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Ê  ÊÊ




Osteomyelitis is a severe pyogenic infection of the bone and surrounding tissues that
requires immediate treatment. Though the bone is affected site, normally root cause of
such infection is not injuries caused to bone. Most often the infection is originated from
some other body parts and is spread to bone through blood stream. If the bone has
undergone trauma recently, such bone becomes predisposed to the infection. It is a
bone inflammation caused by bacteria. Generally there are three routes where a
bacterium enters the body such as in the bloodstream or hematogenous spread,
adjacent soft tissue infection or contiguous focus and direct introduction of
microorganisms. Chronic Osteomyelitis occurs due to loss of blood supply to bone.
Such loss of blood supply is caused when bone tissues dies. As is suggestive from the
nomenclature µchronic¶ (which means prolonged), the Osteomyelitis conditions persists
for many years. People with diabetes, hemodialysis, people who have suffered trauma
recently and people who abuse IV drugs are considered on higher risk of developing
chronic Osteomyelitis. Fortunately, it is a rare health condition. According to the
available statistics, one person among 5000 people gets affected with Osteomyelitis.




 


The group decided to choose this case because it is interesting, rare and newly
encountered health crisis experienced by a patient confined in the hospital where they
had two weeks exposure. The case study gives the story behind the disease process by
capturing what happened to bring it about and can be a good opportunity to plan for
actions in order to treat or prevent it from happening to healthy individuals. It is a very
special case caused by Pseudomonas aeruginosa, the versatile "blue-
green pus bacteria" that opportunistically infects people, especially those who are
immunocompromised.


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½  Ê !

— The primary objective of this case study is to contribute to improved global


health by providing necessary knowledge, assessment or findings,
diagnostics and prevention about a type of pseudomonas infection which
is Osteomyelitis.
— This study will help the nursing profession by providing information about
the proper management and care for pseudomonas infected person.
— It will also educate the people, especially those infected with a type of
bacterium called Pseudomonas aeruginosa to seek medical care in order
to prevent further complications.
— It will increase awareness about the importance of having a healthy
lifestyle, diet and exercise.
— This study will elaborate the inter relatedness of environment, life style
habits and an attack of bacteria causing chronic or acute osteomyelitis
and other pseudomonas infections.
— This study aims to convey the patient and significant others with
informations about the disease process, medications, treatment, diet and
its course of medical and nursing interventions.
— To assess patient thoroughly, identify health problems, plan care,
application of planned activities and evaluate its effect to the patient.
— To present the case study to the group members and clinical instructors
then evaluate and learn the outcome of the study to the patient and to the
students.
— To understand the course and essence of the chosen care study and add
up additional knowledge and understanding in the nursing profession.

"½#Ê$ʽÊ

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— The actual signs and symptoms observed to the person.
— The pathophysiology of the underlying disease process.
— The medications, diagnostic exams, care plans, and discharge planning.
— The nursing aspect of care to a patient who had pseudomonas infection.

#&

— This study is not limited to patients with osteomyelitis alone, but it is for all
people who are interested in pseudomonas infections. We are more focused

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on primary prevention through health education because primary prevention
is the true prevention.
— This study in general with limited background and skills of students to care for
the patient and problem identified carry through the process of referral to the
clinical instructor, and doctor¶s orders during the 36 hours duty in Puerto
Community Hospital. Interventions were rendered gradually depending on the
objective assessment of the students. The following information only involves
the exact words and answers supported by the client and significant others.

ÊÊ ½#  Ê!

