Osteomyelitis definition, incidence, etiology, clinical manifestations, diagnostics, management

1. OSTEOMYELITIS
Presented by: Ms. Avelin D’Souza
1st year M.Sc. Nursing5/30/20161

2.  Osteomyelitis is an infection
and inflammation of the bone and bone
marrow.
 Osteomyelitis is an infectious usually painful
inflammatory disease of bone often of
bacterial origin that may result in the death of
bone tissue. – Merriam Webster.
Definition
5/30/20162

3.  The overall prevalence is 1 case per 5,000 children.
Neonatal prevalence is approximately 1 case per
1,000.
 The incidence of vertebral osteomyelitis is
approximately 2.4 cases per 100,000 population.
 Direct trauma and contiguous focus osteomyelitis are
more common among adults and adolescents than in
children.
 Vertebral osteomyelitis is more common in persons
older than 45 years
Incidence
5/30/20163

4. Structure and function of the skeletal system
There are 206 bones in the human body, divided into
four categories:
• Long bones (e.g., femur)
• Short bones (e.g., metacarpals)
• Flat bones (e.g., sternum)
• Irregular bones (e.g., vertebrae)
Anatomy and physiology
5/30/20164

5.  Bone is composed of cells, protein matrix, and
mineral deposits. The cells are of three basic
types—osteoblasts, osteocytes, and osteoclasts.
 Covering the bone is a dense, fibrous membrane
known as the periosteum. The periosteum
nourishes bone and allows for its growth; it also
provides for the attachment of tendons and
ligaments. The periosteum contains nerves, blood
vessels, and lymphatics.
Cont.…
5/30/20165

6. 1. Suppurative osteomyelitis
a) Acute suppurative osteomyelitis
b) Chronic osteomyelitis
Primary (no preceding phase)
Secondary suppurative (follows an acute phase)
Classification
5/30/20166

7. 1. Non-suppurative osteomyelitis
 Diffuse sclerosing
 Focal sclerosing (condensing osteitis)
 Proliferative periostitis (periostitis
ossificans, Garré's sclerosing osteomyelitis)
 Osteoradio necrosis
Cont.…
5/30/20167

8.  Staphylococcus aureus
 Staphylococcus epidermidis
 Streptococcus viridens
 Escherichia coli
 Mycobacterium tuberculosis
 Pseudomonas
5/30/20168
Etiology

9.  Certain conditions and behaviors that weaken the immune
system increase a person's risk for osteomyelitis, including:
 Diabetes (most cases of osteomyelitis stem from diabetes)
 Sickle cell disease
 HIV or AIDS
 Rheumatoid arthritis
 Intravenous drug use
 Alcoholism
 Long-term use of steroids
 Hemodialysis
 Poor blood supply
 Recent injury
5/30/20169
Cont.…

10.  Fever, irritability, fatigue
 Nausea
 Tenderness, redness, and warmth in
the area of the infection
 Swelling around the affected bone
 Lost range of motion
Clinical Manifestations
5/30/2016
10

11. When the infection is blood
borne, the onset is usually
sudden, occurring often
with the clinical
manifestations of septicemia
 Chills
 High fever
 Rapid pulse
 General malaise
5/30/201611
Cont.…

12.  X-Ray
 Radioisotope bone scans
 Blood studies
 Wound and blood culture studies
 Level of C-reactive protein
 MRI and CT scan
Assessment and
Diagnostic Findings
5/30/201612

13. The initial goal of therapy is to control and halt the
infective process.
 Pharmacologic therapy
 Vigorous and prolonged IV antibiotic therapy is the
treatment of choice for acute osteomyelitis as long as
bone ischemia has not yet occurred. As soon as the
culture specimens are obtained, IV antibiotic therapy
begins first in the hospital then is continued at
 home for 4-6 weeks or as long as 3-6 months
 The antobiotics include Vancomycin, Neomycin,
Gentamycin, Tobramycin, Cefazolin
Medical Management
5/30/201613

