Osteomyelitis..

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Created By : Ashwag Hammed. Naseem Hassan. Balsam Mohammed. Maria Mohammed. Ebtehal zweed. Salsabil Abdullah. Areej Al-motery.

Objectives : Definition of Osteomyelitis. Classification of Osteomyelitis. Causes of Osteomyelitis. Risk factors of Osteomyelitis. Signs & symptoms of Osteomyelitis. Investigations of Osteomyelitis. Treatments and nursing management of Osteomyelitis. Complications of

Definition:

Osteomyelitis is the medical term for an infection in a bone.

Osteomyelitis is an acute or chronic bone infection.

Classifications:Host immune status : Type A: Normal immune status. Type B: Some degree of immunocomprimised status primary grafting. Type C: Significant immunocomprimised status. Type I : - Medullary osteomyelitis. - Does not necessarily require bone

Cont ..
-Type I : - medullary Osteomyelitis. - does not necessarily require bone grafting. -Type II : - superficial Osteomyelitis affecting outer surface of bone. - bone exposure second to soft-tissue loss, or an adjacent soft tissue abscess abutting cortex. -Type III : - well marginated sequestration of cortical bone. - can be excised w/ creating instability. -Type IV: - permeative destructive lesion causing instability.

Conditions which may classify as a compromised healer include :

Diabetes. Use of steroids. Poor nutrition. Extensive scarring. Use of tobacco products. Cancer. Previous radiation therapy. Organ failure. Chronic lymphedema. Old age.

Pathophysiology:

Osteomyelitis can occur as a result of Hematogenous seeding, spread of infection to bone, or direct inoculation of infection into the bone as a result of trauma or surgery. Hematogenous Osteomyelitis is usually monomicrobial, while Osteomyelitis due to contiguous spread or direct inoculation is usually polymicrobial. In long bone Hematogenous Osteomyelitis, most common site of infection is in the metaphysis. Major blood vessel to long bones usually penetrates the bone then travels towards both ends, forming metaphysical vascular loop.

Causes:

Most cases of Osteomyelitis are caused by : (staphylococcus bacteria).

Germs can enter a bone in a variety of ways, including:

Via blood stream. From a nearby infection. Severe puncture wounds Direct contamination. This may occur

Risk factors:

Bone fracture Any condition that causes aweakening of the immune system such as: Diabetes. Organ transplant. Chemotherapy. AIDS. Kidney failure. Intravenousdrug abuse. Joint replacement. Peripheral neuropathy. Peripheral vascular disease. Sickle cell anemia.

Signs and Symptoms:

Bone pain. Fever. General discomfort, uneasiness, or ill-feeling (malaise). Local swelling, redness, and warmth.

Other symptoms that may occur with this disease :

Chills. Excessive sweating. Low back pain. Swelling of the ankles, feet, and legs.

Investigations:

A physical examination shows bone tenderness and possibly swelling and redness. Tests may include: Blood cultures. Bone biopsy (which is then cultured). Bone scan. Bone x-ray. Complete blood count (CBC). C-reactive protein (CRP). Erythrocyte sedimentation rate (ESR). MRI of the bone. Needle aspiration of the area around affected bones.

Laboratory and Imaging:CBC : (WBC 18,000, 68% segs, 7% bands, 20% Lymphs, 5% monos, H/H 13/40, Plt. 260,000).

ESR : 60. CRP : 15.

Cont ..
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X-rays: X-rays can reveal damage to your bone. Computerized tomography (CT) scan: creating detailed cross-sectional views of a person's internal Structures. Magnetic resonance imaging (MRI): MRIs can produce exceptionally detailed images of bones and the soft tissues that surround them. Bone biopsy: it can reveal what particular type of germ has infected your bone.

The most common treatments for Treatments:osteomyelitis are antibiotics. Doctor can choose an antibiotic that depend on the type of infection. Click to edit Master subtitle style -The antibiotics are usually administered through a vein at least six weeks. - Side effects may include nausea, vomiting and diarrhea.

MEDICATIONS :

Surgery:
Depending on the severity of the infection. surgery may include one or more of the following procedures :

Drain the infected area: Opening up the area

around the bone and allow surgeon to drain any pus or fluid that has accumulated in response to the infection.

Remove diseased bone and tissue: It's

called debridement, the surgeon removes as much of the diseased bone and taking a small margin of healthy bone to ensure that all the infected areas have been removed.

Another procedures:

Remove any foreign objects.

Nursing management :Nursing Assessment:

Important health information: Past health history Medications Surgery or other treatments. Subjective data: IV drug use, malaise. Anorexia, weight loss, chills. Weakness, paralysis, muscle spasms. Local tenderness over affected area.

Objective data: General: Restlessness, high, spiking temperature, night sweats.

Integumentary: Diaphoresis, erythema, warmth, edema at infected bone.

Musculoskeletal: Restricted movement, wound drainage, spontaneous fractures.

Nursing Diagnoses :Acute pain: Inflammatory process secondary to infection. crying, restlessness, altered muscle tone, decreased activity. Impaired physical mobility: Pain, immobilization devices, weightbearing limitations. Inability or unwillingness to change positions. Ineffective therapeutic regimen management: Lack of knowledge regarding long-term

Nursing Interventions :-

1-control the patient's pain with prescribed analgesics and non pharmacologic techniques. 2-monitor his response to antibiotic therapy. 3- observe the patient's I.V. site for signs of complications. 4- monitor the area of infection and neurovascular status (if an extremities

5- apply gentle range-of-motion exercises to the joints above and below the affected site. 6- unless contraindicated, provide nutritional support in the form of a high-protein diet. 7- teach your patient how to take prescribed antibiotics and how to recognize possible adverse reactions.

Teach your patients to :-

1-Eat a variety of fruits and vegetables. 2- Stop smoking. 3- Continue antibiotic treatment as prescribed.

Planning :Over all goals :

Have satisfactory pain and fever control. Cooperate with treatment plan.

Maintain a positive outlook on outcome of disease.

Complications:

Bone death (osteonecrosis). Septic arthritis: In some cases, infection within bones can spread into a nearby joint. Impaired growth. In children Skin cancer. Amputation.

Any Questions... ?!

THANK YOU
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