it is covering introduction, etiology, clinical manifestations, pathophysiology, diagnostic test fro confirmation, medical management, surgical management and nursing management.

2. TOPICS TO BE COVERED
▪ INTRODUCTION
▪ ETIOLOGY
▪ CLINICAL MANIFESTATIONS
▪ PATHOPHYSIOLOGY
▪ DIAGNOSTICTEST
▪ MEDICAL MANAGEMENT
▪ SURGICAL MANAGEMENT
▪ NURSING MANAGEMENT

3. INTRODUCTION
o It is infection or inflammation of bone and bone marrow
that result in bone necrosis.
o It is a rare but serious condition. Bones can become
infected in a number of ways: Infection in one part of the
body may spread through the bloodstream into the bone,
or an open fracture or surgery may expose the bone to
infection.
o More than 50% of infection are caused by
Staphylococcus aureus.
o Other infectious agent include Pseudomonas,
Enterococci, and Streptococci.

4. NORMAL BONE
OSTEOMYELITIS
BONE

5. ETIOLOGY
1.BACTERIA
PYOGENIC
OSTEOMYELITIS
Eg:
staphylococcus
aereus
NON PYOGENIC
OSTEOMYELITIS
Eg:
Mycobacterium
tuberculosis

6. ETIOLOGY(SOME OTHER BACTERIA)
1
• PSEUDOMONAS (IN IV DRUG USER)
2
• SALMONELLA (IN SICKLE CELL DISEASE)
3
• GONORRHEA (IN SEXUALLY ACTIVE ADULTS)

