6.1 Osteomyelitis, Pyogenic Arthritis, Tuberculosis Spondylitis, Gangrene

Question 1

Osteomyelitis definition

Answer 1

An infection of bone and associated structure,
causing ischemia,
tissue necrosis,
breakdown of bone structure
Decalcification

Question 2

Most common cause of osteomyelitis

Answer 2

Staphylococcus aureus
(Spread through bloodstream, fracture or surgery)

Question 3

Osteomyelitis mode of infection

Answer 3

• hematogenous
• non-hematgogenous
  1) Direct inoculation (assess to bone)
  2) contiguous focus (from adjacent soft tissue and joint)

Question 4

Pathophysiology of osteomyelitis

Answer 4

1. Inflammation, vascular congestion, edema, small vessel thrombosis
2. Infection extend into surrounding soft tissue —> Ischemia and bone necrosis
3. Sequestrum 爛骨片 form when blood supply compromise
4. Involucrum (new bone) form and surround sequestrum

Question 5

Sequestrum
Involucrum

Answer 5

Sequestrum 爛骨片
Involucrum (new bone form)

Question 6

Risk factors of osteomyelitis

Answer 6

-Hematogenous
Endocarditis
Intravenous devices
Injection drug use (IV, CVC, Hb)
-Non-hematogenous
Poorly healing soft tissue wound
DM
Peripheral vascular disease/ neuropathy
*Orthopaedic implant

Question 7

Acute vs chronic s/s of osteomyelitis

Answer 7

Acute: gradual onset over days
Chills rigor fever
Local inflammation

Chronic: fever usually absent
Ulceration, Drainage, pain, swelling

Question 8

Blood test for infection

Answer 8

WBC, ESR, CRP
Blood culture
C&ST for wound culture

Question 9

Osteomyelitis X-ray characteristic

Answer 9

Irregular decalcification,
bone necrosis,
Sequestra,
New bone formation

Question 10

Surgery for osteomyelitis

Answer 10

• Surgical debridement, irrigation, drainage (remove necrotic bone, improve blood supply)
• Sequestrectomy (remove Involucrum and Sequestrum)
• bone graft and tissue graft (repair damaged blood vessel and form new bone)

Question 11

Goal of nursing management

Answer 11

Pain relief
- analgesic
- monitor neuromuscular status
- immobilization of affected limb

Improve physical mobility
-Early: bed rest and avoid manipulation
-Prevent complications due to immobility by position change, good body alignment
-Full participation in ADL within physical limitations

Question 12

osteomyelitis: Medical intervention
Related nursing management

Answer 12

Long duration and long dose antibiotics

Nursing management: educate possible toxic and adverse reaction
Completing the course

Question 13

Pyogenic (Septic) arthritis definition
Affected part

Answer 13

Infection in synovial fluid and joint

(All type of joint, commonly large joints) eg knee, wrists ankles hip

Question 14

Pathophysiology of septic arthritis

Answer 14

1. Hematogenous spread (from other part of body)
2. Direct inoculation (trauma, open fracture)
3. Contiguous spread (from pre-existing infection)

Question 15

The most common causative of septic arthritis

Answer 15

Staphylococcus aureus

Question 16

Sign and symptoms of septic arthritis

Answer 16

Local inflammation,
Restricted joints movement
Chills rigor fever

Question 17

Tuberculous spondylitis :
Causative agent
Mode of infection
Location

Answer 17

Spinal tuberculosis/ pott disease
- Mycobacterium tuberculosis
- TB infection spreads from lungs to spine
- Usually lower thoracic and upper lumber spine region

Question 18

Pathophysiology of tb spondylitis

Answer 18

Hematogenous spread
Extra spinal source of infection

—> anterior aspect of vertebral body —> intervertebral discs —> progressive bone destruction —> anterior collapse of vertebral body —> deformity and kyphosis —> severe functional impairment

Question 19

Clinical manifestations of tb spondylitis

Answer 19

-Back pain (increase severity)
-Gibbus deformity (collapse of vertebral spine then kyphosis)
-muscle spasm and rigidity
-Paraplegia
-Impaire sensation

Question 20

Diagnostic test for tb spondylitis

Answer 20

Tuberculin skin test: positive

Question 21

Tb spondylitis:
Circumstances for patient of surgery

Answer 21

Spinal disease with:
Advanced/ worsening neurological deficits progressing while on appropriate therapy
Kyphosis>40 degree
Chest wall cold abscess

Question 22

Patient education for tb

Answer 22

-Advise balance bwt exercise & rest
-Avoid crowded areas
-Discuss importance of follow-up and compliance of drug therapy
-Avoid damage to liver (eg alcohol) —> hepatotoxicity

Question 23

Gangrene
Causes

Answer 23

Dead or dying tissue due to
- Inadequate or loss of local blood supply
- serious bacteria infection
- traumatic injury

Question 24

Dry vs wet gangrene

Answer 24

Dry:
- By progressive occlusion of peripheral arterial blood supply to distal tissue
- Dry, hard texture, have clear cut
- Develop slowly
- common in patient with peripheral arterial disease and atherosclerosis

Wet gangrene:
- By tissue compromise by poor venous or arterial blood flow become infected
- can progress from dry gangrene with necrotic tissue infected
- moist, gross swelling, blistering
Drain fluid and smells bad

Question 25

Risk factor of gangrene

Answer 25

- DM (hyperglycemia damage nerve and blood vessel) - Atherosclerosis (restricted BS) - Peripheral arterial disease PAD (progress narrowing) - Raynaud’s syndrome

Question 26

Medical management of gangrene

Answer 26

(For prevent further deterioration only Surgical debridement Maggot therapy Vascular surgery Amputation Antibiotics

Question 27

Nursing intervention of gangrene

Answer 27

- Aseptic technique dressing - Limited vigorous activity - Foot care: sign of injury, change in skin color, keep nail trimmed, comfortable well-fitting shoes