osteomyelitis

Question 1

patho of osteomyelitis

Answer 1

Infection in bone caused by bacteria (most often), viruses, parasites, or fungi. The infection may be acute or chronic. Invasion by one or more pathogenic organisms, stimulates the inflammatory response in bone tissue. The inflammation produces an increased vascular leak and edema, often involving the surrounding soft tissues.

Question 2

3 different categoris of osteomyelitis

Answer 2

• exogenous
• endogenous
• continguous

Question 3

exogenous

Answer 3

( outside of body)infectious organisms enter from outside the body as in open fracture or after surgery

Question 4

endogenous

Answer 4

( inside body) infectious organisms are carried by the blood stream from other area of infection in the body

Question 5

continguous

Answer 5

bone infection results from skin infection of adjacent tissue

Question 6

acute osteomyelitis

Answer 6

• Fever, temp usually above 101F
• Swelling around the affected area
• Possible erythema and heat in affected area
• Tenderness of the affected area
• Bone pain that is constant, localized, and pulsating, and worsens with movement
• At risk for sepsis: blood cultures and than antibiotics

Question 7

chronic osteomyelitis

Answer 7

• Treatment is delayed
• Foot ulcers or bone surgery
• Sinus tract formation: tract of infection leading up the bone
• Localized pain
• Draining from the affected area
• Intermittent with flare up

Question 8

risk factors for osteomyelitis

Answer 8

Diabetes mellitus
Severe atherosclerosis
MRSA infection
Elderly
Skin ulceration or other wounds
Recent Surgery
Iv drug user 
Pneomonia
Uti 
Contingious oa from the ulcer wound

Question 9

wbc normal range

Answer 9

4.5-11

Question 10

wbc clinical significance

Answer 10

18.5

elevated due to infection

Question 11

erythrocyte sedimentation rate (ESR)

Answer 11

0-20 mm/hr

Question 12

ESR clinical significance

Answer 12

24 mm/hr
faster than normal rate may indicate inflammation in the body
Starts slightly elevated and rises with more infection

Question 13

find no advanced directivies. what is your responsibility

Answer 13

Ask the patient if he has an existing advanced directive. If the patient does not have one or does not know what it is, you should educate the patient about what it is and why it is necessary. Put a plan in place before the patient’s surgery, and if the patient does not want an advanced directive, respect his wishes.

Question 14

E.B. asks you “What do they do with my leg after it is removed?” How do you respond?

Answer 14

It’s your choice on what you wish to happen after it is amputated. Some cultures decide to have the amputation stored for later burial or buried immediately. Other times, it can be donated for scientific research, or sent to biohazardous waste and is cremated.
Culturally component nursing care

Question 15

not undergoing an AKA what would be the nonsurgical management for a patient with osteomyelitis?

Answer 15

4-6 weeks of antimicrobial therapy, more than 1 antimicrobial may be prescribed, it is important that the medication to be given at the specifically prescribed times to maintain therapeutic serum levels

• Central lines for infusion therapy
• Hypobaric oxygen therapy: extreme high concentration of oxygen. Oxygen diffuse in bone to help with healing process

Question 16

rationale for orders:

• Contact Precautions-
• Continue Zosyn 3.375g IV q6h
• 0.9% NS 125mL/hr
• Lispro Sliding Scale Insulin AC/HS:
• Insulin Glargine 40 units HS:
• Hydromorphone 0.5mg q2h IV-
• Titrate 02 >92%:
• Finger Stick Blood Glucose AC/HS:
• Elevate stump for 48 hours-
• Then lie patient prone (on belly) for 15 minutes, four times a day
• Reinforce dressing only

Answer 16

Contact Precautions- Positive for MRSA

• Continue Zosyn 3.375g IV q6h - help treats infection
• 0.9% NS 125mL/hr- maintain fluid and electrolyte
• Lispro Sliding Scale Insulin AC/HS: rapid Diabetes Type II
• Insulin Glargine 40 units HS: long Diabetes Type II
• Hydromorphone 0.5mg q2h IV- pain control
• Titrate 02 >92%: titrate O2 level to maintain O2 saturation >92%. Perfusion of oxygen to wound
• Finger Stick Blood Glucose AC/HS: Blood Glucose Monitoring
• Elevate stump for 48 hours- decrease inflammation and prevention of blood clots. After 48hr dont elevate due to contractors
• Then lie patient prone (on belly) for 15 minutes, four times a day: stretch hip muscles, and avoid abduction contractures, tendons and ligaments shorten, muscle contractor: leg will rise and have a contractor
• Reinforce dressing only- reinforce the area by covering it with another dressing. Label it “reinforcement” and write the date, time, and your initials on it. First dressing done by surgeon. May increase inflammation if you do not wrap it as tight

Question 17

interventions for healing a stump

Answer 17

• Promote mobility as tolerated
• Assess for adequate tissue perfusion and hemorrhaging (pinkish color, warm but not hot)
• Vital signs, specifically pulses near the amputation site
• Monitor and treat pain
• Assess psychosocial needs (body image issues)
• Maintaining a healthy diet
• Exercise

Question 18

postoperative assessment for stump

Answer 18

• Assess for skin irritation, breakdown, signs of infection, color, temperature, pulse, ROM of hip, drainage, warmth,
• Document the patient’s neuromuscular status including: pain, movement, sensation, warmth, temperature, distal pulses, and capillary refill

Question 19

On the evening of the first postoperative day, E.B. becomes more awake and begins to complain of pain. He states “My right leg is really hurting; how can it hurt so bad if it’s gone?” What is your best response?

a. “That is a side effect of the medication.”
b. “You can’t be feeling that because your leg was amputated.”
c. “Don’t worry, that sensation will go away in a few days.”
d. “Are you able to rate the pain on a scale of 0 to 10?”

Answer 19

D

Question 20

phantom limb pain

Answer 20

Phantom limb pain, although the limb is gone the nerve endings at the site of the amputation continue to send pain signals to the brain that make the brain think the limb is still there. Finding a treatment to relieve phantom pain can be difficult. Doctors usually begin with medications such as over-the-counter pain relievers, antidepressants, anticonvulsants, narcotics, NMDA receptor antagonists. Doctors may then add noninvasive medical therapies such as mirror box, acupuncture, repetitive transcranial magnetic stimulation, spinal cord stimulation. Surgery may be an option if other treatments haven’t helped, the only surgical option is brain stimulation.

Question 21

saftey at home for stump

Answer 21

• Make sure there’s enough space to move around with a wheelchair, and limit obstacles around the house (throw rugs, stairs, etc)
• Ensure access to important locations such as bathroom and kitchen
• Make modifications to house to allow access with wheelchair