Assessment

HISTORY. Question the patient about any previous bone trauma, open injuries, or surgical procedures. Elicit information about the patient's general well-being, level of fatigue, and previous illnesses, specifically any infections. In the acute phase, the patient may report the chracteristic signs of an infection: high temperature, chills, fever, increased pulse, nausea, diaphoresis, general weakness, and malaise. In the chronic phase, the patient may report an exacerbation characterized by low-grade fever, fatigue, pain, and purulent drainage from a sinus tract.

PHYSICAL EXAMINATION. Local and systemic signs and symptoms of osteomyelitis are generally present. Examination of the area reveals local infectious symptoms, such as redness or swelling and increased warmth. A foul-smelling draining wound may be present, with an intense pain or tenderness over the affected bone; you may note muscle spasms as well. The patient often protects the extremity by intentionally limiting movement in the joint closest to the affected area. Observe the patient's gait to identify a limp or abnormal gait.

PSYCHOSOCIAL. If the patient has an acute condition, assess the level of anxiety related to treatment plans, potential for sepsis, or potential of the illness to become chronic. In the chronic condition, the patient may be depressed and discouraged. A mistrust of the healthcare team may develop if interventions do not result in permanent resolution of the infection. Chronic pain and decreased mobility can lead to long-term disability, resulting in financial burdens, changes in body image or self-image, and alteration in family or social roles.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Bone scan

Normal bony

Bone changes

Identifies areas of infection; iden

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