CASE PRESENTATIO

N

OSTEOMYELITIS

• INTRODUCTION

Osteomyelitis is infection in the bone. Osteomyelitis can occur in infants, children and adults. Different types of bacteria typically affect the different age groups. In children , osteomyelitis most commonly occurs at the end of the long bones of the arms and legs , affecting the hips , knees, shoulders and wrist. In adults , it is more common in the bones of the spine or in the pelvis.

• CAUSES:

There are several different ways to develop osteomyelitis . The first is for bacteria to travel through the bloodstream ( bacteremia) and spread to the bone, causing an infection. This most often occurs when the patient has an infection elsewhere in the body, such as pneumonia or a urinary tract infection , that spreads through the blood to the bone.

An open wound over a bone can lead to osteomyelitis.

• A recent surgery or injection around the bone can also expose the bone to bacteria and lead to osteomyelitis.

• Pt. with conditions or taking medications that weaken their immune system are at a higher risk of developing osteomyelitis. This include patients with cancer , chronic steroid use, sickle cell disease, HIV and the elderly.

Patient Profile

Name: Patient X Sex: M c/s: W Age: 77 y/o Birthday: 11-

24-1934 Data of Admission: 01-30-

2012Diagnosis: CHRONIC

OSTEOMYELITIS, HUMERUS R S/P OR PLATING

2. PHYSICAL ASSESSMENT

A. GENERAL SURVEY

Patient X was lying semi-

fowler’s on bed, conscious, and

coherent

a. Vital Signs

Temp: 100. 019° F 36.8 ° C axillary PR: 82 bpm radial RR: 22 cpm diaphragmatic BP: 110/70 left arm Lying down

b. HEAD

-Pink papillary conjunctiva, no nuchal rigidity and no carotid bruit.

c. NEUROLOGIC STATUS -oriented to time, person and

place.

Gordon’s Functional Health Assessment

• Gordon’s health pattern assessment tool include:

1. Health- perception management

2. Nutritional-metabolic pattern

3. Elimination pattern

4. Activity-exercise pattern

5. Sleep- rest pattern

6. Cognitive-perceptual pattern

7. Self- perception pattern

8. Role-relationship pattern

9. Sexuality-reproductive pattern

10.Coping- stress pattern

11. value- belief pattern

• Gordon’s health pattern assessment tool include:

1. Health- perception management:

Past medical history:

Illnesses: none

Surgery: debribment removal of plate @ right arm. During hospitalization

Do not smoke, drink alcohol occasionally amount & type Gin 1 bottle. Perception to health is good. Exercise regularly, follow prescribe regimen during hospitalization use side rails for safety.

2.NUTRITIONAL METABOLIC

• HT.52• WT.Before 65kg After 55kg• Diet regular• Appetite normal• Feeding. Before self after assisted• Condition of mouth pink• Skin color pink, warm dry and

intact w/ good skin turgor.

3. ELIMINATION• Bowel Habits consistent color yellow 1-

2 per day.• Bladder Habits frequent color clear• Abdomen firm & symmetry

4. ACTIVITY –EXERCISEA. Musculoskeletal:

Self care ability: like eating and bathing need assistance from the others

Assistive device use: none

Gait: normal

Posture: normal & no deformities

B. CV

Pulse: 75 bpm

Blood pressure: 100/70

Temp. 37 degree Celsius

Extremities:

Capillary refill: normal

Nails: normal pinkish color

Hair distribution: normal

Push/pulls: right weak left strC. Respiratory:

Chest is symmetrical

Respirations: 20 cpm

5. SLEEP-RESTUsual sleeping habits: 8 hrs per night

1 hr am nap & 1 hr pm nap

6.COGNITIVE –PERCEPTUALLOC: Alert

Mood: Pleasant

Memory: Good

Pupil size: Normal

Reflexes: Normal

Grasps: right weak left strong

ong

Pain: none

Senses: Visual acuity use eye glasses

Hearing: impaired R/L

Touch: Normal

Smell: Normal

Ability to communicate: clearly

Ability to make decisions: moderately deficult

7. SELF-PERCEPTION-SELF-CONCEPTAppearance: calm

Answers questions: readily, with positive eye contact

Usual view of self: positive

Level of control in the situation: 8 (rate from 0-10)

