Osteomyelitis: Causes, Symptoms & Treatment (PDF)

Altered musculoskeletal: Infections Definition Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs. Etiology 1. pathogenic b...

Altered musculoskeletal: Infections Definition Osteomyelitis is an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if an injury exposes the bone to germs. Etiology 1. pathogenic bacteria The most common pathogens in osteomyelitis depend on the patient's age. Staphylococcus aureus is the most common cause of acute and chronic hematogenous osteomyelitis in adults and children. Increasingly isolated from patients with osteomyelitis is methicillin-resistant Staphylococcus aureus (MRSA) 2. exogenous osteomyelitis occurs when bone extends out from the skin allowing a potentially infectious organism to enter from an abscess or burn, a puncture wound, or other trauma such as an open fracture. Surgery- Direct contamination with germs can occur during surgeries to replace joints or repair fractures  3. hematogenous osteomyelitis In adults who are older, debilitated, or receiving hemodialysis: S. aureus (methicillin-resistant S. aureus [MRSA] is common) and enteric gram-negative bacteria In injection drug users: S. aureus, Pseudomonas aeruginosa, and Serratia species In patients with sickle cell disease, liver disease, or immunocompromise: Salmonella species 4. primary lesions Primary lesions, which are associated with specific causes on previously unaltered skin, occur as initial reactions to the internal or external environment. Vesicles, bullae, and pustules are formed by fluid within skin layers. Nodules, tumors, papules, wheals, and plaques are palpable, elevated, solid masses. Jenis jangkitan Akut Osteomyelitis: - kudis. - Trauma - Luka - Tidak diketahui. Kronik osteomyelitis. - osteomelitis akut. - Fracture terbuka - Luka parah - Pembedahan tulang. Patofisiologi akut Osteomyelitis Infeksi luka. ↓ Mikroorganisma – salur darah melalui bekalan darah. ↓ Bekalan darah – jantung- sistemik- tulang ↓ Mikroorganisma sampai ke tulang – metaphysic – merebak diafisis. ↓ Membiak – inflamasi di metaphysis. ↓ Panas, kesakitan bengkak,kemerahan – hasilkan nanah dan osteomeilities akut. diagnostic investigation -Pemeriksaan fizikal. - laboratory test- pemeriksaan darah – leukosit dan ESR ( erythrocyte sedimentation rate meningkat menunjukkan infeksi berlaku) - Mantoux test - x-rays spine and chest X- ray – selepas 2 minggu kejadian ( perubahan tulang akan kelihatan ). - MRI - radioactive bone scanning - bone biopsy (* sila rujuk ke nota sebelumnya) management medication Ubat – antibiotic – Tab penicillin ( test dose),methiacine, lefazalon. Antipirektik – Tab pcm. Analgesic contohnya tramadol dan pethadine. Surgery 1. Insisi dan penyaliran. 2. pencucian dengan larutan 0.9 % n/s 3. Dressing packing – selepas insisi dan penyaliran. 4. Rehat diatas katil untuk mengurangkan beban ke atas tulang yang terlibat. Osteomeilities kronik Tanda osteomelitis kronik iaitu kehadiran sinus dan discaj. Patofisiologi kronik Osteomyelitis Osteomelitis akut. ↓ Peredaran darah ke tisu –tisu tulang menjadi kurang. ↓ Kurangnya bekalan darah menyebabkan nekrosis tisu tulang tumbuh ke atas sequestrum – involucrum ( pertumbuhan tulang baru yang kadang kala mengelilingi suatu jisim tulang berjangkit dalam osteomelities) ↓ Setelah pertumbuhan involucum inflamasi dalam kaviti masih berlubang dan meningkat v tekanan didalam kaviti. ↓ Peningkatan tekanan dalam kaviti – menyebabkan tisu-tisu tulang pecah dan nanah / sekresi akan keluar melalui saluran tersebut – sinus ↓ Osteomelities kronik. clinical manifestations of acute and chronic osteomyelitis - fever, irritability, fatigue - nausea - tenderness, redness, and warm in the area of the infection - swelling around the affected bone - lost range of motion - osteomyelitis in the vertebrae – severe back pain, especially at night Rawatan pembedahan 1. Sequestrectomy – pembuangan tulang yang mati dan berjangkit ( kadang-kadang melibatkan rawan ) Setelah sequestrectomy tulang terlibat berbentuk saucer oleh itu internal fiksasi dan external fiksasi diperlukan untuk melibatkan tulang. Seelpas sequestrectomy ‘ bone grafting’ juga dijalankan dan biasanya tulang jenis kansellous.Dan kaviti tersebut juga ditutup dengan otot-otot flap. 2. Evacuation – pengosongan kandungan kaviti. 3. Osteotomy – pembuangan untuk membuang sesuatu tulang. 4. Debridement – porses membersih luka yang terdedah dengan membuang bahan-bahan asing dan tisu mati. Complication 1. Akut kronik 2. Septic arthritis 3. Fracture patologikal 4. Endocarditis 5. Abscess Determine nursing intervention for patients with TB of the bone and osteomyelitis Altered body temperature: hyperthermia related to the disease process  Altered nutrition: less than body requirement related to anorexia Potential spread of disease (TB) (* Based on discussion)