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Introduction To Nursing Lavc

John Marsh
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Week 8 Notes

  • Los Angeles Valley College
  • Introduction to Nursing

Shareena (osteomyelitis 1496-1500; bone CA 1500-1501)
-Severe infection of the bone, bone marrow and surrounding soft tissue
-Staph aureus is the common cause of infection
-Infecting microorganisms can invade:
 Indirectly (hematogenous)- most frequently affects growing bone in boys younger than 12 y/o and is associated with their
higher incidence of blunt trauma. Adults with genitourinary and respiratory tract infection or vascular insufficiency (DM), are
at high risk for the spread of a primary infection via blood to the bone. Most common sites of infection are pelvis, tibia &
 Direct entry- can occur at any age when an open wound (penetrating wounds, fractures), allows microorganisms to enter the
body. Osteomyelitis maybe R/T foreign body (implant, orthopedic prosthetic device like plate or total joint prosthesis)
-After gaining entry into the blood, microorganisms grow and pressure increases bc of the non expanding nature of most bone.
Increasing pressure  ischemia  bone death which can spread through the bone cortex and marrow cavity
-Sequestra (dead bone) eventually separates from the surrounding living bone
-Involcrum: formation of new bone in periosteum that continues to have a blood supply
-ATB and WBC have difficulty reaching the sequestrum thru the blood, thus it can become a reservoir for microorganisms that spread
to other sites (lungs and brain). If it does not resolve or debrided surgically, sinus tract may develop resulting to chronic purulent
cutaneous drainage
Clinical manifestation:
Acute osteomyelitis (infection less than a month)
 Local: constant bone pain that worsens with activity and unrelieved by rest, swelling, tenderness, warmth at the infection site,
restricted movement of the affected part
 Systemic: fever, night sweats, chills, restlessness, nausea, malaise
 Later signs: drainage from cutaneous sinus tracts or the fracture site
Chronic Osteomyelitis (lasts longer than a month, or failed to respond to initial ATB treatment, process of exacerbation or remission)
 Local signs: constant bone pain, swelling & warmth at the infection site, granulation tissue turns to a scar tissue. Avascular
scar tissue provides an ideal site for continued microorganism growth bc it cannot be penetrated by ATB
Septicemia, septic arthritis, pathologic fractures, amyloidosis
Diagnostic Studies:
 Positive blood & Wound Cultures
 Leukocytosis
 ↑ ESR (definitive lab)- in chronic infective process
 ↑ C-Reactive Protein (definitive lab) for acute infection
 Soft Tissue Bone BX (definitive way to identify causative microorganism)
 Radionuclide Scans (Gallium & Indium)
 CT Scan to evaluate extent of infection
 MRI- more sensitive than CT in detecting bone marrow edema which is an early indication
 X-Ray (signs of osteomyelitis usually do not appear until 10 days to weeks after initial symptom)
Interprofessional Care:
-Aggressive, prolonged IV ATB for acute osteomyelitis via central venous access device or PICC line if bone ischemia has not
occurred (culture or bone biopsy should be done if possible before drug therapy)
-Surgical debridement and decompression of ATB is delayed
-IV atb maybe started in the hospital then continued at home for 4 to 6 weeks or as long as 3-6 months
-ATB choice: PCN, nafcillin, neomycin, Vanco, cephalexin, cefazolin, cefoxitin, gentamicin, tobramycin
-ATB PO: fluoroloquinolone (Cipro) for 6 to 8 weeks maybe prescribed instead of IV ATB
-Treatment for chronic osteomyelitis: surgical removal of poorly perfused tissue and dead bone , and extended use of ATB
-Suction irrigation system maybe inserted and wound closed after debridement
-Intermittent or constant irrigation of the area with ATB
-The limb or surgical site is protected with cast or braces
-Post op: negative pressure wound therapy
-Hyperbaric 02 as adjunct therapy in refractory cases of chronic osteomyelitis. It stimulates new blood growth and healing in the
infected tissue
-Removal of orthopedic device if it’s the source of the infection
-Muscle flaps or skin grafts to provide wound coverage over dead space in the bone, but should never be placed in the presence of
active or suspected infection



Introduction To Nursing Lavc

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