Osteomyelitis Nursing Care Plans Diagnosis and Interventions
Osteomyelitis NCLEX Review and Nursing Care Plans
The infection of the bone is usually caused by either the spread of the pathogen from the bloodstream into the bone, or the infection of the bone due to an open fracture or a surgical procedure.
About 2 in 10,000 people suffer from osteomyelitis in the U.S. The bacteria Staphylococcus aureus is the most common cause of osteomyelitis.
Certain groups of people may be at higher risk for osteomyelitis, such as people with diabetes or HIV.
Signs and Symptoms of Osteomyelitis
- Inflammation – swelling (edema), warmth and redness (erythema) over the infected area
- Pain around the infected area
- Loss of range of motion (ROM)
Causes and Risk Factors of Osteomyelitis
S. aureus is usually found in the nose or on the skin even in healthy individuals.
An open fracture or a severe puncture wound may cause the bacteria to infect the injured bone, or enter the bloodstream. Joint replacement and fracture repair surgeries put the patient at risk for osteomyelitis.
Advanced age is one of the risk factors of osteomyelitis.
Other risk factors include circulation disorders (such as poorly controlled diabetes, sickle cell disease and peripheral artery disease), HIV/AIDS, rheumatoid arthritis, long-term steroids, injection of illegal drugs, and the use of urinary catheters, central lines, or dialysis machine tubing.
Complications of Osteomyelitis
- Osteonecrosis. If left untreated, osteomyelitis may lead to bone death called osteonecrosis. The infected bone area may hinder the normal blood circulation within the bone, causing the bone tissues to be deprived of oxygen and nutrients. The dead bone areas need surgical removal and the patient will have to receive antibiotics therapy.
- Impaired growth in children. Osteomyelitis of the growth plates or the soft areas of the long bones may affect a child’s growth.
- Septic arthritis. When the infection spreads to a nearby joint, it can cause septic arthritis.
Diagnosis of Osteomyelitis
- Physical examination – to check for signs of inflammation and any loss of ROM
- Blood test – Full blood count to check for elevated white blood cells; blood culture to determine any infection in the blood and its causative agent
- Imaging – X-ray of the affected bone; MRI for a more detailed imaging of the bones and soft tissues; CT scan can be done if the patient is unable to have an MRI
- Bone biopsy – insertion of a needle to the bone to take a sample and know the causative agent
Treatment for Osteomyelitis
- Surgery. The surgeon will open the infected area and drain any fluid or pus. Debridement follows, wherein the surgeon removes the diseased part of the bone and surrounding tissues. To bring back the blood flow to the bone, the surgeon may use a piece of bone or other tissue to empty the space post-debridement. Amputation of the limb may be required for severe osteomyelitis.
- Antibiotics. The type of antibiotic therapy required by the patient is determined by the causative agent found through a bone biopsy. The course of antibiotics is usually given for about 4 to 6 weeks. Beta-lactam antibiotics such as penicillins and cephalosporins are commonly used for S. aureus osteomyelitis. Fever reducers and pain relievers such as paracetamol or Tylenol may be given as supportive medication for fever and/or pain.
- Lifestyle changes. Diabetic patients with osteomyelitis require strict blood sugar control and management. Smoking cessation can help promote a faster healing process.
Osteomyelitis Nursing Diagnosis
Osteomyelitis Nursing Care Plan 1
Nursing Diagnosis: Hyperthermia related to the disease process of osteomyelitis as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.
Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.
|Osteomyelitis Nursing Interventions||Rationales|
|Assess the patient’s vital signs at least every 4 hours.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered.|
|Remove excessive clothing, blankets and linens. Adjust the room temperature.||To regulate the temperature of the environment and make it more comfortable for the patient.|
|Administer the prescribed antibiotic and anti-pyretic medications.||Use the antibiotic to treat osteomyelitis, which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.|
|Offer a tepid sponge bath.||To facilitate the body in cooling down and to provide comfort.|
|Elevate the head of the bed.||Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.|
Osteomyelitis Nursing Care Plan 2
Nursing Diagnosis: Acute Pain related to the disease process of osteomyelitis as evidenced by pain score of 10 out of 10, verbalization of sharp pain, guarding sign on the affected area, facial grimace, crying, and restlessness
Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.
