1. osteomyelitis
Prepared by
Ms.mahalakshmi.l
M,Sc nursing 1st year

2. INTRODUCTION

3. OBJECTIVES OF
OSTEOMYELITIS
• define osteomyelitis
• state the cause for osteomyelitis
• explain the pathophysiology for osteomyelitis
• enumerate the clinical manifestation for
osteomyelitis
• discuss the diagnostic studies for osteomyelitis
• describe the management for osteomyelitis
• discuss the nursing diagnosis for osteomyelitis

4. DEFINITION
• Osteomyelitis is an acute infection of the bone and bone
marrow.
ACUTE <2weeks
SUB ACUTE 2weeks-3weeks
CHRONIC >3weeks

5. INCIDENCE
• Chronic osteomyelitis occurs in about 2 in
10,000 adults.
• Children have the acute form of the disease
more often than adults do, at a rate of about 1 in
5,000

6. RISK FACTORS
• Age
• Obese and malnourished patients
• Patients have impaired immune system
• Chronic illness
• Prolonged use of corticosteroid therapy or
immunosuppressive drugs
• Post operative surgical wound infection

7. CAUSTIVE ORGANISM
• Staphylococcus aureus
• E.coli
• Pseudomonas
• Klebsilla
• Salmonella

8. Diagnostic test
• WBC and ESR
• Blood and tissue cultures
• MRI and CT scans
• Radio nucleotides bone
scans

9. MEDICAL
MANAGEMENT
• Parenteral antibiotics
• Balance diet
• Immobilized the affected area to decrease
discomfort
• Wet warm soaks for 20mins several times a day
given to the patient for increasing circulation

10. SURGICAL
MANANGEMENT
• Debridement
• Sequestrectomy

11. NURSING DAIGNOSIS
• Acute pain related to surgical wound as evidenced by
pain scale score is 6.
 Immobilize the affect part by using splints
 Elevate the part
 Administer prescribed analgesic
 Avoid excessive manipulation of affected part handle with
great care & gentleness
 Teach the patient to use non pharmacological strategies
like relaxation techniques , guided imaginary & deep
breathing
 Warm soaks, soaks , moist packs provided to patient

12. • Impaired physical mobility related to surgery
 Maintain functional position of limb when
immobilization provided .
 Teach the patient to perform ROM exercises
4hrly & participate in carrying out ADLS

13. • Risk for infection
 Maintain strict asepsis while carrying out any
procedure. Adhere to strict hand washing
practices.
 Administer prescribed antibiotics.
 High protein & vitamin c rich diet.

14. OSTEOMALACIA

15. OBJECTIVES FOR
OSTEOMALACIA
• define osteomalacia
• state the cause for osteomalacia
• list down the risk factors for osteomalacia
• explain the pathophysiology for osteomalacia
• enumerate the clinical manifestation for osteomalacia
• discuss the diagnostic studies for osteomalacia
• describe the management for osteomalacia
• discuss the nursing management for osteomalacia

16. osteomalacia
• Osteomalacia also called adult rickets. It is
metabolic bone disorder characterized by
inadequate or delayed mineralization of bone
matrix in mature compact or spongy bone.

17. causes
• Vit D deficiency
• Phosphate depletion
• Chronic renal failure
• Calcium malabsorption

18. PATHOPHYSIOLOGY
• Decreased level of
• Decreased absorption of from
intestines

19. • Activate
• Results in continuous loss of

21. Diagnostic test
• Blood test-low serum calcium, increased
alkaline phosphate, increased parathyroid
hormone levels are present
• Urinary excretion of calcium & creatinine is
low

22. Medical management
• Vit D , calcium & phosphorus supplements are
prescribed.
• Exposure to sunlight
• Advice the patient to take vit D rich diet
• Safe use of vitamin D supplements
recommended as higher doses are toxic as it
increase the level of calcium

23. Nursing management
• Advice the patient about intake of diet rich in calcium &
phosphorus.
• Teach about safety measures to prevent falls.
• Encourage the patient towards use of assistive devices.
• Teach the patient to observe anorexia, nausea/vomiting,
frequent urination, muscle weakness & constipation as
these are the systems of vit D toxicity.

24. OSTEOPOROSIS

25. OBJECTIVES FOR
OSTEOPOROSIS
• define osteoporosis
• state the cause/risk factors for osteoporosis
• explain the pathophysiology for osteoporosis
• enumerate the clinical manifestation for osteoporosis
• discuss the diagnostic studies for osteoporosis
• describe the medical/dietary management for
osteoporosis
• discuss the nursing diagnosis for osteoporosis

26. osteoporosis
• Osteoporosis means “ porous bone” . This is
characterized by loss of bone density, change in
bone structure and increased bone fragility and
increase suceptivity to bone fractures

27. RISK FACTORS
• Un modifiable risk factors
 Sex
 Age
 Ethinicity
 Genetics
 Small body frame
 Female athletes
 Endocrine disorders
• Modifiable factors
 Calcium defiency

29. Clinical manifestation
• Progressive loss of curative of spine, decrease in height,
low back pain & fracture of fore arm, spine or hip.
• Pain
• Dorsal kyphosis & cervical lordosis develops
• Dowager’s lump present.
• Impaired breathing , abdominal distension & constipation
may occur.

30. Diagnostic test
• DEXA
• Blood analysis
• Urine analysis
• X-ray

31. MEDICAL
MANAGEMENT
• Diet : calcium & vit d enrich diet should be
taken.
• Calcium supplements given to all post
menopausal females.
• Selective estrogen receptor modulator :
raloxifene reduce the risk of osteoporosis.

32. (CONT….)
• Bisphosphonates increase bone density &
reduce fractures. Advice the patient to take
these medicines empty stomach and walk for
atleast 1 hr after taking medicine.
• Calcitonin increase bone formation & decrease
bone reabsorption.
• Sodium fluoride given as it stimulate osteoblast
activity & increase formation of bone.

33. BONE TUMOR

34. OBJECTIVES FOR BONE
TUMOR
• define bone tumor
• list down the types for bone tumor
• enumerate the clinical manifestation for bone tumor
• discuss the diagnostic studies for bone tumor
• describe the medical/surgical management for bone
tumor
• discuss the nursing management for bone tumor

35. BONE TUMOUR
• Bone tumour may be benign or malignant
(rapidly growing) & can affect any age.

36. CAUSES
• Unknown
• Past trauma
• Carcinogens
• Paget disease & hereditary predisposition

37. TYPES OF BONE
TUMOUR
• Benign tumour
• Malignant bone tumour
 Osteosarcoma
 Ewing’s sarcoma
 Fibrosarcoma
 chondrosarcoma

38. CLINICAL
MANIFESTATION
• Pain is the most common bone cancer symptom
• Weakned bone, sometimes leading to fracture
• Joint swelling & tenderness
• Fatigue fever
• Unintended weight loss
• anemia

39. INVESTIGATION
• Blood count & ESR
• Blood & urine calcium level
• Tumour markers e.g. Alkaline phosphatase for
osteoblastic tumour & LDH for ewing’s sarcoma
• Radiological studies i.e. xray ,ct scan,mri
• Bone biopsy is needed for confimation of the diagnosis

40. MANAGEMENT
• Chemotherapy
• Radiation therapy
• Surgery
 Wide excision of the tumour
 Amputation
 cryosurgery

41. ANY QUESTION?