Septic arthritis

Prepared by:

Prabita Shrestha

Introduction: Septic arthritis is a painful infection in the joint. It may also be referred to as infectious arthritis.

It occurs when an infection, caused by a bacteria or virus, spreads to a joint or the fluid surrounding the joint (synovial fluid).

This infection usually begins in another area of the body and spreads through the bloodstream to the joint tissue.

The infection may also enter the body through surgery, open wounds, or injections.

Contd…

Infectious arthritis usually only occurs in one joint.

Most often, the joint affected is a large joint such as the knee, hip, or shoulder.

It occurs more often in children and older adults.

Causative agents:

Neisseria gonorrhea (in children)

Meningococci

Streptococcus haemolyticus

Staphylococcus aureus

Coliform bacteria

Salmonella

Haemophilus influenza

Risk Factors:Joint problems such as arthritis, gout, and lupus

Previous joint surgery/diseases

Skin conditions and open wounds

Drug or alcohol abuse

Drugs that suppress the immune system

Weakened immune system

Cancer

Diabetes mellitus

Advanced age

Pathophysiology:

Bacterial invasion

Synovial tissues responds by becoming inflamed

The joint cavity may become involved ,& pus develops in the synovial membrane & synovial fluid

If allowed to progress the inflection causes abscesses in the synovium & subchondral bone, eventually destroying cartilage

Ankylosis of the joint may result

Patient reports pain, swelling & tenderness of joint

Clinical manifestations:Symptoms of septic arthritis can vary depending on the individual’s age, as well as the medications the individual is taking.

Symptoms may include:

Severe pain that worsens with movement

Swelling of the joint

Warmth and redness around the joint

Fever

Chills

Fatigue

Decreased appetite

Contd…

Inability to move the limb with the infected joint (pseudoparalysis)

Rapid heartbeat

Irritability.

Investigations:1. Arthrocentesis:

It is a test frequently used to diagnose if there is an infection in the joint, and what is causing the infection.

It involves inserting a needle into the affected joint to take a sample of synovial fluid. The sample is sent to the lab to be examined for color, consistency, and the presence of white blood cells and bacteria.

Contd…

2. Blood test:

To check white blood cell count and to determine if any bacteria are present in bloodstream. This information can help to determine how serious the infection is.

3. Culture of synovial joints

4. X-ray of joints reveals loss of joint space

5. Ct-scan

6. MRI

Management: Appropriate antibiotic therapy Rest/immobilization of joint Synovial Fluid Drainage• Many individuals with infectious arthritis need to have

their synovial fluid drained. This is done to remove the infected fluid, ease pain and swelling, and increase the speed of recovery.

• Synovial fluid is most often drained by arthroscopy. In this procedure, a doctor makes several small incisions near the affected joint. Then he or she will feed a small tube containing a camera into the incision which helps to guide them in suctioning the infected fluid from your joint

Contd…• Sometimes doctors are able to use arthrocentesis,

which uses a small needle, to remove infected fluid without requiring surgery. This procedure often has to be repeated over the course of several days to ensure enough fluid is drained.

Other Treatment Options• Rarely, more severe cases of infectious arthritis

require surgery to wash out the joint, remove damaged sections of the joint, or replace the joint.

• Using non-steroidal anti-inflammatory medications (NSAIDS)

• Resting the joint• Applying heat to the joint• Splinting the affected joint• Physical therapy

Nursing management ASSESSMENT: Assess the pain Assess the patient physical status History should be taken regarding the joint pain and

swellings Vitals signs are taken in which elevated temperature can

be found

Nursing diagnosis:• Acute and chronic pain related to pathologic process• Ineffective coping related to fear of the unknown• Disturbed sleeping pattern related to pain• Self care deficit related to disease portion

RELIEVING PAIN• The nurse should prepare the patient and gives

support during the painful procedures• Analgesics must be given to alleviate pain• If the joints are inflammed, let the patients rest and

avoid activities that stress the joints• Apply local heat or cold to affected joints for

approximately 20-30 min three to four times a day.• Change positions frequently. Use splints to maintain

proper body alignment• Avoid pillow under knee to prevent knee and hip

flexion deformities

INEFFECTIVE COPING RELATED TO FEAR OF THE UNKNOWN

• Explain about the disease condition using teaching aids appropriate to the patients and family members levels of understanding

• Allow significant other opportunities to share feelings and frustration including the need for adequate nutrition and regular follow up care

• Allow patient to get involve in the daily activities which can be done by him

• Communicate frequently with the patients in order to view his emotions and expressions related to his disease condition

PROMOTE SLEEPING PATTERNS

• Encourage performance of bed time rituals such as hygiene activity, reading or having a warm drink

• Initiate pain relief measures before bedtime if appropriate

• Encourages proper positioning of joints• Encourage a balance of activity and rest• Provide for uninterrupted sleep to enable

completion of sleep cycle

PROMOTE SELF CARE

• Assess the patient in his self care activities• Provide pain relief before the patients undertakes self

care activities• Provide privacy and an environment conductive to

performance of each activity• Schedule activities to provide for adequate rest periods

References:

1. Black hawk’s, medical surgical nursing; 7th edition; page no. : 609-611

2. Phipps. Medical surgical nursing, 7th edition; page no. : 1542-1570; 1569-1570

3. Basvanthapa bt. Medical surgical nursing, 1st edition; page no. : 490; 437-498

4. Lippincott; Atlas of pathophysiology; 2nd edition; page no. :228-229

5. Lippincott; manual of nursing practice; 8th edition; page no. : 1090-1091