|Osteomyelitis Nursing Interventions||Rationale|
|Administer prescribed pain medications.||To alleviate acute/chronic bone pain. Pain is usually described as sharp and spasmic. It can be aggravated by activity, especially full-weight bearing activities.|
|Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.||To monitor effectiveness of medical treatment for the relief of bone pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.|
|Apply cold and hot pack on the affected area.||Use the cold pack for 10 to 15 minutes to reduce swelling and inflammation, as well as to reduce pain impulses. Then, use the heat pack for pain relief and for the restoration of range of motion (ROM).|
|Elevate the head of the bed if the patient is short of breath.||To increase the oxygen level by allowing optimal lung expansion.|
|Place the patient in complete bed rest during severe episodes of pain. Perform relaxation techniques such as deep breathing exercises, guided imagery, and provision of distractions such as TV or radio.||To enable to patient to rest and to provide comfort.|
Osteomyelitis Nursing Care Plan 3
Impaired Physical Mobility
Nursing Diagnosis: Impaired Physical Mobility related to musculoskeletal or neuromuscular impairment, pain, fatigue, and restricted joint movement secondary to osteomyelitis as possibly evidenced by reluctance to move, refusal to transfer and ambulate, limited range of motion, decreased muscle strength, and refusal to perform activities of daily living (ADLs).
- The patient will independently execute physical activity or within the threshold of activity restrictions.
- The patient will demonstrate the employment of adaptive changes to encourage transferring and ambulation.
- The patient will not demonstrate complications due to immobility such as abnormal bowel pattern, impaired skin integrity, abnormal breath sounds, and presence of thrombophlebitis.
|Osteomyelitis Nursing Interventions||Rationale|
|Evaluate the patient’s posture and gait.||It is paramount to evaluate indicators of decreased ability to move purposefully and ambulate because it will guide the health practitioner in choosing the appropriate intervention and management to employ. Such indicators include the following: Shorter steps leading to an unstable gait Uneven weight-bearing Apparent limpRounding of the back Hunching of shoulders|
|Evaluate the patient’s weight.||In osteomyelitis, the strength of the affected bone is compromised due to the infective process. As much as possible, the application of stress to the bone must be avoided. Excessive weight can contribute to stress-induced on the bone.|
|Administer antibiotics as prescribed.||Prolonged antibiotic therapy is the foundation of treatment because osteomyelitis is caused by direct inoculation or the spread of bacteria to the host’s tissues. Ideally, antibiotic administration should be guided with culture studies and sensitivity testing. However, initial therapy with empiric antibiotics is still acceptable in the absence of these data. While on antibiotic treatment, also monitor the patient’s response to therapy and signs of superinfection (e.g., oral candidiasis, or loose or foul-smelling stools). Observe for evidence of infection, phlebitis, or infiltration on the intravenous access site.|
|Evaluate the patient’s ability to perform ADLs. Ascertain what adaptive ways the patient has already taken to allow the execution of self-care measures.||The patient may have had installed assistive devices such as handlebars, raised toilet seats or asked help from a relative to pick up dropped objects. Obtaining these kinds of information can guide the nurse in estimating the functional capacity of the patient. Knowledge of the patient’s functional capacity, in turn, can help in formulating individualized interventions.|
|Encourage the patient to participate in ADLs within the physical limitations.||Performing activities of daily living promote general well-being. Encouraging physical activity at home can help the patient transition to perform tasks independently. However, it must be noted that the joints superior or inferior to the affected part should be gently placed on the patient’s range of motion. A balance between keeping the joints mobile and performing too much activity must be maintained.|
|Evaluate if the patient is knowledgeable and comfortable with assistive devices.||It is pivotal to ensure that the patient is knowledgeable on the proper use of assistive devices for ambulation to enhance the patient’s mobility and decrease the risk of falls. It is also essential to ensure that they are comfortable in using assistive devices because some patients may refuse to utilize them as it can emphasize their disability.|
|Assist and teach the patient on how to perform isometric, and active and passive range of motion exercises applicable to all extremities.||Physical exertion through exercise can help in promoting free joint mobility and circulation. It can also help in improving muscle tone and coordination, and preventing non-functional contracture.|
|Allow the patient to rest in between exercises.||Rest periods are vital to allow the patient to recover and conserve energy. This can increase the likelihood that the patient can complete the performance tasks needed to be accomplished. You may also encourage the patient to employ relaxation techniques during rest periods such as breathing exercises and resting to recharge and conserve energy.|
