Exam 2: Osteomyelitis

A patient develops flushing, rash, and pruritus during an IV infusion of vancomycin [Vancocin]. Which action should a nurse take? 1.Reduce the infusion rate. 2.Administer diphenhydramine [Benadryl]. 3.Change the IV tubing. 4.Check the patency of the IV.

1 red man syndrome develops from vancomycin being infused too rapidly

what is the most important when teaching a parent about preventing osteomyelitis 1. parents can stop worrying about bone infection once their child reaches school age 2. parents need to clean open wounds thoroughly with soap and water 3. children will always get a fever if they have osteomyelitis 4. children should wear long pants when playing outside because their legs might get scratched

2 bc bacteria from an open wound can lead to osteomyelitis, thorough cleaning with soap and water is best prevention

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? 1- Wound packing 2- Wound irrigation 3- Vitamin supplements 4- Surgical debridement

4

A patient with diabetes is attending a class on the prevention of associated diseases.What action should the patient perform to reduce the risk of osteomyelitis? A) Increase calcium and vitamin intake. B) Perform meticulous foot care. C) Exercise 3 to 4 times weekly for at least 30 minutes. D) Take corticosteroids as ordered.

Ans: Perform meticulous foot care.Feedback:Diabetic foot ulcers have a high potential for progressing to osteomyelitis. Meticulous foot care can help mitigate this risk. Corticosteroids can exacerbate the risk of osteomyelitis. Increased intake of calcium and vitamins as well as regular exercise are beneficial health promotion exercises, but they do not directly reduce the risk of osteomyelitis.

Following a knee replacement surgery, a nurse's next door neighbor asks, "I don't think I am healing right. Can you come look at my knee?" Upon assessment, the nurse notices the client is warm to touch and has a fever; the incision is inflamed and not well approximated with foul-smelling drainage around the incision line. At this point, the nurse tells the client she needs to go see her surgeon because the client may have: a. Contaminated the wound with MRSA b. Osteomyelitis c. An abscess in the pocket of the incision d. Potential bone cancer

b. Osteomyelitis Explanation:Osteomyelitis after trauma or bone surgery usually is associated with persistent or recurrent fever, increased pain at the operative or trauma site, and poor incisional healing, which often is accompanied by continued wound drainage and wound separation. Prosthetic joint infections often present with joint pain, fever, and cutaneous drainage. There is no indication the client has developed a bone cancer.

A client has developed osteomyelitis and asks the health care provider how the problem occurred. Which response is most accurate? a. Deficiency of calcium b. Rheumatoid disease c. Excessive vitamin intake d. Direct contamination of an open wound

d.(Osteomyelitis represents an acute or chronic infection of the bone and marrow. All types of organisms—including parasites, viruses, bacteria, and fungi—can cause osteomyelitis, but certain pyogenic bacteria and mycobacteria are the most common. Organisms may reach the bone by seeding through the bloodstream (hematogenous spread), direct penetration or contamination of an open fracture or wound (exogenous origin), or extension from a contiguous site. Vitamin intake or deficiency will not cause infection.)

In which order will the nurse implement these collaborative interventions prescribed for a patient being admitted who has acute osteomyelitis with a temperature of 101.2° F? (Put a comma and a space between each answer choice [A, B, C, D].) a. Obtain blood cultures from two sites. b. Send to radiology for computed tomography (CT) scan of right leg. c. Administer gentamicin (Garamycin) 60 mg IV. d. Administer acetaminophen (Tylenol) now and every 4 hours PRN for fever

ANS:A, C, D, BThe highest priority for possible osteomyelitis is initiation of antibiotic therapy, but cultures should be obtained before administration of antibiotics. Addressing the discomfort of the fever is the next highest priority. Because the purpose of the CT scan is to determine the extent of the infection, it can be done last

the parents of a child diagnosed with osteomyelitis asks how the child acquired the illness. which is the nurses best response 1. direct inoculation of the bone from stepping barefoot on a sharp stick 2. an infection from a scratched mosquito bite carried the infection through the bloodstream to the bone 3. the blood supply to the bone was disrupted bc of the childs diabetes 4. an infection of the URT

2 infection through the bloodstream is the most likely cause of osteomyelitis in a child

After several weeks of antibiotic therapy for the treatment of osteomyelitis, a patient is preparing for discharge. When providing health education related to self-care, the nurse should emphasize which of the following topics? 1- The need to avoid ASA and anticoagulants 2- The need to resume normal physical activity as soon as possible 3- The importance of maintaining a healthy diet 4- The importance of adhering to further antibiotic treatment

