Primary Nursing Diagnosis

Pain (acute) related to swelling and inflammation

OUTCOMES. Comfort level; Pain control behavior; Pain level; Symptom control behavior; Symptom severity; Well-being

INTERVENTIONS. Pain management; Analgesic administration; Cutaneous stimulation; Heat/cold application; Touch; Exercise therapy; Progressive muscle relaxation

U PLANNING AND IMPLEMENTATION Collaborative

The most critical factor in eliminating osteomyelitis is prevention. To prevent direct infections, early care of injuries that break the skin and aseptic care of surgical wounds are essential. Indirect infections may be prevented by aggressive treatment of infections at any location. Early diagnosis and treatment are extremely important to prevent chronic osteomyelitis. With early treatment, the chances of effectively controlling acute osteomyelitis are quite good. The physician who suspects osteomyelitis prescribes broad-spectrum intravenous antibiotics immediately after blood, wound, or bone cultures are obtained to determine the causative organism.

Early and adequate d├ębridement of open fractures to remove necrotic tissue limits bacterial growth. Administration of prophylactic antibiotics in patients with open fractures and after surgery to reduce fractures decreases the incidence of post-traumatic osteomyelitis; it is important for the antibiotics to reach the bone before bone necrosis occurs. If treatment is delayed and necrotic bone develops, there is a decrease in effectiveness of the antibiotic to combat infection.

The physician usually prescribes analgesics for pain. Heat applications may also decrease discomfort. Usually the patient limits his or her own activity, but the joints above and below the affected part are often immobilized with a splint or a bivalved cast to decrease pain and muscle spasm and to support wound healing. No weight bearing is permitted on the affected part. A diet high in calories, protein, calcium, and vitamin C is started as soon as possible to promote bone healing. If there is pus formation under the periosteum, the physician performs a needle aspiration and possibly insertion of a drainage tube to evacuate the subperiosteum area. If the response to antibiotics is slow and an abscess develops, an incision and drainage (I and D) may be done. The surgeon may place catheters in the wound for irrigation or for direct antibiotic instillation. Treatment for chronic osteomyelitis may include surgical d├ębridement of devitalized and infected tissue so that permanent healing can take place. This operation, called a sequestrectomy, consists of the removal of the sequestrum and the overlying involucrum (sheath or covering).

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Antibiotics

Varies with drug;

Depends on cultures

Kill bacteria and

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