Monday, February 1, 2010

Focus On Osteomyelitis

It is a severe infection of bone, bone marrow and surrounding soft tissues..

Etiology and Pathophysiology



Development of osteomyelitis



Chronic Osteomyelitis of the Femur




Clinical Manifestations on Acute Osteomyelitis

-Initial infection
Infection of <1 month in duration.
Both systemic and local.

-Systemic
Fever, night sweats, chills, restlessness, nausea.

-Local
Constant bone pain that worsens with activity.
Swelling, tenderness, warmth at infection site.
Restricted movement of affected part.
Later signs: drainage from sinus tracts.


Clinical Manifestations Chronic Osteomyelitis

-Bone infection lasting longer than a month.
-Infection that has failed to respond to initial course of antibiotic therapy.
-Systemic signs may be diminished.
-Local signs of infection more common:
Constant bone pain
Swelling, tenderness, warmth at infection site


Variety of antibiotics may be prescribed

-Penicillin, nafcillin (Nafcil)
-Neomycin, vancomycin
-Cephalexin (Keflex)
-Cefazolin (Ancef)

-Adults with chronic osteomyelitis may be prescribed oral therapy + fluoroquinolone for 6 to 8 weeks instead of IV antibiotics


Long-term and mostly rare complications

-Septicemiainvasion of the bloodstream by virulent microorganisms (as bacteria, viruses, or fungi) from a focus of infection that is accompanied by acute systemic illness—called also blood poisoning)

-Septic arthritis (relating to or caused by inflammation of joints due to infectious, metabolic, or constitutional causes ; also : a specific arthritic condition (as gouty arthritis or psoriatic arthritis))

-Pathologic fractures (A pathologic fracture occurs when a bone breaks in an area that is weakened by another disease process. Causes of weakened bone include tumors, infection, and certain inherited bone disorders. There are dozens of diseases and conditions that can lead to a pathologic fracture. )

-Amyloidosis (a disorder characterized by the deposition of amyloid in organs or tissues of the animal body @ Amyloidosis is a rare disease in which a protein called amyloid accumulates in various tissues and organs, impairing normal function.)

Nursing Assessment

-Important health information-
Past health history
Bone trauma, open fracture, open or puncture wounds, other infections
Medications
Surgery or other treatments


Acute intervention

-Patient is frequently on bed rest in early stages of acute infection.
-Good body alignment and frequent position changes prevent complications associated with immobility and promote comfort.
-Foot drop can develop quickly in lower extremity if foot is not supported in a neutral position by a splint or if there is excessive pressure from a splint.
-Instruct patient to avoid activities that ↑ circulation and swelling and serve as stimuli to spread infection.
-Exercise, heat application.
-Teach patient potential adverse and toxic reactions with prolonged and high-dose antibiotic therapy.
-Lengthy antibiotic therapy can result in an overgrowth of Candida albicans.
-Patient and family often frightened and discouraged.
-Continued psychologic and emotional support is an integral part of nursing management.


Reference: Retrieved from Mosby, Inc. an affliate of Elsevier Inc.



Abu Fateh,
Post review on Osteomyelitis,
Endocrine Disorder,
Medical Surgical Nursing Care for a Positive Outcomes,
Jalan Hospital Campus,
25200 Kuantan.

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