Lecture Notes: Osteomyelitis, Amputations, and Wound Care

Overview

• Osteomyelitis: Infection of the bone causing inflammation, necrosis, and new bone formation.
• Classification:
  • Hematogenous: Blood-borne infection.
  • Contiguous: From bone surgery, open fractures, or traumatic injuries (e.g., gunshot wounds).
  • Vascular Insufficiency: Common in diabetes or peripheral vascular disease, often affects feet.
• Risk Factors: Older age, poor nutrition, obesity, impaired immune system, chronic illnesses, long-term corticosteroid use, IV drug use.

Pathophysiology

• Common pathogens: Staphylococcus aureus, including MRSA, Streptococci, Enterococci, gram-negative bacteria.
• Infection response: Inflammation, increased vascularity, edema, ischemia, bone necrosis.
• Formation of sequestrum (dead bone tissue) and new bone growth.

Clinical Manifestations

• Sepsis: Life-threatening organ dysfunction due to infection.
• Septic Shock: Profound circulatory and metabolic abnormalities.
• Symptoms: Fever, tachycardia, altered mental status, elevated inflammatory markers.

Diagnosis and Monitoring

• Vital signs: Heart rate, respiratory rate, temperature.
• Lab values: Blood cultures, CBC, C-reactive protein, ESR.
• Blood Cultures: Drawn before antibiotics, results in 3 days.
• CBC: Elevated WBC indicates infection.
• ESR & CRP: Indicate inflammation.

Treatment

• Medications: Anti-infectives, pain management.
  • Common antibiotics: Cefazolin, vancomycin, penicillin G, ceftriaxone, levofloxacin, piperacillin, clindamycin.
• PICC Line: For prolonged antibiotic administration.
• Amputation: If antibiotic therapy fails.

Nursing Care

• Isolation Precautions: For MRSA positive patients.
• Wound Care: According to provider orders.
• Pain Management: Similar to fracture management.
• Post-operative Care: Monitoring for complications.
• Weight-bearing status and ambulation assistance.

Complications

• Infections: Super infections (e.g., C. diff), cellulitis.
• Sepsis-related: Bloodstream infections, septicemia.
• Chronic Conditions: Non-healing wounds, bone necrosis.

Patient Education

• PICC Line Care: Purpose, maintenance, antibiotic therapy.
• Wound Care: Proper technique and supplies.
• Ambulation: Safe practices and equipment.
• Nutrition: Importance for healing.

Psychosocial Considerations

• Amputation: Addressing loss and grief associated with limb loss.
• Phantom Limb Pain: Real sensation treated with pharmacological/non-pharmacological methods.

Additional Resources

• Link to video on sterile wound dressing change.
• Assignments: Chapters 41 & 42 on fractures and amputations in Lipincott material.

Conclusion

• Complete assigned materials for a better understanding.
• Reach out to the instructor with questions or concerns.