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.
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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
- Protect the affected extremity from further injury and pain by supporting the limb above and below the affected area.
- Prepare the client for surgical treatment, such as debridement, bone grafting or amputation, as appropriate.
- Administer prescribed medications, which may include opioid and non-opioid analgesics and antibiotics.
- 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.