|Evaluate and monitor the patient’s vital signals during and after performing physical activities.||Some patients may be severely deconditioned and engagement in physical activities might permit more elevated oxygen requirements. Tachycardia, tachypnea, and hypertension are signs of increased effort and discomfort during task performance.|
|Encourage the patient to sit in a chair with an elevated seat and stable support.||This adaptive method can help facilitate getting in and out of the chair safely.|
|Administer pain medication, as prescribed.||Wounds from osteomyelitis are often painful. Pain can be relieved through the administration of analgesics. Management of pain is a vital part of the treatment plan as it may also affect the patient’s performance. Administration of pain medications at appropriate times can help in improving the patient’s performance and mobility.|
|Immobilize and elevate the affected part.||Immobilization of the affected part with a splint can help reduce pain and muscle spasms. Whereas elevation of the affected part can decrease the associated discomfort and swelling. This procedure must be managed with care and gentleness as the wounds are very painful.|
|Review proper body mechanics with the patient or ways in order to increase the patient’s participation in activities.||Knowledge of proper body mechanics will decrease the risk of further injury, muscle strain, or pain on the affected area. It can also contribute to the increase in patient participation and motivation in performing progressive activities.|
Osteomyelitis Nursing Care Plan 4
Nursing Diagnosis: Activity Intolerance related to decreased muscle tone and joint pain secondary to osteomyelitis as possibly evidenced by limitation of movement, fatigue, malaise, and muscle atrophy.
- The patient will employ methods that can help alleviate activity intolerance.
- The patient will demonstrate a measurable elevation in activity tolerance.
|Osteomyelitis Nursing Interventions||Rationale|
|Evaluate the level of physical activity and mobility of the patient.||This will serve as baseline data in devising and identifying nursing goals during goal setting and treatment planning.|
|Evaluate the patient’s nutritional status.||Certain nutritional requirements must be met in order to efficiently perform physical activities.|
|Evaluate if the client needs to use ambulation aids such as canes or walkers for activities of daily living.||The use of assistive devices can aid in the improvement of the patient’s mobility by overcoming his/her physical activity limitations.|
|Maintain a balance between assisting the patient with ADLs and patient independence.||Providing patient assistance with ADLs allows energy conservation and prevents fatigue. However, the healthcare provider must also facilitate activities that promote progressive endurance as these will improve the patient’s activity tolerance and self-esteem. Remember that the goal is to maximize the patient’s capabilities and transition to independence.|
|Promote active range of motion exercises as well as participation in planning activities that progressively establish the patient’s endurance.||Physical activity through exercise can help maintain muscle strength, exercise tolerance, and joint range of motion. To allow progressive improvement in terms of endurance and functional capacity, the patient must perform repetitive exercises over an extended period. Performance of strength training exercises can also help in improving the patient’s endurance.|
|Evaluate the suitability of physical activities ordered on a daily basis.||It must be noted that the patient’s condition is dynamic and may be subject to change daily, therefore frequent patient evaluation is still pivotal in promoting patient mobilization as soon as possible.|
|Identify other factors that may contribute to the patient’s activity intolerance.||Other factors that contribute to the patient’s intolerance must be addressed and treated as part of the care plan to help alleviate the patient’s pain and discomfort.|
|Measure and assess the patient’s vital signs before and during physical activities.||Assessment of vital signs at rest provides baseline information in cases of too much exertion during the performance of physical activities (e.g., exercise). It is also important to monitor vital signs during exercise to identify signs of overexertion. The patient’s heart rate must not exceed between 20 to 30 beats per minute above the baseline heart rate. Assess also if the patient needs increased oxygen delivery.|
|Allow rest periods in between physical activities.||Rest periods will allow the patient to restore his/ her baseline energy. However, it is also important to limit rest periods because prolonged bed rest and physical inactivity may cause orthostatic hypertension.|
Osteomyelitis Nursing Care Plan 5
Nursing Diagnosis: Deficient Knowledge related to misinterpretation of information, lack of exposure and recall, unfamiliarity with sources of information secondary to the diagnosis of osteomyelitis as possibly evidenced by reporting the problem and inaccurate follow-through of instruction.
