Musculoskeletal Infection

Question 1

Osteomyelitis - CMs

acute

Answer 1

• Fever greater than 101
• Edema
• Erythema (red tissue)
• Drainage
• Pain

Question 2

Osteomyelitis

Answer 2

• Infection in the bone
• Inflammation
  > swollen, warm, painful, tender
• At risk for necrosis/abscess
• Formation of new bone around infection may occur
• Common organisms
  > staphylococcus aureus (naturally occuring on skin)
  > MRSA

Question 3

Osteomyelitis - CMs

chronic

Answer 3

• After body tries to heal itself; infection still present, low lvls
• Low grade fever in evening
• Drainage, pain
• Vascular insufficiency
  > bones are naturally very vascular
  > ulcerations/sinus tract formation
  > nerve damage; may have no pain

Question 4

Osteomyelitis - Diagnostics

Answer 4

• Biopsy/culture/sensitivity
  > will tell us what antibiotics will be effective
• X-ray/MRI
• Elevated WBC, ESR, C-reactive protein

Question 5

Osteomyelitis - Treatment

Answer 5

• Pain control
• PICC line
  > necessary! long course of antibiotics, may go home w/ PICC for IV antib
• IV antibiotics 3-6 weeks
• Hyperbaric oxygen (HBO)
  > anaerobic bacteria don’t like oxygen
• Surgical debridement
  > dead tissue at higher risk for infection
• Surgical reconstruction
• Avoid loss of limb
  these pts are at a high risk for sepsis

Question 6

Osteomyelitis - Assessment/Diagnosis

Answer 6

• Hx & Px
• Patient reports
  > acute onset of S/S; localized pain, edema, erythema, fever
  > recurrent drainage of infected sinus w/ associated pain, edema, & low-grade fevers
• Assess pt for risk factors

Question 7

Osteomyelitis - Nursing Diagnsis

Answer 7

• Acute pain r/t inflammation & edema
• Impaired physical mobility r/t pain, used of immbolization devices, and weight-bearing limitations
• Risk for infection: bone abscess formation
• Deficient knowledge r/t treatment regimen

Question 8

Osteomyelitis - Nursing Goals

Answer 8

• Relief of pain
• Improved physical mobility w/in therapeutic limitations
• Control & eradication of infection
• Knowledge of treatment regimen
• Transition care-home

Question 9

Osteomyelitis - Nursing Interventions

Answer 9

• Monitor skin & neurovascular status
• Gentle manipulation of limb
• Pain meds as prescribed
• Elevate limb/non-weight bearing
• Monitor:
  > response to antibiotics (check temp)
  > IV access
  > secondary infection (candida)
• Aseptic technique-dressing changes

Question 10

Osteomyelitis - Nursing Evaluation

Answer 10

• Expected pt outcomes may include:
  > experiences pain relief
  > incrs in safe physical mobility
  > shows absence of infection
  > adheres to therapeutic plan

Question 11

Osteomyelitis - Home Care

Answer 11

• Ineffective health maintenance: r/t continued immonility at home, PICC line care, continued antibiotics, dressings, casts/splints
• Goal: pt will follow a mutually agreed upon plan of care & be compliant
• Interventions
  > long-term management of home IV administration
  > PICC line care
  > mobility limitations
  > postop & FU care
  > manis of deteriorating condition
  > no smoking
  > nutrition
  > referral for home care
  > safety & prevention of injury