8. ROLE-RELATIONSHIPPT. live with his live in partner and children

Support system: partner and children

Occupation: auto electrician

Concerns about illness: I can’t go back to work

9. SEXUALITY-REPRODUCTIVEHistory of prostate problem: none

History of penile discharge; none

10. COPING-STRESS TOLERANCEPrimary way you deal with stress?: prayer

support from the family

Concerns regarding hospitalization/illness?: financial

11. VALUE-BELIEFReligion:Roman Catholic

Religious Practices: occasional, visit calabanga church once a month.

ANATOMY OF THE SKELETAL SYSTEM

Functions of the Skeletal System• Support Provide a hard framework.

• Protection of many vital organs.

• Movement . Act as levers with skeletal muscles moving them. Joints control possible movements.

• Storage Especially calcium and phosphate

• Blood Cell Production Certain bones have active marrow.

Categories:

• Axial Skeleton

• Appendicular Skeleton

HUMERUS

• PATHOPHYSIOLOGY

Decrease vascular supply to the bone extending into the surrounding soft tissue

Large area of dead bone (when the medullary and periosteal

blood supplies are compromised

Osteomyelitis

Bone Injury

Internal Fixator-plate

Infection:-edema

-pus-vascular congestion

-small vessel thrombosis

DIAGNOSTIC TEST

C- REACTIVE PROTEIN• CRP is used mainly as a

marker of inflammation.• Measuring and charting

CRP values can prove useful in determining disease progress or the effectiveness of treatments.

1.6mg/dl Less than 0.8 mg/dl

• Recent research suggests that patients with elevated basal levels of CRP are at an increased risk of diabetes, hypertension and cardiovascular disease.

URINALYSIS

URINALYSIS

4-6

• the presence of pus in a urine sample, indicating a urinary tract infection anywhere from the kidneys to the urethra. Cloudiness in urine may be caused by either pus or chemicals, a difference determined by simple laboratory tests.

moderate

• Presence of bacteria indicates infection.

BLOOD TEST

• A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a needle, or via fingerprick. Blood tests are used to determine physiological and biochemical states, such as disease, mineral content, drug effectiveness, and organ function

COMPLETE BLOOD COUNT

MEDICATION

TRAMADOL50mg, q6 hrs PRN ,PO

• I: Tramadol is used to treat moderate to moderately sever pain.

• A:Tramadol binds to µ-opiate receptors and inhibits reuptake of norepinephrine and serotonin. It reduces intensity of pain stimuli incoming from sensory nerve endings, altering pain perception and emotional response to pain.

• AR: Dizziness or vertigo, Nausea and Vomiting, Constipation, Headache, Somnolence, Pruritus,CNS Stimulation,Asthenia,Diaphoresis,Dyspepsia,Dry mouth,Diarrhea,Malaise,Vasodilation,Anorexia,Flatulence,Rash,Visual disturbance,Urinary retention or frequency,Menopausal symptoms

CEFAZOLIN1g,TIVT q 8hrs

• A: Bind to bacterial cell wall membrane, causing cell death.

• I:Treatment of Skin & skin structure infections; pneumonia; urinary tract infections; bone & joint infections

• Ci: Hypersensitivity to cephalosphorins. Serious hypersensitivity to penicillin.

• AR:

CNS: Seizures (high doses)

GI: Pseudomembranous colitis,

diarrhea, nausea, vomiting, cramps

• GU: Interstitial nephritis

• DERM: Rashes, urticaria

• HEMAT: Blooddyscrasias, hemolytic anemia

RANITIDINE50 mg,TIVT 1 hr prior to OR

• A: Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.

