infections of the musculo- skeletal system osteomyelitis
definition
This infection is common in children and adolescents, but poorly nourished and immune compromised adults patients can also be affected.The condition becomes chronic and debilitating after a sudden onset,because it is usually secondary to existing infection and if not well managed, may persist.
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Clinical manifestations
severe and constant pain
tenderness over the affected area
pyrexia
inability to move the affected part
cellulitis
swelling
causes
blood-borne pyogenic bacteria, mainly staphylococcus aureus from other infected sites, for example boils or infected wounds.
assessment and common findings
Bone x- rays may show irregular decalcification, periosteal elevation and bone necrosis.MRI will assist in confirming the status of the bone and confirming the diagnosis.
Blood laboratory tests will initially show raised sedimentation rate and white cell count
Wound swab and blood cultures are done to identify infecting organisms and drugs to which they are sensitive.
pathophysiology
The infecting organisms form pus under the periosteum of the bone, blocking circulation in and into the bone. The result is necrosis of the affected part of the bone.The infection may spread to the nearest joint, into the medullary cavity and surrounding soft tissues including skin.
Should treatment not be effective, a bone abscess forms, and the necrosed bone crumbles into small fragments, known as the sequestrum. New bone, the involucrum, may form around the abscess making healing impossible.
The skin may then seal on the surface while the infection is brewing underneath. As the abscess ruptures, it forms sinuses which do not effectively drain the abscess, making it chronic.
Nursing diagnosis
Altered comfort related to pain due to the disease process, evidenced by the patient verbalising an experience of pain, warmth and tenderness over the affected area, swelling due to inflammatory processes, risk of extension of infection from the bone abscess
Anxiety due to knowledge deficit about the condition.
management
Immobilisation with a slint
Administration of antibiotic therapy
Administer analgesics as prescribed according to laboratory sensitivity results
If antibiotics fail, the affected bone is surgically opened, necrotic material removed and the area drained.