- Acute Pain related to Inflammation and Tissue necrosis as evidenced by Verbalization of pain and Tenderness with palpation
- Hyperthermia related to Infection and Inflammatory response as evidenced by Increased body temperature and Warmth to touch
- Ineffective tissue Perfusion Related to Inflammatory reaction and Tissue destruction as evidenced by Bone necrosis and delayed healing
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: -Verbal reports from the patient -Expressions of pain, such as crying -Unpleasant feeling (such as a prick, burn, or ache) Objective data: -Significant changes in vital signs -Changes in appetite or eating patterns -Changes in sleep patterns | Acute Pain related to Inflammation and Tissue necrosis as evidenced by Verbalization of pain and Tenderness with palpation | Patient will be able to verbalize relief from pain Patient will verbalize a decrease in pain scale from pain relief measures Patient will demonstrate adequate rest and comfort as evidenced by vital signs within expected limits | 1. Reposition as needed. Repositioning and turning can decrease the stimulation of the pain and pressure receptors. 2. Administer pain medication as prescribed. Mild or moderate pain may be controlled with non-steroidal anti-inflammatory drugs (NSAIDs). More severe pain or pain related to debridement or surgical intervention may require oral or IV opioid medications. 3. Elevate or immobilize the site. Elevation or splinting of an extremity may improve pain by increasing circulation. 4. Collaborate with physical and occupational therapists. Physical and occupational therapists assist in pain management through exercise, stretching, and other techniques. 5. Anticipate referral to a pain specialist. Osteomyelitis and its treatment can be very painful and prolonged. Acute pain can turn into chronic pain depending on the severity and pain tolerance of the patient, which may need a referral to a pain specialist. | Patient verbalized relief from pain Patient verbalized decrease in pain scale from pain relief measures Patient demonstrated adequate rest and comfort as evidenced by vital signs within expected limits |
| Subjective data: Verbal reports from the patient about increased body temperature Objective data: -Increased body temperature -Warmth to touch -Flushed skin -Tachypnea -Tachycardia | Hyperthermia related to Infection and Inflammatory response as evidenced by Increased body temperature and Warmth to touch | Patient will demonstrate core body temperature within normal limits Patient will demonstrate blood pressure, heart rate, and respiratory rate within normal limits | 1. Provide a tepid sponge bath. Tepid sponge baths lower body temperature and provide comfort to the patient. 2. Apply a cooling blanket. A cooling blanket can lower the internal body temperature by surface cooling. Monitor closely to prevent a rapid drop in body temp. 3. Initiate antibiotics. Long-term antibiotics are required for the treatment of osteomyelitis to control the infectious process. Instruct patients that antibiotic therapy may be required for weeks. 4. Instruct on symptoms. Teach the patient and family that if fever, chills, warmth to the skin, or skin flushing is observed that the body is attempting to fight off infection and to seek immediate assistance. | Patient demonstrated core body temperature within normal limits Patient demonstrated blood pressure, heart rate, and respiratory rate within normal limits |
| Subjective data: -Altered skin sensations -Claudication -Peripheral pain -Numbness and tingling Objective data: -Weak or absent peripheral pulses -Cool skin temperature -Thickened nails -Skin discoloration: pallor when legs are raised and rubor when dependent | Ineffective tissue Perfusion Related to Inflammatory reaction and Tissue destruction as evidenced by Bone necrosis and delayed healing | Patient will demonstrate improved perfusion as evidenced by decreased pain, erythema, and swelling Patient will demonstrate no signs of infection, such as fever and abscess formation | 1. Establish blood flow at the site. Blood circulation distributes nutrients throughout the body, aids in controlling waste production, enhances site recovery, and speeds up the healing process. Healthy blood flow across vessels, arteries, veins, and capillaries maximizes perfusion. 2. Manage chronic conditions and lifestyle factors. Diabetes, peripheral vascular disease, sickle cell disease, neuropathy, smoking, malnutrition, and more affect the revascularization of the affected area. These need to be addressed before surgical intervention. 3. Provide DVT prophylaxis. Anticoagulants should be administered as ordered to promote circulation and prevent the development of blood clots. 4. Prepare for possible surgery. Depending on the degree of vascular insufficiency, procedures to restore adequate blood flow, such as debridement or vascular surgery may be necessary. 5. Prevention through pressure ulcer prophylaxis. Patients who are immobile or bed-bound are at an increased risk of experiencing osteomyelitis due to pressure ulcers. By implementing appropriate interventions such as turning schedules and skin care, this can be prevented. | Patient demonstrated improved perfusion as evidenced by decreased pain, erythema, and swelling Patient demonstrated no signs of infection, such as fever and abscess formation |