• I:Treatment and prevention of heartburn, acid indigestion, and sour stomach.

CI: Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance.

AR: CNS: Confusion, dizziness, drowsiness,

hallucinations, headache

CV: Arrhythmias

GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea

GU: Decreased sperm count, impotence

ENDO:Gynecomastia

HEMAT:Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia

LOCAL:Pain at IM site

Paracetamol50 mg, PO,TID

• A:Inhibits prostaglandin synthesis in the CNS and blocks the pain impulse through a peripheral action. It acts on the hypothalamic heat-regulating center, producing peripheral vasodilation. It results in antipyresis and produces analgesic effect.

• AR:Side effects are well tolerated. Cramping, heartburn, abdominal distention can be experienced. On a rarity, hypersensitivity reactions.

NURSING THEORY

Adaptation Model

Sister Calista Roy The Four Modes of

Adaptation• Physiologic-Physical Mode Physical and chemical

processes involved in the function and activities of living organisms; the underlying need is physiologic integrity as seen in the degree of wholeness achieved through adaptation to change in needs.

• Self-concept- Group Identity Mode

Focuses on psychological and spiritual integrity and sense of unity, meaning, and purposefulness in the universe.

• Role Function Mode

• Roles that individuals occupy in society, fulfilling the need for social integrity. It is knowing who one is in relation to others.

• Interdependence Mode

Self-care deficit nursing theory

• (Dorothea Orem)

When an individual is very unable to meet their own self-care requisites, a "self-care deficit" occurs. It is the job of the Registered Nurse to determine these deficits, and define a support

• Nurses are encouraged to rate their patient's dependencies or each of the self-care deficits on the following scale:

• Total Compensation• Partial Compensation• Educative/Supportive

Effects on Growth and Developmen

t

Psychosocial Conflict: Integrity v/s

despair

• Major Question: "Did I live a meaningful life?"

• Basic Virtue: Wisdom• Important Event: Reflecting

back on life

Integrity v/s Despair

• Integrity versus despair is the eighth and final stage of Erik Erikson's theory of psychosocial development.

• Occurs during late adulthood from age 65 through the end of life.

Integrity v/s Despair

• People on this stage, reflect back on the life they have lived and come away with either a sense of fulfillment from a life well lived or a sense of regret and despair over a life misspent.

DESPAIR• Is a state of low mood and aversion

to action that can affect a person’s thoughts, behavior, feelings and physical well-being.

INTEGRITY

• Is a concept of consistency of action, values, methods, measure, principle, expectations and outcomes.

NCP

• DISCHARGE PLANNING

• M- Continuing the prescribed antibiotics therapy.

• Antibiotics is given to fight or prevent infection caused by bacteria.

• Pain medicine to take away or decrease pain.

• Home medication:• Tramadol 50mg oral,• Paracetamol 500 mg oral,q4• Ranitidine 50mg oral,q 6hrs• Mefenamic 500mg, oral,bid

• E- Client must have ROM exercises as tolerated to maintain muscle and joint strength.

• Physical therapy helps maintain flexibility and strength and relieve the musculoskeletal pain associated with muscular weakness , paralysis and immobility.

•  

• T- Prolonged antibiotic therapy , lasting a months.

• Physical therapist

• H- Advise to report any adverse effects of the antibiotics before discontinuing

• Explaine that the success of antibiotics treatment depends on the following the complete regimen

• Explain wound care using aseptic technique for dressing changes.

•

• O – follow up check up on OPD as prescribe by the physician ( after 1 week)

• D- eat healthy foods from all of the five groups , fruits , vegetables, breads, dairy products , meat, and fish. Healthy foods may help feel better , have more energy.

• Do not drink beer,wine, and liquor it may interact with the medicine

• Advise to eat foods high in protein and vit. C to support the needs to fight infection

• S- Encouraged patient(SO) to continue his habits in going to church every day and always seek God helps when ever problems occur. 

•ENDLBSN-3BGROUP 2