Osteomyelitis
· Pain and/or tenderness in the infected
Definition: Infection of the bone and
surrounding tissues, most commonly caused
by
Staphylococcus Aureus. It can be either acute
or chronic. This disorder usually occurs
as a result of an infection in one part of the
body that is transported through the
bloodstream to a bone in a distant location.
Also Known As:
· Hematogenous Osteomyelitis
Incedence
· Osteomyelitis affects about 2 in 10,000
people.
· Acute osteomyelitis is rare in children.
It's estimated that one in every 1,000
children under the age of one will develop
acute osteomyelitis.
· The condition is even less common in
children over one, with one in every 5,000
children affected.
· For example, it's estimated that between
30% and 40% of people with diabetes,
who experience a puncture injury to the
foot, will develop osteomyelitis. One in
every 200 people with sickle cell anaemia
(a hereditary blood condition) will
develop osteomyelitis in any given year.
Risk Factors
· Trauma
· Diabetes
· Hemodialysis
· Splenectomy
· Advanced age
- ↓Immune function
· Poor circulation
Manifestation
area
· Swelling and warmth in the infected area
· Fever
· Nausea, secondarily from being ill with
infection
· General discomfort, uneasiness, or ill
feeling
· Drainage of pus through the skin
Additional symptoms that may be
associated with this disease include:
· Excessive sweating
· Chills
· Lower back pain (if the spine is
involved)
· Swelling of the ankles, feet, and legs
· Changes in gait (walking pattern that is a
painful, yielding a limp)
Types
There are three main types of
osteomyelitis:
· Acute osteomyelitis, where the bone
infection develops within two weeks
of an initial infection, injury or the onset
of an underlying disease.
· Sub-acute osteomyelitis, where the
bone infection develops
within one ot two months of an
initial infection, injury or onset of an
underlying disease.
· Chronic osteomyelitis, where the bone
infection develops two months or
more after an initial infection, injury or
onset of an underlying disease.
Stages of Osteomyelitis  hematogenous, loval
PATHOPHYSIOLOGY OF extension , trauma)
OSTEOMYELITIS Pathophysiologic Manifestation on
SEKELETAL Effect on Bodily Function:
SYSTEM  ↓ cardiac output
 ↓ impaired cellular metabolism
 ischemic necrosis
Risk Factors:  systemic infection
-trauma  lysis of the bone cell
-diabetes
-hemodialysis
Clinical Manifestations ( S/S ) :
-splenectomy
 Increased CRP compliment
-advanced age  reactive protein
 Increased erythrocyte
Changes:
 sendimentatiion rate ESR
 Vascular congestion  Drainage of pus through the skin
 Small vessel thrombosis  Pain and/or tenderness in the
 Edema  infected area
 inflammation  Swelling and warmth in the infected
 if compensation fails  area
 great losses  Fever
Molecular Changes:  Nausea, secondarily from being ill
 Pus spread to vascular channel  with infection
 Increase intraosseous pressure Laboratory Exams:
 Decreased blood flow  CBC
 Bone scan
 ESR
exudation of polymorphonuclear  Bone lesion biopsy or culture
leukocytes:
 increased erythrocytes Pathophysiology
 increased WBC  Osteomyelitis tends to occlude
local blood vessels, which causes
ETIOLOGY/CAUSE: bone necrosis and local spread of
1. Newborns (younger than 4 infection.
mo):  Infection may expand through the
 S. aureus, Enterobacter bone cortex and spread under the
 species, and group A and B periosteum, with formation of
Streptococcus species subcutaneous abscesses that may
2. Children, adolescents (aged drain spontaneously through the
4 y to adult): skin.
 S. aureus (80%),  In vertebral osteomyelitis,
group A Streptococcus paravertebral or epidural abscess
species, H. can develop.
 influenzae, and  If treatment of acute osteomyelitis
Enterobacter species is only partially successful, low-
 Enterobacter or Streptococcus grade chronic osteomyelitis
Bacterial invasion ( develops.
Diagnostic Studies
 CBC- WBC may be elevated
(indicates presence of active
infection).
 ESR (erythrocyte sedimentation
rate) - may be elevated (indicates
inflammatory process).
 Bone Scan (indicates infected
bone).
 Bone lesion biopsy or culture
(may reveal the causative
organism).
Management
Medical management for clients with
Osteomyelitis are as follows:
 Analgesics as prescribed.
 Antibiotics as prescribes.
 Dressing changes- use sterile
technique.
 Maintain proper body alignment
and change position frequently to
prevent deformities.
 Immobilization of affected part.
Surgery if needed:
 Incision ad Drainage of bone
abscess.
 Sequestrectomy- removal of dead,
infected bone and cartilage.
 Bone grafting is recommended
after repeated infections.
Nursing Intervention
 control the patient's pain with
prescribed analgesics and
nonpharmacologic techniques
 Perform tepid sponging if the
temperature is above 40˚c
 monitor his response to antibiotic
therapy
 observe the patient's I.V. site for signs
of complications
 monitor the area of infection and
neurovascular status (if an extremity
is involved)
 apply gentle range-of-motion
exercises to the joints above and
below the affected site
 unless contraindicated, provide
nutritional support in the form of a
highprotein diet
 teach your patient how to take
prescribed antibiotics and how to
recognize possible adverse reactions.

Nursing Diagnoses
• Risk for Infection
• Hyperthermia
• Impaired physical mobility
• Acute pain
• Anxiety
Patients with osteomyelitis need to take
care of themselves to improve their
chances of fighting infection. Teach your
patients to:

 Eat a variety of fruits and vegetables,

which can provide the body with the
nutritional support it needs to fight
infection and stay healthy.
 Stop smoking. Smoking slows blood
flow to the hands and feet, making it
more difficult for the body to fight
infection
 Provide your patient with smoking
cessation materials if he needs help.
 Continue antibiotic treatment as
prescribed.
 Advise him to call his health care
provider to report any adverse effects
before discontinuing the drug on his
own.
 The success of antibiotic treatment
depends on following the complete
regimen.

References:
Medical-Surgical Nursing by Josie Quiambao-Udan,
RN, MAN
http://www.nlm.nih.gov/medlineplus/ency/image
pages/9712.htm
http://www.nhs.uk/conditions/Osteomyelitis/Page
s/Introduction.aspx
www.merck.com
Lemone, Page 1267
Professional Guide to Diseases (Eighth Edition),
2005
Edited by-Belinda Josephine,Aseana College of
Health Sciences