4

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? 1- Osteomalacia 2- Ganglion 3- Osteomyelitis 4- Paget disease

4

Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis? 1- Thrombocytopenia and ecchymosis 2- Pruritus and uremic frost 3- Petechiae over the chest and abnormal ABGs 4- Leukocytosis and localized bone pain

4

A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis? 1- Proteus 2- Pseudomonas 3- Salmonella 4- Staphylococcus aureus

4 D. Staphylococcus aureus- S. aureus causes over 50% of bone infections. Proteus, Pseudomonas, and E. coli are also causes, but to a lesser extent.

Which of the following clients should the nurse recognize as being at the highest risk for the development of osteomyelitis? A. A middle-age adult who takes ibuprofen daily for rheumatoid arthritis B. An elderly client with an infected pressure ulcer in the sacral area C. A 17-year-old football player who had orthopedic surgery 6 weeks prior D. An infant diagnosed with jaundice

B Clients who are at high risk of osteomyelitis include those who are poorly nourished, elderly, and obese. The elderly client with an infected sacral pressure ulcer is at the greatest risk for the development of osteomyelitis, as this client has two risk factors: age and the presence of a soft-tissue infection that has the potential to extend into the bone. The client with rheumatoid arthritis has one risk factor and the infant with jaundice has no identifiable risk factors. The client 6 weeks postsurgery is beyond the usual window of time for the development of a postoperative surgical wound infection.

A 49-year-old man with a history of poorly controlled type 1 diabetes has developed osteomyelitis adjacent to a chronic diabetic ulcer on his great toe. The patient has been informed that medical treatment for osteomyelitis requires a longer course of antibiotics than most other infections because: 1- Osteomyelitis is usually caused by simultaneous infection with several microorganisms, which must be treated sequentially. 2- Osteomyelitis requires treatment with topical antibiotics rather than IV antibiotics, necessitating a longer course of treatment. 3- Osteomyelitis is usually the result of fungal infection rather than bacterial infection. 4- Osteomyelitis involves the active infection of bone tissue, which is largely avascular.

4- Osteomyelitis involves the active infection of bone tissue, which is largely avascular.

A patient with osteomyelitis is to receive vancomycin (Vancocin) 500 mg IV every 6 hours. The vancomycin is diluted in 100 mL of normal saline and needs to be administered over 1 hour. The nurse will set the IV pump for how many mL/minute? (Round to the nearest hundredth.)

ANS:1.67To administer 100 mL in 60 minutes, the IV pump will need to provide 1.67 mL/minute.

The nurse is caring for a client who states that he is suddenly having severe pain at a leg fracture site. The nurse notes increased swelling in the limb and difficulty palpating a pulse. The nurse suspects that the client may have which of the following? a. Compartment syndrome b. Fracture blisters c. Reflex sympathetic dystropy d. Hematogenous osteomyelitis

a. Compartment syndromeExplanation:The hallmark symptom of acute compartment syndrome is severe pain out of proportion to the original injury. One of the most important causes of compartment syndrome is bleeding and edema caused by fractures and bone surgery. Edema or swelling may make it difficult to palpate a pulse. Reflex sympathetic dystrophy, while characterized by pain out of proportion to the injury, does not exhibit decreased pulses. Fracture blisters are areas of epidermal necrosis with separation of epidermis from the underlying dermis by edema fluid. They are a warning sign of compartment syndrome. Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the blood stream.

The nurse is caring for a client diagnosed with osteomyelitis. Which mechanism of the disease process can result in necrosis of the bone?1. Devascularization 2. Infection of the bone 3. Decreased bone mass 4. Decreased bone density

1

A nurse is completing discharge teaching for a client who had a wound debridement for osteomyelitis. Which of the following should the nurse include in the teaching? A. Antibiotic therapy should continue for 3 months. B. Relief of pain indicates the infection is eradicated. C. Airborne precautions are used during wound care. D. Expect paresthesia distal to the wound.

a

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? "You need to perform weight-bearing exercises twice a week." "You need to limit the amount of protein and calcium in your diet." "Use your continuous passive motion machine for 2 hours each day." "You will receive IV antibiotics for 3 to 6 weeks."

"You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks. Continuous passive range of motion is used for clients with osteoarthritis. Weight-bearing exercises are used with clients who have osteoporosis. Limiting protein and calcium is not part of the plan of care for clients with osteomyelitis.

