Topic 10: Osteomyelitis

Question 1

Osteomyelitis

Answer 1

severe infection of the bone, bone marrow, and surrounding soft tissue

Question 2

what is the most common cause of infection in osteomyelitis

Answer 2

Staph aureus

Question 3

sequestra

Answer 3

dead bone

Question 4

patho of osteomyelitis

Answer 4

After entering the blood, the microorganism grows, and pressure increases because of the nonexpanding nature of most bone. Increasing pressure eventually leads to ISCHEMIA and vascular compromise of the periosteum. The infection spreads through the bone cortex and marrow cavity, obstructing blood flow and causing necrosis. Bone death occurs due to ischemia.

Question 5

involucrum

Answer 5

part of the bone that continues to have a blood supply
new bone that provides structure and isolates sequestra

Question 6

Clinical Manifestations of Acute Osteomyelitis

Answer 6

· Infection of less than 1 month
· Constant bone pain that worsens with activity and is unrelieved by rest
· Swelling
· Tenderness
· Warmth at infection site
· Restricted movement of affected part

Question 7

systemic manifestations of osteomyelitis

Answer 7

fever, night sweats, chills, restlessness, nausea, malaise

Question 8

Clinical Manifestations of Chronic Osteomyelitis

Answer 8

· Bone infection lasting longer than one month
· Systemic manifestations are lessened
· Constant bone pain
· Swelling
· Warmth at infection site

Question 9

diagnostic studies of osteomyelitis

Answer 9

· Bone or soft tissue biopsy is the definitive way to determine causative agent
· Blood and wound culture s are often positive
· Increase WBC and erythrocyte sedimentation rate (ESR)
· High CRP
Doesn’t usually appear on x-ray until 2-4 weeks after initial clinical symptom

Question 10

what lab levels are high in osteomyelitis

Answer 10

increased WBC, erythrocyte sedimentation rate (ESR), CRP

Question 11

medication for osteomyelitis

Answer 11

give antibiotics as ordered

Question 12

nursing management of osetomyelitis

Answer 12

· Assess wound for signs of worsening infection
· Teach about antibiotic SE, length or treatment, S/S of worsening infection and use of hyperbaric O2 if ordered
· Assess for muscle spasm and give muscle relaxant as ordered; assess response
· Passes pain and intensity and give analgesics as ordered
· Handle affected limb carefully to decrease pain and additional injury

Question 13

oversee UAP

Answer 13

o Handle affected limb carefully based on RN instruction
o Help patient with passive ROM to adjacent joint and active ROM exercise of unaffected limbs
o Notify RN about patient report of pain, tingling , or decreased sensation in affected extremity

Question 14

before staring antibiotic drug therapy…

Answer 14

cultures and biopsy should be done

Question 15

IV antibiotic starts in hospital but continues at home for

Answer 15

4-6 weeks (can be given through central venous access device CVAD)

Question 16

if the bone is poorly perfused or dead bone is present, what can be done

Answer 16

Surgical debridement or drainage

Question 17

Response to drug therapy is monitored through

Answer 17

bone scan and ESR testing

Question 18

treatments

Answer 18

· Surgical removal
· Extended use of antibiotics
· Acrylic bead chains containing antibiotics may be implanted to combat infection
· Irrigation system may be inserted after debridement of dead infected tissue
· Hyperbaric O2: stimulates new blood growth and healing of infected tissue
· Amputation if bone destruction is extensive

Question 19

what is usually needed to decrease pain and reduce risk for further injury in osteomyelitis

Answer 19

Immobilization of affected limb, carefully handle limb and avoid undue manipulation

Question 20

nondrug approaches

Answer 20

guided imagery, relaxation breathing, ect

Question 21

dressings are used to

Answer 21

absorb drainage from wounds (sterile technique)

Question 22

what can promote comfort and prevent complication related to immobility in osteomyelitis

Answer 22

Good body alignment and frequent position changes

Question 23

what needs to be monitored when taking antibiotics to avoid adverse effects

Answer 23

Monitor peak and trough blood levels

Question 24

Cephalosporin reactions include

Answer 24

AE: hives, severe or watery diarrhea, blood in stools, throat or mouth sores

Question 25

Fluoroquinolones reaction include

Answer 25

AE: tendonitis or tendon rupture (especially Achilles tendon)