Nursing Diagnosis for Osteomyelitis
Nursing Care Plans for Osteomyelitis
What is Osteomyelitis?
- The term osteomyelitis consists of three different words that reveal the meaning of osteomyelitis.
- Osteo stands for bone
- myel relates to myelo and stands for marrow
- the ending –itis indicates an inflammatory process
- So osteomyelitis means inflammation of the bone and bone marrow.
The infection of the bone is usually caused by either the spread of the pathogen from the bloodstream into the bone, or the infection of the bone due to an open fracture or a surgical procedure.
About 2 in 10,000 people suffer from osteomyelitis in the U.S. The bacteria Staphylococcus aureus is the most common cause of osteomyelitis.
- Osteomyelitis is the inflammation of the bone and bone marrow and usually results from an infection.
- Bacteria, viruses, or fungi can cause it.
- It occurs when pathogens enter the bone structures and cause an infection.
- These germs create an inflammatory response that causes leaky blood vessels and edema in surrounding tissues.
- During this inflammatory response, leukocytes (a form of white blood cells) rush to the affected area and secret enzymes in an attempt to kill the foreign bacteria.
- In this process, pus is formed and causes increased pressure within the bone structures. This leads to rupture within bone structures and may occlude blood supply, leading to ischemia and bone death.
- The necrotic bone that forms separates from the healthy bone structure. This necrotic encapsulation is called sequestrum (infected dead bone resulting from osteomyelitis).
- The sequestrum is not connected to viable structures of the bone, such as the osteons housing blood supply. This makes treatment difficult because medication such as antibiotics cannot reach the infected area.
- At the same time, new bone cells are formed around the necrotic bone. This is called the involucrum.
- Many infections are caused by Staphylococcus aureus, Pseudomonas, and Enterobacteriaceae.
- Adults mostly experience an infection in the vertebrae (spine), whereas children may experience these infections in long bones.
Signs and Symptoms of Osteomyelitis
What are three clinical signs or symptoms that suggest a diagnosis of osteomyelitis?
- Inflammation – swelling (edema), warmth and redness (erythema) over the infected area
- Pain around the infected area
- Loss of range of motion (ROM)
Causes and Risk Factors of Osteomyelitis
What are the most common causes of osteomyelitis?
S. aureus is usually found in the nose or on the skin even in healthy individuals. However, once S. aureus cause pneumonia in the lungs or urinary tract infection in the bladder, there is a risk of the bacteria traveling via the bloodstream to a damaged part of a bone in the body.
An open fracture or a severe puncture wound may cause the bacteria to infect the injured bone, or enter the bloodstream. Joint replacement and fracture repair surgeries put the patient at risk for osteomyelitis.
Advanced age is one of the risk factors of osteomyelitis.
Other risk factors include circulation disorders (such as poorly controlled diabetes, sickle cell disease and peripheral artery disease), HIV/AIDS, rheumatoid arthritis, long-term steroids, injection of illegal drugs, and the use of urinary catheters, central lines, or dialysis machine tubing.
Complications of Osteomyelitis
- Osteonecrosis. If left untreated, osteomyelitis may lead to bone death called osteonecrosis. The infected bone area may hinder the normal blood circulation within the bone, causing the bone tissues to be deprived of oxygen and nutrients. The dead bone areas need surgical removal and the patient will have to receive antibiotics therapy.
- Impaired growth in children. Osteomyelitis of the growth plates or the soft areas of the long bones may affect a child’s growth.
- Septic arthritis. When the infection spreads to a nearby joint, it can cause septic arthritis.
Diagnosis of Osteomyelitis
How do you diagnose osteomyelitis?
- Physical examination – to check for signs of inflammation and any loss of ROM
- Blood test – Full blood count to check for elevated white blood cells; blood culture to determine any infection in the blood and its causative agent
- Imaging – X-ray of the affected bone; MRI for a more detailed imaging of the bones and soft tissues; CT scan can be done if the patient is unable to have an MRI
- Bone biopsy – insertion of a needle to the bone to take a sample and know the causative agent
Treatment for Osteomyelitis
What are the major interventions for osteomyelitis?
- Surgery. The surgeon will open the infected area and drain any fluid or pus. Debridement follows, wherein the surgeon removes the diseased part of the bone and surrounding tissues. To bring back the blood flow to the bone, the surgeon may use a piece of bone or other tissue to empty the space post-debridement. Amputation of the limb may be required for severe osteomyelitis.
- Antibiotics. The type of antibiotic therapy required by the patient is determined by the causative agent found through a bone biopsy. The course of antibiotics is usually given for about 4 to 6 weeks. Beta-lactam antibiotics such as penicillins and cephalosporins are commonly used for S. aureus osteomyelitis. Fever reducers and pain relievers such as paracetamol or Tylenol may be given as supportive medication for fever and/or pain.
- Lifestyle changes. Diabetic patients with osteomyelitis require strict blood sugar control and management. Smoking cessation can help promote a faster healing process.
Care Plan for Osteomyelitis
Care Plan for Osteomyelitis 1
How do you care for someone with osteomyelitis?
