This action might not be possible to undo. Are you sure you want to continue?
He was admitted on November 19, 2010 at Armed Forces of the Philippines Medical Center. He had severe injuries on his left lower extremity. Patient was immediately brought to a private hospital wherein Xray done. The xray showed fracture of the left tibia and fibula. Patient underwent scenes of operations, which he tolerated well without any transverse affect. His initial diagnosis was Chronic Osteomyelitis, tibia , left, resolved, non-union fibula, left; infected wound at left iliac area. As student nurses, we will study this case in order to be familiar with the manifestations of Osteomyelitis and how we will able to help the patient to be independent in performing activities of daily living within capabilities. Pathophysiology Over 50% of bone infections are caused by Staphylococcus aureus. Other pathogens that are frequently found in osteomyelitis include gram-positve organisms that include streptococci and enterococci, followed by gram-negative bacteria that include Pseudomonas species. The initial response to infection is inflammation, increased vascularity, and edema. After 2 or 3 days, thrombosis of the local blood vessels occurs, resulting in ischemia with bone necrosis. The infection extends into the medullary cavity and under the eriostemon and may spread into adjacent soft tissues and joints. Unless the infective process is treadted promptly, a bone abscess forms. The resulting abscess cavity contains dead bone tissue, which does not easily liquefy and drain. Therefore, the cavity cannot collapse and heal, as it does in soft tissue abscesses. New bone growth forms and surrounds the squirm. Although healing appears to take
place. The area is swollen. taking months or even years to develop. pulsating pain that intensifies with movement as a result of the pressure of the collecting purulent material. Nursing Physical Assessment . The infected area becomes painful. leaving a pocket of infected material dormant within an abscess lined by cortical bone. The presence of a Brodie¶s abscess on X-ray increases the risk of repeat infections. The patient with chronic osteomyelitis presents with a nonhealing ulcer that overlies the infected bone with a connecting sinus that will intermittently and spontaneously drain pus. and tender to touch. painful. The high risk of bone and soft tissue destruction requiring extensive surgery and long-term therapy indicates the need for patients to be referred to specialist centers for treatment. As the infection extends through the cortex of the bone. there are no symptoms of sepsis. occurring often with the clinical and laboratory manifestations of sepsis. the onset is usually sudden. When the infection is blood borne. The systemic symptoms at first may overshadow a=the local signs. and extremely tender. it involves the eriostemon and the soft tissues. a chronically infected sequestrum remains and produces recurring abscessess throughout the patient¶s life. if clinical signs persist after 10 days and there is an associated bone necrosis. warm. swollen. The abscess forms when an infected area is partly overcome by the body¶s defences. It is diagnosed when there is a relapse of a previously treated or untreated infection. The onset of chronic osteomyelitis may be insidious. The patient may describe a constant. When osteomyelitis occurs from spread of adjacent infection or from direct contamination.
and not in cardio respiratory distress. There is no sensor motor deficit. Pulses are full and equal. Patient¶s vital signs were 36. ESR was 15mm/hr. His height is 5¶5ft and weighs 170 lbs. Related Treatments The patient was requested to have an MRI (Magnetic Resonance Imaging) to reveal tissue edema. Also sensitivity test was done to eliminate resistant medications. Clidamycin. RBC and WBC count was normal. the patient was done an MRI on his left knee. There is pain. latreral tibial condyle. He has symmetrical chest expansion. and moist buccal mucosa. There is a minimal joint effusion. The patient has anicteric sclera. There was a light growth of Staphylococcus Aureus. There is also a 20cm vertical surgical scar on lateral aspect of leg. and Cloxacillin. which was found normal. Penicillin. clear breath sounds without restrictions. low signal foci. there is an infected wound with 1x1cm round with regular borders and bloody.M. coherent. 82 bpm for pulse rate. 110/80 mmgH for blood pressure. He was drug-resistant to Erythromycin. In this case. intercondylar region with cortical irregularities.I. and 20 bpm for respiratory rate. Vancomycin. tenderness and loss of motion on left lower extremity.5 degree Celsius for temperature. Blood culture and sensitivity was also done to reveal leukocytosis. and if the bone necrosis are evident. was conscious. pink palpebral conjunctiva. Positive bony deformity on left knee. areas of periosteal elevation. purulent discharge on left iliac area. It shows an altered configuration in the anterior aspect of the lateral femoral condyle. . and minimal edema in the bone marrow. On his left lower extremity. There are irregular shapes scar measuring 10x10 cm on anterior aspect of left leg.
