Osteomyelitis

Nursing Diagnosis, Interventions, and Care Plans for Osteomyelitis-A Student’s Guide

Introduction

Medical practitioners are often faced with the task of treating patients who have suffered from Osteomyelitis.

Osteomyelitis is an infection of the bone which can be life-threatening if not treated quickly. The body has a natural defense against bacteria called white blood cells. White blood cells are capable of fighting off bacteria like antibiotic drugs.

Suppose there are too many white blood cells, or they cannot fight off. In that case, Osteomyelitis can develop into an abscess or pus pocket caused by an accumulation of dead tissue in one area of the body due to inflammation from a wound or illness such as diabetes or lupus.

This article offers a comprehensive guide that will help student doctors and nurses, intervene, and provide care for their patients who have this condition. As you read, keep in mind that our top nursing writers are ready to help in case you get stuck with your nursing assignment. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

What is Osteomyelitis?

Osteomyelitis is a bone infection that can be caused by either an acute bacterial or chronic fungal infection. The infection may be the result of a penetrating or closed wound, resulting in either an acute fracture (a break or crack in bone) or osteoarthritis (inflamed joint). The condition can also occur due to a metabolic disorder. 

Types or Classification of Osteomyelitis

There are four classifications of the disease: acute hematogenous (bloodborne), chronic hematogenous (bloodborne), acute non-hematogenous, and chronic non-hematogenous. The first two classifications have similar symptoms and treatments as they form from bacteria in the bloodstream. At the same time, the latter two develop from bacteria outside of the body, which enters through a wound on your skin or other tissue damage.

What Causes Osteomyelitis?

Osteomyelitis may be caused by many different organisms, including bacteria, fungi, viruses, parasites, or combinations thereof.

The common causes are Staphylococcus aureus and Group A Streptococcus, which are both Gram-positive bacteria that often infect open wounds such as punctures from animal bites, scrapes from sports injuries, or surgical incisions during childbirth. Chronic Osteomyelitis may be caused by fungi, such as Candida albicans.

Individuals with diabetes and lupus have been found to develop Osteomyelitis.

What Are the Signs and Symptoms of Osteomyelitis?

Symptoms of this condition include;

  • Pain in the bones
  • Fever
  • Malaise
  • Local tenderness on palpation
  • Redness at the wound site(s)
  • Decreased range of motion in affected joint(s) or limb(s)
  • Swelling at the wound site (usually fingers or toes)
  • Nail changes(such as length, thickness, softening)
  • Increased hair growth at the wound site.

Common Site for Osteomyelitis

The most common site for Osteomyelitis is the knee joint, followed by other joints such as the shoulder or ankle.

Nursing Diagnosis of Osteomyelitis

Osteomyelitis diagnosis begins with thorough patient history and physical examination to rule out other possible diagnoses that could cause similar symptoms such as fractures or trauma to bone areas.

Impaired skin integrity related to impaired circulation;

Activity intolerance related to functional impairment;

Anxiety/fear-related problems

-Infection and pain related to a broken bone.  Pain, impaired mobility, and sensory deficit in a specific body part related to prior abrasion, surgery, or disease.

-Imaging studies are also necessary for diagnosis; they may show localized bone injury from infection in addition to inflammation which

Deficient Knowledge -related to the understanding of causative factors and prevention associated with Osteomyelitis.

Ps: We also have guides on nursing diagnosis for Cystic Fibrosis

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Nursing Interventions for Osteomyelitis

-The patient should be placed on antibiotics as soon as possible after diagnosis so that they can start fighting the infection while still at home or in the hospital

-Administer IV fluids and monitor intake/output levels

-Encourage movement with range-of-motion exercises

-Provide pain relief measures such as heat, ice packs, massage therapy

Wounds should be cleaned and dressed daily. The physician will provide the patient with a dressing to promote healing.

The nurse should check for infection, swelling, drainage, and any other signs indicating a problem that requires immediate medical attention.   

-Educate family members about risks associated with Osteomyelitis

To provide a safe environment, nurses should assess:

– The wound for signs of infection including pain, redness, and drainage;     

– The surrounding area of the wound for color and temperature;                    

– Signs of systemic complications such as chills or fever could indicate the severity of an infection.   

– The dressing’s condition and how to apply it to promote healing of the wound.   

– The patient’s pain level might be related to an infection;  Nurses should ask patients about their pain level before they administer prescribed medications for pain which could lead to complications such as nausea, vomiting, diarrhea. 

The most fundamental nursing goal is to promote healing by identifying complications early and reporting them to the physician for further evaluation.  

