its about musculoskeletal disorder

2. Septic arthritis
Prepared by:
Prabita Shrestha

3. Introduction:
Septic arthritis is a painful infection in the joint. It may
also be referred to as infectious arthritis.
It occurs when an infection, caused by a bacteria or
virus, spreads to a joint or the fluid surrounding the joint
(synovial fluid).
This infection usually begins in another area of the body
and spreads through the bloodstream to the joint tissue.
The infection may also enter the body through surgery,
open wounds, or injections.

4. Contd…
Infectious arthritis usually only occurs in one joint.
Most often, the joint affected is a large joint such as the
knee, hip, or shoulder.
It occurs more often in children and older adults.

5. Causative agents:
Neisseria gonorrhea (in children)
Meningococci
Streptococcus haemolyticus
Staphylococcus aureus
Coliform bacteria
Salmonella
Haemophilus influenza

6. Risk Factors:
Joint problems such as arthritis, gout, and lupus
Previous joint surgery/diseases
Skin conditions and open wounds
Drug or alcohol abuse
Drugs that suppress the immune system
Weakened immune system
Cancer
Diabetes mellitus
Advanced age

7. Pathophysiology:
Bacterial invasion
Synovial tissues responds by becoming inflamed
The joint cavity may become involved ,& pus develops in the
synovial membrane & synovial fluid
If allowed to progress the inflection causes abscesses in the
synovium & subchondral bone, eventually destroying cartilage
Ankylosis of the joint may result
Patient reports pain, swelling & tenderness of joint

8. Clinical manifestations:
Symptoms of septic arthritis can vary depending on the
individual’s age, as well as the medications the individual
is taking.
Symptoms may include:
Severe pain that worsens with movement
Swelling of the joint
Warmth and redness around the joint
Fever
Chills
Fatigue
Decreased appetite

9. Contd…
Inability to move the limb with the infected joint
(pseudoparalysis)
Rapid heartbeat
Irritability.

10. Investigations:
1. Arthrocentesis:
It is a test frequently used to diagnose if there is an
infection in the joint, and what is causing the infection.
It involves inserting a needle into the affected joint to take a
sample of synovial fluid. The sample is sent to the lab to be
examined for color, consistency, and the presence of white
blood cells and bacteria.

11. Contd…
2. Blood test:
To check white blood cell count and to determine if any
bacteria are present in bloodstream. This information
can help to determine how serious the infection is.
3. Culture of synovial joints
4. X-ray of joints reveals loss of joint space
5. Ct-scan
6. MRI

12. Management:
 Appropriate antibiotic therapy
 Rest/immobilization of joint
 Synovial Fluid Drainage
• Many individuals with infectious arthritis need to have
their synovial fluid drained. This is done to remove the
infected fluid, ease pain and swelling, and increase the
speed of recovery.
• Synovial fluid is most often drained by arthroscopy. In
this procedure, a doctor makes several small incisions
near the affected joint. Then he or she will feed a small
tube containing a camera into the incision which helps to
guide them in suctioning the infected fluid from your joint

13. Contd…
• Sometimes doctors are able to use arthrocentesis,
which uses a small needle, to remove infected fluid
without requiring surgery. This procedure often has to be
repeated over the course of several days to ensure
enough fluid is drained.

15. Other Treatment Options
• Rarely, more severe cases of infectious arthritis
require surgery to wash out the joint, remove damaged
sections of the joint, or replace the joint.
• Using non-steroidal anti-inflammatory medications
(NSAIDS)
• Resting the joint
• Applying heat to the joint
• Splinting the affected joint
• Physical therapy

16. Nursing management
 ASSESSMENT:
 Assess the pain
 Assess the patient physical status
 History should be taken regarding the joint pain and
swellings
 Vitals signs are taken in which elevated temperature can
be found

17. Nursing diagnosis:
• Acute and chronic pain related to pathologic process
• Ineffective coping related to fear of the unknown
• Disturbed sleeping pattern related to pain
• Self care deficit related to disease portion

18. RELIEVING PAIN
• The nurse should prepare the patient and gives
support during the painful procedures
• Analgesics must be given to alleviate pain
• If the joints are inflammed, let the patients rest and
avoid activities that stress the joints
• Apply local heat or cold to affected joints for
approximately 20-30 min three to four times a day.
• Change positions frequently. Use splints to maintain
proper body alignment
• Avoid pillow under knee to prevent knee and hip
flexion deformities

19. INEFFECTIVE COPING RELATED TO FEAR
OF THE UNKNOWN
• Explain about the disease condition using teaching aids
appropriate to the patients and family members levels of
understanding
• Allow significant other opportunities to share feelings and
frustration including the need for adequate nutrition and
regular follow up care
• Allow patient to get involve in the daily activities which can
be done by him
• Communicate frequently with the patients in order to view
his emotions and expressions related to his disease
condition

20. PROMOTE SLEEPING PATTERNS
• Encourage performance of bed time rituals such as
hygiene activity, reading or having a warm drink
• Initiate pain relief measures before bedtime if
appropriate
• Encourages proper positioning of joints
• Encourage a balance of activity and rest
• Provide for uninterrupted sleep to enable
completion of sleep cycle

21. PROMOTE SELF CARE
• Assess the patient in his self care activities
• Provide pain relief before the patients undertakes self
care activities
• Provide privacy and an environment conductive to
performance of each activity
• Schedule activities to provide for adequate rest periods

22. References:
1. Black hawk’s, medical surgical nursing; 7th edition;
page no. : 609-611
2. Phipps. Medical surgical nursing, 7th edition; page no. :
1542-1570; 1569-1570
3. Basvanthapa bt. Medical surgical nursing, 1st edition;
page no. : 490; 437-498
4. Lippincott; Atlas of pathophysiology; 2nd edition; page
no. :228-229
5. Lippincott; manual of nursing practice; 8th edition; page
no. : 1090-1091