks in the skin.