OSTEOMYELITIS

Definition
-Infection of the bone
- Causative agent/s: S. aureus (older children), S. pyogenes (younger children),
susceptibility to Salmonella invasion in long bones (children with Sickle Cell anemia)

Nsg Dx
- Risk for peripheral neurovascular dysfunction R/T the effects of bone infection
- Parental health-seeking behaviors R/T care of the child with osteomyelitis
- Acute pain R/T inflammation and swelling
- Impaired Physical Mobility R/T pain and limitation of the load weight
- Risk for Infection

S/Sx
- Irritability
- Sharp pain at the bone metaphysis
- Pain and/or tenderness in the infected area
- Swelling and warmth in the infected area
- Fever
- Nausea, secondarily from being ill with infection
- General discomfort, uneasiness, or ill feeling
- Drainage of pus through the skin
- Excessive sweating
- Chills
- Lower back pain (if the spine is involved)
- Swelling of the ankles, feet, and legs
- Changes in gait (walking pattern that is a painful, yielding a limp)

Precipitating factors
- Extensive impetigo, burns, or furuncle/skin abscess
- Outside invasion from a penetrating wound, open fracture, or contamination during
surgery

Predisposing factors
- Age; <1 year old: capillaries near epiphysis, older children: metaphysis
- Diabetes Mellitus
- Peripheral vascular disease
- Obesity/Malnutrition
- Chronic smoking
- Autoimmune disorders

Tx
Medical mgt
- IV antibiotics (oxacillin - Bactocill) for as long as 2 weeks by use of Intermittent
infusion device/peripherally inserted central catheter (PICC)
- Oral antibiotic for 3-4 weeks
- Antibiotic solution after aspiration of pus under the periosteum
Nsg mgt
- Encourage limitation on weight bearing on the affected area, bedrest and
immobilization.
- (If pus is present under periosteum) Aspirate using a similar technique to bone marrow
aspiration, insert catheter for antibiotic solution
- Insertion of drainage tube for suction
- Support and educate parents to make an informed decision about the treatment (i.e.
answer questions about the procedure).
- Teach age-appropriate activities for children so they maintain rest.
- Institute infection-control precautions if the child had surgery and drainage tubes in
place.

Dx tests
- X-ray
- MRI
- CBC (wbc level, c-reactive protein level, sedimentation rate)
- Computed tomography scan

Disease process
1. Acute inflammation/Pus formation
2. Pus spreads into vascular channels
3. Impaired blood flow/Compromised local blood supply
4. Chronic ischemic necrosis
5. Separation of large devascularized fragment (Sequestra)

Narrative: Osteomyelitis
 Osteomyelitis is the inflammation of the bone. This happens when microorganisms
reach the bone, which causes infection. Bacteria can affect high-risk individuals, such as
obese people, ones who had trauma like open fracture, or people who have poor blood
circulation due to uncontrolled diabetes. The most common microorganisms that cause
Osteomyelitis are S. Aureus and salmonella. In children, the most common site for this
disorder is in the metaphysis. As the bacteria is implanted in the specific area, there is
acute inflammation, due to the immune cells fighting off the infection. Pus formation
occurs if this is not handled well. After the pus is formed, it spreads into the vascular
channels, causing the blood flow to be impaired. The lack of blood supply leads to chronic
ischemic necrosis, which then ends up in separation of large devascularized fragments.
Osteomyelitis is usually diagnosed with using CBC, which shows increased WBC,
elevated erythrocyte sedimentation rate, and C-reactive protein. In addition, X-Ray can
also be used, which shows thickening of cortical bone & periosteum, loss of normal
architecture of the bone, & osteopenia (loss of bone mass). Bone scan or MRI confirm
the presence of osteomyelitis, and identify an abscess. Treatment include weeks of
antibiotics, which is directed at the organism causing the infection, and surgery if there is
an abscess. For nursing management, it may include encouraging the patient on weight
bearing in the affected area, and bedrest. In addition, nurses can support and educate
the parents about the disorder, as this may be confusing and stressful time for them.

Mana ka?

TRANSIENT SYNOVITIS

Definition
- Acute, nonpurulent inflammation of the synovial membrane
- Unknown etiology; prodrome of upper respiratory disorders

Nsg Dx
- Impaired walking R/T pain and limitation of physical mobility
- Impaired physical mobility R/T pain and promotion of bed rest
- Acute pain R/T inflammation
- Risk for pressure ulcer R/T complete bed rest

S/Sx
- Pain in the groin, lower portion of the thigh or knee, or in the buttocks
- Intense pain (esp morning when first awaken)
- Guarding behavior (flexing the joint in a position of comfort)
- Low grade fever (<38 C)
- Joint area is puffy, swollen, and warm to touch
- Presence of stiffness, pain, and popping feeling when moving/putting pressure on joint

Predisposing factors
- Viral infections (e.g. chicken pox)
- Gout, lupus, rheumatoid arthritis, and osteoarthritis
- Age (more common in 3-10 y.o)
- Gender (more common in boys)

Precipitating factors
- Overworked joint (repetitive motion)
- Infections (septic arthritis, TB)
- Allergic reactions

Tx
Medical mgt
- NSAIDs such as ibuprofen (Motrin)
- Short course of oral corticosteroids
- Surgical removal of inflamed tissue
- Replacement surgery
Nsg mgt
- Cold compress to reduce swelling
- Inform limitation of activity until muscle spasm from pain has passed
- Encourage rest (10-14 days w/ oral corticosteroids)

Dx tests
- Synovial fluid analysis
- Patella tap
- X-ray
- MRI
- Bone scan
- Ultrasound

Disease process
1. Joints are overworked
2. Synovial membrane is inflamed

Arthritis and the likes

1. Excessive growth of the synovium which is part of the inflammatory response
2. Body misidentifies the synovium as a foreign object and attacks it.
3. Cartilage loss eventually damages joint surface
4. Leads to the common characteristics of arthritis such as pain and stiffness of
joints

Narrative
Synovitis
Synovitis is the acute,non-purulent inflammation of the synovial membrane of the
joint. It is characterized by pain in the groin, lower portion of the thigh, knee, or buttocks,
low grade fever, inflammation and swelling at the joint, and guarding behavior when the
affected area is about to be touched. It usually happens when the joints are overworked
or when the synovial membrane is gradually diminished due to the body identifying its
excessive growth as a foreign object because of existing arthritis. The incidence is more
common in children aged between 3-10 and occurs more commonly in males. In order to
treat the inflammation, NSAIDs such as ibuprofen are given to treat the pain and activity
is limited until the pain has passed. Rest and limited is encouraged to aid in recovery and
cold compress can be done in order to reduce swelling at the affected joint. Some
children may need 10 to 14 days of rest and a short course of oral corticosteroids.
Synovitis can be diagnosed through synovial fluid analysis, patella tap, x-ray, MRI, bone
scan, or ultrasound.