½  "½Ê'"Ê#

Name: Mr. Mateo (not his real name)
Age: 73 years old
Birthdate: May 30, 1964
Civil status: Married
Nationality: Filipino
Informant: Mr. Mateo, wife, & daughter
Religion: Roman Catholic
Address: Villanueva, Misamis Oriental
Educational Attainment: Highschool Graduate
Income: 8,000 per month
Most supportive person: Mrs. Lyka (wife)

#Êʽ#"Ê#
Date of admission: November 17, 2010
Time of admission: 02:45 pm
Attending physician: Dr. Peralta, Dr. Peralta, Dr. Orencia, and Dr.
Magdale
Chief Complaint: Unhealed wound on right leg
Admitting diagnosis: Occlusive arterial disease/Congestion of Stasis
R/O wound secondary to infection
Diet: Low salt and sugar diet
Allergy: Allergic to over-the-counter antibiotics with
reactions such as rashes and anaphylactic
shock
Height: 5¶5 inches
Weight: 55 kg

 
G  
   
BP: 140/80 mmHg
T: 37.4 °c
RR: 19 cpm
PR: 52 bpm
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A case of patient Mateo 73 years old, married and a roman catholic,


residing at Villanueva, Misamis Oriental was admitted for the first time at Puerto
Community Hospital on November 17, 2010 at 2:45 PM under Dr. Peralta with the
chief complaint of unhealed right leg wound. 2 years prior to admission, patient
sustained an injury to his right leg from an accidental fall. The injury sustained
was a small wound which was not treated immediately due to lack of knowledge
of how serious it was. The client then observed the wound character is not healing
over time and discharges accumulated prompting him to seek medical advice.
Upon consultation he was given Bacrooban ointment as daily treatment for the
wound. Two years later, the resistance of the wound from medications even with
patient¶s compliance to medication persisted and then subsequently rushed to
Puerto Community Hospital for further evaluation and management.

 
  Ê$"#½Ê(
Patient complained of unhealed wound on his right leg with pus formations.


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Sigmund Freud (1856-1939) is probably the most well known theorist when it comes to
the development of personality. Freud¶s Stages of Psychosexual Development are, like
other stage theories, completed in a predetermined sequence and can result in either
successful completion or a healthy personality or can result in failure, leading to an
unhealthy personality. This stage is marked by a renewed sexual interest and desire,
and the pursuit of relationships. This stage does not cause any fixation. According to
Freud, if people experience difficulties at this stage, and many people do, the damage
was done in earlier oral, anal, and phallic stages. These people come into this last stage
of development with fixations from earlier stages.

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Base on this theory, our patient belongs to the genital stage wherein he has
already achieved sexual desires. They have children and fortunately have a good
relationship with each other.

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Erik H. Erikson adapts and expands Freud theory of the development to include the
entire life span. Relieving that people continue to develop throughout life. He envisions
life as a sequence of levels achievement. As we grow older and become senior citizens
we tend to slow down our productivity and explore life as a retired person. It is during
this time that we contemplate our accomplishments and are able to develop integrity if
we see ourselves as leading a successful life. If we see our life as unproductive, or feel
that we did not accomplish our life goals, we become dissatisfied with life and develop
despair, often leading to depression and hopelessness.


The final developmental task is retrospection: people look back on their lives and
accomplishments. They develop feelings of contentment and integrity if they believe that
they have led a happy, productive life. They may instead develop a sense of despair if
they look back on a life of disappointments and unachieved goals.

Ê$"#ʽÊ(

> Our patient belongs to Psychosocial Stage 8 - Integrity vs. Despair. Integrity
is where our patient belongs since he was able to achieve his goals in life. He is living a
full and happy life with his wife and children. He was able to retire from his job contently
because he was able to raise and support his family. He was able to support his
children and see them successful in their own chosen profession.

"
' ++%&

  
 

"
)  ++%& is a comprehensive theory about the nature
and development of human intelligence first developed by Jean Piaget. It is primarily
known as a developmental stage theory, but in fact, it deals with the nature of
knowledge itself and how humans come gradually to acquire it, construct it, and use it.
Moreover, Piaget claims the idea that cognitive development is at the centre of human
organism and language is contingent on cognitive development.

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Our patient belongs to the formal operational period which is the fourth and final
periods of cognitive development in Piaget's theory. Our patient is very much capable of
thinking logically and abstractly and can reason theoretically. In this stage, individuals
move beyond concrete experiences and begin to think abstractly, reason logically and
draw conclusions from the information available, as well as apply all these processes to
hypothetical situations.

