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Chapter I
Introduction

Pyomyositis is an inflammation of muscle tissue, usually of voluntary muscles
that results in pus roduction. Once considered a tropical disease, it is now seen in
temperate climates as well. The pathogenesis is unclear, but trauma, infections (S.
aureus, S. 1neumonia), and malnutrition have been implicated. Although most cases of
pyomyositis occur in healthy individuals, other pathogenetic factors include nutritional
deficiency and associated parasitic infection in tropical climates. In the temperate
climates, pyomyositis is seen most commonly in patients with diabetes, HIV infection,
and malignancy.
The incidence of reported bacterial pyomyositis is increasing in the United
States, especially among immunocompromised persons. This review summarizes all
reported cases of pyomyositis among human immunodeficiency virus (HIV)-infected
persons worldwide and HIV-negative persons in the United States since 1981. During
the era of combination antiretroviral therapy, bacterial pyomyositis among HIV-infected
persons typically occurred in those with end-stage acquired immunodeficiency
syndrome. Among non-HIV-infected patients, about half have a serious underlying
medical problem, most commonly diabetes mellitus, malignancy, or a rheumatologic
condition. These patients are more likely to have a gram-negative infection, a normal
white blood cell count, multifocal involvement, or higher mortality than those without an
underlying medical condition. The characteristics of cases in temperate areas are
similar to tropical cases, except that the former occurs more often in
immunocompromised persons; this may change with the HIV epidemic in tropical
regions.




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Chapter II
Objectives

General Objectives:
To better understand the disease and its process as it affects the patient.
Specific Objectives:
To assess the physical state of the patient.
To gather data on the history of the patient.
Identify the signs and symptoms manifested by the patient.
To distinguish the precipitating and predisposing factors that trigger this
development.
To trace the pathogenesis based on the signs and symptoms manifested by the
patient.
To use the nursing process as the framework for the care of the patient.















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Chapter III
Demographic Profile

Name: JD
Age: 3 y/o
Gender: Male
Address: 63 Purok St. , Bagong Tanyag, Taguig City
Date of Birth: May 21, 2010
Nationality: Filipino
Religion: Roman Catholic
Chief Complaint: Left arm pain
Date of Admission: April 25, 2014
Time of Admission: 8:16 AM
Place of Admission: Philippine Orthopedic Center
Admitting Diagnosis: Pyomyositis left arm











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Chapter IV
Health History
I. History of Present Illness
Nine days prior to admission
According to JM (mother of the patient) patient JD fell from the bed hitting
his left elbow. According to JM the morning after, patient JD complaining of
left arm pain. JD brought patient JD at POC (Philippine Orthopaedic Center)
for consultation. According to JM, patient JD was diagnosed of incomplete
undisplacement supracondylar left humerus. The Doctor ordered to put a cast
to patient JDs left arm.
One day prior to admission
According to JM, she have noticed that the affected site is swelling and
redness was seen. According to JM, patient JD was complaining of pain on
his left arm and has fever with the temperature of 39C which makes JM
decided to consult again for treatment. According to JM she was advised to
admit patient JD at POC.
II. Family History
According to JM (patient JDs mother) two of his husbands brother has
diabetes.
According to JM (patient JDs mother) both of paternal and maternal line
there were no family history of pyomyositis, hypertension, tuberculosis,
except for diabetes which patient JDs paternal line have.
III. Medical History
According to JM, when patient JD suffered from fever and cough patient
takes over the counter drugs like paracetamol, biogesic, patient JD had
cough, colds and fever but is only hospitalized once (now due to pyomyositis).
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According to JM, patient JD has no allergies on medications and drugs.
JM also added that patient JD has no allergies to any kinds of foods.
Chapter V
Physical Assessment

