Osteomyelitis

Question 1

Most common microorganism

Answer 1

Staphylococcus aureus

Question 2

Indirect entry

Answer 2

spinal cord,
more with kids
Hematogenous

Question 3

Direct entry

Answer 3

Adults

1. Open wound
2. Foreign body presence (e.g., implanted prosthesis)
3. Diabetic or vascular ulcers, or pressure injuries
4. Generally multiple organisms

Question 4

Microorganisms enter blood and grow, increasing

Answer 4

pressure in bone-leading to ischemia & vascular compromise

Question 5

Ischemia results

Answer 5

bone death

Question 6

Dead bone separates from living bone forming

Answer 6

sequestra

Question 7

Periosteum with blood supply forms

Answer 7

new bone called involucrum

Question 8

Acute osteomyelitis is infection less than

Answer 8

1 month in duration

Question 9

Local manifestations

Answer 9

i. Constant pain that worsens with activity; is unrelieved by rest
ii. Swelling, tenderness, warmth
iii. Restricted movement

Question 10

Systemic manifestations

Answer 10

i. Fever
ii. Night sweats
iii. Chills
iv. Restlessness
v. Nausea
vi. Malaise
vii. Drainage (late)

Question 11

Chronic osteomyelitis

Answer 11

longer than a month or has failed to respond to initial antibiotic treatment

Question 12

Complications (long-term/rare):

Answer 12

i. Septicemia
ii. Septic arthritis
iii. Pathologic fractures

Question 13

Chronic Osteomyelitis of Femur

Answer 13

c. Systemic manifestations reduced
d. Local signs of infection more common
i. Pain, swelling, warmth

Question 14

Avascular scar tissue cannot

Answer 14

be penetrated by antibiotics

Question 15

Diagnostic studies

Answer 15

a. Bone or soft tissue biopsy
b. Blood and/or wound cultures
i. Checking for septic
c. WBC count
d. Erythrocyte sedimentation rate (ESR)
i. elevated
e. C reactive protein
i. Elevated
f. X-rays/ MRI/ CT scans
i. Won’t show up in xray for 2 weeks or so
g. Bone scans
h. Radionuclide WBC scan
i. Tags to WBC and tags to site of inflammation

Question 16

Interprofessional Care- Acute osteomyelitis

Answer 16

i. Aggressive, prolonged IV antibiotic therapy (4-6 wks or 4-6 months)
ii. Cultures or bone biopsy before antibiotics
iii. Surgical debridement and drainage of abscess or ulcer

Question 17

antibiotic used

Answer 17

Gentamicin: Drawing peak & trough blood levels

Question 18

Extended use of antibiotics

Answer 18

IV and/or oral up to 8 weeks

Question 19

General objective data

Answer 19

1. Restlessness, high spiking temperature, night sweats
2. Integumentary
3. Diaphoresis, erythema, warmth, edema

Question 20

Possible diagnostic findings

Answer 20

Elevated WBC, positive cultures, elevated ESR, presence of sequestrum and involucrum

Question 21

Priority Problems

Answer 21

a. Acute pain
b. Impaired mobility
c. Lack of knowledge

Question 22

Overall goals

Answer 22

i. Have satisfactory pain and fever management
ii. No complications associated with osteomyelitis
iii. Adhere to treatment plan
iv. Maintain a positive outlook on outcome of disease

Question 23

Acute care

Answer 23

Immobilize 
Treat/assess p!
Sterile dressing
Proper positioning
Prevent complications of immobility

Question 24

Adverse and toxic reactions to antibiotic therapy

Answer 24

1. hearing deficit
2. impaired renal function
3. neurotoxicity

Question 25

hives, severe or watery diarrhea, bloody stools, throat and mouth sores

Answer 25

Cephalosporins

Question 26

tendonitis or tendon rupture

Answer 26

Fluoroquinolones

Question 27

i. Lengthy antibiotic therapy can cause an overgrowth of

Answer 27

Candida albicans and Clostridium difficile

Question 28

Ambulatory Care

Answer 28

ii. Complete entire antibiotic prescription iii. Wound care/dressing changes iv. Physical and psychologic support antibiotic management of CVAD

Question 29

The patient will:

Answer 29

i. Have satisfactory pain management ii. Adhere to recommended treatment plan iii. Show a consistent increase in mobility and range of motion