Northern Luzon Adventist College

Artacho, Sison, Pangasinan

CHRONIC
OSTEOMYELITIS

Presented by:
Cornelio, Claudette Kyle V.
Sumbad, Dredd Alejo R.
I. Introduction
A. Brief Discussion

Osteomyelitis is a serious infection of the bone characterized by inflammation,

typically caused by bacteria. It can affect any bone in the body and may result from
the spread of infection through the bloodstream, direct contamination due to trauma or
surgery, or the extension of soft tissue infections. Osteomyelitis can be acute or
chronic. Acute osteomyelitis develops rapidly and is often more severe, while chronic
osteomyelitis may persist for a longer period, sometimes recurring over time.

B. Significance of the Study

Osteomyelitis is one of the most neglected diseases that we as nurses

encounter in our clinical duties. Understanding the details of this disease will greatly
help us with our duties in the hospital. This case is also beneficial in the actual
practice of our nursing profession.

a.) To be able to know the causes of osteomyelitis.

b.) To be able to understand how a certain infection results to osteomyelitis;
c.) And to be able to know and apply the different nursing interventions and
nursing management of osteomyelitis.

C. Prevalence and Statistics

According to a study the prevalence of chronic osteomyelitis was found to be

86.3%. The tibia and femur were the most commonly involved bones, and
metaphyseal involvement was very common. The most common radiological findings
were sequestrum (56%) and involucrum (53%). Of the total patients with radiological
evidence of chronic osteomyelitis, 16.6% had complications, the most common of
which was a pathologic fracture (12.4%), Mulualem, B., Belay, G., & Bogale, E. K.
(2023). Incidence of osteomyelitis is approximately 13 per 100,000 in children and
approximately 90 per 100,000 in adults. Hematogenous osteomyelitis occurs
predominantly in children and elderly patients while osteomyelitis due to contiguous
infection is most common in adults. Osteomyelitis is more common in males but
equally affects each race. The disease is more common in developing countries.
II. Patient Profile

A. Demographic Data

Age : 58 years old

Sex : Male

Religion : Roman Catholic

Occupation : Unemployed

Address : Balaoc, Santo Tomas, La Union

Marital Status : Married

Activity Level : Dependent

Hospital : La Union Medical Center

Room : Surgery Ward

Date of Admission : September 21, 2023 @ 2:00 PM

Medical Diagnosis : Chronic Osteomyelitis

B. General Data

This is the case of patient R.L., a 58 year old male from Balaoc, Santo Tomas,
La Union, admitted at LUMC on September 21, 2023 and was diagnosed with
Chronic Osteomyelitis. He was a Filipino citizen, married and gifted with 2 children.
He has been unemployed for more than 20 years. Patient R.L. is not part of any
indigenous group.

C. Past/Medical/Family/Social History

The present condition started two years prior to admission when the patient
noted to have a recurrent wound on the left foot. Seven months prior to admission, he
experienced signs and symptoms of irregular pain. And according to the patient, he
takes a pain reliever (Naproxen) when his foot is in pain. As days went by, his foot
started to get swollen and formation of abscess is occuring. His condition was
neglected, as a result, two days prior to admission, he experienced consistent pain and
 fever and was rushed to the emergency room in LUMC. His condition persisted hence
admission.

D. Present Complaint

On admission, patient R.L. was awake and oriented to place, time, and people.
The patient came in with fever, body weakness, swelling and pain on the left foot with
a pain scale of 8/10. Upon assessment, he was advised to be admitted due to his
condition in order to conduct several tests and treatments.

E. Developmental Task

Erik Erikson’s Psychosocial Theory

“Generativity vs. Stagnation During Middle Adulthood”

During this stage, middle-aged adults strive to create or nurture things that will
outlast them, often by parenting children or fostering positive changes that benefit
others. Contributing to society and doing things to promote future generations.

- The patient was able to partially achieve this stage, because he developed a sense of
unity with his life partner , but at an early age he got unemployed but still managed to
raise two children with the help of his wife.

Psychosexual Theory by Sigmund Freud

“Genital Stage”

The Genital Stage is the fifth and final phase of Freud’s psychosexual
development theory, beginning at puberty and lasting into adulthood. During this
stage, individuals start to become sexually mature and begin to explore their sexual
feelings and desires more maturely and responsibly. This period marks the onset of
romantic and sexual emotions, leading to the formation of intimate relationships.

- The patient was able to effectively achieve this stage because he had a wife who loved
him and together they were gifted with two children.

Cognitive Theory of Jean Piaget

“Formal Operational Stage”

As adolescents enter this stage, they gain the ability to think abstractly by
manipulating ideas in their head, without any dependence on concrete manipulation
(Inhelder & Piaget, 1958).
- Patient was able to achieve this stage because he was able to understand the logic
behind any argument and he has the ability to answer questions and recall his past
experiences regarding his condition.

F. Physical Assessment

a. HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN

Before admission, the patient rarely visits a doctor to have a check-up and
seek medical assistance. He has a history of smoking and could consume 10 sticks per
day and did quit 20 years ago. He drinks different types of alcohol but only
occasionally. He is allergic to fish paste/sauce “bagoong”.

During hospitalization, he doesn’t expect to be admitted. However, he shows

interest to recover easily and fast and is cooperating with different health teachings
along with his watcher.

b. NUTRITION/METABOLISM

Before admission, the patient has no specific diet. He only takes supplements
like Vitamin C and Calcium. He has a normal appetite and has a weight of 62 kg.
During hospitalization, his diet was DAT, his appetite increased and gained 5 kg.

c. ELIMINATION

Before hospitalization, he defecates once in 3 days and has normal bladder

habits during the day, but urinates at night 3-4 times. Then during hospitalization, he
defecates once a day. He has no pain during urination and has normal urine color.

d. ACTIVITY/EXERCISE

The patient is unemployed. He usually stays at home and does some

household chores. Before hospitalization, the patient uses a cane in order to support
his left foot during transferring, stair climbing, etc. especially when his left foot is in
pain. He is independent when it comes to self care ability but needs assistance in bed
mobility. But during hospitalization, he needs assistance from his wife when it comes
to self care.

e. SEXUALITY/REPRODUCTIVE

The Patient is married and a father of 2 children. He has no history of Sexually

Transmitted Disease or any disease affecting his genitals. Despite his condition, he
has an active sexual life and no problem about his reproductive pattern.
f. COGNITIVE/PERCEPTUAL