Expected Outcome: Patient verbalizes relief or reduction in pain and appears comfortable. Nursing Diagnosis M. The patient¶s left lower extremity has an infected wound (1x1 cm. quality. Rationale: To assess the effectiveness of the treatment. and intensity of pain. he was done a would culture and detected a light growth of staphylococcus aureus. Nursing Diagnosis: Impaired mobility related to pain or discomfort due to the presence of wound. On 07 January 2011. or adhesives. his IV taken off and was given Ciprofloxacin 500mg tablets every 12 hours for 14 days. Rationale: Motion can aggravate pain. y Encourage patient to verbalize pain and discomfort. Use care and support when moving affected extremity. He has no allergies to latex. y . This shows an infection in his wound that needs to be controlled.On 19 November 2010. he was given Ciprofloxacin 400mg via IV OD. y Perform the prescribe treatment regimen for the underlying condition. with bloody. purulent discharged) on the left iliac area. Actions/Interventions: Immobilize limb. He has an internal fixator in the tibial diaphysis. round with regular borders.I nursing diagnosis is impaired physical mobility related to the pain or discomfort due to the presence of wound. Rationale: This aid the assessment of the location. After a few months. iodine. Observe for body language and facial grimace.
the nurse takes measures to ensure adequate circulation to the affected area (wound suction to prevent fluid accumulation. to maintain needed immobility. avoidance of pressure on the grafted area). intensive antibiotic therapy. Rationale: To reduce anxiety and promote compliance. With long-term. Rationale: To increase muscle tone. the nurse monitors the patient for signs of super infection. The nurse continues to monitor the general health and nutrition of the patient. . If surgery is necessary. y y Reposition patient every 2 hours. Rationale: To prevent skin breakdown.y Encourage the patient in active movements by using assistive devices. The nurse encourages adequate hydration as well. progress from passive as tolerated. elevation of the area to promote venous drainage. or infiltration. and to ensure the patient¶s adherence to weight. y Implement ROM exercises every shift after pain medication unless medically contraindicated. Encourage patient to verbalize feelings and concerns about his altered state of mobility.bearing restrictions. Rationale: This prevents muscle atrophy and joint contracture. infection. Nursing Intervention According to Brunner & Suddarths. the nursing intervention is monitoring the patient¶s response to the antibiotic therapy and observers the IV access site for evidence of phlebitis. The nurse changes dressings using aseptic technique to promote healing and to prevent crosscontamination. A diet high in protein promotes a positive nitrogen balance and healing.
The pain experienced will become chronic in nature.Evaluation Caring for a patient with chronic osteomyelitis posses a challenge for the nursing team. . The patient must understand the rationale for the activity restrictions. Improving physical mobility restrict activity. The patient can have a lenghtly hospital stay. The wounds are frequently very painful and the extremity must be handled with great care and gentleness. Recommendations The patient and family should be taught about the importance of strictly adhering to the therapeutic regimen of antibiotics and preventing falls or other injuries that could result in bone fracture. scarring or amputation of the affected limb. Elevation reduces swelling and associated discomfort. Pain is controlled with prescribed analgesic agents and other pain-reducing techniques. The affected part may be immobilized with a splint to decrease pain and muscle spasm. repeat admissions or required an extensive period of care at home. They can be faced with changes in their body image from the surgery. requiring different approaches to pain management to enable the patient to come with the potentially long-term condition and possible disability. The bone is weakened by the infective process and must be protected by immobilization devices and b avoidance of stress on the bone. The joints above and below the affected part should be gently moved through their range of motion.
BSN 3y3-4 07 February 2011 . Maycinth Katherine A. Barrio Submitted by: Austria.OUR LADY OF FATIMA UNIVERSITY MAIN CAMPUS ± VALENZUELA CITY CHRONIC OSTEOMYELITIS Submitted to: Ms. Rizza Marie A. Bacsa.
Chronic Osteomyelitis http://en. Volume II.org/wiki/Osteomyelitis Avigdor Heyroni.References Brunner & Suddarth 12th Edition. The New England of Journal of Medicine.wikipedia. Page 2069-2072. Wikipedia.html. Koplewitr. .merckmanuals. Chronic Osteomyelitis. MD and Benjamin Z.com/home/sec05/ch065/ch065b. Bone with Bone ± Chronic Osteomyelitis. http://www. Chronic Osteomyelitis. MD. MD. Steven Schmitt.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue listening from where you left off, or restart the preview.