osteomyelitis

osteomyelitis PowerPoint PPT Presentation


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Osteomyelitis Defined. Bacterial infection of boneCan also be caused by fungus, parasites, and virusStaphylococcus Aureus most common bacteriaOsteo=boneMyelo=marrowIt is=inflammationAcute: new bone infection lasting less than 6 weeksChronic: bone infection present longer than 6 weeks or bone infection that has recurredSymptoms: low grade fever, pain, and a draining sinus tract.

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osteomyelitis

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1. Osteomyelitis

2. Osteomyelitis can may affect all or only a portion of the bone. The most common sites of osteomyelitis infection are the legs, feet, pelvis and spine. Acute osteomyelitis is more common in children while chronic osteomyelitis is more common in adults.Osteomyelitis can may affect all or only a portion of the bone. The most common sites of osteomyelitis infection are the legs, feet, pelvis and spine. Acute osteomyelitis is more common in children while chronic osteomyelitis is more common in adults.

3. Pathophysiology After entry bacteria lodge and multiply in the bone Immune system response with inflammation and phagocytosis Pus forms, followed by edema and vascular congestion, sinus tract to skin may form for pus to drain Infection travels to other segments of bone Raises the periosteum of the bone, causing compromised blood perfusion Eventual ischemia and necrosis of bone (sequestrum=dead bone) Involucrum=new bone formation

4. Pathophysiology of Osteomyelitis

5. Etiology Hematogenous Osteomyelitis: pathogens are carried in the blood to the bone from sites of infection elsewhere in the body Spine is usual site of infection in adults UTI, soft tissue infections, endocarditis, and infected IV sites are sources of pathogens Affects older adults, IV drug abusers, those with sickle cell anemia Surgical prosthesis when a piece of metal has been surgically attached to a bone hip and knee replacements Fungus (cocci) can infect bone. In osteomyelitis involving the vertebrae about half the cases are due to staphylococcus aureus, and the other half are due to tuberculosis that has spread via the bloodstream to the bone from the lung. Fungus (cocci) can infect bone. In osteomyelitis involving the vertebrae about half the cases are due to staphylococcus aureus, and the other half are due to tuberculosis that has spread via the bloodstream to the bone from the lung.

6. Etiology (continued) Osteomyelitis from a contiguous infection Caused by an extension of infection from adjacent soft tissues Most common cause of osteomyelitis in adults Can occur due to direct penetrating wounds Decubitus ulcers Neurosurgery Osteomyelitis associated with vascular insufficiency Those with DM and PVD are at risk Neuropathy exposes foot to trauma and pressure ulcers Infection can spread to bone, client unaware Poor perfusion impairs wound healing

7. Risk Factors Intravenous drug abusers Hemodialysis patients Recent trauma Diabetes Mellitus Spleenectomy

8. Manifestations of Osteomyelitis Cardiovascular effects Tachycardia GI effects Nausea and vomiting Anorexia MS effects Limp in involved extremity Localized tenderness Integumentary effects Drainage and ulceration at involved site Swelling, erythema, and warmth at involved site Lymph node involvement

9. Manifestations (continued) Other effects High temperature with chills Abrupt onset of pain Malaise

10. Interdisciplinary Care Diagnosis Based on bone scans MRI and CT scan Biopsy Blood tests Erythrocyte sedimentation rate (ESR) will be elevated Elevated C-Reactive protein CBC (WBC will be elevated) Blood cultures ESR-a test that measures how fast red blood cells settle to the bottom of a test tube C-Reactive protein (a protein that circulates in the blood and is dramatically increased when inflammation is present.ESR-a test that measures how fast red blood cells settle to the bottom of a test tube C-Reactive protein (a protein that circulates in the blood and is dramatically increased when inflammation is present.

11. Interdisciplinary Care (continued) Medications Antibiotic therapy (parenteral) May use a broad-spectrum abx until culture and sensitivity reports are back Antibiotic therapy is continued for 4-6 weeks Picc line or central venous catheter is often placed for this purpose Prior to availability of abx, blow fly larvae were introduced into the wound to feed on the infected material, effectively scouring it clean Objective of treatment is to eliminate the infection and prevent if from getting worse. Objective of treatment is to eliminate the infection and prevent if from getting worse.

12. Interdisciplinary Care (continued) Surgery Extensive debridement of the infected site may be required Periosteum is excised and the cortex is drilled to evacuate the abscess and drain infected pus May have drainage tubes attached to irrigation and suction Muscle or skin flap may be used to fill in the dead space left behind Nurse must follow strict aseptic technique when handling drainage system and doing dressing changes The treatment generally consists of surgical debridement of the infected bone and soft tissue structures along with prolonged use of antibiotics, usually 4-6 weeks, may need up to 8 weeks if infection is in the spine. The treatment generally consists of surgical debridement of the infected bone and soft tissue structures along with prolonged use of antibiotics, usually 4-6 weeks, may need up to 8 weeks if infection is in the spine.

13. Nursing Care Nursing Diagnoses and Interventions Risk for infection Compromised immune system puts client at risk for super infection Needs adequate calories and protein in diet to promote healing Maintain strict hand washing practices Wash hands before and after contact even if gloves are worn Prevents spread of infection by minimizing entry of organisms into susceptible clients Administer antimicrobial therapy at specified times Optimal blood levels of antibiotic therapy are MANDATORY in clients with infectious process

14. Nursing Care (continued) Hyperthermia Monitor temperature every 4 hours and when client reports fever or chills (blood cultures are often ordered when an acute temperature elevation occurs) A sudden rise in temperature may indicate inadequate antimicrobial management Provide cooling measures as necessary Ice packs, cooling blanket Ensure a daily fluid intake of 2000-3000 ml’s Dehydration can occur from evaporative losses during temperature elevation

15. Nursing Care (continued) Impaired Physical Mobility Maintain affected limb in functional position when immobilized (to avoid flexion contractures) Maintain rest and avoid subjecting affected extremity to weight bearing activities (avoids pathologic fracture due to weakened bone) Active or passive range of motion every 4 hours Flexion contracture occurs when the client remains immobile Pain, infection, inflammation and the use of immobilizers can all impair the mobility of a client with osteomyelitis. Patient with a prosthesis that has been removed will not be able to walk. Pain, infection, inflammation and the use of immobilizers can all impair the mobility of a client with osteomyelitis. Patient with a prosthesis that has been removed will not be able to walk.

16. Nursing Care (continued) Acute pain Use splint or immobilizer when client experiences acute pain from swelling Ask physician to order scheduled times for pain medications Use non-pharmacologic methods for pain control Avoid excessive manipulation of involved area

17. Community-Based Care After acute hospitalization most care is provided at home Home health nurse follows for dressing changes and intravenous antibiotics Include following topics for home care: Careful hand washing Taking all antibiotics as prescribed Need to take pain medications on a regular basis How to perform wound care and where to secure supplies for wound care Rest or limited weight bearing for the affected extremity Doing active ROM exercises Importance of maintaining good nutrition

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