Patient has no sensory deficits, oriented to people and place, responds to

stimuli verbally and physically. He speaks Tagalog, Ilocano, and Pangasinan. He
describes his pain/disease as chronic and before hospitalization, he takes pain
relievers to manage the pain (naproxen).

g. ROLES/RELATIONSHIP

He is well supported and loved by his family. Then during hospitalization, his
wife stays and takes care of him.

h. SELF-PERCEPTION/SELF-CONCEPT

Before hospitalization, the patient has a poor outlook in terms of recovery. But
during hospitalization, he is weak looking but manages to smile. Agreed to undergo
different laboratory tests and surgery despite what he feels. He is hopeful, positive and
cooperates in order to recover with his condition.

i. VALUE/BELIEF

He is a Roman Catholic, and rarely attends services. But he is willing to be

offered a prayer every end of the shift, he also enjoys watching and listening to our
serenades. Despite his financial problems, Faith in God makes him motivated to fight
for his disease.

j. COPING/STRESS

Prior to hospitalization, he is coping with stress by talking to his children

through call and enjoys staying at home with his wife. During hospitalization, he is
worried about his financial needs but still manages to smile. He copes by browsing on
FB, watching videos, sleeping, and praying.

k. SLEEP/REST

Prior to hospitalization, the patient has irregular sleeping habits. He usually

sleeps at 8 P.M. and wakes up at 2 A.M. which only makes up 5-6 hours of sleep.
Sometimes, he experiences insomnia and wakes up feeling inadequately rested after
sleep. During hospitalization, the patient experiences insomnia but feels rested after
sleep.
III. Anatomy and Physiology

The skeletal system, a complex framework of bones, cartilage, tendons, ligaments,

and joints, serves as a fundamental component of the human anatomy and physiology.
Composing various bone types, including long bones like the femur, short bones like those in
the wrist, flat bones such as the skull, and irregular bones like vertebrae, this system provides
structural integrity, support, and protection to the body. Bone tissue is diversified into
compact bone, dense and hard on the outer layer, and spongy bone, less dense and porous in
the inner layer. Bone marrow, housed within bones, plays a crucial role in blood cell
production, with red marrow responsible for hematopoiesis and yellow marrow primarily
composed of fat. Cartilage, present at joints, reduces friction and absorbs shock, with hyaline
cartilage covering joint ends and fibrocartilage providing support in structures like
intervertebral discs. Joints exhibit various classifications, including fibrous, cartilaginous, and
synovial joints, each contributing to different levels of movement. Ligaments and tendons,
fibrous connective tissues, stabilize joints and enable movement by connecting bones to
bones and muscles to bones, respectively. Skeletal muscles, attached to bones by tendons,
facilitate voluntary movements. The functions of the skeletal system encompass structural
support, protection of vital organs, facilitation of movement, blood cell formation, and
mineral storage, highlighting its indispensable role in maintaining the integrity and
functionality of the human body.

IV. Pathophysiology

Osteomyelitis is most commonly caused by bacteria, with Staphylococcus aureus

being a predominant pathogen. The infection may begin through several routes, including
hematogenous spread (through the bloodstream), direct extension from adjacent tissues, or
contamination through open fractures or surgical procedures. Once the bacteria reach the
bone, they adhere to its surface and begin to colonize. The bone's avascular nature and
complex architecture provide an ideal environment for bacteria to establish themselves. The
host's immune system responds to the infection with an inflammatory reaction. Neutrophils,
macrophages, and other immune cells migrate to the site of infection to combat the invading
pathogens. Inflammatory cells release cytokines, signaling molecules that amplify the
immune response. This inflammatory response forms pus (a protein-rich exudate containing
dead phagocytes, tissue debris, and microorganisms) and causes increased intramedullary
pressure. The inflammatory exudate can rupture through the cortex to the periosteum if left
unchecked. Disruption of the periosteum impairs the periosteal blood supply leading to bone
ischemia and necrosis. Separated pieces of necrotic bone are called sequestra, which
occasionally contain pus. New bone formation over the injured periosteum is called
involucrum, and it may partially surround a sequestrum. Discharge from a sequestrum can
lead to sinus tract formation. Patient is present with localized pain and swelling. Systemic
symptoms such as fever occur. In chronic cases, there may be persistent or recurrent
infections, and bone deformities may develop.
V. Diagnostic Test and Therapeutic Procedures

A. Blood Typing

BLOOD TYPING
Date: 09/21/23

Blood Typing: O
RH: Positive

B. Clinical Chemistry Result

Examination Normal Value Result

Sodium (Na+) 135 - 148 mmol/l 139.2

Potassium (K+) 3.5 - 5.3 mmol/l 4.10

Chloride (Cl-) 98 - 107 mmol/l 103.3

Indication & Interpretation: In cases of osteomyelitis, the levels of sodium, potassium, and
calcium in the body may be influenced by various factors, including the severity of the
infection, the overall health of the individual, and the presence of complications. Generally,
infections and inflammatory conditions can have systemic effects on electrolyte balance, but
the specific impact can vary. In some instances of osteomyelitis, electrolyte levels such as
sodium, potassium, and calcium may remain within normal ranges, especially in the absence
of severe complications or widespread systemic effects. However, it's important to note that
individual cases can differ, and the effects on electrolyte balance may be influenced by
factors such as: Local vs. Systemic Infection, complication, overall health of the patient and
treatment.

C. Hematology Result (Septer 21, 2023)

Component and Quantity Result

Hemoglobin (male 130 – 180 g/L 115

Hematocrit (male 40 – 50 vol%) 43.4

RBC count (male 4.2 – 6 x10^12/L) 4.34

WBC count (adult: 4 – 11x10^9/L) 15.89

Platelet count (150 – 450x10^9/L) 432

 ESR (Westergren method) (male: 0 – 15 mm/hr) 85 mm/hr

Differential Count

Segmenters (55.0 – 65.0 %) 64.1

Lymphocytes (25.0 – 35.0 %) 28.0

Monocytes (3.0 – 6.0 %) 7.5

Eosinophils (2.0 – 4.0 %) 0.4

Basophils (0.0 – 1.0 %) 0.0

Albumin 38 – 51 g/L 31

Indication & Interpretation: Osteomyelitis, being an inflammatory condition primarily

affecting the bones, may not directly cause specific changes in routine hematology
parameters. The hematocrit, red blood cell (RBC) count, and platelet count being within
normal ranges during osteomyelitis can be influenced by several factors: effective immune
response, limited bone marrow involvement and body compensatory mechanisms.

