Definition:
Definition:
Osteomyelitis is a bone infection caused by bacteria; however, fungi, parasites, and viruses also can cause bone infections.
Etiology:
There are two types, Exogenous and endogenous. Exogenous is an infection that enters from outside the body. Through open fractures, wounds, or surgical procedures. Endogenous or Hematogenous, is caused by pathogens carried in the blood from sites of infection else where in the body. In hematogenous osteomyelitis, the infection spreads from bone to adjacent soft tissues.
Pathophysiology:
First the pathogen provokes an intense inflammatory response. This inflammation of the bone is characterized by vascular engorgement, edema, leukocyte activity, and abscess formation. The small terminal vessels thrombose and seal the bone's canaliculi. The inflammation then spreads into the marrow cavity and through the metaphyseal openings into the cortex.
Osteoblasts lay down new bone that can partially or completely surround the infected bone.
In adults the infection disrupts and weakens the cortex which predisposes the bone to pathologic fractures.
Signs & Symptoms:
Acute osteomyelitis - causes an abrupt onset of inflammation. If an acute infection is not completely eliminated the disease may become subacute or chronic.
Subacute osteomyelitis - the sign and symptoms are usually vague.
Chronic osteomyelitis - infection is indolent or silent between exacerbations. The microorganisms persist in small abscesses or fragments of necrotic bone and produce occasional flare ups of acute osteomyelitis.
Reference Pages:
Pathophysiology - 1451 - 1456 & 1497 - 1500
Med/Surg nusing - 1796 - 1798
Related Diagnostic Tests:
WBC count
Radionuclide bone scanning
Tomography and MRI
Medical Management:
Antibiotics and drainage of the inflammatory exudate
Placement of tubes into holes drilled into the bone cortex for continuous antibiotic irrigation and drainage.
Nursing Management:
- Wound care
- Management of Pain
- Follow appropriate medication schedule
- Educate pt.
- Monitor for signs of infection
- Monitor V/S
- Elevate extremity to reduce swelling
Health Deviation SCR: (this illness/injury requires the client to…)
This pt has a number of complications that need to be address.
- Pt needs to maintain control over his diabetes.
- Pt must not remove dressings and contaminate surgical wound
- Pt must refrain from ambulating until Ok'd by MD.
- Pt must follow strict medication routine
- Pt will probably need PT because of the remove of toes.
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