Article Updated: January 8, 2022
Nursing Diagnosis for Osteomyelitis
Having investigated and litigated claims where the victim was diagnosed with osteomyelitis, I have discovered that the majority of the time this diagnosis is evidence of medical negligence.
In the nursing home and hospital settings where the victim had a stage IV pressure wound, that is often the culprit.
The culprit for causing the wound is often a negligent nursing home and hospital.
Below, you’ll learn the medical 101’s of an osteomyelitis nursing diagnosis.
If you have more questions after reading my research, I invite you to reach out anytime.
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Nursing Diagnosis for Osteomyelitis
9 – About the Author
What is Osteomyelitis?
While rare in the general population, osteomyelitis is a condition that affects elderly in nursing homes at a higher than average rate. This is often because of poor nursing diagnosis for osteomyelitis and the underlying causes of the illness.
A poor nursing diagnosis allows this condition to develop into a serious problem that can become life-threatening.
Osteomyelitis is an infection that affects the bones in the body. An infection in the bone can happen to anyone, but is far more likely in an individual who has recently broken a bone, or those who have had serious deep infections in other parts of their bodies.
Sores that are open at the skin level for example are often associated with osteomyelitis.
When an infection is not treated in other parts of the body they can spread deeply and eventually reach the bones causing serious infections that need to be dealt with through invasive and painful procedures including amputation of limbs.
Infections of the bone do not have to get to such a serious point and can be dealt with in a relatively easier manner but this relies heavily on proper and proactive nursing diagnosis for osteomyelitis and the categories of preceding injuries which can lead to bone infections.
Causes of Osteomyelitis
Osteomyelitis is caused from infections in the body that reach the bone. While any infection can ultimately reach the bone if it is not treated properly, some are more commonly associated with osteomyelitis than others.
Open Sores on the Skin
An open sore or wound on the skin also known as a pressure sore or an ulcer has 4 different stages. The more serious stages leave a person with deep wounds that are susceptible to serious infections and are hard to treat and spread easily to other parts of the body.
A sore like this can cause osteomyelitis in many cases. In fact, a large percentage of osteomyelitis is caused by an open sores on the body.
The open sores are not a direct cause of osteomyelitis, meaning just because a person has an open sore does not mean they will develop a bone infection.
However, there is a strong correlation between the presence of an open sore with the bone infections because when the former is not treated, there can be an infection spread deeper into the body.
When a wound and infection are not treated properly, bacterial infections get into the bone tissues putting a person at risk of osteomyelitis.
Some parts of the body are more prone to osteomyelitis than others, including the legs, arms and pelvic bones.
Cellulitis is another infection that affects the skin and can lead to osteomyelitis.
When a person has cellulitis it means that they have an infection of not only the outer areas of skin, but also the deep underlying tissue of the skin as well.
Often the bacteria responsible for this includes streptococcus and staphylococcus as well as many other bacteria strains.
When cellulitis is not treated properly and early on, it too can spread deeper into the body and cause osteomyelitis.
Recent Broken Bones
A very closely linked predictive factor for osteomyelitis is a broken bone.
When a bone is broken, particularly when there is an open wound associated with the fracture, i.e. the bone has gone through the skin, a much higher chance for infection is present.
While open sores on the skin and cellulitis can eventually lead into an infection in the bone, an open break involving the bone can cause an infection to directly impact the bone.
When this happens there can be infection deep into the joints and into the breaks of the bone which can spread quickly.
Any broken bone injury that is followed with common symptoms of osteomyelitis are an immediate cause for concern.
Symptoms Of Osteomyelitis
Symptoms of osteomyelitis are not always easy to spot but with diligent observation and proper testing the condition can be found easily.
In fact, a bone infection can be diagnosed as early as 3-5 days from the onset of infection.
When a poor nursing diagnosis for osteomyelitis is given, an otherwise easy condition to treat ends up with serious consequences like the need for amputations.
Symptoms of osteomyelitis include:
◊ Swelling in area of infection
◊ Pain in affected area
◊ Warmth on site of infection
These symptoms, especially when accompanied with other conditions like the presence of severe diabetes, a broken bone or open sores on the skin can be red flags that osteomyelitis can also be present.
Diagnosis of Osteomyelitis
There are a variety of tests that can help ensure osteomyelitis is not left untreated. This is where it is important to note that a nursing diagnosis for osteomyelitis has many tools including tests like the probe to bone test (PBT) as well as traditional tests like blood tests, imaging tests and biopsies of the bone.
There is no shortage of tools to ensure a timely and comprehensive nursing diagnosis for osteomyelitis is possible for all patients. The key is ensuring that healthcare professionals, nurses, doctors and home care workers are trained and able to identify when a person needs a test to state definitively that they have osteomyelitis so that the condition can be treated properly.
Clinical diagnosis of osteomyelitis, according to The National Center for Biotechnology and the National Institute of Health, is difficult and requires “a high index of suspicion” meaning the nursing diagnosis for osteomyelitis will rely heavily on the intuitive skills and experience of medical professionals.
The tools for diagnosis exist but are useless unless medical practitioners are able to competently assess a patient’s history and physical realities to evaluate if osteomyelitis is a condition they can be susceptible to.
Patient’s with high risk, like those with open fractures, PVD, open sores on their skin, and elderly patients with diabetes in the foot are all examples of where a medical professional should use sound judgment to decide to order tests like bone biopsies, blood tests and MIR imaging to verify whether or not osteomyelitis is present.
Treatment for Osteomyelitis
Not all osteomyelitis treatment is the same and the exact plan to treat depends on the body part affected and the severity of the case. Osteomyelitis in the head and neck for example has a different treatment plan due to the complex anatomy of the region.
