Marcus Josiah M. Reyes, SN-UST Batch 2010 Section 8 RLE 4

A severe infection of the bone and surrounding tissues (Maher, Salmond, & Pellino, 2002). Can occur in any age, but common to children younger than 12 years of age. Males have higher incidence than females (Maher, et al, 2002).

Hematogenous Through the bloodstream Contiguous focus Extension from adjacent tissue infection Direct infection into the bone

Predominantly occur in children, middle-aged, and older adults (Maher, et al, 2002). There is usually a single organism that enters a bone via the bloodstream from a site of infection (most commonly S. aureus) (Maher, et al, 2002). Common sources of infection: UTI, skin infection, URTI, and acute otitis media (Maher, et al, 2002).

Involves rich red marrow (Maher, et al, 2002). In children and infants: the long bones

Onset is insidious (Maher, et al, 2002). Infection spreads to adjacent bone through the soft tissue (Maher, et al, 2002). Greater risk for clients with Diabetes Mellitus and severe atherosclerosis (Maher, et al, 2002).

Microbes gain entry to the bone through open fractures, penetrating wounds, or contamination in a surgical procedure (Maher, et al, 2002). Implanted items may also cause infection (Maher, et al, 2002).

Entry of MicrobeInflammationIncreased VascularityEdema After 2-3 days, thrombosis Ischemia with bone necrosis Extends to medullary cavity, periosteum, and adjacent tissues Bone abscess formation SequestrumInvolucrum Chronic Osteomyelitis

If hematogenous, common sepsis manifestations: Chills High fever Rapid pulse General Malaise

At first, systemic sx may overshadow the local signs Constant, pulsating pain that intensifies with movement Swollen and tender area of infection Chronic Osteomyelitis presents continuously draining sinus or recurrent inflammation

CBC ESR Blood Cultures Superficial Cultures Biopsy X-Rays Radionuclide Bone Scans MRI

If with current infection, postpone orthopaedic surgery Strict aseptic technique during orthopaedic surgery Prophylactic antibiotics Urinary catheters and drains are removes as soon as possible

Pharmacologic IV Antibiotic Therapy for 3-6 weeks Then, oral ATB for 3 months Direct application Surgical Surgical Debridement Sequestrectomy Saucerization Internal fixation or external supportive devices

Infection IN ATBs, as ordered Hand Washing Strict Asepsis Monitoring of ATB compliance Health Education Infection Control Infection Prevention ATB administration

Pain Deep Breathing Exercises Splinting Analgesics, as ordered

Impaired Physical Mobility and Activity Tolerance Complete Bed Rest Diversional Activities Active ROM exercises to unaffected areas Passive ROM exercise to affected area, approved by the MD Assistive Devices

Anxiety Active Listening Stress Reduction (relaxation, guided imagery) Diversional Activities Health Education regarding illness

Knowledge Deficit: Disease and Medication Health Education to the patient and family

Maher, A., Salmond, S., & Pellino, T. (2002). Orthopaedic Nursing 3 rd Ed. PA: W.B. Saunders Company Smeltzer, S., Bare, B., Hinkle, J., & Chever, K. (2008). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 11 th Ed. PA: Lippincott Williams & Wilkins