osteomyelitis

A child with newly diagnosed osteomyelitis has nausea and vomiting. The parent wishes to give the child ginger cookies to help control the nausea. The nurse should tell the parent: A) "You can try them and see how he does." B) "I will need to get a prescription." C) "Your child needs medication for the vomiting." D) "We discourage the use of home remedies in children."

A

Events that can lead to osteomyelitis

-bone surgery -trauma -fractures -prosthetic implants -sepsis/septicemia

biopsy considerations

-done under general anesthesia, is extremly painful - done via throclear punch

risk factors

-long-term skin infections -poorly controlled diabetes -arteriosclerosis -hypertension -smoking -hypercholesteremia -impaired immune system -prosthetic joints -IV drug use -sickle cell anemia -cancer -rotten teeth

What general care principles for your nursing practice could protect a patient from osteomyelitis infection?

-non-touch aseptic technique -hand washing -following orders -clean environment -sterile technique

What procedures/situations would prevention provention interventions be most applicable?

-wound care -post-surgical care -orthopedic care -central line care -day to day patient interactions

CHRONIC

*

osteomyeltitis questions

**

what advantages do kids have over adults

- have better health status and less comorbities = less complications -bone is still growing -improved compliance because parents are responsible for their compliance

long term consequences can arise from osteomyelitis?

-Amputation -Immobility -Weakness -Pressure ulcers -general health decline -Repeat procedures, hospital admissions → Further risks?

surgical assessments to prevent infection

-Be alert: Monitor wounds closely -Are there tracts or fistulas?

acute diagnostics

-CT -biopsy -cultre and sensitivity

examples of antibitoics given

-Gentamicin chain placed into the defect and removed after seven days -IV cefuroxime and IV Fosfomycin (12 days) -16 days of PO amoxicillin and clavulanic acid

Signs/symptoms

-Localized bone pain -reduced ROM -red/hot/swelling locally -possibly pus overlying skin -muscle spasms -fever -malaise -excessive sweating -chills

medication for acute osteomyelitis

-antibitoics

route of antibiotics

-injected directly into site -IV -oral

A child is to receive IV antibiotics for osteomyelitis. Before the initial dose of antibiotics can be given, the nurse confirms that a blood sample for which test has been drawn? A) Creatinine B) Culture C) Hemoglobin D) White blood count

B

A child is being treated with vancomycin 40mg/kg/day IV divided into three doses for osteomyelitis. The healthcare provider has prescribed drug protocol management b pharmacy and a trough vancomycin level 30 minutes before the third dose scheduled for 0900. 0830 lab results: 7 mcg/mL Therapeutic range: 10-15 mcg/mL A) Administer the 0900 dose B) Notify the healthcare provider C) Notify the pharmacist D) Draw a peak drug level

C - pharmicits do dosing

surgial intercentions for acute osteomyelitis

Surgical debridement and curettage done while in OR for biopsy

CT consdierations

a CT without contrast may or may not show the damage, could need contrast → assess kidneys first

why is arteriosclerosis a risk factor

arteriosclerosis → plaque build up → ↓ blood flow

when does bone necrosis occur

when circulation is blocked off

when is the only time drainage is seen

with chronic osteomyeltitis

what are major concerns with acute

↑ pain, fever, chills

chronic can cause what

cancers, from skin changing so much

method of immobilization after surgical debridement

cast → cast care

What is osteoporosis of the patella in kids often misdiagnosed as

chondroblastoma, benin tumor in kids

endogenous sources

come from inside the body ex) CLABSI

what is major concern with treamtment

compliance, will be on antibiotics for an extended time

consequences of long term anitbitoic use

d-diff

what population has a hard time recovering for chronic

diabetics, often resutls in ambutations

diagnostic consdierations

diagnosis is often delayed

exogenous sources

from the outside of the body ex) scratch

when should central line dressings get changed

if they get wet

when is ↑ ESR seen in acute osteomyelitis

in later stages

why are rotten teeth a risk facor

infection can go into vasculature

what is C reactive protein an indicator of

inflammation

WBCS

may or may not be ↑ in acute, wont be if its too early on

surgical debridement

removal of necrotic and dead bone

acute s/sx

sinus track formation

what to assess for when monitorting wounds

sinus tracks, ulcerated skin, drainage