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Case Presentation Osteomylitis
Case Presentation Osteomylitis
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: 1124-1934 Data of Admission: 01-302012 Diagnosis: CHRONIC OSTEOMYELITIS, HUMERUS R S/P OR PLATING
2.
PHYSICAL ASSESSMENT
A. GENERAL SURVEY
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.
Gordons 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
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 12 per day. Bladder Habits frequent color clear Abdomen firm & symmetry
4. ACTIVITY EXERCISE
A. 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-REST
Usual sleeping habits: 8 hrs per night 1 hr am nap & 1 hr pm nap
6.COGNITIVE PERCEPTUAL
LOC: 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-CONCEPT Appearance: 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-RELATIONSHIP PT. live with his live in partner and children Support system: partner and children Occupation: auto electrician Concerns about illness: I cant go back to work 9. SEXUALITY-REPRODUCTIVE History of prostate problem: none History of penile discharge; none
11. VALUE-BELIEF
Religion:Roman Catholic Religious Practices: occasional, visit calabanga church once a month.
Appendicular Skeleton
HUMERUS
PATHOPHYSIOLOGY
Bone Injury
Internal Fixator -plate Infection: -edema -pus -vascular congestion -small vessel thrombosis
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
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
Recent research suggests that patients with elevated basal levels of CRP are at an increased risk of diabetes, hypertension an d 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
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
MEDICATION
I:
CEFAZOLIN
1g,TIVT q 8hrs A: Bind to bacterial cell wall
membrane, causing cell death.
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
RANITIDINE
50 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.
AR:
CNS: Confusion, dizziness, drowsiness,
hallucinations, headache
LOCAL:Pain at IM site
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.
Interdependence Mode
(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
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 persons 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