Date assessed: May 2, 2014
BMI: 14 (underweight)
General Survey
Patient JD is not in distress and is in a calm psycho-emotional state. Body built of patient
JD is ectomorph. His gait is coordinated and smooth. Speech is intact and coherent while level
of consciousness is alert. Dress/grooming is fair.
Skin
Inspection reveals evenly pale skin tones without unusual or prominent discolorations.
Client has no odor on perspiration. Skin is normally thin with good skin turgor and warm
temperature.
Head and Face
Upon inspection the head is symmetric, round, erect and in midline. No lesions are
visible. The face is symmetric with a round oval, elongated, no facial wrinkles and no abnormal
movements noted.
Upon palpation the head is hard, smooth and without lesions. The temporal artery is
elastic and not tender.
Neck
Upon inspection the neck is symmetric with head centered and without bulging masses.
Thy thyroid cartilage, cricoid cartilage and thyroid gland move upward symmetrically as the
clients swallows. C7 is usually visible and palpable. Neck is in full range of motion.
Upon palpation trachea is in midline.
Eyes
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Upon inspection eyelids is in normal position with no abnormal widening. No redness,
discharge, or crusting noted on lid margins. Conjunctiva and sclera appear moist and smooth.
Eyeballs are symmetrically aligned in socket without protruding. No redness over
lacrimal gland. Irises are round, flat and evenly colored. Pupils are equal in size and reactive to
light and accommodation. Pupils converge evenly.
Upon palpation lacrimal punctum is visible without swelling.
Ear
Upon inspection the ears are equal in size bilaterally, auricles aligned with the corner of
each eye within a 10-degree angle of vertical position. Skin smooth, with small amount of moist
yellow cerumen in external canal ,no lesions, no lumps, no discharge.
Mouth
Upon inspection lips are pink, smooth and moist without lesions. Buccal mucosa is pink,
moist and without exudate. Parotid ducts visible with no redness or swelling. Varicose veins on
the ventral surface of the tongue present. With equal bilateral strength in tongue.
Nose
Upon inspection nose is smooth and symmetric. Able to sniff and blow through each
nostril. No purulent discharge noted. Frontal and maxillary sinus trans illuminate and are non-
tender to palpation and percussion.
Thoracic and Lungs
Scapulae are symmetric and non-protruding shoulders. Scapulae are at equal horizontal
positions. Chest expansion symmetric. No retracting of intercostal spaces. No pain or
tenderness noted on palpation.
Percussion tones resonant over all lung fields. Vesicular breath sounds auscultated over
lung fields. No adventitious sounds present.
Heart and Neck Vessel
Upon auscultation of the carotid arteries there is no bruits or other sound heard. Pulses
are equally strong. Apical heart rate auscultated, 87 beats/min, regular rhythm, S1 heard best at
apex, S2 heard best at base. No S3 or S4 auscultated. No splitting of heart sounds or murmur
noted.
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Peripheral Vascular Assessment
Arms are equal in size, no swelling, pinkish skin tone, no clubbing of fingertips, warm
bilaterally. Capillary refill time less than 2 seconds, radial and brachial pulses strong bilaterally.
Legs are warm bilaterally, nontender inguinal lymph nodes palpated, femoral, popliteal, dorsalis
pedis, and posterior tibial pulses strongly palpated bilaterally. No apparent varicosities.
Abdomen
Upon inspection, patient has distended abdomen, skin of abdomen is free of striae,
scars, lesions, or rashes. Umbilicus is midline. Abdomen is flat and symmetric with no bulges or
lumps. Upon auscultation, soft click and gurgles heard at a rate of 17 per minute.
Upon percussion, percussion reveals generalized tympany over all four quadrants. No
tenderness or guarding in any quadrant with light palpation.
Upon palpation, no masses palpated. Umbilicus and surrounding area free of masses,
swelling, and bulges.
Upper and Lower Extremities
Upon inspection, both side of the body are equal in size. Upper left arm has long arm
posterior mold. Upper right arm, lower right leg and lower left leg has full ROM. Upper left arm
has limited ROM with muscle strength of right arm: 5/5; right leg: 5/5; left arm: 2/5; left leg:0/5.









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Chapter VI
Gordons Functional Health Pattern