A hospitalized client has been diagnosed with osteomyelitis of the left tibia. The nurse understands that this condition is most likely to be a result of which events in the client's recent history? 1. Sprained left ankle 2. Decreased calcium intake 3. Open trauma to the left leg 4. Starting to smoke cigarettes

3

A patient is receiving vancomycin [Vancocin]. The nurse identifies what as the most common toxic effect of vancomycin therapy?1.Ototoxicity 2.Hepatotoxicity 3.Renal toxicity 4.Cardiac toxicity

3 renal toxicity (aka nephrotoxicity)

The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? 1- Avascular necrosis 2- Fat embolism 3- Osteomyelitis 4- Compartment syndrome

3- Osteomyelitis

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure? Withholding all oral intake Administering large doses of I.V. antibiotics as ordered Administering large doses of oral antibiotics as ordered Instructing the client to ambulate twice daily

Administering large doses of I.V. antibiotics as ordered Explanation: Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited.

A nurse is collaborating with the physical therapist to plan the care of a patient with osteomyelitis. What principle should guide the management of activity and mobility in this patient? stress on the weakened bone maintenance of baseline ADLS bed rest

Ans: Stress on the weakened bone must be avoided.Feedback:The patient with osteomyelitis has bone that is weakened by the infective process and must be protected by avoidance of stress on the bone.This risk guides the choice of activity in a patient with osteomyelitis. Bed rest is not normally indicated, however. Maintenance of prediagnosis ADLs may be an unrealistic short-term goal for many patients.

The client develops osteomyelitis that has originated from infectious organisms that reach the bone through the bloodstream. This is known as which type of osteomyelitis? a. Hematogenous b. Vascular insufficiency c. Chronic d. Direct penetration

a.(Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the bloodstream. The other types are not caused by infectious organisms in the bloodstream.)

A 56 year-old male is obese and has poorly-controlled type 2 diabetes mellitus. The home care nurse who changes the dressing on his chronic foot ulcer three times weekly has noted that the client's bone is now visible in the wound bed. The client has a fever and has not complained of any notable increase in pain to his foot. Which of the following statements best captures what is likely occurring? 'a. The client is possibly experiencing direct penetration osteomyelitis in which microorganisms have entered through his foot wound. b. Infectious microorganisms in his blood supply have proliferated in the distal portions of his skeletal system. c. Vascular insufficiency has contributed to infection in both soft tissue and now his bone.' d. His immunocompromised status associated with diabetes has allowed skin flora to penetrate his foot bone via the surface wound.

c. Vascular insufficiency has contributed to infection in both soft tissue and now his bone.Explanation:Diabetes is strongly associated with vascular insufficiency; this process is more likely than infection from the bloodstream, and his situation is not indicative of direct penetration osteomyelitis. Decreased immune status is not directly responsible for his problem.

A patient is diagnosed with osteomyelitis of the right leg. What signs and symptoms does the nurse recognize that are associated with this diagnosis? - pain - erythema - sob - fever - low blood pressure

pain, erythema in the right leg, and fever

The nurse is caring for a client diagnosed with osteomyelitis. Which data noted in the client's record are supportive of this diagnosis? Select all that apply. 1. Pyrexia 2. Elevated potassium level 3. Elevated white blood cell count 4. Elevated erythrocyte sedimentation rate 5. Bone scan impression indicative of infection

1. Pyrexia (aka fever), 3, 4, 5

The nurse is caring for a client who sustained an open fracture and is diagnosed with acute osteomyelitis of the right lower extremity. Which intervention should the nurse plan to perform? 1. Apply ice to the affected area. 2. Perform sterile dressing changes. 3. Instruct the client on leg exercises. 4. Measure the leg circumference daily.

2

] Which assessment finding for a patient who has had a surgical reduction of an open fracture of the right radius is most important to report to the health care provider? a. Serous wound drainage b. Right arm muscle spasms c. Right arm pain with movement d. Temperature 101.4° F (38.6° C)

ANS: D An elevated temperature is suggestive of possible osteomyelitis. The other clinical manifestations are typical after a repair of an open fracture

An 80-year-old man in a long-term care facility has a chronic leg ulcer and states that the area has become increasingly painful in recent days. The nurse notes that the site is now swollen and warm to the touch. The patient should undergo diagnostic testing for what health problem? Osteomalacia Osteomyelitis Septicarthritis Osteoporosis

Ans: Osteomyelitis Feedback:When osteomyelitis develops from the spread of an adjacent infection, no signs of septicemia are present, but the area becomes swollen, warm, painful, and tender to touch. Osteoporosis is the most prevalent bone disease in the world. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Septicarthritis occurs when joints become infected through spread of infection from other parts of the body (hematogenous spread) or directly through trauma or surgical instrumentation.