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Robert Havighurst believed that learning is basic to life and that people continue to learn
throughout life. He defines a developmental task as a task which arises at or about a
certain period in the life of an individual, successful achievement of these tasks leads to
his happiness and to success and later tasks, while failure leads to unhappiness in the
individual, disapproval by society and difficulty in later tasks.

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 > Our patient belongs to the later maturity age period. He is adjusting to the
decrease of physical and strength, to retirement and reduced income, establishing an
explicit affiliation with one's age group. He was able to meet social and civil obligations
and established satisfactory physical living arrangements.


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ë Admit under the service of Dr. Orencia ë for treatment and management
ë Secure consent to care ë for legal document purposes
ë Low salt, diabetic diet ë for diabetic nutrition
ë CBC, BUN, Creatinine ë To check any abnormalities
components of the blood and
kidney
ë IVF with PLR 1L @ 10 gtts/min ë Hypotonic solution: A solution with a
lower salt concentration than in
normal cells of the body and the
blood.
ë Inhibits bacterial cell wall synthesis
ë Imiprinum 500 mg IVTT every 8 hours
which leads to cell death
ANST
ë Daily dressing of Dakin¶s Solution 10%
ë A hypochlorite solution that kills
care of male nurse on duty available

A
ë Refer to Dr. Peralta for co-mgt RE: bacteria and viruses functions
poss-Diabetes D.Baquino ë For treatment and management
9:15 pm with other physician (specialty)
ë prepare 2 ³u´ PRBC
ë is a preparation of red blood cells
that are transfused to correct low
blood levels -123 mg/dl, low in
ë for blood typing T.O. Dr. Bacquiano hemoglobin
ë For cross matching
+&,-2/01-1
ë transfuse 2 ³u´ PRBC after proper ë To help increase hemoglobin level
cross matching

 3
, %+
ë seen and examine pt. reffered to ë one of the tests used to diagnose
co-mgt re-FBS 119 diabetes mellitus

ë for HB A1C ë It measure the blood glocuse


concentration
ë start metformin 500 mg 1 tab OD ë To lower blood glucose level
ë calcium ascorbate 1 cap BID ë A vitamins C that also contains zinc
which will boost immune system
5:15pm
ë IVFTF with PLR 1L @ 10 gtts/min ë Hypotonic solution: A solution with a
lower salt concentration than in
normal cells of the body and the
blood.
+&,-4/01-1
8:40 pm
ë Repeat CBC after 2nd ³u´ of blood ë To check blood components
transfused specifically hemoglobin level
ë HGT BID ë To check sugar level
+&,01/01-1
ë D/C HGT monitoring ë Hemoglobin are in normal range
ë IVF to follow 1L @ 2 gtts/min and roll out Diabetes mellitus
ë Hypotonic solution: A solution with a
lower salt concentration than in
normal cells of the body and the
blood.

ü
+&,0-/01-1
ë Keep wound moist with Dakins ë A hypochlorite solution that kills
solution bacteria and viruses functions

+&,00/01-1
9:30 am
ë Will go off service please refer ë Bactericidal inhibits bacteria cell
back for any other medical wall synthesis
problems 5th day imipinem
granulation tissue formation @
posterior aspect
ë Dressing as ordered ë To promote comfort and to prevent
further complication of the wound
ë X-ray @APL new R/O osteomylelitis ë To view the anterior posterior leg

+&,05/01-1
ë for referral to Dr. Orencia for co-mgt ë for treatment and management
+&,06/01-1
10:45 am
ë for chest x-ray ë helps medical professionals see
parts of the lungs,diagnose and
plan for treatment
ë for tissue biopsy ë To remove a sample tissue to
determine if it¶s benign or malignant

4:20 pm
ë for sputum AFB once discharged,
c/o local health center ë To monitor progress of PTB

6:50pm
ë IVFTF D5W @ same rate ë A hypotonic solution that replace
water and low calorie need and
spares body protein and provides
nutrition

