Summary
Highlights
Osteomyelitis is an infection of the bone, primarily caused by Staphylococcus aureus. Infections can be exogenous (from outside) or endogenous (from inside) and spread through the bone shaft or marrow. Common causes include open fractures, stage four skin ulcers, surgical procedures, and diabetic foot ulcers.
Assessment findings for osteomyelitis include classic signs of infection such as fever, pain, redness, and swelling. If bacteria enter the bone, it triggers an inflammatory response, leading to the recruitment of immune cells and the release of inflammatory chemicals like cytokines. This results in swelling, redness, pain, and the formation of abscesses within the bone, further damaging tissue.
The primary management for osteomyelitis involves a long course of antibiotics, typically four to six weeks. Due to the potential for kidney damage from prolonged antibiotic use, patients are advised to drink plenty of water. Analgesia is also administered for effective pain management.
Assistive devices are tools designed to help individuals with mobility issues move and walk, reducing the risk of falls and injuries. These devices are beneficial for patients with conditions like fractures, sprains, or those who have undergone amputation. The three main types discussed are canes, walkers, and crutches.
Canes are for minor instability and uneven strength, held on the unaffected side with the elbow slightly flexed. The walking sequence is: cane forward, then affected leg alongside the cane, followed by the unaffected leg ahead of the cane. Walkers provide maximum stability for unsteady clients, supporting weight bearing on both legs. The sequence is: lift/roll walker forward, then affected leg into the walker, followed by the stronger leg.
Crutches are for lower extremity injuries. They must be fitted correctly, with shoulder rests two to three finger widths (2 inches or 5 cm) below the axilla and elbows flexed at 30 degrees to prevent axillary nerve damage. The principal stance is a tripod position, 6 inches in front and to the sides. Different crutch gaits include two-point (opposite foot and crutch move together), four-point (foot and opposite crutch move one at a time), three-point (both crutches and non-weight-bearing foot together, then strong foot), and swing-through (both crutches forward, then swing both feet through).
A key principle for ascending or descending stairs with crutches or a cane is 'up with the good and down with the bad.' When going up, the good (unaffected) leg moves first, followed by the crutches/cane and the affected leg. When going down, the crutches/cane and the affected (bad) leg move together first, then the good leg follows.