A patient with diabetes has been diagnosed with osteomyelitis. The nurse notes that the patient's right foot is pale and mottled, cool to touch, with a capillary refill of greater than 3 seconds. The nurse should suspect what type of osteomyelitis? Contiguous Hematogenous Osteomyelitis w vascular insufficiency Osteomyelitis with muscular deterioration

Ans: Osteomyelitis with vascular insufficiency Feedback:Osteomyelitis is classified as hematogenous osteomyelitis (i.e., due to blood-borne spread of infection); contiguous-focus osteomyelitis, from contamination from bone surgery, open fracture, or traumatic injury (e.g., gunshot wound); and osteomyelitis with vascular insufficiency, seen most commonly among patients with diabetes and peripheral vascular disease, most commonly affecting the feet. Osteomyelitis with muscular deterioration does not exist.

The nurse recognizes that the client with osteomyelitis is at risk for: Bone abscess formation Congestive heart failure Fever Diabetes

Bone abscess formation Fever is a symptom of acute osteomyelitis but not the greatest risk. Diabetes is a risk factor for Osteomyelitis.

A nurse is administering IV vancomycin to a patient. The nurse knows a side effect that is unique to vancomycin is:' 1. Retinal toxicity 2. Neurotoxicity 3. Respiration depression 4. Red man syndrome

Correct answer: 4 Rationale: When administered too quickly through an IV, vancomycin is known to cause red man syndrome. Red man syndrome is characterized by flushing, hypotension, and rash on face, neck, back, and arm

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Farenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which of the following complications? a) Osteomyelitis b) Hypovolemic shock c) Atelectasis d) Urinary retention

Hypovolemic shock Explanation:Indicators of hypovolemic shock include a heart rate greater than 100 beats per minute, a blood pressure less than 90/60 mm Hg, and urine output less than 30 ml per hour.

A variety of complications can occur after a leg amputation. All of the following are possibilities in the immediate postoperative period, except? a) Hemorrhage b) Osteomyelitis c) Infection d) Hematoma

Osteomyelitis Explanation:Chronic osteomyelitis may occur after persistent infection in the late postoperative period. Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period.

Which term refers to a disease of a nerve root? Radiculopathy Involucrum Sequestrum Contracture

Radiculopathy Explanation: When the client reports radiating pain down the leg, the client is describing radiculopathy. Involucrum refers to new bone growth around the sequestrum. Sequestrum refers to dead bone in an abscess cavity. Contracture refers to abnormal shortening of muscle or fibrosis of joint structures.

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing? Wound irrigation Vitamin supplements Wound packing Surgical debridement

Surgical debridement Explanation: In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.

An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with Clindamycin Vancomycin Ceftriaxone Tylenol

Vancomycin

A pt who experienced an open fracture of the humerus 2 weeks ago is having increased pain at the fracture site. To identify a possible causative agent of osteomyelitis at the site, what should the nurse expect testing to include? a. x-rays b. CT scan c. bone biopsy d. WBC count and erythrocyte sedimentation rate (ESR)

c. a, b, and d are all ways to diagnose osteomyelitis. A bone biopsy or blood culture can help determine the causative agent of the osteomyelitis

ATI: a nurse is discussing the plan of care with a client who has osteomyelitis of an open wound on his heel, which of the following information should the nurse include? you will need to apply a cold pack to the site 3x a day your provider might ask you to walk frequently to increase circulation to the area you will need to limit your consumption of high protein foods your provider might prescribe a central catheter line for long term antibiotic therapy

d - rationale osteomyelitis is an acute or chronic bone infection; the client will require weeks to months of IC antibiotic therapy for treatment, therefore the nurse should discuss the need for long term IV access for antibiotic therapy

The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which nursing diagnosis is appropriate for the client? Select all that apply - Acute pain - Disturbed body image - Hair loss - Loss of appetite - Imbalanced nutrition: less than body requirements

• Acute pain• Disturbed body image• Imbalanced nutrition: less than body requirements