The levels of specific white blood cell (WBC) types, such as segmenters (neutrophils),
lymphocytes, and basophils, are influenced by the body's immune response to infection.

A decrease in hemoglobin levels during osteomyelitis can be attributed to several factors

related to the body's response to infection and inflammation such as During the inflammatory
response to infection, various cytokines and inflammatory mediators are released. Some of
these substances can suppress the production of red blood cells and affect the lifespan of
existing red blood cells.

In response to infection, the body often increases the production of white blood cells, which
are responsible for fighting off pathogens. Erythrocyte Sedimentation Rate (ESR), this is a
marker of inflammation and may be elevated in the presence of osteomyelitis. They are not
part of standard hematology results but are often included in the broader context of
inflammatory markers.

Osteomyelitis triggers an acute phase response, which is the body's immediate and
non-specific reaction to inflammation or infection. During the acute phase, there is an
increase in certain proteins called acute-phase proteins, such as C-reactive protein (CRP) and
fibrinogen, while the production of albumin may decrease.
Hematology Result (September 28, 2023)

Component and Quantity Result

Hemoglobin (male 130 – 180 g/L 91

Hematocrit (male 40 – 50 vol%) 32.7

RBC count (male 4.2 – 6 x10^12/L) 3.41

WBC count (adult: 4 – 11x10^9/L) 13.06

Platelet count (150 – 450x10^9/L) 274

MCV (80 – 100 fL) 95.8

MCH (27 – 31 pg) 26.7

MCHC (310 – 360 g/L) 278

Indication & Interpretation: Hemoglobin, hematocrit, and red blood cell (RBC) count
might occur after debridement in osteomyelitis. Debridement is a surgical procedure aimed at
removing infected or dead tissue from the affected area, and the impact on blood parameters
can result from several factors such as blood Loss during surgery like debridement involves
surgical removal of infected or necrotic tissue, in some cases, this procedure can lead to
blood loss, either through direct bleeding from vessels or through the removal of tissue that
contains blood.

An increase in white blood cell (WBC) count after debridement in osteomyelitis is a common
and expected response. Debridement involves the surgical removal of infected or dead tissue
from the affected bone, and the subsequent rise in WBC count is typically part of the body's
natural response to infection and tissue damage.

After surgery, specifically debridement for osteomyelitis, platelet count and mean corpuscular
volume (MCV) may remain within normal ranges for several reasons such as limited effect
on platelets during debridement, which involves the removal of infected or necrotic tissue,
may not have a direct and significant impact on platelet count. Platelets are primarily
involved in blood clotting, and their levels are less influenced by surgical procedures that do
not involve substantial blood loss.

A decrease in Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin

Concentration (MCHC) after surgery for osteomyelitis debridement could be attributed to
several factors, including the effects of surgery, inflammation, and changes in the overall
blood composition. Some potential reasons for a decrease in MCH and MCHC are Blood
Loss During Surgery and postoperative recovery. Surgical procedures, including
debridement, can result in blood loss. If there is significant bleeding during surgery or blood
is removed as part of the procedure, it could lead to a dilution of red blood cells (RBCs),
affecting MCH and MCHC values. The recovery period after surgery involves various
physiological changes, including changes in blood parameters. The body may undergo
adjustments in response to the surgical stress and inflammation, affecting MCH and MCHC.

Differential Count

Segmenters (55.0 – 65.0 %) 74.3

Lymphocytes (25.0 – 35.0 %) 16.6

Monocytes (3.0 – 6.0 %) 6.6

Eosinophils (2.0 – 4.0 %) 2.4

Basophils (0.0 – 1.0 %) 0.1

Indication and Interpretation: Changes in white blood cell differentials, including an

increase in segmenters (neutrophils) and monocytes, a decrease in lymphocytes, and normal
levels of eosinophils and basophils, after surgery for osteomyelitis debridement can be
reflective of the body's immune response to the procedure and the underlying infection. Here
are potential reasons for these changes: neutrophil Increase, neutrophils are the primary white
blood cells involved in the early stages of the inflammatory response and defense against
bacterial infections. An increase in neutrophils (segmenters) is a common response to
surgical trauma and infection. Debridement involves the removal of infected or necrotic
tissue, triggering a localized inflammatory response. Monocyte Increase, Monocytes are
white blood cells that play a role in later stages of the immune response. An increase in
monocytes can be indicative of ongoing inflammation and tissue repair after surgery.
Monocytes differentiate into macrophages, which are involved in phagocytosis and clearing
debris. Lymphocyte Decrease, Lymphocytes are a crucial component of the adaptive immune
response. A decrease in lymphocytes after surgery may be a transient response to the stress of
surgery, but it can also be influenced by factors such as corticosteroid use during or after
surgery. Normal Eosinophils and Basophils, Eosinophils and basophils are types of white
blood cells involved in specific immune responses. Normal levels of eosinophils and
basophils suggest that the surgery and underlying condition are not causing an allergic or
hypersensitivity reaction, as these cells are often involved in such responses.
 D. Miscellaneous Result

Specimen: Sequestrum
Examination Desired: Acid Fast Staining

Result: Negative for Acid Fast Bacilli

Indication & Interpretation: A negative acid-fast bacilli (AFB) result in the context of
osteomyelitis, particularly when using sequestrum (dead or devitalized bone tissue), generally
suggests that acid-fast bacteria, such as Mycobacterium tuberculosis, are not present or not
detectable in the sampled tissue. The negative result could be due to several reasons such as
Non-Tuberculous Osteomyelitis: Acid-fast bacilli, particularly Mycobacterium tuberculosis,
are associated with tuberculosis (TB). However, osteomyelitis can also be caused by other
bacteria, fungi, or pathogens that do not belong to the acid-fast group. If the causative agent
is not acid-fast, the AFB test would be negative.

E. Gram Staining Result

Specimen: Sequestrum

Result:
Epithelial cells/LPO: Few
Pus Cells/LPO: Few
Organism/OIF: No recognizable microorganisms seem

Indication & Interpretation: The presence of few epithelial cells and pus cells in a
sequestrum sample from osteomyelitis suggests an inflammatory process with an immune
response. In Epithelial Cells, the presence of epithelial cells may suggest that the sample
includes tissue fragments from the affected area. Epithelial cells are a component of the
lining of structures like blood vessels and cavities. Their presence in a sequestrum sample
could be due to the ongoing inflammation and destruction of surrounding tissues. In Pus Cells
(Neutrophils), Pus cells typically refer to neutrophils, which are a type of white blood cell
involved in the immune response against bacterial infections. An increased number of pus
cells in the sample indicates an active inflammatory response, as the body attempts to defend
against and eliminate the infecting microorganisms.
 F. Plain CT Scan of the Foot

History: Consider Osteomyelitis

Comparison: none provided
Technique: Multiple axial tomographic sections of the head, without contrast.
Findings: Osseous structures and soft tissues: there are lytic changes involving the anterior
aspects of the calcaneus, talus, navicular, medial and lateral cuneiform, cuboid bones and
proximal heads of the metatarsals. A sequestrum is noted in the navicular bone, surrounded
by extensive soft tissue thickening with minimal fluid components, likely beginning
abscess formation. Extensive fat stranding are also seen surrounding the aforementioned
bones.

