Osteomyelitis

WHAT WENT WRONG?
Osteomyelitis is an infection of the bone. In an adult, it is most commonly due to
direct contamination of the site during trauma, such as an open fracture. Bacteria
that cause infections elsewhere in the body may also enter the bloodstream and
become deposited into the bone, starting a secondary infection site there. This is
more common in children and adolescents. Some of the patients have been treated
with antibiotics previously for the initial infection.
The causative organism is not always identified. More than three-quarters of the
identified organisms are Staphylococcus aureus. Acute infection is associated with
inflammatory changes in the bone and may lead to necrosis. Some patients will
develop chronic osteomyelitis.



PROGNOSIS
The sooner the infected area can be made infection-free, the better the prognosis
for the patient. There is a risk for developing chronic osteomyelitis. This risk is
greater in patients with a compromised immune system or poor blood supply to
the area (such as diabetics).

SIGNS AND SYMPTOMS

• Pain
• Fever, chills
• Malaise

TEST RESULTS

• Elevated white blood count (WBC).
• X-ray osteolytic lesions (localized loss of bone density).

• Bone scan shows area of increased cellular activity—detects site of infection.
• Culture and sensitivity tests to determine the infecting organism and anti-
biotic—may be difficult to determine infecting organism.
• Bone biopsy to identify organism.

TREATMENT
Removal of necrotic bone tissue and local pus or drainage is often necessary to
speed healing. Typically, patients need antibiotics for several weeks to properly
treat the infection.
• Debridement of the area to remove necrotic tissue.
• Drain the infected site.
• Immobilize or stabilize the bone if necessary.
• Administer antibiotics parenterally for 4 to 6 weeks or orally for 6 to 8
weeks:
• nafcillin, vancomycin, penicillin G, piperacillin, ticarcillin/clavulanate,
ampicillin/sulbactam, pipercillin/tazobactam, clindamycin, cefazolin, line-
zolid, ceftazidime, ciprofloxacin
• Administer analgesic to relieve discomfort as needed:
• ibuprofen, naproxen, acetaminophen
• oxycodone, hydrocodone
• If there is vascular insufficiency or gangrene, amputation may be needed.


NURSING DIAGNOSES
• Impaired mobility
• Activity intolerance
NURSING INTERVENTION
• Monitor vital signs, changes in blood pressure, elevated pulse, elevated tem-
perature and respiratory rate.
• Monitor wound site for redness, drainage, and odor.
• Monitor IV access site for patency.
• Explain to the patient:
• When and how to take medications.
• Importance of completing antibiotic medication.
• How to flush venous access device.
• Signs of infiltration, clotting of venous access device.
• When to call for assistance with venous access.