Lecture Notes: Osteomyelitis, Amputations, and Wound Care

Overview

• Osteomyelitis: Infection of the bone resulting in inflammation, necrosis, and new bone formation.
  • Classifications:
    • Hematogenous: Blood-borne spread.
    • Contiguous: Contamination from surgeries, open fractures, injuries.
    • Vascular Insufficiency: Common in diabetes, peripheral vascular disease.
  • At-Risk Populations: Older adults, malnourished, obese, impaired immune system, chronic illnesses (e.g., diabetes, rheumatoid arthritis), long-term corticosteroid or immunosuppressive therapy, IV drug users.

Pathophysiology

• Commonly caused by Staphylococcus aureus (including MRSA).
• Pathogens: Gram-positive (streptococci, enterococci) and Gram-negative (pseudomonas).
• Infection leads to inflammation, increased vascularity, edema, thrombosis, ischemia, bone necrosis.
• Chronic osteomyelitis involves sequestrum (dead bone tissue), recurring abscesses.

Clinical Manifestations

• Sepsis: Life-threatening organ dysfunction from infection.
  • Signs: Hypotension, tachycardia, hyperthermia, elevated respiratory rate, decreased urinary output, changes in mental status.
  • Septic Shock: Severe sepsis with organ dysfunction, high mortality.

Diagnostic Assessments

• Blood Cultures: Obtained before antibiotics, may take 3 days for results.
• Complete Blood Count (CBC): Check for elevated or decreased white blood cell count.
  • Band cells indicate immature white blood cells due to overwhelming infection.
• C-reactive Protein (CRP), ESR: Indicators of inflammation.

Treatment

• Medications: Anti-infectives (e.g., cefazolin, vancomycin), pain management.
• Antibiotic therapy may require a PICC line for extended treatment at home or rehabilitation.
• Surgical Interventions: Debridement, amputation, implantation of antibiotic beads.

Nursing Priorities

• Isolation Precautions: For MRSA positive wounds.
• Wound Care: According to specific orders.
• Pain Management: Based on comprehensive assessment.
• Pre-operative & Post-operative Assessment: Establish baseline, monitor for complications.
• Patient Education: Care for PICC line, wound care, prevention of further injuries or infections.
• Holistic Care: Address loss and grief in amputations, educate on phantom limb pain.

Complications

• Short-term: Pain, altered mobility, superinfections (e.g., C. diff, thrush).
• Long-term: Chronic infection, bone necrosis, septicemia.

Patient Education & Health Promotion

• Wound Care: Proper technique and supplies.
• Antibiotic Therapy: Understanding PICC line maintenance and medication administration.
• Ambulation & Mobility: Use of supportive devices, safety precautions.

Additional Learning

• Assigned Practice: Case study on amputations in textbook chapter 42.
• NCLEX Questions: Review for understanding of amputations and osteomyelitis.

Note

• If further clarification is needed, contact the lecturer via email or after class.