Impression:
Overall Findings Suggest Osteomyelitis with Possible Beginning Abscess Formation

Indication: A CT (computed tomography) scan of the foot may be indicated in cases of

osteomyelitis to provide detailed imaging of the affected area. CT scans are excellent for
visualizing detailed bone anatomy. It provides high-resolution images that help assess the
extent of bone involvement, identify any abnormalities, and detect changes in bone density
associated with osteomyelitis. It also provides information about the surrounding soft tissues.
This is important for assessing the overall extent of the infection and its impact on
neighboring structures.

G. Surgery/Operation

Surgery/Operation Date

Debridement: Application of Antibiotic beads 9/28/23

Indication: Debridement is the process of removing dead, damaged, or infected tissue to

promote healing and prevent the spread of infection. This procedure is often used to treat
wounds, ulcers, burns, and various types of infections, including osteomyelitis (inflammation
of bone caused by infection).

Antibiotic-impregnated beads are used as a local delivery system for antibiotics in the
treatment of osteomyelitis. They are employed in specific situations where the infection is
localized to a particular area of bone and systemic antibiotic therapy alone may not be
sufficient. It is often used in conjunction with surgical procedures, such as debridement.
Debridement involves the removal of infected or dead tissue from the affected bone. After
debridement, antibiotic beads may be placed directly into the surgical site to provide
sustained antibiotic release.

Note that the use of antibiotic beads is determined on a case-by-case basis, and the decision is
made by the treating healthcare team based on factors such as the specific characteristics of
the infection, the patient's overall health, and the response to treatment. The beads are
typically made of a material that gradually releases antibiotics over time, providing a
localized and targeted therapeutic effect. The choice of antibiotics and the duration of
treatment with antibiotic beads depend on the sensitivity of the causative bacteria and the
clinical response to therapy.
VI. NURSING CARE PLAN

#1 Acute Pain
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SD: “Masakit po Acute Pain After 30 Independent 1. The pain scale is a measurable After 30 minutes of nurse
ang aking paa” as related to minutes of 1. Assess the patient’s element that the nurse can use to better patient interaction:
verbalized by the inflammation Nursing pain level using an understand the severity of pain. The patient reported level
patient and infection Intervention: accepted pain assessment (Lewis, S. M., Dirksen, S. R., 0 of pain on a 0 to 10 pain
secondary to The patient will tool such as the numeric Heitkemper, M. M., & Bucher, L. scale as 0 as no pain and
OD: osteomyelitis. report an pain scale. (2014). Medical-Surgical Nursing: 10 as highest pain, as
Pain scale : pain acceptable pain Assessment and Management of evidenced with vital signs
level of 8 on a 0 to level of 3 or less Clinical Problems) of BP 120/80, temp. 36.5
10 pain scale; 0 as Rationale: on a 0 to 10 ℃ and relaxing body
no pain and 10 as Infection pain scale, as posture.
highest. directly affects evidenced by 2. Nonverbal signs of pain include
the bone, vital signs guarding the affected site, facial GOAL MET
-Blood leading to within normal 2. Assess for nonverbal grimacing, self-focus, and changes in
pressure:130/80 destruction of limits and a signs of pain. vital signs. (Lewis, S. M., Dirksen, S.
bone tissue and relaxing body R., Heitkemper, M. M., & Bucher, L.
-Temperature: periosteum. This posture. (2014). Medical-Surgical Nursing:
38.4℃ can result in Assessment and Management of
localized pain Clinical Problems)
-grimace due to nerve
irritation and
damage 3. Monitor vital signs at 3. An increased blood pressure and
Infection least every four hours. heart rate may indicate uncontrolled
directly affects pain. (Lewis, S. M., Dirksen, S. R.,
the bone, Heitkemper, M. M., & Bucher, L.
leading to (2014). Medical-Surgical Nursing:
destruction of Assessment and Management of
bone tissue and Clinical Problems)
periosteum. This
can result in 4. Administer pain 4. Mild or moderate pain may be
localized pain reliever (Etoricoxib 90 controlled with non-steroidal
due to nerve mg) as ordered. anti-inflammatory drugs (NSAIDs).
irritation and More severe pain or pain related to
damage (Lewis, debridement or surgical intervention
S. M., Dirksen, may require oral or IV opioid
S. R., medications. (Lewis, S. M., Dirksen, S.
Heitkemper, M. R., Heitkemper, M. M., & Bucher, L.
M., & Bucher, L. (2014). Medical-Surgical Nursing:
(2014). Assessment and Management of
Medical-Surgica Clinical Problems)
l Nursing:
Assessment and 5. Administer antibiotics 5. Osteomyelitis is often caused by
Management of (Clindamycin 300 mg) as bacterial infection. Administering
Clinical prescribed antibiotics as prescribed is crucial for
Problems). treating the underlying infection,
which can contribute to pain relief by
addressing the root cause. (Lewis, S.
M., Dirksen, S. R., Heitkemper, M. M.,
& Bucher, L. (2014). Medical-Surgical
Nursing: Assessment and Management
of Clinical Problems)

6. Encourage bed rest. 6. The least movement of the affected

area promotes healing and alleviates
pain. (Lewis, S. M., Dirksen, S. R.,
Heitkemper, M. M., & Bucher, L.
(2014). Medical-Surgical Nursing:
Assessment and Management of
Clinical Problems)

7. Elevate the involved 7. Often the inflammatory process

area with pillows to causes the area to become edematous,
reduce swelling. and the skin becomes tight, causing
 discomfort. Elevation may help reduce
swelling and alleviate pain. (Lewis, S.
M., Dirksen, S. R., Heitkemper, M. M.,
& Bucher, L. (2014). Medical-Surgical
Nursing: Assessment and Management
of Clinical Problems)