Antibiotic treatments are one of the most effective treatments for bone infections but this does require early and vigilant nursing diagnosis for osteomyelitis.
However, it is important to note that when courses of antibiotics are given for a condition like pressure ulcers, it can often mask the fact that an infection has reached the bone, especially in stage III and IV pressure wounds. This again means that doctors and nurses need to be highly sensitive to the fact that osteomyelitis may also be present and specific treatment is needed for the bone infection as well.
Osteomyelitis will more than likely require hospitalization as well as surgical procedures to remove the infected portions of bone.
Treatment will usually start with weeks of medication and antibiotics followed with additional therapies like debridement, the use of oxygen therapy, surgery to repair bone damage, fluid drainage, and in severe cases amputation of the affected limb, when possible.
Liability for Nursing Diagnosis For Osteomyelitis
If someone has been affected by osteomyelitis in a nursing home or during their care in a hospital, the medical providers may be liable for the condition.
In the case of a nursing home, if the bone infection comes from a poorly treated bed sore the liability can be on the nursing home, hospital or caregiver that was responsible for the patient’s well-being.
The reason for this is that bed sores are often preventable as are many other infections, especially infections that have gotten to a higher level of severity.
Nursing homes and hospitals are responsible for both treating and preventing medical conditions like stage IV pressure wounds, and also responsible for identifying serious conditions like osteomyelitis.
This duty of care and expectation of proper diagnosis is particularly true of the elderly because they present with conditions like open sores from laying in bed and diabetes that are known predictive factors for osteomyelitis.
Those who have pressure sores are at a much higher chance than the average person to get osteomyelitis and therefore nursing staff need to be diligent in ensuring that any infection spread to the bone is identified early on and treated immediately.
When they fail those responsibilities the victim will suffer greatly and lose quality of life, suffer an amputation, and invasive long-term medical treatment, all of which are preventable outcomes.
Help With Osteomyelitis Claims
I have personally investigated and handled over half a dozen medical malpractice and nursing home claims where the victim suffered osteomyelitis.
If that diagnosis is mentioned in the death certificate, there is grounds for a deep-dive investigation to flush out the source and cause of the bone infection.
That search for the truth typically uncovers many arrows pointing at negligent nursing facilities and corporate hospitals who did not care adequately for patients.
These investigations are costly, and can take 9-12 months. If you’d like me to investigate a claim for you, send me an email or call me 24/7.
Reza Davani, Esq.
State Bar No.: #1212110211
Federal Bar No.: #30168
Pressure Ulcer Legal Library
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Supporting Literature, Citations & Resources:
Marriott, R., & Rubayi, S. (2008). Successful truncated osteomyelitis treatment for chronic osteomyelitis secondary to pressure ulcers in spinal cord injury patients. Annals of plastic surgery, 61(4), 425-429.
Chandra Prasad, K., Chandra Prasad, S., Mouli, N., & Agarwal, S. (2007). Osteomyelitis in the head and neck. Acta oto-laryngologica, 127(2), 194-205.
Unger, E., Moldofsky, P., Gatenby, R., Hartz, W., & Broder, G. (1988). Diagnosis of osteomyelitis by MR imaging. American Journal of Roentgenology, 150(3), 605-610.
Momodu, I. I., Savaliya, V., & Doerr, C. (2021). Osteomyelitis (Nursing). StatPearls [Internet].
Shone, A., Burnside, J., Chipchase, S., Game, F., & Jeffcoate, W. (2006). Probing the validity of the probe-to-bone test in the diagnosis of osteomyelitis of the foot in diabetes. Diabetes care, 29(4), 945-945.
Naude, L. (2005). Osteomyelitis-diagnosis and management: wound care. Professional Nursing Today, 9(4), 26-32.
Momodu II, Savaliya V. Osteomyelitis. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.
Hirshberg, J., Rees, R. S., Marchant, B., & Shay, D. (2000). Osteomyelitis related to pressure ulcers: the cost of neglect. Advances in skin & wound care, 13(1), 25.
Livesley, N. J., & Chow, A. W. (2002). Infected pressure ulcers in elderly individuals. Clinical infectious diseases, 1390-1396.
Bellando-Randone, S., & Lepri, G. (2019). Infections, Cellulitis, and Osteomyelitis. In Atlas of Ulcers in Systemic Sclerosis (pp. 95-98). Springer, Cham.
About the Author
This nursing home and medical malpractice article was written by Baltimore, Maryland nursing home attorney Reza Davani, Esquire. Mr. Davani received his Juris Doctor degree from a Tier 1 law school, the University of Maryland Francs King Carey School of Law. He received his first license to practice law from the State of Maryland’s Court of Appeals (MD State License No. 1212110211), and just four months later received a federal law license from the United States District Court for the District of Maryland (Federal License No. 30168).
Mr. Davani has been practicing law for over 10 years. He began practicing law by helping clients as a sanctioned student lawyer before receiving his law license, and second chaired his first jury trial in federal court before even graduating law school. He is a registered member of the Maryland Association for Justice (MAJ), the American Bar Association (ABA), the American Association for Justice (AAJ), and was formerly on the MAJ’s Legislative Leader’s Circle.
Mr. Davani has taken over 20 cases to trial in state and federal court, and favorably settled well over 100 cases for injured victims. He has personally helped his clients recover over $15,000,000 in personal injury, medical malpractice, and nursing home abuse settlements and verdicts in Maryland and other states. He is dedicated to fighting for justice, and welcomes the opportunity to help you.
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