Group 4B: Ann Bolyn D. Afable Freya Fe R. Ricafrente Lorelyn A. Sanchez Charmaine B. Ugalde Rudimar R.

Villas Loise Camille Vivar BACKGROUND HISTORY

Topic: Osteomyelitis

Osteomyelitis (osteo- derived from the Greek word osteon, meaning bone, myelo- meaning marrow, and -itis meaning inflammation) simply means an infection of the bone or bone marrow.It can be caused by a variety of microbial agents (most common in staphylococcus aureus) and situations, including:

An open injury to the bone, such as an open fracture with the bone ends piercing the skin. An infection from elsewhere in the body, such as pneumonia or a urinary tract infection that has spread to the bone through the blood (bacteremia, sepsis). A minor trauma, which can lead to a blood clot around the bone and then a secondary infection from seeding of bacteria. Bacteria in the bloodstream bacteremia (poor dentition), which is deposited in a focal (localized) area of the bone. This bacterial site in the bone then grows, resulting in destruction of the bone. However, new bone often forms around the site. A chronic open wound or soft tissue infection can eventually extend down to the bone surface, leading to a secondary bone infection.

Osteomyelitis affects about people two out of every 10,000. If left untreated, the infection can become chronic and cause a loss of blood supply to the affected bone. When this happens, it can lead to the eventual death of the bone tissue. Osteomyelitis can affect both adults and children. The bacteria or fungus that can cause osteomyelitis, however, differs among age groups. In adults, osteomyelitis often affects the vertebrae and the pelvis. In children, osteomyelitis usually affects the adjacent ends of long bones. Long bones (bones of the limbs) are large, dense bones that provide strength, structure, and mobility. They include the femur and tibia in the legs and the humerus and radius in the arms. Osteomyelitis does not occur more commonly in a particular race or gender. However, some people are more at risk for developing the disease, including:

People with diabetes Patients receiving hemodialysis People with weakened immune systems People with sickle cell disease Intravenous drug abusers The elderly

ANATOMY AND PHYSIOLOGY

The Skeletal System serves manyimportant functions; it provides the shape andform for our bodies in addition to supporting,protecting, allowing bodily movement, producingblood for the body, and storing minerals. It serves as a framework for tissues and organs to attach themselves to. This system acts as a protective structure for vital organs. Located in long bones are two distinctions of bone marrow(yellow and red). Theyellow marrow has fatty connective tissue and is found in the marrow cavity. Duringstarvation, the body uses the fat in yellow marrow for energy. The red marrow of somebones is an important site for blood cell production.

PATHOPHYSIOLOGY

MODIFIABLE -lifestyle,open and punture wound

NON-MODIFIABLE -age,gender

Bacterial invasion/infection on the open wound Hematogenous spread of infection to the bone Organisms invade the bone tissues and nitrate and inflammatory respone Fever,leukocytosis,inflammation and pus formation

Exudates continue to grow Pressure develops at the site causing pain Exudate extends into the medullary cavity and under the periostem

Vascular engorgement due to inflammation Compromised blood flow

Sequestrum Osteoblastic response Involcrum

CLINICAL MANIFESTATION The symptoms of osteomyelitis can include:

Pain and/or tenderness in the infected area Swelling and warmth in the infected area Fever Nausea, secondarily from being ill with infection General discomfort, uneasiness, or ill feeling Drainage of pus through the skin Additional symptoms that may be associated with this disease include: Excessive sweating Chills Lower back pain (if the spine is involved) Swelling of the ankles, feet, and legs Changes in gait (walking pattern that is a painful, yielding a limp) MEDICAL MANAGEMENT Osteomyelitis often requires prolonged antibiotic therapy, with a course lasting a matter of weeks or months. A PICC line or central venous catheter is often placed for this purpose. Osteomyelitis also may require surgical debridement. Severe cases may lead to the loss of a limb. Initial firstline antibiotic choice is determined by the patient's history and regional differences in common infective organisms. A treatment lasting 42 days is practiced in a number of facilities. Local and sustained availability of drugs have proven to be more effective in achieving prophylactic and therapeutic outcomes. In 1875, American artist Thomas Eakins depicted a surgical procedure for osteomyelitis at Jefferson Medical College, in a famous oil painting titled The Gross Clinic. Prior to the widespread availability and use of antibiotics, blow fly larvae were sometimes deliberately introduced to the wounds to feed on the infected material, effectively scouring them clean. Hyperbaric oxygen therapy has been shown to be a useful adjunct to the treatment of refractory osteomyelitis.[15][16] Open surgery is needed for chronic osteomyelitis, whereby the involucrum is opened and the sequestrum is removed or sometimes saucerization can be done. NURSING MANAGEMENT Nursing Diagnosis: 1. Acute pain r/t inflammation and swelling 2. Impaired physical mobility r/t use of immobilization devices and weight-bearing limitations 3. Risk for infection: bone abscess formation 4. Knowldege deficit r/t the treatment regimen

Nursing Responsibilities for client with Osteomyelitis: control the patient's pain with prescribed analgesics and non pharmacologic techniques monitor his response to antibiotic therapy observe the patient's I.V. site for signs of complications monitor the area of infection and neurovascular status (if an extremity is involved) apply gentle range-of-motion exercises to the joints above and below the affected site unless contraindicated, provide nutritional support in the form of a high-protein diet teach your patient how to take prescribed antibiotics and how to recognize possible adverse reactions. Patients with osteomyelitis need to take care of themselves to improve their chances of fighting infection. Teach your patients to: Eat a variety of fruits and vegetables, which can provide the body with the nutritional support it needs to fight infection and stay healthy. Stop smoking. Smoking slows blood flow to the hands and feet, making it more difficult for the body to fight infection. Provide your patient with smoking cessation materials if he needs help. Continue antibiotic treatment as prescribed. Advise him to call his health care provider to report any adverse effects before discontinuing the drug on his own. The success of antibiotic treatment depends on following the complete regimen PROGNOSIS Prognosis varies depending on how quickly an infection is identified, and what other underlying conditions exist to complicate the infection. With quick, appropriate treatment, only about 5% of all cases of acute osteomyelitis will eventually become chronic osteomyelitis. Patients with chronic osteomyelitis may require antibiotics periodically for the rest of their lives. (http://www.drugs-web.com/health/o/osteomyelitis/osteomyelitis-prognosis.htm) With treatment, the outcome for acute osteomyelitis is usually good. The outlook is worse for those with long-term (chronic) osteomyelitis, even with surgery. Amputation may be needed, especially in those with diabetes or poor blood circulation. The outlook for those with an infection of an orthopedic prosthesis depends, in part, on:

The patient's health The type of infection Whether the infected prosthesis can be safely removed ( http://www.nlm.nih.gov/medlineplus/ency/article/000437.htm)
LAB RESULTS

CBC URINALYSIS XRAY CRPC/CREATIV PROTEIN ESR/ERYTHROCYTE SEDIMENTATION RATE BLOOD CULTURE