{
  "name": "Osteomyelitis",
  "slug": "osteomyelitis",
  "url": "https://nursingplex.com/care-plans/osteomyelitis",
  "category": "Musculoskeletal",
  "summary": "Bone infection needing long IV antibiotics, immobilization and wound care.",
  "nursing_diagnoses": [
    "Acute pain",
    "Risk for infection",
    "Impaired physical mobility"
  ],
  "overview": [
    "Osteomyelitis is infection of bone and marrow, most often from Staphylococcus aureus. It reaches bone by direct inoculation from open fracture or surgery, by contiguous spread from a diabetic foot or pressure ulcer, or hematogenously from a distant infection — the usual route in children.",
    "Infection raises pressure inside rigid bone, compromising blood flow. Devitalized bone (sequestrum) forms, antibiotics cannot penetrate it, and the infection becomes chronic. That single mechanism explains why treatment is long IV antibiotic courses, often six weeks or more, plus surgical debridement.",
    "Nursing care centers on protecting a weakened bone from fracture, maintaining immobilization and alignment, pain control that permits sleep and gentle movement, meticulous wound and central line care, and monitoring the inflammatory markers that track response to therapy."
  ],
  "key_facts": [
    {
      "label": "Usual organism",
      "text": "Staphylococcus aureus, including MRSA; Salmonella is classic in sickle cell disease."
    },
    {
      "label": "Marker trend",
      "text": "ESR and CRP guide response; CRP falls first and is the more responsive marker."
    },
    {
      "label": "Antibiotic duration",
      "text": "Typically 4–6 weeks or longer of IV therapy, often through a PICC line at home."
    },
    {
      "label": "Sequestrum",
      "text": "Dead bone that antibiotics cannot reach — surgical debridement is required for cure."
    },
    {
      "label": "Fracture risk",
      "text": "Infected bone is weak; avoid weight bearing and handle the limb gently to prevent pathologic fracture."
    },
    {
      "label": "Diabetic foot",
      "text": "A probe-to-bone ulcer strongly suggests underlying osteomyelitis."
    }
  ],
  "nursing_priorities": [
    "Eradicate infection with sustained, therapeutic antibiotic levels.",
    "Control pain sufficient for rest and prescribed movement.",
    "Protect the affected bone from fracture and deformity.",
    "Maintain wound integrity and prevent secondary infection.",
    "Support nutrition and long-term adherence to home IV therapy."
  ],
  "assessment": {
    "subjective": [
      "Deep, constant, throbbing bone pain unrelieved by rest and worse with movement",
      "Fever, chills, malaise and fatigue",
      "History of open fracture, orthopedic hardware, ulcer, IV drug use or recent infection",
      "Concerns about long treatment, mobility loss and home IV management"
    ],
    "objective": [
      "Localized swelling, erythema, warmth and point tenderness over bone",
      "Drainage, sinus tract formation and wound depth or probing to bone",
      "Temperature, heart rate and systemic infection signs",
      "WBC, ESR, CRP, blood cultures and bone culture results",
      "Imaging findings: MRI early changes, radiographic changes appearing late",
      "Neurovascular status distal to the site and any hardware present"
    ],
    "related_factors": [
      "Direct inoculation from trauma, surgery or hardware",
      "Contiguous spread from pressure or diabetic foot ulcers",
      "Hematogenous seeding from bacteremia",
      "Poor perfusion, diabetes, immunosuppression and malnutrition",
      "IV drug use and prolonged vascular access"
    ]
  },
  "goals": [
    "The client will be afebrile with normalizing WBC, ESR and CRP.",
    "The client will report pain at or below 3/10 and rest comfortably.",
    "The affected limb will remain properly aligned without pathologic fracture.",
    "The wound will show granulation without purulent drainage.",
    "The client will complete the full antibiotic course and demonstrate safe home IV care."
  ],
  "interventions": [
    {
      "title": "Antimicrobial therapy",
      "points": [
        "Obtain cultures — ideally bone culture — before the first antibiotic dose when the patient is stable.",
        "Administer IV antibiotics exactly on schedule to maintain trough levels; monitor vancomycin levels and renal function.",
        "Assess the PICC or central line site each shift and use strict aseptic technique for all access.",
        "Trend CRP and ESR weekly and report a plateau or rise."
      ]
    },
    {
      "title": "Immobilization and bone protection",
      "points": [
        "Maintain splint, cast or traction in prescribed alignment and support the limb with both hands when moving it.",
        "Enforce ordered non-weight-bearing status and coordinate with therapy for safe transfers.",
        "Assess neurovascular status distal to the site: color, temperature, capillary refill, pulses, sensation and movement.",
        "Report sudden severe pain or deformity, which may signal pathologic fracture."
      ]
    },
    {
      "title": "Pain and wound care",
      "points": [
        "Give scheduled analgesia and premedicate before dressing changes and therapy.",
        "Use aseptic technique for dressing changes, document drainage amount, color and odor, and manage wound vacuum therapy as ordered.",
        "Support the surgical team's debridement plan and monitor postoperative drains and packing.",
        "Protect surrounding skin from maceration and keep the extremity elevated to reduce edema."
      ]
    },
    {
      "title": "Nutrition and long-term support",
      "points": [
        "Provide a high-protein, high-calorie diet with vitamin C and zinc for bone and wound healing.",
        "Correct glucose control in diabetic patients — hyperglycemia impairs healing and immune function.",
        "Arrange home infusion services, supplies and follow-up laboratory draws before discharge.",
        "Address the psychological burden of months of restricted activity and provide realistic timelines."
      ]
    }
  ],
  "patient_teaching": [
    "Finish the entire antibiotic course even after symptoms disappear; stopping early causes chronic infection.",
    "Report fever, increased pain, new drainage or redness at the wound or line site.",
    "Keep the limb elevated and do not bear weight until specifically cleared.",
    "Care for the central line with clean technique, keep dressings dry and never let the line get wet in the shower.",
    "Eat protein-rich foods and keep blood glucose controlled to speed healing.",
    "Attend all lab draws and clinic visits; therapy is adjusted from those results."
  ]
}