Marcus Josiah M. Reyes, SN-UST

Batch 2010 Section 8 RLE 4

A severe infection of the bone and surrounding tissues (Maher, Salmond, & Pellino, 2002).

Can occur in any age, but common to children younger than 12 years of age. Males have higher incidence than females (Maher, et al, 2002).

HematogenousThrough the bloodstream

Contiguous focusExtension from adjacent tissue infection

Direct infection into the bone

Predominantly occur in children, middle-aged, and older adults (Maher, et al, 2002).

There is usually a single organism that enters a bone via the bloodstream from a site of infection (most commonly S. aureus) (Maher, et al, 2002).

Common sources of infection: UTI, skin infection, URTI, and acute otitis media (Maher, et al, 2002).

Involves rich red marrow (Maher, et al, 2002).In children and infants: the long bones

Onset is insidious (Maher, et al, 2002).Infection spreads to adjacent bone through

the soft tissue (Maher, et al, 2002).Greater risk for clients with Diabetes Mellitus

and severe atherosclerosis (Maher, et al, 2002).

Microbes gain entry to the bone through open fractures, penetrating wounds, or contamination in a surgical procedure (Maher, et al, 2002).

Implanted items may also cause infection (Maher, et al, 2002).

If hematogenous, common sepsis manifestations:ChillsHigh feverRapid pulseGeneral Malaise

At first, systemic sx may overshadow the local signs

Constant, pulsating pain that intensifies with movement

Swollen and tender area of infectionChronic Osteomyelitis presents continuously

draining sinus or recurrent inflammation

CBCESRBlood CulturesSuperficial CulturesBiopsyX-RaysRadionuclide Bone ScansMRI

If with current infection, postpone orthopaedic surgery

Strict aseptic technique during orthopaedic surgery

Prophylactic antibioticsUrinary catheters and drains are removes as

soon as possible

PharmacologicIV Antibiotic Therapy for 3-6 weeksThen, oral ATB for 3 monthsDirect application

SurgicalSurgical DebridementSequestrectomySaucerizationInternal fixation or external supportive devices

InfectionIN ATBs, as orderedHand WashingStrict AsepsisMonitoring of ATB complianceHealth Education

Infection ControlInfection PreventionATB administration

PainDeep Breathing ExercisesSplintingAnalgesics, as ordered

Impaired Physical Mobility and Activity ToleranceComplete Bed RestDiversional ActivitiesActive ROM exercises to unaffected areasPassive ROM exercise to affected area,

approved by the MDAssistive Devices

AnxietyActive ListeningStress Reduction (relaxation, guided imagery)Diversional ActivitiesHealth Education regarding illness

Knowledge Deficit: Disease and MedicationHealth Education to the patient and family

Maher, A., Salmond, S., & Pellino, T. (2002). Orthopaedic Nursing 3rd Ed. PA: W.B. Saunders Company

Smeltzer, S., Bare, B., Hinkle, J., & Chever, K. (2008). Brunner & Suddarth’s Textbook

of Medical-Surgical Nursing 11th Ed. PA: Lippincott Williams & Wilkins