ARIES CHOLIFAH, S.Kp., M.Pd.

DEFINISI
Adalah infeksi pada tulang

TIPE
 Akut  Sembuh < 4 mgg
 Kronis  Sembuh > lama
 PATOFISIOLOGI
PATHOGEN INVASION TISSUE INFLAMMATION

Superimposed Increase
Infection vascularity

BONE ABSCESS EDEMA FORMATION

BONE NECROSIS Blood vessel

(Sequestrum Formation) thromboses

DECREASED BLOOD
FLOW TO BONE
 Patient with OSTEOMYELITIS
History

Nursing assessment/diagnosis

Prepare patient for diagnostic tests

Assist with closed drainage

Prepare and administer acute-phase antibiotics

Continued infection Resoived infection

Continue long-term antibiotics

and monitor response

Good
Poor response
response

Prepare patient for open drainage

Provide supportive care

Provide supportive education

MEKANISME INVASI
1. Acute Hematogenous osteomyelitis
- Sering pada anak-anak
- Dari bagian lain tubuh
- Terutama pd Tl.panjang, mis: femur &
vertebrae
- Mikroba patogen > suhu tulang yg kaya
suplai vaskular & marrow cavity
2. Direct Inoculation
- Dewasa
- Penetrasi trauma
- Mikroba berasal dari kulit atau obyek
yang penetrasi
3. Contiguous Spread
- Jar. sekitar terinfeksi
- Dewasa dg ggn vaskuler, mis :
DM atau peripheral vascular disease
- Usila
4. Chronic Osteomyelitis
- Dapat berasal dari tipe akut
- Resti  Dewasa dg ggn vaskular
- Lamanya tahunan

ETIOLOGI
1. Acute hematogenous  Staphylococcus
aureus
- Bakteriemia
- Penyakit penyerta
 - Trauma non penetrasi  perdarahan 
nekrose
- UTI
- Usila
- IV jangka lama, drug abuse
- Hemodialisis jangka lama
- Infeksi salmonella dr sal. Pencernaan

2. Direct Inoculation  Psudomonas

aeroginosa
- Infeksi jar. lunak - Luka tusuk
- Gigitan hewan - Operasi tulang
3. Contiguous Spread
- Infeksi dari jar. lunak sekitar
- Poor dental hygiene & RÖ th/ 
Infeksi mandibula
- Otitis media
- DM
4. Osteomyelitis Kronis
- Inadequatedly treated
- Bakteri gram negatif
- Bakteri gram negatif + gram positif
PENCEGAHAN
 Identifikasi faktor resiko :
- Infeksi luka, pus (+)
- dehisensi luka
- OP yg lama
- nutrisi buruk
- lansia
- obesitas
- DM
- Artritis rematoid
- th/ kortikosteroid jangka panjang
 Teknik a & antiseptik u/ tindakan perawatan
 Identifikasi & monitor pasien resiko tinggi
 Penanganan infeksi fokal
 Antibiotik profilaksis

PENGKAJIAN
RIWAYAT
- Usia

- R/ drug abuse

- Infeksi lain pd tubuh

- Kondisi kesehatan, mis : DM, anemia
- Trauma non penetrasi
- Luka penetrasi
- Prosedur operasi
- Prosedur invasive
- Th/ radiasi
- Faktor resiko : malnutrisi
P.E.
- Demam > 38O C

- Bengkak, eritema, redness

- Draining ulcer

- Bone pain : konstan, localized, pulsating

sensation  dg gerakan
- Tidak nyaman  nerve damage  blood
supply
PENGKAJIAN PSIKOSOSIAL
- Takut tidak sembuh, amputasi
- Th/ antibiotik > 4 mgg  hospitalisasi lama
- Isolasi sosial

LAB
- Leukosit 
- ESR 
- Kultur darah  bakteriemia
- RÖ
TES Dx. LAIN
- Bone scan dg technitium atau gallium

identifikasi  90% osteomyelitis

- CT scan & MRI

> sensitif dlm Dx. osteomyelitis

- Biopsi tulang

Kultur jar. lunak atau pus u/ tentukan

jenis mikroba.
Dx. Keperawatan
Common Diagnosis
The typical nursing diagnoses for aclient with
osteomyelitis include the following :
1. Potensial for injury related to bone infection
2. Pain related to infectious process
3. Impaired physical mobility related to pain
and inflammation
4. Altered (peripheral) tissue perfusion related
to inflammation and infection
5. Impaired skin integrity related to
inflammation, wound, or ulceration
Additional Diagnosis
The following additional diagnoses may be
applicable to the client with osteomyelitis :
1. Activity intolerance related to pain
2. Anxiety related to possible treatment
failure and need for surgery
3. Fear related to possible disfiguring
surgery
4. Anticipatory grieving related to possible
amputation
5. Impaired home maintenance
management related to lack of support
systems
6. Altered nutrition: less than body
requirements related to need for
increased nutrients to promote healing
7. Body image distrubance related to
isolation or surgery
8. Sleep pattern distrubance related to pain
and round-the-clock antibiotic therapy
9. Altered (peripheral) tissue perfusion
related to diabetes or other peripheral
vascular desease
10. Knowledge dificit related to treatment
regimen
Contoh Intv. Keperawatan
 Kaji tingkat & intensitas nyeri
 Mobilisasi dg bidai  < spasme otot
 Pantau status neurovaskuler
 Pembatasan aktivitas
 Kolaborasi obat; analgetik, antibiotik
 Pantau T.V
 Pantau tanda-tanda infeksi
 Diet TKTP
 Cek laboratorium
 Jelaskan penyakit & program terapi