7. ETIOLOGY
2. OPEN WOUND FROMTRAUMA OVER BONE

8. ETIOLOGY
3.HISTORY OF INTRAOSSEUS INJECTIONING

9. ETIOLOGY
4.BLOOD-STREAM INFECTION

10. ETIOLOGY
5. PERIPHERALVASCULAR DISEASE

11. ETIOLOGY
6.BONE SURGERY

12. ETIOLOGY
7.OPEN FRACTURE

13. ETIOLOGY
8.DIABETES

14. ROUTE OF ENTRY OF ORGANISM
1.HEMATOGENOUS SPREAD

15. ROUTE OF ENTRY OF ORGANISM
2.DIRECT ENTRY OF ORGANISM (ORTHOPEDIC IMPLANTS)

16. ROUTE OF ENTRY OF ORGANISM
2.DIRECT ENTRY OF ORGANISM (GUNSHOT INJURY)

17. ROUTE OF ENTRY OF ORGANISM
2.DIRECT ENTRY OF ORGANISM (OPEN FRACTURE)

18. ROUTE OF ENTRY OF ORGANISM
3.NEIGHBOURING CONNECTIVE TISSUES (EG DIABETES MELLITUS)

19. ROUTES OF ENTRY OF ORGANISM

20. PATHOPHYSIOLOGY

21. PATHOPHYSIOLOGY

22. PATHOPHYSIOLOGY
PUSS
COMING
OUT OF
BONE

24. CLINICAL MANIFESTATIONS
▪ IN CASE OF BLOODBORNE INFECTION :
FEVER

25. CLINICAL MANIFESTATIONS
▪ IN CASE OF BLOODBORNE INFECTION :
CHILLS

26. CLINICAL MANIFESTATIONS
▪ IN CASE OF BLOODBORNE INFECTION :
MALAISE

27. CLINICAL MANIFESTATIONS
▪ IN CASE OF BLOODBORNE INFECTION :
RAPID PULSE

28. CLINICAL MANIFESTATIONS
▪ IN CASE OF BLOODBORNE INFECTION :
PAIN, SWELLING ANDTENDERNESS ON AFFECTED SITE

29. CLINICAL MANIFESTATIONS
▪ IN CASE OF DIRECT SPREAD:
BONE SWELLING

30. CLINICAL MANIFESTATIONS
▪ IN CASE OF DIRECT SPREAD
WARMING OF AFFECTED AREA

31. CLINICAL MANIFESTATIONS
▪ IN CASE OF DIRECT SPREAD :
PAIN ANDTENDERNESS ONTOUCH

32. CLINICAL MANIFESTATIONS
▪ IN CASE OFVASCULAR INSUFFICIENCY:
MACROVASCULAR AND MICROVASCULAR CHANGES

33. CLINICAL MANIFESTATIONS
▪ IN CASE OFVASCULAR INSUFFICIENCY:
IMPAIRED IMMUNE RESPONSE

35. Medical management
▪ The initial goal of therapy is to control and halt the
infective process.
▪ PHARMACOLOGICAL THERAPY
▪ Vigorous and prolonged IV antibiotic therapy is the
treatment of choice for acute osteomyelitis as long as
bone ischemia has not yet occurred. As soon as the
culture specimen are obtained , iv antibiotic therapy
begins first in hospital then is continued at home for
4-6 weeks or as long as 3-6 months

36. MEDICAL MANAGEMENT ( CONTD….)
▪ The antibiotics include :
▪ Vancomycin
▪ Neomycin
▪ Gentamycin
▪ Tobramycin
▪ Cefazolin

37. MEDICAL MANAGEMENT ( CONTD….)
▪ HYPERBARIC OXYGENTHERAPY
▪ 100 % oxygen may be
administered as an adjunct
therapy in refractory case of
chronic osteomyelitis. The
therapy is thought to stimulate
circulation, healing in infected
area.

38. Surgical management
▪ Debridement
▪ A sequestrectomy ( removal of enough
involucrum to enable the surgeon to
remove sequestrum )
▪ Amputation

40. NURSING MANAGEMENT
NURSING DIAGNOSIS :
1) Acute Pain RelatedTo Inflammation And Swelling .
2) Impaired Physical Mobility RelatedTo Pain , Use Of
Immobilization Devices AndWeight Bearing Limitations.
3) Risk For Extension Of Infection ; Bone Abscess
Formation.
4) Deficient Knowledge RelatedToTheTreatment
Regimen.

41. RELIEVING PAIN
-The Affected Part Is ImmobilizedWith A
SplintTo Decrease Pain And Muscle Spasm.
-The Nurse MonitorsThe Neurovascular
Status Of Affected Extremity (5p's).The
Wounds AreVery Painful, AndThe Extremity
Must Be Handled With Great Care And
Gentleness.

42. Cont....
-Elevation Reduces Swelling And Associated
Discomfort.
- Pain Is ControlledWith Prescribed
Analgesics And Other Pain Reducing
Techniques.

43. IMPROVING PHYSICAL MOBILITY
- Treatment Regimen Restrict Activity.The
Bone Is Weakened ByThe Infective Process
And Must Be Protected By Immobilization
Devices And By Avoidance Of Stress OnThe
Bone.
-The Patient Must UnderstandThe
Rationale ForThe Activity Restrictions.

44. Cont...
-The Joints Above And BelowThe Affected
Part Should Be Gently PlaceThrough Range
Of Motion.
-The Nurse Encourages Full Participation In
Adls WithinThe Physical LimitationsTo
Promote General Well-being.

45. CONTROLLING THE INFECTIOUS PROCESS
-The Nurse MonitorsThe Patient's
ResponseTo AntibioticTherapy And
ObservesThe IV Access Site For Evidence Of
Phlebitis And Infection.
- With Long-term Intensive Antibiotic
Therapy,The Nurse MonitorsThe Pt. For
Signs Of Suprainfection.

46. Cont...
- If Surgery Was Necessary,The NurseTakes
MeasuresTo Ensure Adequate Circulation,
To Maintain Needed Immobility, AndTo
Comply With Weight Bearing Restrictions.
-The Nurse Changes Dressing Using Aseptic
Technique And ContinueTo MonitorThe
General Health And Nutrition OfThe Pt.

47. KNOWLEDGE DEFICIT RELATED TO
TREATMENT REGIMEN
-Teach Pt. AboutTheTime And Dose Of
MedicationTaken.
- Described Desired Affects Of MedicationTo
Pt.
-Describe Sign And Symptoms Of Over And
Under dose Of Medication.