Understanding Osteomyelitis and Wound Care

Sep 3, 2024

Lecture on Osteomyelitis, Amputations, and Wound Care

Overview of Osteomyelitis

  • Definition: Osteomyelitis is an infection of the bone leading to inflammation, necrosis, and new bone formation.
  • Types of Osteomyelitis:
    • Hematogenous: Blood-borne spread of infection.
    • Contiguous: Contamination from bone surgery, open fractures, or traumatic injuries.
    • Vascular Insufficiency: Common in patients with diabetes and peripheral vascular disease, typically affecting the feet.
  • Risk Factors:
    • Older adults, malnourished, obese individuals.
    • Those with impaired immune systems, chronic illnesses (e.g., diabetes, rheumatoid arthritis).
    • Long-term corticosteroid or immunosuppressive agents users.
    • IV drug users.

Clinical Manifestations

  • Localized symptoms can often be overshadowed by systemic symptoms.
  • Signs of sepsis can include:
    • Increased heart rate, fever, tachycardia.
    • Altered mental status, elevated lactate levels.
    • Changes in blood markers (WBC count, C-reactive protein).

Pathophysiology

  • Initial response includes inflammation, increased vascularity, edema.
  • Thrombosis of blood vessels leads to ischemia and bone necrosis.
  • Possible progression to chronic osteomyelitis with persistent infection.
  • Most common pathogens include Staphylococcus aureus and MRSA.

Complications

  • Chronic infection, bone necrosis, abscess formation.
  • Could progress to septic shock and organ dysfunction if untreated.

Diagnosis and Treatment

  • Key Lab Tests:
    • Blood cultures, CBC, C-reactive protein, ESR.
  • Microbiological Culture:
    • Important for guiding antibiotic therapy.
  • Imaging for bone involvement.
  • Treatment:
    • Broad-spectrum antibiotics until specific pathogen is identified.
    • Surgical interventions may include debridement or amputation.

Nursing Care and Management

  • Monitor vital signs diligently.
  • Adhere to contact isolation protocols for infections like MRSA.
  • Pain management and mobility support (e.g., surgical shoe for support).
  • Watch for complications like superinfections (C. diff, Candida).

Patient Education

  • Antibiotic Therapy:
    • Importance of PICC line maintenance.
  • Wound Care:
    • Instruction on wound dressing and recognizing signs of infection.
  • Holistic Considerations:
    • Addressing loss and grief, especially in amputation cases.
    • Managing phantom limb pain effectively.

Associated Learning and Assignments

  • Engage with Chapter 42 on amputations for detailed case studies.
  • Watch provided video on sterile wound dressing changes for practical insights.

These notes provide a high-level summary of key concepts related to osteomyelitis, its complications, and care strategies. Additional study through assigned readings and case studies is recommended.