8. Provide hot and cold 8. Cold packs help reduce swelling,

packs in area with pain whereas warm applications may help
with pain relief and increase range of
motion. (Lewis, S. M., Dirksen, S. R.,
Heitkemper, M. M., & Bucher, L.
(2014). Medical-Surgical Nursing:
Assessment and Management of
\ Clinical Problems)

Dependent: 9. Activities such as watching

9. Encourage the patient television, listening to music, or even
to find resources to help face-timing family members and
with distraction. friends may help divert attention away
from the pain. (Ackley, B. J., &
Ladwig, G. B. (2019). Nursing
Diagnosis Handbook: An
Evidence-Based Guide to Planning
Care. Mosby.)
#2 Hyperthermia
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SD: “Mainit rin po Hyperthermia Short Term: 1. Monitor the patient’s 1. To assist in creating an accurate After 1 hour of nursing
siya Ma’am” as related to After 1 hour of body temperature diagnosis and monitor effectiveness intervention, the
verbalized by the infectious process nursing of medical treatment, particularly the patient’s temperature
watcher. as evidenced by intervention, the antibiotics and fever-reducing drugs decreased from
elevated body patient's administered. Ackley, B. J., & 38.4°C to 36.5°C.
temperature of temperature will Ladwig, G. B. (2019). Nursing
38.4°C decrease from Diagnosis Handbook: An
OD: 38.4 to 36.5 Evidence-Based Guide to Planning
-Flushed skin and Care. Mosby.
warm to touch Rationale: Long Term: 2. Remove excessive
Hyperthermia After 4 hours of clothing, blankets and 2. To regulate the temperature of the After 4 hours of
Temp: 38.4°C during appropriate linens. Adjust the room environment and make it more nursing interventions,
PR: 110 osteomyelitis is a nursing temperature. comfortable for the patient. Ackley, the patient's vital signs
RR :28 result of the interventions, B. J., & Ladwig, G. B. (2019). returned to normal
body's natural and the patient's Nursing Diagnosis Handbook: An range.
Pt looks pale and adaptive immune vital signs will Evidence-Based Guide to Planning RR: 20
weak in appearance. response to return to normal Care. Mosby. PR: 82
infection. When range.
the bone is 3. Provide a tepid sponge 3. To facilitate the body in cooling
infected with bath down and to provide comfort. GOAL MET
bacteria, the Ackley, B. J., & Ladwig, G. B.
immune system (2019). Nursing Diagnosis
recognizes the Handbook: An Evidence-Based
presence of Guide to Planning Care. Mosby.
pathogens and
activates an 4. Promote Hydration 4. Adequate hydration is crucial for
inflammatory patients with hyperthermia.
response. Elevated Encourage oral fluids or, if
body temperature necessary, administer intravenous
creates an fluids to maintain fluid balance and
environment less support the body's cooling
favorable for the mechanisms.
growth and Ackley, B. J., & Ladwig, G. B.
replication of (2019). Nursing Diagnosis
certain bacteria. Handbook: An Evidence-Based
Higher Guide to Planning Care. Mosby.
temperatures can
limit the survival 5. Administer prescribed 5. Use the antibiotic to treat
and reproduction etoricoxib and osteomyelitis, which is the
of pathogens, paracetamol underlying cause of the patient’s
contributing to the hyperthermia. Use the
body's efforts to fever-reducing medication to
control and stimulate the hypothalamus and
eliminate the normalize the body temperature.
infection. Ackley, B. J., & Ladwig, G. B.
(2019). Nursing Diagnosis
Fauci, A. S., Handbook: An Evidence-Based
Braunwald, E., Guide to Planning Care. Mosby.
Kasper, D. L.,
Hauser, S. L., 6. Maintain 6. Create a comfortable environment
Longo, D. L., environmental comfort. by adjusting room temperature and
Jameson, J. L., & providing cooling measures such as
Loscalzo, J. fans. Adequate ventilation and a
(Eds.). (2008). comfortable room temperature can
Harrison's help the patient dissipate heat.
Principles of Ackley, B. J., & Ladwig, G. B.
Internal Medicine (2019). Nursing Diagnosis
(17th ed.). Handbook: An Evidence-Based
McGraw-Hill Guide to Planning Care. Mosby.
Medical.
#3 Risk for Infection
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATIO
N

SD: “May sugat Risk for After 8 hours 1. Monitor Vital 1. Regularly assess and monitor vital signs, including After 8 hours of
po ako sa Infection related of Signs temperature, heart rate, respiratory rate, and blood nurse patient
kaliwang paa ko to systemic nurse-patient pressure. An elevation in temperature and other interaction, the
Nurse” as intervention, abnormal vital signs may indicate systemic infection. patient remained
spread of
verbalized by the the patient will (Ackley, B. J., & Ladwig, G. B. (2019). Nursing free from
patient osteomyelitis remain free Diagnosis Handbook: An Evidence-Based Guide to systemic
from systemic Planning Care. Mosby.) infection as
OD: Osteomyelitis is infection as evidenced by
-Wound on left characterized by evidenced by 2. Assess for 2. Observe systemic symptoms such as fever, chills, stable vital signs,
leg bone infection, stable vital Systemic Symptoms malaise, and fatigue. Recognizing early signs of absence of
-Swelling and there is a signs, absence systemic involvement allows for prompt intervention generalized
-Skin Warmth to of generalized to prevent the spread of infection. symptoms, and
risk of systemic
touch symptoms, and (Ackley, B. J., & Ladwig, G. B. (2019). Nursing negative
spread. negative Diagnosis Handbook: An Evidence-Based Guide to laboratory
Monitoring for laboratory Planning Care. Mosby.) findings.
signs of findings.
systemic 3. Monitor 3. Regularly review laboratory results, including GOAL MET
infection and Laboratory Values complete blood count (CBC) and inflammatory
implementing markers (erythrocyte sedimentation rate). Elevated
white blood cell count and inflammatory markers may
preventive
indicate systemic infection.
measures are (Ackley, B. J., & Ladwig, G. B. (2019). Nursing
essential. Diagnosis Handbook: An Evidence-Based Guide to
Planning Care. Mosby.)
(Longo, D. L.,
Fauci, A. S., 4. Educate the Patient 4. Provide education to the patient about the signs and
Kasper, D. L., about systemic symptoms of systemic infection.
Hauser, S. L., infection (Ackley, B. J., & Ladwig, G. B. (2019). Nursing
Diagnosis Handbook: An Evidence-Based Guide to
Jameson, J. L., Planning Care. Mosby.)
& Loscalzo, J. 5. Administer 5. Administer prescribed antibiotics promptly and
(2022). Antibiotics as accurately. Timely administration of antibiotics is
Harrison's Prescribed crucial in preventing the spread of infection and
Principles of addressing systemic involvement.
Internal (Ackley, B. J., & Ladwig, G. B. (2019). Nursing
Medicine (pp. Diagnosis Handbook: An Evidence-Based Guide to
200-215). Planning Care. Mosby.)
McGraw-Hill.)
6. Encourage 6. Adequate hydration supports overall physiological
Hydration function and helps in flushing out toxins. Encourage
the patient to maintain good oral intake unless
contraindicated.
(Ackley, B. J., & Ladwig, G. B. (2019). Nursing
Diagnosis Handbook: An Evidence-Based Guide to
Planning Care. Mosby.)