Nurses should be aware of:      

– Signs of infection, such as redness, drainage, swelling, or increased pain;       

  -Systemic problems that might lead to sepsis such as chills, fever, and malaise;

 Nurses should assess patients who have Osteomyelitis daily, especially when they are placed in a rehabilitation center for further treatment and recovery process under the care of a physical therapist.

Care Plan for Osteomyelitis

-Planned interventions related to altered skin integrity, activity intolerance due to pain and anxiety.

-Provide comfortable supplies and clothing for immobility.

– Provide supportive measures such as proper positioning to reduce risk of pressure ulceration;

– Assist patient with feedings if necessary. Teach the importance of a healthy diet, adequate fluid intake, and exercise to prevent a recurrence.

-Medication administration based on physician’s orders.

-Monitor vital signs such as blood pressure, heart rate, respiratory rate, and temperature if the Osteomyelitis is severe.  The nurse will check these parameters daily and compare them with baseline values from a previous visit. 

-Identify a qualified health professional to perform a physical assessment and take vital signs if the family/caregiver is not available.  The nurse will inform them of any concerns such as increased pain, swelling, redness, or drainage from the infected area and anything else that seems abnormal.

-Assist with obtaining the equipment necessary for AROM exercises.  If the patient is bed-bound, they may need to perform these exercises to prevent additional complications; they can be performed while lying flat on the back, sitting up in a chair with feet resting on the floor, and even standing if it’s possible.

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Complications of Osteomyelitis

The most common complications of Osteomyelitis are decreased circulation and a compromised immune system.

Decreased Circulation:

If there is severe soft tissue damage, an increase in pressure on the artery walls can cause a decrease in blood flow, resulting in gangrene. 

Compromised Immune System:

This complicating factor is hazardous for children; a weakened immune system often results in recurrent infections and sepsis, which can be fatal.

Other Complications May Include:

Skin breakdown due to immobilization or/and debris which may lead to infection. The patient’s skin is put at significant risk if they develop bedsores, pressure ulcers, or impaired circulation, which could lead to amputation of the affected limb;

CS may experience feelings of apprehension, anxiety, or even fear when faced with the possibility of experiencing physical discomforts such as pain that could interfere with their daily routine activities, mobility, and independence. 

Requirements When Caring for Osteomyelitis

-Keep the area clean and dry by applying an antibiotic cream over incisions to prevent infection.

-The patient may require a special diet due to physical limitations and complications (e.g., nausea, vomiting, diarrhea, GI upset);

-CS should not smoke because the damaged bone or tissue is susceptible.

-If there are complications, CS may require additional treatment such as AROM (Active Range of Motion) and passive exercises with the assistance of a therapist.  

Physiotherapy could help restore muscle strength, mobility, and breathing ability, preventing worsening of pain, swelling, and decreased circulation. 

Treatment of Osteomyelitis

The most crucial part of treating Osteomyelitis is to prevent the spreading of infection into deeper tissues.  The medical team will try to control the disease by using medications and dressing the affected area. However, if there are complications such as systemic problems that lead to sepsis, nurses should be aware of signs and symptoms, which include:

Compartment Syndrome

This is when pressure on an injured limb causes inflammation in the muscles and tissues surrounding the injury.   

The result is increased pressure in the damaged muscle – which can cause impaired blood flow and lead to permanent damage or even amputation of the limb.  

Signs of Compartment Syndrome

Nurses are responsible for identifying signs such as:

-Swelling, pain, and loss of function at the site of injury;

-The patient’s temperature is higher than 101.3F;

– Decreased or absent pulse in the injured area;

– Localized numbness due to lack of blood flow to the limb.

– Discoloration and the skin temperature of the area; if there is pain associated with an inability to move that part of their body, nurses must assess the patient immediately and notify the physician. 

If possible, neurovascular checks have to be performed to assess blood flow or to feel in the limb. 

Treatment of Compartment Syndrome

– Administering analgesia;

– Giving patient adequate oxygenation and ventilation;      

-The physician may choose to drain the excess fluid using a needle into the area;       

– A patient may need to stay in the hospital for further monitoring and treatment to ensure that circulation is restored in the affected limb.  

-Application of a pressure garment (a tight-fitting sleeve) to a patient may be necessary for people who suffer from compartment syndrome after an injury. It helps prevent swelling and maintain circulation in that area.

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Conclusion

Osteomyelitis is a severe condition that can result from an untreated injury, a surgical procedure, or the use of medical devices. It is characterized by inflammation of the bone and bone marrow.

Symptoms include fever, chills, pain at the site of infection, localized redness in the body area above the injection site, swelling around the disease area.

Treatment for Osteomyelitis includes antibiotics to treat bacteria in addition to surgery and other measures as indicated by symptoms.

If you have Osteomyelitis, it’s crucial to consult your doctor because prolonged untreated infections can lead to chronic pain or even amputation in extreme cases.

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