- The patient will verbalize understanding of the disease, its prognosis, and associated complications
- The patient will verbalize an understanding of the disease process and intervention as evidenced by compliance to the treatment regimen.
- The patient will demonstrate the required skills to prevent reinfection as evidenced by active participation and compliance in the treatment regimen and disease management.
- The patient will list the signs and symptoms that require medical follow-up.
- The patient will demonstrate lifestyle changes that can help alleviate the condition.
|Osteomyelitis Nursing Interventions||Rationale|
|Educate the patient on the importance of taking antibiotics, as ordered.||The patients must be educated on the prolonged nature of pharmacologic therapy and the need for strict compliance will help ensure adequate wound healing. This will in turn decrease the risk for recurrence. It is important to reiterate that the patients must strictly take the medications until the end of the treatment course and not skip or delay doses.|
|If the physician ordered the patient to sent home with an intravenous line, teach them on the proper use and maintenance of the IV line.||Some patients may be allowed to be discharged with a PICC line for the long-term antibiotics to be administered. Teach the patient how to use and maintain the IV line and how to keep the site clean to decrease the risk of acquiring infections.|
|Educate the patients about the signs and symptoms of infection and its implication.||Osteomyelitis is an acute or chronic inflammatory process that involves the bone and adjacent structures secondary to infections caused by bacteria, fungi, and mycobacteria. Signs and symptoms at the site of infection are indicative that an inflammatory process is ongoing in the body. These include the following: Redness/ warmth Pain Warmth SwellingLoss of function In acute osteomyelitis, dull pain at rest or on exertion may be felt on the affected site and may be accompanied by constitutional symptoms such as fevers and chills. In chronic osteomyelitis, local symptoms are still present but constitutional symptoms are less likely to occur.|
|Educate the patient on the signs and symptoms of neurovascular compromise and its implications.||Neurovascular compromise marked by sudden changes in sensation, elevated pain, and numbness may indicate ischemia.|
|Educate the patient on the signs and symptoms that necessitate the notification of the healthcare provider.||These symptoms include increased pain on the incision, fever, reduced sensation or motor activity, wound drainage, and inflammation. Immediate assessment and intervention are necessary to prevent the occurrence of complications or permanent injury.|
|Educate the patient on the principles of infection control and wound care and its importance after the surgical procedure.||After surgical debridement, educate the patient on the importance of strict compliance to the antibiotic regimen even after surgery has been executed. Adequate and accurate knowledge of incisional care will enhance wound healing and reduce the risk of infection. The family members or primary healthcare provider of the patient must also be educated in how to take care of the wound and incision to prevent acquisition of infections. Patients who are qualified to be discharged may hire a home health wound nurse who would visit 2-3 times a week to monitor wound healing. Wound care clinics, if available, may be beneficial to patients who are ambulatory. Knowledge on proper wound care and containment of infection may hasten patient recovery and can help reduce morbidity due to osteomyelitis.|
|Educate the patient on the importance of follow-up care.||To manage issues or complications associated with osteomyelitis, long-term medical supervision may be necessary. It is also vital to reincorporate the patient and help him/her transition to altered activities and lifestyle.|
|Educate the patient on the safe and proper application of heat through the use of heating pads or warm packs.||Application of heat can help in restoring circulation to the surgical area and can aid in nutrient transport which is vital for wound healing. This will also help in the removal of pathogens and exudates which can exacerbate the condition. Heat can also reduce muscle spasms secondary to irritation of nerve roots during the healing process.|
|Educate the patient on the possibility of unrelieved pain or breakthrough pain.||As the activity level increases, the patient may continuously feel the pain for a couple of months as physical activity can contribute to the stretching of the scar tissue. Pain relief from the surgical procedure may also be temporary once the action of pain relievers has gone off.|
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