7. Promote rest and 7. Adequate rest allows the body to conserve energy
comfort and directs resources toward fighting infection.
Encourage the patient to balance activity with
sufficient periods of rest.
(Ackley, B. J., & Ladwig, G. B. (2019). Nursing
Diagnosis Handbook: An Evidence-Based Guide to
Planning Care. Mosby.)

8. Maintain Strict 8. During invasive procedures, wound care, or any

Aseptic Technique contact with potential sources of infection, adhere to
strict aseptic technique to prevent introducing
additional pathogens and minimize the risk of
systemic spread.
(Ackley, B. J., & Ladwig, G. B. (2019). Nursing
Diagnosis Handbook: An Evidence-Based Guide to
Planning Care. Mosby.)
#4 Disturbed Sleep Pattern related to pain and discomfort associated with osteomyelitis.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SD: “Hindi po ako Disturbed Sleep Short term goal: 1. Assess and monitor 1. Regularly assess the intensity, location, After 8 hours of
makatulog ng maayos Pattern related to After 8 hours of pain and characteristics of pain using a pain nurse-patient
sa gabi kasi sumasakit pain and nurse-patient assessment tool to determine the intervention, the
po ang paa ko” as intervention, the effectiveness of pain management patient was able to
discomfort
verbalized by the patient will be interventions. (Ackley, B. J., & Ladwig, G. report feeling
patient associated with able to report B. (2019). Nursing Diagnosis Handbook: rested and show
osteomyelitis feeling rested and An Evidence-Based Guide to Planning improvement in
OD: show Care. Mosby.) sleep/rest pattern
-Sunken eyeballs Rationale: improvement in
-Yawning "Disturbed Sleep sleep/rest pattern. 2. Administer prescribed analgesics and The patient was
-Taking naps when Pattern related to other pain management interventions as able to describe an
there is a chance pain and Long Term: The 2. Administer pain ordered, ensuring that pain is adequately improvement in
discomfort patient will be relief measures controlled, especially before bedtime. sleep/rest pattern,
associated with able to describe (Ackley, B. J., & Ladwig, G. B. (2019). increased
osteomyelitis" is an improvement Nursing Diagnosis Handbook: An sensation of
established based in sleep/rest Evidence-Based Guide to Planning Care. well-being and
on the pattern, increase Mosby.) feeling rested,
recognition that sensation of managed
pain and well-being and 3. Assist the patient in finding a condition
discomfort from feeling rested and comfortable sleeping position, using independently and
osteomyelitis can manage condition pillows, cushions, or additional support as improved his
significantly independently 3. Implement comfort needed to alleviate pressure on affected sleeping state.
impact a patient's and to improve measures areas. (Ackley, B. J., & Ladwig, G. B.
ability to achieve his sleeping state. (2019). Nursing Diagnosis Handbook: An
restful sleep. Evidence-Based Guide to Planning Care. GOAL MET
Implementing Mosby.)
interventions
focused on pain 4. Encourage 4. Teach and encourage relaxation
management, relaxation techniques techniques, such as deep breathing
comfort exercises, guided imagery, or progressive
measures, and muscle relaxation, to help the patient relax
sleep hygiene before bedtime and reduce overall tension.
can help address (Ackley, B. J., & Ladwig, G. B. (2019).
the sleep Nursing Diagnosis Handbook: An
disturbances Evidence-Based Guide to Planning Care.
associated with Mosby.)
the underlying
condition. 5. Create a conducive 5. Ensure a quiet and comfortable sleep
sleep environment environment. Adjust lighting, noise levels,
Ackley, B. J., & and room temperature to enhance
Ladwig, G. B. conditions for restful sleep. (Ackley, B. J.,
(2019). Nursing & Ladwig, G. B. (2019). Nursing
Diagnosis Diagnosis Handbook: An Evidence-Based
Handbook: An Guide to Planning Care. Mosby.)
Evidence-Based
Guide to 6. Advice patient to 6. To compensate for the lack of sleep.
Planning Care. take a nap (Ackley, B. J., & Ladwig, G. B. (2019).
Mosby. Nursing Diagnosis Handbook: An
Evidence-Based Guide to Planning Care.
Mosby.)

