Osteomyelitis Nursing Diagnosis Care Plan NCLEX Review
Nursing Study Guide for Osteomyelitis
Osteomyelitis is a rare and serious medical condition wherein the bone is infected.
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.
However, once S. aureus cause pneumonia in the lungs or urinary tract infection in the bladder, there is a risk of the bacteria traveling via the bloodstream to a damaged part of a bone in the body.
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.
Nursing Care Plans for Osteomyelitis
- 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.
|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.|
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.
|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.|
Other nursing diagnoses:
- Impaired Physical Mobility
- Activity Intolerance
- Risk for Injury