OM Flashcards
What is the duration of acute OM
<1mth
What is the duration of chronic OM
> 1mth
What microorganisms are most commonly seen in OM
Staph A* & mycobacterium TB
Risk factors of OM
- Trauma/injury
- Surgical procedures
- Open wound
- Bloodstream/haemtogenous spread (*most common)
- Infection from other parts of the body (ear, tonsil, teeth, sinus & genitourinary)
- Weak immunity (HIV)
- Poor circulation (DM/cellulitis)
- IV drug use
- Periodontal disease
- Indwelling central catheter
- Prosthetic joint
Where do OM usually occur in ADULTS
Vertebrae, sternocalvicular, sacroiliac joint, symphysis pubis
Where do OM occur in CHILDREN
Long bones of appendicular skeleton
What can OM cause at site of infection
Septic arthritis & pathologic fracture
What is the SS of OM
- Bone pain
- Redness
- Swelling
- Warmth
- Fever
- Malaise
- Nausea
- Restless
- Night sweats/chill
- Bacteraemia
- Pain on movement of affected extremity
- Loss of movement
- Local tenderness
What test can be done for OM
- MCS
- Hx & PE
- X-ray
- Conventional radiology
- Nuclear imaging studies
- CT scan
- MRI
- Radionuclide bone scan
- Bone biopsy
What treatment is done for ACUTE OM
- IV abx (abx for 4 wks, 1-2 wk on IV, rest on PO)
- Surgical debridement
- Abx irrigation
- Acrylic bead chains containing abx
What is the tx of CHRONIC OM
- Incision & drainage
- Wound debridement
- Sequestectomy
- Hyperbaric O2
- IV abx
Which part of the body does OM TB affect the most
Spine because its closest to the vertebrae/leg
(*more difficult to control & more destructive)
What are the SS of OM TB
Local: pain, immobility, muscle atrophy, swelling
Systemic: Fever/night sweat, Leukocytosis, Cough, manifestations to pulmonary TB
What is the goal of tx for OM
- Eradicate infection
- Monitor complication & pt discomfort & pain
What are the nursing management for OM
- Establish contact precaution
- Assess VS (bp) & lvl of pain
- Administer pain meds
- Help with non-pharmacological pain mgt techniques
- Administer fluid & abx
What are the pre-surgical debridement care to be done for OM
- Standard pre-opt care
- Perform focused NV assessment of affected extremity
- to report if
A. Decreased/absent pulse
B. Prolonged cap refill of more than 3 seconds
C. Dusky, pale skin - cool to touch
D. Numbness, tingling/decreased sensation
E. Pain that does not improve with meds
- to report if
What are the post-surgical debridement care for OM
- Monitor for systemic infection (VS & lab result)
- report if
I. Increased WBC + left shift
II. Increased serum lactate
III. Increased procalcitonin
IV. Altered LOC
V. Hypotension
VI. Tachycardia
VII. Tachypnoea
VIII. Fever
- report if
- Protein rich diet to support healing
- Coordinate ongoing care after discharge
- IV abx
- Dressing change (*sign of wound healing: decreased size, exudate & contraction of wound edge)
How does Jackson Pratt/JP drain work
Prevent extra fluid from building up after surgery/have infection by sucking fluid through squeezable bulb
How does Hemovac drain work
Prevent extra fluid from building up after surgery/have infection by sucking fluid into flat container with spring
Factors affecting wound healing
- Clean/uncontaminated
- Moist wound bed for continuous granulation
- Blood flow (remove dead tissue/necrotic/escahr)
- Pressure
- Location of wound (joint/movement area which are further away from circulation)
- Diet (increased protein, decreased sugar & salt to prevent dehydration)
- Med (chemo & blood thinners)
What is MEASURE
Measure wound; Exudate quality & amt; Appearance of wound bed; Suffering; Undermining, Re-evaluation every 2-4wk; Edge of wound
What is the discharge plan for OM
- Knowledge on OM
- Refer to home nurse to assess surgical wound, administer IV abx & monitor process
- Teach how to care for central venous access if have
- Eat diet rich in protein, vitamin & mineral
- Manage chronic condition (DM/PVD - inspection leg daily and take measures to prevent injury)
What is to be reported to the HCP for OM
- Develop other wound/ulcer/break in skin
- Fever, chill
- Increased redness, swelling, numbness/pain
