Osteomyelitis 
Defination
Is an infection of the bone that results in inflammation, necrosis and formation othe new bone.
Classification
Hematogeneus osteomyelitis: it is an infection of the bone through the blood.
Contiguous inoculation osteomyelitis: caused by direct contact of the tissue and bacteria during bone surgery, open fracture and traumatic injury.
Pathophysiology
Causative pathogens:
-Staphylococcus aureus
-Streptococci
-Enterococci
-pseudomonas
Vertebral osteomyelitis: osteomyelitis with vascular insufficiency most commonly in patients with diabetes and peripheral vascular disease.
Initial response to infection is inflammation, increased vascularity and edema.
Thrombosis of the local blood vessels occurs after 2 or 3 days.
Resulting in the ischemia with bone necrosis.
Infection extend to the medullary cavity and under the periosteum, may spread into adjacent soft tissue and joints.
The resulting abscess cavity contains the sequestrum that does not easily liquefy and drain.
Clinical manifestations
Symptoms:
-Chills.,fever, rapid pulse
and malaise.
-Pain, edema and extremely tender in the infected area.
Elevated erythrocyte sedimentation rate
C-reactive protein
Positive blood culture s
Diagnosis
X-ray:
Demonstrate soft tissue edema.
Periosteal elevation.
Bone destruction.
MRI:
Effective in early detection and surgical localisation of osteomyelitis.
CT scan:
Demonstrate abnormal calcification, ossification
and intracoastal abnormalities.
Ultrasonography:
Demonstrate changes after the onset of symptoms.
Lab findings:
Blood culture
Aspiration samples of the infected site.
Pharmacological Management
Antibiotic therapy:
Doxycycline, inhibit protein synthesis of susceptible bacteria.
Vancomycin, inhibit bacterial wall synthesis block polymerization.
Cephalosporins, inhibit bacterial cell wall synthesis.
Clindamycin, recommended as a second line for sensitive Staphylococcus infection.
Surgical management
Sequestrum resection
Debridment
Joint drainage
Analgesics
Nursing management
Describe osteomyelitis to the patient help them to gain insight.
Demonstrate safe use of ambulatory aids and assistive devices.
Instruct the patient about weight bearing and activity restrictions.
Advice the patient on how to comply with antibiotic regimen.
Relief pain with pharmacological and nonpharmacological interventions.
Promote healing through aseptic dressing changes.
Demonstrate proper wound care to avoid infection.
Advice the patient to report signs and symptoms of continuing infections.