SEPTIC ARTHRITIS

• Joints become infected

• Infected by spread of infection from other parts of body (hematogenous spread)
• Contribute to development of Septic Arthritis:
o Previous trauma to joints –  risk to area
o Coexisting arthritis
o Diminished host resistance (poor health  ability to fight infection)
• Adult mostly caused by : Gonococci and Staphylococci
• *****Accumulating pus results in Chondrolysis (destruction of hyaline cartilage) which heals poorly,
and they may loose function of the joint.

CLINICAL MANIFESTATIONS
• Warm, painful, swollen joints with  ROM – specific to joint
• Systemic chills, fever, leukocytosis (Inc WBC)
• Elderly: Clients taking corticosteroids or immunosuppressive meds may NOT exhibit typical clinical
manifestations
o You would look at the joints and assess the joints

ASSESSMENT AND DIAGNOSTIC FINDINGS

• Source of infection assessed (primary location)
• Aspiration, examination, culture synovial fluid
• Computed tomogrtaphy and MRI (may disclose damage to joint lining)
• Radioisotope scanning (useful localizing process)

MANAGEMENT
• Prompt treatment is essential
• IV Antibiotics – Naficillin, Cefoperazone, Gentamicin
o Penicillin G used for Gonoccal septic arthritis
o Continued until symptom disappear
• Monitor synovial fluid for sterility and  WBC***** Check several times
• Athrotomy - Arthroscopy
• Remove excessive joint fluid, exudates, debris
o Comfort and decrease joint destruction due to proteolytic enzymes in purulent fluid
• Inflamed joint supported and immobilized in functional position by splint –  comfort
• Analgesics – Codeine – Control Pain
• NSAID’s: After infection responds to antibiotic therapy
• Monitor Fluid and nutritional status
• Passive ROM: When infection subsides
• Prompt treatment without other barriers  recovery of normal function
• Assessed periodically for reoccurrence
• Articular cartilage damages, joint fibrosis and diminished function may result

NURSING MANAGEMENT
• Educate regarding disease process
• Control pain with pharmacologic / nonpharmacologic
• Important: supporting affected joint, adhering to prescribed meds, observe wt bearing and activity
restrictions
• Demonstrates and encourages patient practice safe use of ambulatory aids and assistive devices
• Aseptic dressing changes and wound care
• ROM exercises when infection subsides
 Not talked about in class
PEDIATRICS
• Develop through hematogenous dissemination from another focus
• Occasionally results from direct extension of soft tissue infection
• Occur predominantly in males – Adolescent age group
• Infancy: incidence equal between boys and girls
• Hip, Knee, Shoulder, other large joints more commonly affected
• Usually only one joint involved
• Diagnostic evaluation
o Blood culture
o Joint fluid aspirate
o Radiographs

CLINICAL MANIFESTATIONS
• Hx traumatic injury affected joint
• Fever
• Leukocytosis
•  Erythrocyte
• Sed rate present but may not demonstrate in affected infants
• Involved Joint:
o Warm and tender
o Erythematous
o Swollen
o Painful on even gentle pressure
• Superficial involved joint extremely painful
• Deep- seated involvement of joint show little superficial evidence

MOST COMMON PATHOGENS

• Staphylococcus Aureus
• Group A Streptococci
• Haemophilus Influenzae

THERAPUETIC MANAGEMENT
• Open surgical drainage of hip and shoulder joint dz
• Repeated aspirations of joint space in other joints
• GOALS:
o Cleanse joint and avoid destruction of articular cartilage
o Decompress joint avoid interference with blood supply to epiphysis
o Eradicate infection with adequate antibiotic therapy
o Prevent secondary bone infection and hematogenous spread

THERAPY
o IV antibiotic therapy
o Relief of pain
o Immobilization of joint
o Prohibition of wt bearing until completely healed