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+&,07/01-1
1 pm
ë For repeat CBC, Crea, K, PTPA ë To check any abnormalities
components of the blood and
kidney
ë For CBC, 12 leads ECG ë To check any abnormalities
components of the blood and
kidney and to know the pericardium
conductivity
3pm
ë Reschedule biopsy tomorrow 9 am ë To remove a sample tissue to
determine if it¶s benign or malignant

ë Please follow up medical evaluation ë To monitor the health condition of


the patient
7:40pm
ë IVTT with D5W 1L @ 20 gtts/min ë A hypotonic solution that replace
water and low calorie need and
spares body protein and provides
nutrition
+&,08 01-1
4:35 pm
ë Soft tissue biopsy (done) ë To remove a sample tissue to
determine if it¶s benign or malignant
ë Transfer to room ë To provide comfort and rest

ë For dressing tomorrow 11/27/10 ë To promote comfort and to prevent


further complications of the affected
area
ë For billing tomorrow am ë To check the patient¶s bill



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**
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--9-.9-1  Elevated level: reduced

 50 8 5.23- 20 mg/dL renal blood blow, urinary
tract obstruction, increased
protein catabolism
--9-.9-1 - 4 0.6-1.2 mg/dL Increased blood creatinine

 is usually a sign of problems
with kidney function. The
creatinine level is also
raised with injury to muscle
and during increased
breakdown of muscle tissue
--9-.9-1 --4 - 70-105
 
--9019-1 ,-05 130-180 mg/dL Low Hb level may indicate
&%  anemia, recent hemorrhage,
 or fluid retention, causing
hemodilution

 #&% -4 25-55 High risk for viral infection or


other infections

High risk for viral infection or


other infections
 $ -1 4-8
--9059-1 There is cortical 
:9
 #  thickening and
irregularity
involving the


distal half of the
tibia and fibula.
Soft tissue
lucencies are
noted in the
medical aspect
of the distal
Right leg
--9069-1 Heart is enlarged
:9
 by CT ratio
(14:26 with LV
prominence.
Aorta is tortuous
and calcified
Impression: PTB
minimal bilateral
cardiomegaly
tortuous aorta
--9079-1 ,--0 130-180
&%   57 0.40-.54
 $ -- 4-8 +
+

,
3
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  !

1.  
&(Imipenem


&( Primaxin

( November 17, 2010


( Antibiotic
; (500mg IVTT q 8hours after ANST (-)
$ 
&  ½ ( Bactericidal inhibits bacterial cell wall synthesis. Kills
susceptible organism, including many gram-positive, gram-negative and anaerobic
bacteria.
%  Ê
( For bacterial infection.


( Contraindicated to patients hypersensitive to drug or any of its
component.
½+  ( Fever, dizziness, seizure, hypotension, nausea, vomiting,
diarrhea, rash, urticaria,pruritus.
 "
(
— Asses patient infection before starting therapy and regularly thereafter.
— Obtain urine specimen for culture and sensitivity test before starting therapy.
— Be alert for adverse reaction and drug interaction.


0    
&(Calcium Ascorbate


&( Nature Z

(November 18, 2010


( Anti-bacterial
; ( 500 mg IV OD
$ 
&½ (
%  Ê
( To strengthen their muscle and bones and to slowdown or hold
the aging process or its effects. An immune booster and aids in fighting bacterial
infections.


(
½+ ( Diarrhea, constipation, nausea, vomiting, abdominal cramps/pain,
or heartburn
 "
(Êf you have any of the following health problems, consult your
doctor before using this medication: diarrhea, stomach trouble, parathyroid disease,
lung disease (sarcoidosis) or kidney stones. 




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5    
&(Metformin


&( Avandamet 

(November 18 ,2010


( Antidiabetic
; ( 500 mg 1 tab OD
$ 
&  ½ ( Decreases hepatic glucose production and intestinal
absorption of glucose and improves insulin sensitivity. Therapeutic: Lowers blood
glucose level.
%  Ê
( to decrease sugar level in the body


( Contraindicated in patient hypersensitive to drug or any of its
components.
½+  ( Nausea, vomiting, diarrhea, headache, dizziness, abdominal
discomfort
 "
(
— Assess patient glucose level before therapy and regularly thereafter to
monitor the drug¶s effectiveness.
— Assess patient¶s kidney function before therapy and reassess at least
annually.

