Management of Osteomyelitis

I. Definition

•    Osteomyelitis is a pyogenic bone infection.  

II. Risk Factors

•    Trauma or secondary infection (most commonly Staphylococcus aureus).
•    Blood-borne (hematogenic) osteomyelitis is more common in children after a throat infection.
•    Resulting from orthopedic surgical procedures is more common in older persons.

III. Pathophysiology

•    Circulation of infectious microbes through the bloodstream to susceptible bone leads to inflammation, increased vascularity and edema.
•    The organisms grow, pus forms within the bone, and abscess may form. This deprives the bone of its blood supply, eventually leading to necrosis.

IV. Assessment/Clinical Manifestations/Signs And Symptoms

•    Localized bone pain
•    Tenderness, heat and edema in the affected area
•    Guarding of the affected area
•    Restricted movement in affected area
•    Purulent drainage from a skin abscess

Systemic symptoms
- High fever and chills in acute osteomyelitis
- Low-grade fever and generalized weakness in chronic osteomyelitis

Laboratory and diagnostic study findings
•    White blood cell count reveals leukocytosis
•    Erythrocyte sedimentation rate is elevated
•    Blood culture identifies the causative organisms.
•    Radiographs and bone scan demonstrate bone involvement in advanced disease.

V. Medical Management

•    Initial goal is to control and arrest the infective process.
•    Affected area is immobilized; warm saline soaks are provided for 20 minutes several times a day
•    Blood and wound cultures are performed to identify organisms and select the antibiotic
•    Intravenous antibiotic therapy is given around-the-clock.
•    Antibiotic medication is administered orally (on empty stomach) when infection appears to be controlled; the medication regimen is continued for up to 3 months
•    Surgical debridement of bone is performed with irrigation; adjunctive antibiotic therapy is maintained.

VI. Nursing Diagnosis

•    Pain related to inflammation and swelling
•    Impaired physical mobility associated with pain, immobilization devices, and weight-bearing limitations
•    Risk for extension of infection: bone abscess formation
•    Deficient knowledge about treatment regimen

VII. Nursing Management

•    Protect the affected extremity from further injury and pain by supporting the limb above and below the affected area.
•    Prepare the client for surgical treatment, such as debridement, bone grafting or amputation, as appropriate.
•    Administer prescribed medications, which may include opioid and non-opioid analgesics and antibiotics.

Promote healing and tissue growth.
- Provide local treatments as prescribed (e.g. warm saline soaks, wet to dry dressings)
- Provide a diet high in protein and vitamins C and D.

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