Osteomyelitis Flashcards
1
Q
- Severe infection of bone, bone marrow, & surrounding soft tissue
- Most common microorganism is Staphylococcus aureus, but can be c/b variety of organisms
A
Etiology & Pathophysiology
- Indirect entry (hematogenous)
- Young boys
- Blunt trauma
- Vascular insufficiency disorders
- GI & respiratory infections
> Pelvis, tibia, & vertebrae, which are vascular-rich sites of bone, are most common infection sites
2
Q
- Direct entry - via open wound
- Foreign body presence (e.g., implant, orthopedic prosthetic device [e.g., plate, total joint prosthesis])
A
- Microorganisms grow → inc pressure in bone → ischemia & vascular compromise (of periosteum)
- Infection spreads through bone → cortex devascularization & necrosis
3
Q
Development of Osteomyelitis
A
4
Q
Clinical Manifestations: Acute osteomyelitis
- Infection of <1 month in duration
Local manifestations
- pain unrelieved by rest; worsens w/activity
- swelling, tenderness, warmth
- restricted movement
A
Systemic manifestations
- fever, night sweats
- chills, restlessness
- nausea, malaise, drainage (late) [from cutaneous sinus tract and/or fx site)
5
Q
Clinical Manifestations: Chronic Osteomyelitis
- infection lasting longer >1 month or has failed to respond to initial course of abx therapy
- either a continuous & persistent problem (a result of inadequate acute treatment) or a process of exacerbations and remissions
A
- Systemic signs diminished (fever, swelling, & erythema would be LESS LIKELY in chronic than acute)
- Sinus tracts often form
- Granulation tissue turns to scar tissue → avascular → ideal site for microorganisms to grow → away from abx penetration
6
Q
Diagnostic Studies
- Bone or soft tissue bx (definitive way)
- Blood &/or wound cultures
- WBC count ↑
- ESR ↑
- X-rays (won’t appear until about 10 days to wks >appearance of clin sx’s)
- Bone scans
- MRI/CT scans
A
Collaborative Care - Acute Osteomyelitis
- Vigorous & prolonged IV abx therapy (as long as bone ischemia hasn’t occurred)
- Cultures or bone bx (before rx therapy started)
- Surgical debridement & decompression (if abx therapy delayed)
7
Q
- Course of IV abx therapy 4-6 wks minimum (or as long as 3-6 mos)
- May be completed @ home or in SNF (via CVC or PICC)
A
- Variety of abx depending on microorganism
> penicillin
> nafcillin (Nafcil)
> neomycin
> vancomycin
> cephalexin (Keflex)
> cefazolin (Ancef)
> cefoxitin (Mefoxin)
> gentamicin (Garamycin)
> tobramycin (Nebcin)
8
Q
Collaborative Care - Chronic Osteomyelitis
- Surgical removal
- Extended use of abx
- Abx-impregnated polymethyl methacrylate bead chains
- Intermittent or constant abx irrigation of bone
A
- Casts or braces
- Negative-pressure wound therapy
- Hyperbaric oxygen therapy
> w/100% O2; is thought to stimulate circulation & healing within infected tissue - Removal of prosthetic devices
- Muscle flaps, skin grafting, bone grafting (restore blood flow)
- Amputation
9
Q
- Oral fluoroquinolone (Cipro) for 6-8 wks for chronic osteomyelitis
- Oral abx therapy may also be given >acute IV therapy is completed to ensure resolution of infection
A
- Monitor pt’s response to rx therapy w/bone scans & ESR tests
10
Q
- Long-term & mostly rare complications
> Septicemia
> Septic arthritis
> Pathologic fx’s
> Amyloidosis
A
Subjective Data
11
Q
- Past health hx
> bone trauma, open fx, open or puncture wounds, other infections (e.g., streptococcal sore throat, bacterial pneumonia, sinusitis, skin or tooth infection, chronic UTI) - Medications
> use of analgesics or abx - Surgery or other treatments
> bone surgery
A
- IV drug & alcohol abuse, malaise
- Anorexia, weight loss, chills
- Weakness, paralysis, muscle spasms
- Local tenderness, increase in pain w/movement of affected bone
- Irritability, withdrawal, dependency, anger
12
Q
Objective Data
- Restlessness, high spiking temp, night sweats
- Diaphoresis, erythema, warmth, edema
A
- Restricted movement, wound drainage, spontaneous fx’s
- ↑ WBC, + cultures, ↑ ESR, presence of sequestrum & involucrum
13
Q
Nursing Diagnoses
- Acute pain
- Ineffective self-health management
- Impaired physical mobility
A
Planning - Overall Goals
- Have satisfactory pain & fever control
- Do not experience any complications assoc w/osteomyelitis
- Cooperate w/treatment plan
- Maintain a positive outlook on outcome of dz
14
Q
Nursing Implementation - Health Promotion
- Control infections already in body
- Susceptible adults
> Immunocompromised
> Wear orthopedic prosthetic devices
> Have vascular insufficiencies - Instruct regarding local & systemic manifestations (monitoring & reporting)
> sx’s of bone pain, fever, swelling, & restricted limb movement
A
Nursing Implementation - Acute Interventions
15
Q
- Immobilization & careful handling of affected limb (e.g., splint, traction)
- Assess & treat pain
> NSAIDs, opioid analgesics, muscle relaxants; non-drug approaches - Dressing care
> sterile technique - Proper positioning to prevent complications of immobility
! flexion contracture - d/t pt positioning of affected extrem in a flexed position to promote comfort
! footdrop - if foot is not correctly supported in neutral position by a splint or there’s excessive pressure from a splint, which can injure peroneal nerve
A
- Pt teaching re: adverse & toxic rxn’s to abx therapy
! Ototoxicity, nephrotoxicity, neurotoxicity
! Hives, diarrhea, bloody stools, throat & mouth sores
! Tendon rupture - Monitor peak & trough lvls