6    
&(Celecoxib


&( Aubrex

( November 19, 2010


( Anti-inflammatory
; ( 200 mg 1 cap BID P.O PRN for pain
$ 
&  ½ ( Analgesics and anti-inflammatory activities related to
inhibition of the COX-2 enzyme which is activated in inflammation does not affect the
COX-1 enzyme,which protects the lining of the GI tract and has blood clotting and
renal functions
%  Ê
( Management for pain


( Contraindicated in patients with hypersensitivity to drug.
½+  ( Anaphylactic reactions, Renal toxicity, Hallucinations,
anusmia,vasculitis
 "
(
— Establish safety measures if CNS or visual disturbance occurs.
— Administer drug with feeds or after meals if GI upset occurs.
— Monitor patient for sign and symptoms of liver toxicity.

c
7    
&(Dackin¶s solution

( November 18, 2010


( Antiseptic
<; (Wash right leg OD
%   Ê
( to treat skin and tissue infections that could result from cuts,
scrapes and pressure sores. 


( contraindicated to patient hypersensitivity to solution
½+  ( Pain or burning sensation, Rash or itching, Redness of skin
around edge of wound gets worse, swelling or hives
 "
(
— Keep the solution stored at room temperature.
— Cover the jar with aluminum foil to protect it from light
— Be sure the jar lid is tight for storing.

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The blood vessels form a complicated system of connecting tubes throughout the body.
There are three major types of these vessels. Arteries carry blood from the heart. Veins
return blood to the heart. Capillaries are extremely tiny vessels that connect the arteries
and the veins.



The blood consists chiefly of a liquid called plasma and three kinds of solid particles
known as formed elements. Plasma is made up mostly of water, but it also contains
proteins, minerals, and other substances. The three types of formed elements are called
red blood cells, white blood cells, and platelets. Red blood cells carry oxygen and
carbon dioxide throughout the body. White blood cells help protect the body from
disease. Platelets release substance that enable blood to clot. Platelets thus aid in
preventing the loss of blood from injured vessels.


White blood cells Red blood cells

Platelets

 

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A musculoskeletal system (also known as the locomotors system) is an organ


system that gives animals (including humans) the ability to move using the muscular
and skeletal systems. The musculoskeletal system provides form, support, stability, and
movement to the body.

It is made up of the body's bones (the skeleton), muscles, cartilage, tendons, ligaments,
joints, and other tissue that supports and binds tissues and organs together). The
musculoskeletal system's primary functions include supporting the body, allowing
motion, and protecting vital organs The skeletal portion of the system serves as the
main storage system for calcium and phosphorus and contains critical components of
the hematopoietic system

This system describes how bones are connected to other bones and muscle fibers via
connective tissue such as tendons and ligaments. The bones provide the stability to a
body in analogy to iron rods in concrete construction. Muscles keep bones in place and
also play a role in movement of the bones. To allow motion, different bones are
connected by joints. Cartilage prevents the bone ends from rubbing directly on to each
other. Muscles contract (bunch up) to move the bone attached at the joint.

The Skeletal System serves many important functions; it provides the shape and form
for our bodies in addition to supporting, protecting, allowing bodily movement, producing
blood for the body, and storing minerals. The number of bones in the human skeletal
system is a controversial topic. Humans are born with about 300 to 350 bones;
however, many bones fuse together between birth and maturity. As a result an average
adult skeleton consists of 206 bones. The number of bones varies according to the
method used to derive the count. While some consider certain structures to be a single
bone with multiple parts, others may see it as a single part with multiple bones. There
are five general classifications of bones. These are Long bones, Short bones, Flat
bones, Irregular bones, and Sesamoid bones. The human skeleton is composed of both
fused and individual bones supported by ligaments, tendons, muscles and cartilage. It is


a complex structure with two distinct divisions. These are the axial skeleton and the
appendicular skeleton.

