Osteomyelitis is inflammation of bone caused by infection. It most commonly affects children under 10 and is usually caused by Staphylococcus aureus. Symptoms include pain, fever, and tenderness. Diagnosis involves cultures, imaging, and biopsy. Treatment involves antibiotics, supportive care, and sometimes surgery. Nursing management focuses on pain control, wound care, monitoring for complications, and ensuring proper rest and immobilization during recovery.

1. Osteomyelitis
Anu Chalise
MN 2nd year
4th batch

2. Objectives
At the end of the session participants will be able to :
• define osteomyelitis
• state epidemiology of osteomyelitis
• list types of osteomyelitis
• state aetiology
• describe pathophysiology
• state clinical manifestations

3. Objectives
• describe therapeutic management of osteomylitis
• describe nursing management of osteomyelitis
• list complication of osteomyelitis
• state prevention of osteomyelitis

4. Definition
• Inflammation of the bone caused by an infection,
which may spread to the bone marrow and tissues
near the bone.
• May occur at any age but most frequently is seen in
children 10 years of age or younger.
• S. aureus is the most common causative organism.
• H. influenzae has become a less common causative
pathogen: after Haemophilus influenzae type b
immunization

5. Anatomy of Bone

6. Osteomyelitis

7. Osteomyelitis

8. Epidemiology
• The annual incidence of pediatric osteomyelitis is
approximately 13 per 100,000 individuals.
• Osteomyelitis occurs in all patient age groups.
• Osteomyelitis occurs more commonly in males for
unknown reasons.
• Osteomyelitis occurs equally among all races.
• Osteomyelitis is more common in developing
countries.

9. Types
a. Duration of Infection:
• Acute: <2 weeks
• Subacute: 2-6 weeks
• Chronic:
– >6 weeks
– Persistent or relapsed infection
– Infection associated with prosthetic devices
– Histologic evidence of dead or necrotic cortical
bone

10. Cont’d…
b. Mechanism of Infection:
• Hematogenous
• Contiguous source (trauma, nosocomial
contamination following surgical procedure and
extension from adjacent soft tissue infection)

11. Aetiology
Causative Agent
Newborns
• Staphylococcus aureus
• Group B streptococcus
• Gram-negative enteric rods
Infants
• S. aureus (methicillin-sensitive S. aureus 70,
methicillin-resistant S. aureus 30)
• Haemophilus influenza

12. Contd…
Older Children
• S. aureus
• Pseudomonas organisms
• Salmonella organisms
• Neisseria gonorrhoeae
Adolescents and Adults
• Pseudomonas organisms
• Mycobacterium tuberculosis

13. Contd…
Acute hematogenous osteomyelitis: bloodborne
bacterium causes an infection in the bone.
Examples: Pneumonia, urinary tract infection
Exogenous osteomyelitis: direct inoculation of the
bone from a puncture wound, open fracture, surgical
contamination, or adjacent tissue infection.

14. Contd…
• Person with immunosuppression, and malnutrition
are at risk
• The body part most commonly affected include the
foot, femur, tibia, and pelvis.

15. Pathophysiology
Bacteria adhere to bone.
Suppurative infection with inflammatory cells,
edema, vascular forming an abscess.
Formation of Sequestrum and subperiosteum
abscess

16. Contd…
New bone (involucrum) is formed along the live
bone and infection borders.
Sinus tracts from perforations in the involucrum
may drain pus

17. Contd…

18. Contd…

19. Contd…
The pathology is different in infants, children older than
1 year of age, and adults.
In infants:
• blood vessels cross the growth plate into the
epiphysis and joint space
• infection spread into the joint.
In children:
• infection is contained by the growth plate
• joint infection is less likely

20. Clinical Manifestations
• Severe pain
• Fever
• Irritability
• Tenderness with or without local signs of
inflammation.
• Resist movement.
• In infants these symptoms may be minimal or absent
• Pus discharge may be present from infected side

21. Contd…
• Infants may have an adjacent joint effusion
• More than one bone may be affected.

22. Diagnostic Evaluation
• Obtain cultures of : subperiosteal pus along with
cultures of blood, joint fluid, and infected skin
samples.
• Bone biopsy
• CBC: leukocytosis
• Elevated erythrocyte sedimentation rate

23. Contd…
• Elevated C-reactive protein.
• A three-phase technetium bone scan
• CT can detect bone destruction
• MRI provides anatomic details of the area of
involvement