Health Perception Health Management
According to JM (mother of patient JD) patient JD doesnt have problem in sight,
hearing, touch, smell and taste. According to JM, she takes OTC meds and patient JD takes it in
times of illnesses such as cough, colds, fever and other common illnesses. According to JM,
patient JD has no allergies on medications and drugs. JM also added that patient JD has no
allergies to any kinds of foods.
Nutrition Metabolism
Before hospitalization
According to JM, patient JD eats anything, especially biscuits, cereals, green
leafy vegetable and his favorite candy is potchi and jelly ace. Patient JD has a good appetite.
According to JM patient JD drinks 1 glass of milk (lactum) everyday and 4 glasses of water a
day.
During hospitalization
According to JM, patient JD has poor appetite he only eats a slice of cake, cup
of rice, drink 2 glasses of milk (lactum) per day and 2 glasses of water a day.
Elimination
Before hospitalization
According to JM, patient JD defecates 1-2 times a day with well formed, brown
stools. He urinates 3 times a day with clear, yellowish colored urine and has no problem in
elimination.
During hospitalization
According to JM, patient JD has an absent of bowel elimination 4 days prior to
admission while urination increased due to increased fluid intake.
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Activity-Exercise
Before hospitalization
According to JM, patient JD does his exercise by playing and dancing. He also
take a walk around in their house.
During hospitalization
According to JM, patient JD he only moves his lower extremities and his upper
right arm.
Sleep Rest
Before hospitalization
According to JM, patient JD was able to consume 8 hours sleeping time and had
a schedule of nap twice a day.
During hospitalization
According to JM, patient JD takes a nap 20-30 minutes 3 times a day and at
night she only sleeps 3-4 hours.
Roles and Relationship
According to JD he has lots of friends in school even in their community. He always
plays basketball and he loves to play with his dog.
Values Beliefs
According to patient JD the most important thing on his life was his mother patient JD
give value to it.




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Chapter VII
Anatomy and Physiology

The humerus is the long bone in the upper arm, located between the elbow joint and the
shoulder. At the elbow, it connects primarily to the ulna, as the forearms radial bone connects
to the wrist. At the shoulder, the humerus connects to the body through the scapula. The
humerus bone is the home of many muscular insertion and origination points, including the
deltoid, the pectoralis major, and many others. The brachial artery travels most of the bones
length, before it subdivides into the ulnar and radial arteries at the elbow. In the upper arm, the
brachial branches into several arteries, transiting oxygenated blood from the lungs and heart.
The radial nerve runs a similar course over the bone and into the forearm. Because it connects
at the shoulder with a rotational joint, the humerus is instrumental in supporting many of the
arms functions, including all lifting and physical activities. Since the humerus is one of the
longest bones in the body, it is one of the most commonly broken or fractured.













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Fall
Predisposing factor:
- family history of diabetes
-tropical country
Precipitating factor:
- BMI: 14 (underweight)

Inflammatory response Trauma
Vascular response
[Cite your source here.]
Vasodilatio
n
Chemical response
Systemic response
[Cite your source here.]
Pain
Redness
Heat
Leukocytosis
infiltration
PR & RR
ESR
Fever
Abscess formation
Pyomyositis



Chapter VIII
Path
ophy
siolo
gy


















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Chapter IX
Laboratory and Diagnostic
Date: April 24,2014




Laboratory test

Normal values

Actual Result
Interpretation

Hemoglobin mass

122-183 g/L


121

normal

Hematocrit

0.37-0.54

0.34
normal

Leukocyte count

122-183 g/L

21.33
.
High leukocyte count
due to bacterial infection
Differential count
Segmenters




Lympocytes



Monocytes
Eosinophils


Basophil


0.50-0.70




0.20-0.40



0.00-0.07
0.00-0.05


0.00-0.02

0.68




0.20



0.07
0.05


- Low
segmenters
caused by
antibiotics.

- High
lymphocytes
due to bacterial
infection
- Normal
- High Eosinophil
due to bacterial
infection


Platelet count


150-400 x 10/L

598


High platelet count due
to bacterial infection



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Date: April 29,2014


Gram Stain

Laboratory test

Normal values

Actual Result
Interpretation

Hemoglobin mass

122-183 g/L


124

normal

Hematocrit

0.37-0.54

0.37
normal

Leukocyte count

122-183 g/L

12.09
.
normal
Differential count
Segmenters




Lympocytes



Monocytes
Eosinophils


Basophil


0.50-0.70




0.20-0.40



0.00-0.07
0.00-0.05


0.00-0.02

0.41




0.46



0.06
0.07


- Low
segmenters
caused by
antibiotics.

- High
lymphocytes
due to bacterial
infection
- Normal
- High Eosinophil
due to bacterial
infection


Platelet count


150-400 x 10/L

757


High platelet count due
to bacterial infection



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Result
RBC= few; WBC= +; Gram positive cocci in singly= +; no spore seen



























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