osteomyelitis - updated
TRANSCRIPT
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OsteomyelitisOsteomyelitis
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DEFINITIONDEFINITION
y Osteomyelitis is a serious bone infection, usually caused byanother external tissue infection visible on the skin's
surface. Osteomyelitis is usually caused by the bacteria
staphylococcus aureus, or staph infection. Other bacterial
organisms and fungi can cause osteomyelitis as well. It may
be acute , occurring within days or weeks, or chronic ,
staying for months or years. Osteomyelitis can happen to
anyone of any age and may affect any bone. Approximately
50% of cases occur in preschool-aged children. Young
children primarily experience acute hematogenousosteomyelitis because of the rich vascular supply in their
growing bones. Bacteria usually cause bone infection by
infecting an open fracture (broken bone with open skin
wound).
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You may also get osteomyelitis after a bone operation.
Germs from another infection may also get to your
bone by traveling through the blood. Anything thatcauses a weak immune system or poor blood flow may
increase your risk for having osteomyelitis.
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OsteomyelitisOsteomyelitis ComplicationsComplications
y Death of bone or osteonecrosis
Infection of the bone can hinder the
circulation of the blood inside the bone,
which leads to death of the bone. Thebone will heal after surgery has removed
small areas of bone which is dead. If a
section of the bone is large and has died,the patient might need to have the limb
amputated in order to stop the migrating
of the infection.
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RISK/PREDISPOSING FACTORSRISK/PREDISPOSING FACTORS
y Diabetes
y Hemodialysis
y Injected drug use
y Poor blood supply
y Recent trauma
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MANIFESTATIONMANIFESTATION
SYMPTOMS OF OSTEOMYELITISSYMPTOMS OF OSTEOMYELITISy Muscle spasm
y Muscle weakness or atrophy in later
stagesy Pain radiating to the buttocks, legs, and
feet
y Pain made worse with coughing, straining,or laughing
y Severe low back pain
y Tingling or numbness in legs or feet
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Septic ArthritisSeptic Arthritis
Infections in bones can migrate
to adjacent joints
y Growth impairment
Children normally have osteomyelitis in
the areas that are soft and referred to as
the growth plates which are located at
both ends of the long bones of the legs
and arms. In these infected bones,
growth that is normal can be disturbed.
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Cancer of the skinCancer of the skin
If osteomyelitis results in a sore that is
open and draining pus, the skin
surrounding it is at a high risk of creatingsquamous cell cancer.
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DIAGNOSTIC STUDIESDIAGNOSTIC STUDIES
1. Bone scan
During this test, a small amount of Technetium-99
pyrophosphate, a radioactive material, is injected intravenously into the
body. If the bone tissue is healthy, the material will spread in a uniform
fashion. However, a tumor or infection in the bone will absorb the
material and show an increased concentration of the radioactive
material, which can be seen with a special camera that produces the
images on a computer screen. The scan can help your doctor detect
these abnormalities in their early stages, when X-ray findings may only
show normal findings.
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y 2. Bone Biopsy
Another effective test for osteomyelitis is a bone biopsy.
Your doctor will remove a small section of bone to be sent
to a lab to confirm the bacteria. Knowing the exact bacteria
in the infection, or the exact strain of staph bacteria, will
allow the doctor to prescribe the best antibiotics.
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3.Blood tests
When testing the blood, measurements are taken
to confirm an infection: a CBC (complete blood
count), which will show if there is an increased
white blood cell count; an ESR (erythrocyte
sedimentation rate); and/or CRP (C-reactive
protein) in the bloodstream, which detects andmeasures inflammation in the body.
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PathophysiologyPathophysiology
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MANAGEMENTMANAGEMENT
Medical management for clients with
Osteomyelitis are as follows:
y
Analgesics - This medicine is given to fight or prevent an infection
caused by bacteria. Always take your antibiotics exactly as ordered
by your caregiver. Keep taking this medicine until it is completely
gone, even if you feel better. Stopping antibiotics without your
caregiver's OK may make the medicine unable to kill all of the
germs.Never"save" antibiotics or take leftover antibiotics that
were given to you for another illness.
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y Pain medicine:You may be given medicine to take at
home to take away or decrease pain. Your doctor will
tell you how much to take and how often to take it.
Take the medicine exactly as directed by your doctor.
Do not wait until the pain is too bad before taking your
medicine. The medicine may not work as well at
controlling your pain if you wait too long to take it. Tell
your doctor if the pain medicine does not help, or if
your pain comes back too soon.
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SURGERYSURGERY
y Incision and Drainage of bone abscess.
y
Sequestrectomy- removal of dead, infected bone and cartilage.
y Bone grafting is recommended after repeated infections.
y Limb amputation-This is a last resort. Surgeons can amputate the
limb that is affected so as to halt the infection from further
spreading.
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Acute Pain related to inflammationAcute Pain related to inflammation
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Hyperthermia related toHyperthermia related to
bacterial infectionbacterial infection
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Discharge PlanningDischarge Planningy Medications
y Teach patient and SO about the medication purpose,
dosage, route, and possible side effects of all prescribed
medications.
y Teach patient and SO to keep a written list of the
medicines the patient take, the amounts, and when and
why he takes them.
y Advise them to not use any medicines, over-the-counter
drugs, vitamins, herbs, or food supplements without firsttalking to the doctor.
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y Advise them to always take the medicine as directed by
the doctor. Call your caregiver if you think yourmedicines are not helping or if you feel you are having
side effects.
y Advise them that if they are taking medicine that makes
them drowsy, do not drive or use heavy equipment.
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ExerciseExercise
y Advise patient to do ROM exercises as tolerated to
promote joint flexion and avoid stiffness.
y Provide safety measures to the clients environment to
avoid further injury.
y Advise client to do some light exercises like walking(if
able) to promote good circulation.
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TreatmentTreatment
y Advise SO to give support to the patient while
undergoing treatment regimen.
y Educate client and SO about the treating regimen being
implemented.
y Encourage cooperation and compliance of patient and
SO to the treatment regimen.
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Health TeachingHealth Teaching
y Advise SO to help client in self-care if client is unable to
address self-care needs
y Educate client on ROM exercises to be used.
y Educate client and SO on proper wound cleaning and
timely dressing changes.
y Advise client and SO to wash hands after wound
cleaning to prevent spread of infection
y Advise client to take care of your skin and feet if you
have diabetes. You may do this by checking and washingyour skin and feet everyday.
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Ongoing AssessmentOngoing Assessment
y Ensure that client and SO is well educated about
current condition
y Ensure that client has fully understood all health
teachings done and also the proper home care regimen
y Ensure that the client has a scheduled follow-up check-
up to update health care personnel about condition.
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DietDiet
y Advise client to eat healthy foods from all of the five
food groups: fruits, vegetables, breads, dairy products,
meat and fish.
y Teach client that eating healthy foods may help you feel
better, have more energy, and help you heal faster.
y Advise client that it may be easier to eat smaller meals
more often