• 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.
• 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
- 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.