The Skeletal System serves as a framework for tissues and organs to attach
themselves to. This system acts as a protective structure for vital organs. Major
examples of this are the brain being protected by the skull and the lungs being
protected by the rib cage.

Located in long bones are two distinctions of bone marrow (yellow and red). The yellow
marrow has fatty connective tissue and is found in the marrow cavity. During starvation,
the body uses the fat in yellow marrow for energy. The red marrow of some bones is an
important site for blood cell production, approximately 2.6 million red blood cells per
second in order to replace existing cells that have been destroyed by the liver. Here all
erythrocytes, platelets, and most leukocytes form in adults. From the red marrow,
erythrocytes, platelets, and leukocytes migrate to the blood to do their special tasks.

Another function of bones is the storage of certain minerals. Calcium and phosphorus
are among the main minerals being stored. The importance of this storage "device"
helps to regulate mineral balance in the bloodstream. When the fluctuation of minerals
is high, these minerals are stored in bone; when it is low it will be withdrawn from the
bone.

%
&

The primary function of the respiratory system is to supply the blood with oxygen
in order for the blood to deliver oxygen to all parts of the body. The respiratory system
does this through breathing. When we breathe, we inhale oxygen and exhale carbon
dioxide. This exchange of gases is the respiratory system's means of getting oxygen to
the blood. Respiration is achieved through the mouth, nose, trachea, lungs, and
diaphragm. Oxygen enters the respiratory system through the mouth and the nose. The
oxygen then passes through the larynx (where speech sounds are produced) and the
trachea which is a tube that enters the chest cavity. In the chest cavity, the trachea
splits into two smaller tubes called the bronchi. Each bronchus then divides again

è
forming the bronchial tubes. The bronchial tubes lead directly into the lungs where they
divide into many smaller tubes which connect to tiny sacs called alveoli. The average
adult's lungs contain about 600 million of these spongy, air-filled sacs that are
surrounded by capillaries. The inhaled oxygen passes into the alveoli and then diffuses
through the capillaries into the arterial blood. Meanwhile, the waste-rich blood from the
veins releases its carbon dioxide into the alveoli. The carbon dioxide follows the same
path out of the lungs when you exhale. The diaphragm's job is to help pump the carbon
dioxide out of the lungs and pull the oxygen into the lungs. The diaphragm is a sheet of
muscles that lies across the bottom of the chest cavity. As the diaphragm contracts and
relaxes, breathing takes place. When the diaphragm contracts, oxygen is pulled into the
lungs. When the diaphragm relaxes, carbon dioxide is pumped out of the lungs.

 
&

The circulatory system is an organ system that passes nutrients (such as amino
acids, electrolytes and lymph), gases, hormones, blood cells, etc. to and from cells in
the body to help fight diseases and help stabilize body temperature and pH to maintain
homeostasis. This system may be seen strictly as a blood distribution network, but
some consider the circulatory system as composed of the cardiovascular system, which
distributes blood,[1] and the lymphatic system, which distributes lymph. While humans,
as well as other vertebrates, have a closed cardiovascular system (meaning that the
blood never leaves the network of arteries, veins and capillaries), some invertebrate
groups have an open cardiovascular system. The most primitive animal phyla lack
circulatory systems. The lymphatic system, on the other hand, is an open system.Two
types of fluids move through the circulatory system: blood and lymph. The blood, heart,
and blood vessels form the cardiovascular system. The lymph, lymph nodes, and lymph
vessels form the lymphatic system. The cardiovascular system and the lymphatic
system collectively make up the circulatory system.

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The Pulmonary circulation is the portion of the cardiovascular system which


transports oxygen-depleted blood away from the heart, to the lungs, and returns
oxygenated blood back to the heart. Oxygen deprived blood from the vena cava enters
the right atrium of the heart and flows through the tricuspid valve into the right ventricle,
from which it is pumped through the pulmonary semi lunar valve into the pulmonary
arteries which go to the lungs. Pulmonary veins return the now oxygen-rich blood to the
heart, where it enters the left atrium before flowing through the mitral valve into the left
ventricle. Then, oxygen-rich blood from the left ventricle is pumped out via the aorta,
and on to the rest of the body.