Acute Pain r/t infectious process and swelling
Expected Outcome: The patient will report an acceptable pain level of 3 or less on a 0 to 10 pain scale, as evidenced by vital signs within normal limits and a relaxing effect and body posture.
|Assess the patient’s pain level using an accepted pain assessment tool such as the numeric pain scale. Note characteristics of pain.
Precipitating events such as movement and positioning may contribute to pain. In addition, quality, severity, and location may indicate how advanced the infection already is.
|Monitor vital signs at least every four hours.
An increased blood pressure, heart rate, and respiration may indicate uncontrolled pain.
|Administer pain medication as ordered.
Osteomyelitis pain can range from mild to moderate to severe. Some patients may even be pain-free. Nevertheless, pain management may slightly differ depending on whether patients suffer from acute or chronic pain. Pain medications such as acetaminophen, naproxen, Ibuprofen, or even opioids such as oxycodone or morphine may be ordered by the physician.
|Encourage bed rest.
The least movement of the affected area promotes healing and alleviates pain. The area may be supported with a splint device to ensure minimal movement or disturbance.
|Be considerate during wound care and use appropriate timing with pain medication.
Using a gentle approach to dressing changes and wound care may help with pain control. Another way to maximize pain control is to provide wound care during peaks of pain medications. For example, the nurse may wait for thirty minutes to one hour before performing wound care after administering oral pain medication.
|Elevate the involved area to reduce swelling.
Often the inflammatory process causes the area to become edematous, and the skin becomes tight, causing discomfort. Elevation may help reduce swelling and alleviate pain.
|Provide hot and cold packs if not contraindicated.
Cold packs help reduce swelling, whereas warm applications may help with pain relief and increase range of motion.
|Provide resources to help with distraction.
Activities such as watching television, listening to music, or even face-timing family members and friends may help divert attention away from the pain.
Care Plan for Osteomyelitis 2
Hyperthermia r/t to inflammatory response secondary to infection
Expected Outcome: The patient will maintain a core body temperature within normal limits as evidenced by consistent temperature measurements of less than 100° Fahrenheit, dry skin, and normal respiration rate.
|Monitor the patient’s temperature at designated times and as clinically indicated.
Following a trend of the patient’s temperature helps determine the effectiveness of antipyretic medications and antibiotics.
|Obtain temperature measurements from the same site and with the same tool.
Different sites and methods may skew measurements and cause trends to be inaccurate.
|Administer antipyretics as ordered.
Antipyretic medications may help reduce fever for a period of time.
|Remove warm clothing and adjust the room temperature.
These external factors may affect the patient’s body temperature.
|Provide temperature lowering measurements such as a fan or cold cloth to the forehead.
These measures may help lower body temperature.
|Offer tepid baths.
Using lukewarm water during baths instead of hot water may help to keep the temperature from rising.
Care Plan for Osteomyelitis 3
Ineffective Tissue Perfusion r/t ischemia due to disease process
Expected Outcome: The patient will have adequate tissue perfusion as evidenced by the absence of pain, absence of necrotic bone tissue, and dry, warm, intact skin.
|Anticipate surgical intervention in patients with chronic, unrelieved osteomyelitis.
To remove necrotic bone tissue, the surgeon may perform a sequestrectomy or debridement to revascularize viable tissue.
|Assess the patient’s neurovascular status. Note pain, movement, sensation, warmth, temperature, pulses, and capillary refill.
These signs indicate a neurovascular compromise.
|Consider a treatment called hyperbaric oxygen therapy (HBO).
Osteomyelitis is associated with reduced blood flow to the bone and therefore limited oxygen supply needed for wound healing. The patient is exposed to high amounts of oxygen that permeates the tissues. As a result, this therapy treatment increases tissue perfusion and wound healing.
Care Plan for Osteomyelitis 4
Knowledge Deficit r/t new diagnosis; surgery
Expected Outcome: The patient will verbalize an understanding of the disease process and demonstrate the necessary skills to prevent reinfection, as evidenced by complying with the prescribed treatment regimen.
|Teach about the importance of taking antibiotics as prescribed.
Patients need to know that antibiotics should be taken until finished and not to skip or delay doses.
|Teach about line care if the patient is sent home with an intravenous line.
Some patients may return home with a PICC line to receive long-term antibiotics. But again, knowing how to care for it and keeping the site clean helps reduce the risk for infection.
|Educate about signs and symptoms of neurovascular compromise.
Sudden changes in sensation, numbness or increased pain may indicate ischemia.
|Educate about signs and symptoms of infection.
Redness, swelling, pain, and warmth at the site may indicate infection.
|Educate about the principles of infection control and wound care after surgery.
Patients and families need to know wound and incision care to prevent infection.
More Care Plans:
Risk for Infection Nursing Diagnosis & Care Plan
Impaired Physical Mobility Nursing Diagnosis & Care Plan
Activity Intolerance Nursing Diagnosis & Care Plan
Acute Pain Nursing Diagnosis & Care Plan