6. Indirect
• Extension of soft tissue infection (eg,
infected pressure or vascular ulcer, incisional
infection)
• Hematogenous (bloodborne) spread from other
sites of infection (eg, infected tonsils, infected
teeth, upper respiratory infections)
7. Direct
• Direct bone contamination from bone surgery,
open fracture, prosthesis or traumatic injury (eg,
RTA )
8. Factors affect the extent of
infection
• Virulence of the infecting organism,
• Underlying disease
• Immune status of the host,
• The type, location, and vascularity of
the bone
9. • inflammation, increased vascularity, and
edema
• After 2 or 3 days, thrombosis of the blood
vessels occurs in the area, resulting in
ischemia with bone necrosis
• The infection extends into the medullary
cavity and under the periosteum ,cortex
and marrow cavity and may spread into
adjacent soft tissues and joints
10.
11. • Unless the infective process is treated
promptly, a bone abscess forms. The
resulting abscess cavity contains dead
bone tissue (the sequestrum), which does
not easily liquefy and drain
• New bone growth (the involucrum) forms
and surrounds the sequestrum.
12.
13.
14. • When bone infection persists for months,
the resulting infection is referred to as
chronic osteomyelitis
15.
16. CLINICAL
MANIFESTATIONS
• SYSTEMIC-
• fever, night sweats, chills,restlessness, nausea
and malaise
LOCAL-
constant bone pain, swelling,t enderness and
warmth at the site of infection, drainage from site
and restricted movement of affected part
17. DIAGNOSIS
• History and physical examination
• X-ray- Irregular decalcification, bone necrosis
are evident
• Biopsy, wound culture- to determine the
microorganism
• Blood investigation- WBC, ESR,blood culture
• MRI,CT,radionuclide Bone scan - TO detect the
extent of infection
18.
19. Management
• Goal- control and halt the infection
process
immobilize the body part to prevent
pathological fractures
• Warm wet soaks for 20 minutes several
times a day may be prescribed to increase
circulation
20. Pharmacologic
management
Antibiotic treatment should be based on the
identification of pathogens from bone
cultures at the time of bone biopsy or
debridement.
• Commonly used antibiotics
clindamycin,
rifampin,
Linezolid
22. Surgical management
• If the patient does not respond to antibiotic
therapy, the infected bone is surgically exposed,
the purulent and necrotic material is removed,
and the area is irrigated with sterile saline
solution
• A sequestrectomy (removal of enough
involucrum to enable the surgeon to remove the
sequestrum) is performed
24. Nursing Diagnoses
• Acute pain related to inflammatory process
secondary to infection as evidenced by guarding,
restlessness
Intervention
• Assess the severity,intensity, characteristics of
pain
• Provide non pharmacologic pain relief methods
• Immobilize and support the body part
• Administer analgesics and evaluate the
effectiveness of pain control
25. • Impaired physical mobility related to pain,
immobilization devices and weight bearing
devices
• Interventions
Assist the patient to stand and ambulate specified
distance
Apply or provide assistive devices
Monitor patients use of crutches or other walking
aids
26. Ineffective therapeutic regimen management
related to lack of knowledge regarding long term
management of osteomyelitis
• Intervention
• Demonstrate and teach asceptic techniques and
wound care to the patient
• Instruct the purpose ,dosage , action of each
medication
• Instruct the possible adverse effect,
consequences of discontinuation of medication