7. Educate the patient 7. Provide education on the importance of

about sleep hygiene maintaining good sleep hygiene practices,
including maintaining a consistent sleep
schedule, avoiding stimulants close to
bedtime, and creating a relaxing bedtime
routine. (Ackley, B. J., & Ladwig, G. B.
(2019). Nursing Diagnosis Handbook: An
Evidence-Based Guide to Planning Care.
Mosby.)
#5 Knowledge Deficit
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SD: “Paano po Knowledge Deficit Short term goal: 1. Assess baseline 1. Understanding the patient's current After 30 minutes
nars alagaan ang related to After 30 mins of knowledge knowledge level allows for tailoring education of nurse-patient
paa ko kasi malapit osteomyelitis and nurse-patient to meet individual needs. intervention, the
na kaming umuwi” its management. intervention, Hinkle, J. L., & Cheever, K. H. (2022). patient was able to
as verbalized by the patient will be Brunner & Suddarth's textbook of demonstrate
the patient Rationale: able to medical-surgical nursing (Edition 15.). improved
The nursing demonstrate an Wolters Kluwer Health/Lippincott Williams & knowledge of
OD: diagnosis understanding of Wilkins. pg. 1144 osteomyelitis and
Inability to follow "Knowledge osteomyelitis, its its management as
healthcare needs Deficit related to causes, treatment 2. Provide 2. Clear explanations of the causes, risk evidenced by
and precaution of lack of exposure modalities, and information on factors, and symptoms of osteomyelitis lay the accurate
reinfection and understanding preventive osteomyelitis foundation for informed decision-making and verbalization of
of osteomyelitis measures. self-management. causative factors,
and its Hinkle, J. L., & Cheever, K. H. (2022). symptoms,
management" is Brunner & Suddarth's textbook of treatment
based on the medical-surgical nursing (Edition 15.). modalities, and
understanding that Wolters Kluwer Health/Lippincott Williams & preventive
patients may not Wilkins. pg. 1144 measures.
be familiar with
the condition and 3. Discuss treatment 3. Understanding prescribed medications and GOAL MET
its treatment, options treatments promotes adherence, reducing the
leading to risk of complications and supporting optimal
potential outcomes.
difficulties in Hinkle, J. L., & Cheever, K. H. (2022).
managing the Brunner & Suddarth's textbook of
disease effectively. medical-surgical nursing (Edition 15.).
Education is a Wolters Kluwer Health/Lippincott Williams &
critical component Wilkins. pg. 1144
of empowering
patients to actively 4. Educate on wound 4. Proper wound care is essential in
participate in their care preventing infection and promoting healing.
care and make Patient understanding enhances compliance
informed with care regimens.
decisions. Hinkle, J. L., & Cheever, K. H. (2022).
Brunner & Suddarth's textbook of
(Lewis, S. M., medical-surgical nursing (Edition 15.).
Dirksen, S. R., Wolters Kluwer Health/Lippincott Williams &
Heitkemper, M. Wilkins. pg. 1144
M., & Bucher, L.
(2014). 5. Emphasize 5. Awareness of the importance of follow-up
Medical-Surgical follow-up care appointments encourages continuity of care
Nursing: and facilitates timely interventions if
Assessment and complications arise.
Management of Hinkle, J. L., & Cheever, K. H. (2022).
Clinical Problems. Brunner & Suddarth's textbook of
Mosby.) medical-surgical nursing (Edition 15.).
Wolters Kluwer Health/Lippincott Williams &
Wilkins. pg. 1144

6. Review preventive 6. Education on preventive measures

measures empowers the patient to actively participate in
their health and reduce the risk of recurrence
or complications.
Hinkle, J. L., & Cheever, K. H. (2022).
Brunner & Suddarth's textbook of
medical-surgical nursing (Edition 15.).
Wolters Kluwer Health/Lippincott Williams &
Wilkins. pg. 1144
 VII. DRUG STUDY

Name of Drug Classification Mechanism of Indication Contraindication Adverse Effect Nursing Responsibilities
Action

Generic Antibiotic Clindamycin is an Clindamycin History of Fever, serum

Name: antibiotic that is an hypersensitivity to sickness, Conduct a thorough patient assessment,
Clindamycin inhibits bacterial antibiotic clindamycin or sensitization, including medical history, allergies, and
protein synthesis. medication lincomycin; history swelling of face current medications, to identify any
Brand Name: Its mechanism of with a broad of regional (following contraindications or potential risks associated
Cleocin action involves spectrum of enteritis, ulcerative topical use), with clindamycin.
binding to the 50S activity colitis, or generalized
subunit of the against antibiotic-associate myalgia, Provide clear and thorough education to the
Dosage: bacterial certain d colitis; superinfections, patient regarding the purpose of clindamycin,
300mg ribosome, leading bacteria. Its pregnancy proctitis, the prescribed dosage, and the importance of
to the inhibition use is (category B), vaginitis, pain, completing the full course of treatment.
of peptide bond indicated for lactation. induration, Inform the patient about potential side effects
Route: formation and the the treatment sterile abscess and when to seek medical
IV blocking of of various (following IM attention.Administration:
bacterial protein bacterial injections);
synthesis. infections. thrombophlebiti
Administer clindamycin according to the
s (IV infusion).
prescribed route (usually oral or intravenous)
Frequency:
and schedule. Follow proper aseptic
Q8
techniques during intravenous administration
to minimize the risk of infection.

Accurately calculate and administer the

correct dosage of clindamycin based on the
patient's weight and the prescribed regimen.
Name of Drug Classification Mechanism of Indication Contraindication Adverse Effect Nursing Responsibilities
Action

Generic Name: COX-2-selecti Etoricoxib Contraindicated in Significant: Fluid

Etoricoxib ve (coxib) selectively For the patients with retention; new-onset or Provide clear and comprehensive
class of inhibits treatment of peptic ulcer, exacerbation of education to the patient regarding the
Brand Name: nonsteroidal cyclooxygenase-2 rheumatoid severe heart oedema, hypertension, purpose of etoricoxib, including its use
Arcoxia antiinflammat (COX-2), an arthritis, disease, stroke, new-onset or recurrent for pain and inflammation.
ory drugs enzyme that is osteoarthritis, and CHF; increased ALT
(NSAIDs). responsible for ankylosing hypersensitivity. or AST, Screen for any history of allergies,
Dosage: the synthesis of spondylitis, hypersensitivity especially to NSAIDs or sulfonamides,
90 mg prostaglandins. chronic low reactions (e.g. as individuals with a history of allergic
Prostaglandins are back pain, anaphylaxis, reactions may be at an increased risk of
signaling acute pain and angioedema). hypersensitivity to etoricoxib.
Route: molecules that gout. Cardiac disorders:
Oral play a role in Palpitations, Be particularly vigilant for signs of
inflammation, arrhythmia. fluid retention, especially in patients
pain, and fever. Gastrointestinal with pre-existing cardiovascular
disorders: Abdominal conditions.
pain, constipation,
Frequency: flatulence, gastritis, Regularly assess the patient's pain level
OD acid reflux, diarrhea, and response to etoricoxib. Adjustments
dyspepsia, epigastric to the treatment plan may be necessary
discomfort, nausea, based on the patient's pain relief and
vomiting, overall condition
oesophagitis, oral
ulcer.
Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effect Nursing Responsibilities

Generic Name: Analgesic Paracetamol is thought Contraindicated in An allergic reaction,

