Osteomyelitis Nursing Management

Definition
  • Osteomyelitis is a pyogenic bone infection.  
Risk Factors
  • Trauma or secondary infection (most commonly Staphylococcus aureus).
  • Blood-borne (hematogenic) osteomyelitis is more common in children after a throat infection.
  • Resulting from orthopedic surgical procedures is more common in older persons.
Pathophysiology
  • Circulation of infectious microbes through the bloodstream to susceptible bone leads to inflammation, increased vascularity and edema.
  • The organisms grow, pus forms within the bone, and abscess may form. This deprives the bone of its blood supply, eventually leading to necrosis.
image by : nlm.nih.gov

image by : nlm.nih.gov

Assessment/Clinical Manifestations/Signs And Symptoms
  • Localized bone pain
  • Tenderness, heat and edema in the affected area
  • Guarding of the affected area
  • Restricted movement in affected area
  • Purulent drainage from a skin abscess
Systemic symptoms
  • High fever and chills in acute osteomyelitis
  • Low-grade fever and generalized weakness in chronic osteomyelitis
Laboratory and diagnostic study findings
  • White blood cell count reveals leukocytosis
  • Erythrocyte sedimentation rate is elevated
  • Blood culture identifies the causative organisms.
  • Radiographs and bone scan demonstrate bone involvement in advanced disease.
Medical Management
  • Initial goal is to control and arrest the infective process.
  • Affected area is immobilized; warm saline soaks are provided for 20 minutes several times a day
  • Blood and wound cultures are performed to identify organisms and select the antibiotic
  • Intravenous antibiotic therapy is given around-the-clock.
  • Antibiotic medication is administered orally (on empty stomach) when infection appears to be controlled; the medication regimen is continued for up to 3 months
  • Surgical debridement of bone is performed with irrigation; adjunctive antibiotic therapy is maintained.
Nursing Diagnosis
  • Pain related to inflammation and swelling
  • Impaired physical mobility associated with pain, immobilization devices, and weight-bearing limitations
  • Risk for extension of infection: bone abscess formation
  • Deficient knowledge about treatment regimen
Nursing Management
  1. Protect the affected extremity from further injury and pain by supporting the limb above and below the affected area.
  2. Prepare the client for surgical treatment, such as debridement, bone grafting or amputation, as appropriate.
  3. Administer prescribed medications, which may include opioid and non-opioid analgesics and antibiotics.
  4. Promote healing and tissue growth.
    • Provide local treatments as prescribed (e.g. warm saline soaks, wet to dry dressings)
    • Provide a diet high in protein and vitamins C and D.
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