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
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osteomyeltitis questions
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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