Paracetamol (pain reliever) to act centrally in the Paracetamol is patients known with which can cause a Perform a thorough
and antipyretic brain, particularly in the used to relieve hypersensitivity to rash and swelling, assessment of the patient's
Brand Name: (fever hypothalamus, which is mild to paracetamol, in flushing, low blood medical history, including
Panadol reducer). involved in the moderate pain. It hepatic, and renal pressure and a fast allergies and any
regulation of body is often failure. heartbeat – this can pre-existing conditions,
temperature. employed for sometimes happen especially liver diseases.
Dosage: It inhibits the activity of the management when paracetamol is
300 mg an enzyme called of headaches, given in hospital Accurately calculate the
cyclooxygenase (COX), muscle aches, into a vein in your appropriate dosage based
Route: specifically the COX-2 toothaches, and arm blood disorders, on the patient's weight and
IV enzyme. COX is menstrual pain. such as condition, especially in
involved in the synthesis thrombocytopenia pediatric patients.
of prostaglandins, which It is also (low number of
are lipid compounds that platelet cells) and Emphasize the importance
commonly used
Frequency: play a role in leukopenia (low of adhering to
to reduce fever
PRN inflammation, pain, and number of white recommended dosages and
associated with
fever. blood cells) liver avoiding excessive or
various causes,
and kidney damage, prolonged use to prevent
such as
if you take too much potential liver damage.
infections,
influenza, or (overdose) – this can
be fatal in severe Educate patients about the
other febrile importance of avoiding
illnesses. cases.
alcohol consumption, as it
may increase the risk of
liver damage when
combined with
paracetamol.
VIII. Conclusion

Osteomyelitis has been one of the most difficult and challenging problems confronted
in the medical field. This inflammatory bone infection, often caused by bacteria, poses
significant challenges in terms of diagnosis, treatment, and ongoing management. Which
requires a multidisciplinary approach involving healthcare professionals from various
specialties. The key to successful management is early diagnosis and appropriate surgical
treatment. Learning about the disease and its management will help nurses take care of
patients with osteomyelitis. As nursing students, with this new knowledge, we may apply
what we’ve learned in our clinical assignments to deliver better nursing care to our future
patients.
Isaiah 46: 4 says, “Even to your old age and gray hairs I am He, I am He who will
sustain you. I have made you and I will carry you; I will sustain you and I will rescue you.”
Dealing with illness can be a discouraging and isolating experience. In such moments, it is
important to remember that God has promised to walk through every situation right beside us,
and when things are at their worst, to carry us through it. We must remember that Jesus has
an intimate understanding of everything that we are going through.

IX. Prognosis

The prognosis for people with osteomyelitis is usually good with early and proper
treatment. However, sometimes chronic osteomyelitis develops, and a bone abscess may
return weeks to months or even years later. It may be more difficult to treat and can have a
less favorable prognosis. It may require prolonged courses of antibiotics and, in some cases,
repeated surgeries.

For the patient, his prognosis is quite favorable since the intervention is performed
promptly and followed by appropriate antibiotic therapy. After two weeks, he was still in the
hospital for further observations and to assess the progress of treatment that was done.

X. Recommendations

To the Patient

Always remember that it's never too late to seek medical attention and take steps
towards recovery. You must attend all follow-up appointments as scheduled. Regularly
monitoring it to assess the progress of treatment and make any necessary adjustments. And If
there are contributing factors to the development of your osteomyelitis, like underlying
medical conditions or behaviors that may increase the risk of infection, you must work with
your healthcare provider to address these factors.
To Nurses and Healthcare Providers

Nurses must focus on educating patients about the signs and symptoms of
osteomyelitis, especially if they have underlying conditions or risk factors. Provide
information on the importance of adherence to prescribed medications and treatment plans.
And to prevent infection, they must emphasize the importance of good hygiene practices,
especially for patients with open wounds or surgical sites. Note that every patient is unique,
and healthcare workers should tailor their approach based on the specific circumstances of
each patient. Collaboration, communication, and a comprehensive approach are the essentials
in managing osteomyelitis effectively.

To the Community

The community must focus on prevention, early detection, and prompt treatment.
Everyone must practice and maintain proper hygiene in order to prevent various infections.
Individuals should consult with their healthcare providers for personalized advice based on
their specific health status and risk factors. Because early intervention and adherence to
medical advice play a crucial role in the prevention and management of osteomyelitis.

To the Nursing Students

As students, you should always remember that caring for patients with osteomyelitis
requires a comprehensive and interdisciplinary approach. You must continuously seek
opportunities for hands-on experience, engage in clinical rotations, and be open to learning
from experienced healthcare professionals.

To the Family

If a family member has been diagnosed with osteomyelitis, it can be a challenging

time for both the affected individual and their loved ones. Always remember to not neglect it
because early and proper treatment is the key for a good prognosis. You must communicate
with healthcare providers and seek their medical advice. Provide great emotional support and
be patient with them.
XI. Bibliography

Hinkle, J. L., & Cheever, K. H. (2022). Brunner & Suddarth's textbook of medical-surgical
nursing (Edition 15.). Wolters Kluwer Health/Lippincott Williams & Wilkins. pg. 1142-1144

Longo, D. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Jameson, J. L., & Loscalzo, J. (Eds.).
(2018). Harrison's Principles of Internal Medicine. 20th ed. McGraw-Hill.

Kumar, V., Abbas, A. K., & Aster, J. C. (Eds.). (2015). Robbins and Cotran Pathologic Basis
of Disease. 9th ed. Elsevier Saunders.

Lewis, S. M., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2014). Medical-Surgical
Nursing: Assessment and Management of Clinical Problems. Mosby.

Ackley, B. J., & Ladwig, G. B. (2019). Nursing Diagnosis Handbook: An Evidence-Based

Guide to Planning Care. Mosby.

Fauci, A. S., Braunwald, E., Kasper, D. L., Hauser, S. L., Longo, D. L., Jameson, J. L., &
Loscalzo, J. (Eds.). (2008). Harrison's Principles of Internal Medicine (17th ed.).
McGraw-Hill Medical.

Momodu II, Savaliya V. Osteomyelitis. [Updated 2023 May 31]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK532250/

https://www.nursetogether.com/osteomyelitis-nursing-diagnosis-care-plan/

https://rnlessons.com/osteomyelitis/

Mulualem, B., Belay, G., & Bogale, E. K. (2023). Magnitude of chronic osteomyelitis and its
associated factors in children as diagnosed on X-ray visiting at Felege Hiwot Comprehensive
Specialized Hospital, Northwest Ethiopia: A cross-sectional study. SAGE open medicine, 11,
20503121231161191. https://doi.org/10.1177/20503121231161191

National Institute for Health and Care Excellence (NICE). (2019). Osteomyelitis: acute -
Assessment and management in adults. Retrieved from
https://www.nice.org.uk/guidance/ng37

Centers for Disease Control and Prevention (CDC). (2020). Osteomyelitis. Retrieved from
https://www.cdc.gov/groupbstrep/about/osteomyelitis.html