Osteomyelitis: NCLEX Review

Osteomyelitis: Key Concepts

• Definition: Osteomyelitis is a bone infection, often caused by bacteria entering the bone via open fractures, surgery, or the bloodstream.

• Risk Factors: Individuals with open wounds, compromised immune systems (e.g., diabetes, HIV), or recent surgery are at higher risk. Children and adolescents are also at higher risk.

• Types of Osteomyelitis:

  • Acute: Rapid-onset infection with fever, localized bone pain and tenderness.
  • Chronic: Persistent infection and inflammation lasting more than 8 weeks, potentially with or without initial symptoms.

• Clinical Manifestations:

  • Local Symptoms: Pain, swelling, warmth, redness (erythema), and tenderness over affected area.
  • Systemic Symptoms: Fever, chills, malaise (discomfort), and leukocytosis (increased white blood cell count).
  • Other Symptoms: Limited range of motion.

• Diagnosis:

  • History and Physical Examination: Evaluating risk factors (e.g., recent trauma or surgery), assessing localized infection signs.
  • Imaging Studies: X-rays (early bone damage), but Magnetic Resonance Imaging (MRI) offers a detailed view of soft tissues and bone marrow, showing infection extent.
  • Lab Tests: Blood tests for elevated white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), common in infections.
  • Bone Biopsy and Cultures: Aspiration or incisional biopsy to identify the causative organism and guide antibiotic treatment.

• Treatment:

  • Antibiotics: Crucial, intravenously administered, tailored to identified organism, and given for weeks to months.
  • Surgical Drainage: Debridement of dead bone and infected tissue, potentially involving incision and drainage or bone resection.
  • Pain Management: Appropriate analgesics, including NSAIDs or opioids.
  • Wound Care: Essential for preventing infection spread, especially in cases with open wounds.

• Complications:

  • Bone Loss and Destruction: Impairing function and stability.
  • Joint Damage: Infection spreading to adjacent joints.
  • Sepsis: Life-threatening bloodstream infection, potentially causing shock and organ failure.
  • Neurovascular Compromise: Swelling compressing nerves and blood vessels, causing functional impairment.

• Nursing Considerations:

  • Monitoring Vital Signs: Essential (temperature, pulse, blood pressure).
  • Pain Management Strategies: Individualized pain management plans.
  • Assessment of the Affected Area: Frequent assessment and documentation of changes (size, color, pain).
  • Patient Education: Crucial information on disease progression, treatment, medications, and follow-up care.
  • Emotional Support: Providing support for patients and families facing a serious condition.

• Patient Education Points:

  • Medication Adherence: Completing the full antibiotic course to prevent recurrence.
  • Wound Care Instructions: Adherence to wound care instructions, including dressing changes, and reporting warning signs to healthcare providers.
  • Follow-up Care: Importance of regular follow-ups for monitoring disease progression, treatment response, and complications.

• Key Diagnostic Tests:

  • Complete Blood Count (CBC): Elevated white blood cell count (leukocytosis) suggestive of infection.
  • Erythrocyte Sedimentation Rate (ESR): Elevated levels often indicate inflammation.
  • C-reactive protein (CRP): elevated levels indicate inflammation.

• Differential Diagnosis: Differentiating osteomyelitis from other conditions with similar symptoms, including cellulitis, fractures, and tendinitis, requiring accurate identification.