Osteomyelitis Stephanie Licano

What is Osteomyelitis? A local or generalized infection of bone and bone marrow can be usefully subclassifed on the basis of the causative organism, the route, duration and anatomic location of the infection.

Causes…... Bacteria is most often introduced through trauma The bacteria can also travel from one site of the body to the bone causing infection Staphylococcus aureus is also the most common organism seen in osteomyelitis Trauma: Compound fracture or surgery ie: joint replacements or internal fixation of fractures Bacteria: invades the bone and then degeneration occurs

Occurs invariably in children, usually in the long bones Also in adults it may be because of compromised host resistance due to debilitation, intravenous drug abuse, disease or drugs (e.g. immunosuppressive therapy).

You might want to check for… Abrupt onset of high fever Irritability Malaise Restriction of movement Local edema, erythema, and tenderness Non-healing ulcer Chronic fatigue Sinus tract drainage (fever is present in only 50% of neonates with osteomyelitis)

Tests CBC: The WBC count may be elevated, but it frequently is normal Radiology MRI Ultrasound CT scanning Radionuclide bone scanning osteomyelitis, culture or aspiration findings in samples of the infected site are normal in 25% of cases. Blood culture results are positive in only 50% of patients with hematogenous osteomyelitis.

Diagnosis requires 2 of the 4 following criteria: Purulent material on aspiration of affected bone Positive findings of bone tissue or blood culture Localized classic physical findings of bony tenderness, with overlying soft-tissue erythema or edema Positive radiological imaging study

Treatment Osteomyelitis often requires prolonged antibiotic therapy Severe cases may lead to the loss of a limb. Initial first line antibiotic choice is determined by the patient's history and regional differences in common infective organisms. Surgical debridement Antibiotic: can last for several weeks or months Such as cephalothin (Keflin) and ancef

Some Nursing Interventions… Use gentleness while moving the patient Rest of the affected part is completely necessary Use of pillows and sandbags for good alignment Wounds are irrigated with hydrogen peroxide, or another antiseptic or antibiotic solution then covered using strict medical asepsis Patients are placed on drainage and secretion precautions PAIN IS EXTREMELY SEVERE!!!!!! Also diet is high in calories, protein, and vitamins

Patient Teaching The patient should be taught about signs of infection, like an elevated temperature It is also important for the patient to be aware of the recurrence of signs and symptoms Patients should be told to avoid trauma to the affected bone because fractures are common

Complications Bone abscess Bacteremia Fracture Loosening of the prosthetic implant Overlying soft-tissue cellulitis Draining soft-tissue sinus tracts

Prognosis Acute osteomyelitis may respond to treatment after several weeks. Chronic osteomyelitis may persist for years with exacerbations and remissions