14. Hyperbaric oxygen therapy:
 100% oxygen may be administered as an
adjunct therapy in refractory cases of chronic
osteomyelitis. This therapy is thought to
stimulate circulation, healing in the infected
area.
Cont.…
5/30/201614

15. Surgical management:
 Debridement.
 A sequestrectomy (removal of enough
involucrum to enable the surgeon to remove the
sequestrum)
 Amputation
Cont.…
5/30/201615

16. Assessment:
Subjective data:
 Important health history
 Functional health patterns
Objective data:
 General
 Integumentary
 Musculoskeltal
Nursing process
5/30/201616

17. Nursing Diagnoses
Based on the nursing assessment data, nursing
diagnoses for the patient with osteomyelitis may
include the following:
•Acute pain related to inflammation and swelling
•Impaired physical mobility related to pain, use of
immobilization devices, and weight-bearing
limitations
•Risk for extension of infection: bone abscess
formation
•Deficient knowledge related to the treatment
regimen
Cont.…
5/30/201617

18.  Relieving pain
 The affected part may be immobilized with a
splint to decrease pain and muscle spasm.
 The nurse monitors the neurovascular status of
the affected extremity. The wounds are
frequently very painful, and the extremity must
be handled with great care and gentleness.
 Elevation reduces swelling and associated
discomfort. Pain is
 controlled with prescribed analgesics and other
pain reducing techniques
Nursing Interventions
5/30/201618

19.  Improving physical mobility
 Treatment regimens restrict activity. The bone is
weakened by the infective process and must be
protected by immobilization devices and by
avoidance of stress on the bone.
 The patient must understand the rationale for the
activity restrictions.
 The joints above and below the affected part should
be gently placed through their range of motion.
 The nurse encourages full participation in ADLs
within the physical limitations to promote general
well-being.
Cont.…
5/30/201619

20.  Controlling the infectious process
 The nurse monitors the patient’s response to antibiotic therapy
and observes the IV access site for evidence of phlebitis,
infection, or infiltration.
 With long-term, intensive antibiotic therapy, the nurse
monitors the patient for signs of superinfection (e.g., oral or
vaginal candidiasis, loose or foul-smelling stools).
 If surgery was necessary, the nurse takes measures to ensure
adequate circulation (wound suction to prevent fluid
accumulation, elevation of the area to promote venous
drainage, avoidance of pressure on grafted area), to maintain
needed immobility, and to comply with weight-bearing
restrictions.
 The nurse changes dressings using aseptic technique to
promote healing and to prevent cross-contamination. The
nurse continues to monitor the general health and nutrition of
the patient. A diet high in protein and vitamin C ensures a
positive nitrogen balance and promotes healing. The nurse
encourages adequate hydration as well.
Cont.…
5/30/201620

21. Long bone osteomyelitis is difficult to treat and is
responsible for significant morbidity and expense.
The goal of treatment is to arrest its spread and
repair the damage it has caused. Appropriate
treatment includes culture-directed antibiotic
therapy and operative debridement of all necrotic
bone and soft tissue.
Conclusion
5/30/201621

22. Summary
5/30/201622

23. Brunner & Siddharth, ‘Textbook of Medical surgical nursing’,
Volume 1, 11th edition, Wolters Kluwer publication, New Delhi
2009, pg. 2060 - 2065.
 Lewis et al, ‘Medical Surgical Nursing’, 7th edition, Elsevier
publication 2007 New Delhi, pg. 1668 – 1672
 Lippincott, ‘Manual of Nursing Practise’, 10th edition, Wolters
Kluwer publication, New Delhi 2010, pg. 1144 - 1145
 http://www.uptodate.com/contents/overview-of-osteomyelitis-in-
adults
 www.slideshare.com
 www.mayoclinic.org/diseasesconditions/osteomyelitis/basics/.../co
n-20025518
Reference
5/30/201623

24. 5/30/201624

25. 5/30/201625