Osteomyelitis

A. Pusey Murray (Mrs)

RN, Cert Psych Nursing & Nursing
Admin, BSc (Hons), MPH, Dip.
Ed.
 Objectives
At the end of this session students will be able
to :
Define the term Osteomyelitis
Outline the etiology of Osteomyelitis
List the diagnostic tests
 Objectives
List the clinical manifestations of
Osteomyelitis

Discuss the medical and nursing management

of Osteomyelitis
 Definition
Osteomyelitis is a severe pyogenic bone
infection.
 Etiology
• Bone infection can be caused by bacteria
(more common) or fungi (less common).
• Infection may spread to a bone from infected
skin, muscles, or tendons next to the bone, as
in osteomyelitis that occurs under a chronic
skin ulcer (sore).
 Etiology
• A current or past injury may have made the
affected bone more likely to develop the
infection.
• The infection that causes osteomyelitis can
also start in another part of the body and
spread to the bone through the blood.
 Etiology
Risk factors are:
• Diabetes Mellitus
• Poor blood supply
• Recent trauma
 Diagnostic Tests
• Tests may include:
• Blood cultures
• Bone biopsy (which is then cultured)
• Bone scan
• Bone x-ray
• Complete blood count (CBC)
 Diagnostic Tests
• C-reactive protein (CRP
• Erythrocyte sedimentation rate (ESR)
• MRI of the bone
• Needle aspiration of the area around affected
bones
 Pathophysiology
• In osteoporosis the rate of bone loss exceeds
bone formation resulting in a decrease in total
bone mass. Bones affected by osteoporosis
lose calcium and phosphate salts resulting in
porous, brittle bones that are susceptible to
fracture.
 Clinical Manifestations
• Bone pain
• Fever
• General discomfort, uneasiness, or ill-feeling
(malaise)
• Local swelling, redness, and warmth
• Chills
• Excessive sweating
 Clinical Manifestation
• a passageway that opens in the skin through
which pus or fluid leaks (this is known as a
discharging sinus)
 Medical Treatment
• The goal of treatment is to get rid of the
infection and reduce damage to the bone and
surrounding tissues.
 Medical Treatment
• Antibiotics are given to destroy the bacteria
causing the infection. Often, the antibiotics
are given through an IV (intravenously,
meaning through a vein) rather than by
mouth. Antibiotics are taken for at least 4 - 6
weeks, sometimes longer.
 Medical Treatment
• Surgery may be needed to remove dead bone
tissue if there is an infection that does not go
away.
• Infection of an orthopedic prosthesis, such as
an artificial joint, may need surgery to remove
the prosthesis and infected tissue around the
area.
 Complications
• Need for amputation
• Reduced limb or joint function
• Spread of infection to surrounding tissues or
the bloodstream
• Abscess
 Nursing Management
• Administer prescribed medications, which
may include analgesics, calcium supplements.
• Use caution when turning, lifting and
transferring the client to prevent injury.
• Promote spinal stability by applying a
lumbosacral corset, if indicated, avoid
appliances that can decrease mobility.
 Nursing Management cont’d
• Encourage increase in intake of foods high in
calcium (eg. milk, cheese, broccoli), vitamin D,
fiber and protein.
• Teach knee flexion and muscle relaxing
exercises.
• Instruct client to perform range of motion
exercises at least twice daily.
 Nursing Management cont’d
• Encourage client to sleep on a firm, nonsagging
mattress.
• Teach the client about the disease process and
prevention of progression.
• Teach safety measures to prevent injury from
falls.
• Importance of reporting to health care provider
any indicators of pathologic fracture(deformity,
limb shortening, ecchymosis)
 Nursing Management cont’d
• Stress needs to be reported promptly report
any indicators of vertebral fractures (e.g.
paresthesias, weakness, paralysis or loss of
bowel or bladder function)
• Importance of follow up care, and date of next
appointment.
 References
Berbari E,F. et al.(2009) Osteomyelitis. In:
Mandell GL, et al. Mandell, Douglas and
Bennett's Principles and Practice of Infectious
Diseases. 7th ed. Philadelphia, Pa.: Churchill
Livingstone Elsevier