24. Therapeutic Management
Analgesic and antipyretics for symptomatic
management.
Supportive Care:
• Adequate rest and immobilization of part
• Nutritious diet
• Wound Care
• Maintenance of hydration
• Ambulation and exercise

25. Contd…
After culture specimens are obtained, empiric
therapy is started with IV antibiotics.
• For S.aureus nafcillin or clindamycin is generally
used.
• Methicillinresistant S. aureus may require
vancomycin.
• Antibiotic is initiated and continued for at least 4
weeks

26. Contd…
It is important to monitor for hematologic, renal,
hepatic, ototoxic, and other potential side effects.
Surgical Procedure:
Sequestrectomy and surgical drainage to decompress
the metaphyseal space before pus erupts and
spreads to the subperiosteal space.

27. Nursing Management
Nursing Assessment
Assessment of sign and symptoms: fever, pain,
tenderness, restistriction of mobility, infection.

28. Contd…
Nursing Diagnosis
• Hperthermia related to infection
• Acute pain related to inflammation of bone
• Impaired mobility related to pain and tenderness
• Impaired skin integrity related to open skin wound
• Anxiety related to medical procedure, prolong
hospitalization

29. Contd…
Nursing Intervention
The child is positioned comfortably with the affected
limb supported.
The child may require pain medication ,sedation and
antipyretics.
Take vital signs and record them frequently.

30. Contd…
Antibiotic therapy requires careful observation and
monitoring of the IV equipment and site.
The stability of the drugs and their toxic nature are
also considered when determining the rate of
administration.
For long-term antibiotic therapy, a venous access
device, such as a peripherally inserted central
catheter is preferred.

31. Contd…
The wound is managed according to the provider’s
directions.
The amount and character of drainage on the wound
dressing are also noted.
Intake and output are measured and recorded, and
the character of both the wound and drainage is
noted.
Use aseptic technique while doing invasive
procedure.

32. Contd…
As the infection subsides, physical therapy is
instituted to ensure restoration of optimum function.
 Provide age appropriate play therapy to children
Provide emotional support to parents.
Family centred care
Home care management

33. Contd…
Evaluation
• Patient have no sign of fever, pain and tenderness.
• Patient feel comfort during movement.

34. Complications
• Bone death (osteonecrosis).
• Septic arthritis
• Impaired growth
• Skin cancer
• Fracture

35. Prevention of Osteomyelitis
• Take precautions to avoid cuts, scrapes and animal
scratches or bites.
• Clean the injured area immediately and apply a clean
bandage.
• Check wounds frequently for signs of infection.
• Treat hematogenous infection initially.

36. Summary
Inflammation of the bone caused by an infection.
Aetiology:
• Hematogenous: S. aureus, H. influenzae
• Contiguous
Types: Acute(<2weeks), Subacute(2-6weeks),
chronic(>6weeks)
Management: Symptomatic Management,
Antibiotics, Sequestrectomy

37. Contd…
Nursing Management:
• Pain Management, Positioning, Nutrition, Infection
Prevention.

38. Assignment
Define osteomyelitis. State its clinical features and
write nursing management of child with
osteomyelitis. (2+3+5)

39. References
• Hockenberry, M.J., Wilson, D. and Rodgers,C.C. (2018).
Wong’s Essentials of Pediatric Nursing. 2nd ed. India: Reed
Elsevier.
• Uprety, K. (2018).Essential of Child Health Nursing. 1st
edition. Kathmandu: Akshav Publication.
• Shrestha, T. (2016). Essential Child Health Nursing. 2nd
edition. Kathmandu: Medhavi Publication.
• Kyle, T. and Carman, S.(2013). Essentials of Pediatric
Nursing.2nd edition. Philadelphia:Wolters Kluwer Health.
• Ball, J., Bindler, R., Cowen, K., Shaw, M.(2017). Principles of
Pediatric Nursing. 7th edition. America: Pearson Education.

40. References
• C. Michael Gibson.(2020). Osteomyelitis
epidemiology and demographics. Retrived on
20/8/2020 from
Gibsonhttps://www.wikidoc.org/index.php/Osteomy
elitis_epidemiology_and_demographics#:~:text=Inci
dence%20of%20osteomyelitis%20is%20approximatel
y,is%20most%20common%20in%20adults.

41. Thank You