&   


Systemic circulation is the portion of the cardiovascular system which transports


oxygenated blood away from the heart, to the rest of the body, and returns oxygen-
depleted blood back to the heart. Systemic circulation is, distance-wise, much longer
than pulmonary circulation, transporting blood to every part of the body.


  


The coronary circulatory system provides a blood supply to the heart. As it


provides oxygenated blood to the heart, it is by definition a part of the systemic
circulatory system

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DEFINITION: is the medical term for an infection in a bone. Infections can reach a bone
by traveling through your bloodstream or spreading from nearby tissue. Infections can
also begin in the bone itself if trauma exposes your bone to germs. Bone infections
commonly affect the long bones of your body, such as your leg bones and upper arm
bone, as well as your spine and pelvis.

"Ê"Ê ½"Ê"Ê½Ê ½
-Age -Injury from falling
-Alcohol intake
-Stress

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[*]
[ ] impaired vision [ ] blind , *  -
ÊÊ  

[ ] pain redden [ ] drainage è ÊÊÊ
MMMMMMMM
 
MMMMMMMMMMMMM
Ê: 
[ ] gums [ ] hard of hearing [ ] deaf
M MMMMMMMMMMMM
:
[ ] burning [ ] edema [ ] lesion teeth * .
:Ê MM MMM
[ ] assess eyes ears nose  
:ÊÊ  
[ ] throat for abnormality [ x] ]no
noproblem
problem

"MMMMMMM
:ÊÊÊ  
""MMMMM
"( :Ê  

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[ ] asymmetric [ ] tachypnea [ ]] barrel
barrelchest
chest
:  
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:Ê  
[ ] apnea [ ] rales []
[ ]cough
cough /
:ÊÊ  
[ ] bradypnea [ ] shallow [ ] rhonchi "MMMMMMMMMMM
:ÊÊÊ  
% 
  

[ ]] sputum
sputum [[ ]] diminished
diminished []
[ ]dyspnea
dyspnea :Ê:  
/ 
 /

[ ] orthopnea [ ] labored [ ] wheezing ::  
  ) !cMM
::Ê  
[ ] pain [ ] cyanotic 0

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::ÊÊ  
[ ] assess resp. rate, rhythm, pulse blood  MMMMMMMM
::ÊÊÊ  
MMMMMMMMMMMMMM
[ ] breath sounds, comfort [*
[ x ]] no
no problem
problem ::Ê  
MMMMMMMMMMMMMM
½Ê½#½( ::  
MMMMMMMMM
::Ê  
[ ] arrhythmia [ x] tachycardia
] tachycardia[*[ ]numbness
]numbness MMMMMMMMMMMMMM
::ÊÊ  
[ ] diminished pulses [ ] edema [ ] fatigue  MMMMM
::ÊÊÊ  
MMMMMMMMMMMMMM
[ ]]irregular
irregular[[ ]]bradycardia
bradycardia[[ ]]mur
murmur
mur ::Ê:  
MMMMMMMMMMMMMM
[ ] tingling [ ] absent pulses [ ] pain :::  
MMMMMMMMMMMMMM
:::Ê  
Assess heart sounds, rate rhythm, pulse, blood MMMMMMMMMMMMMM
:::ÊÊ  
Pressure, circ., fluid retention, comfort MMMMMMMMMMMMMM
:::ÊÊÊ  
MMMMMMMMMMMMMM
[ ]]no
noproblem
problem :::Ê  
M MMMMM
½Êʽ#½( :::  
 
* MMM
:::Ê  
[ ] obese [ ] distention [ ] mass MMMMMMMMMMMMMM
:::ÊÊ  
[ ] dyspagea [ ] rigidity []
[ ]pain
pain :::ÊÊÊ  
MMMMMMMMMMMMMM
[ ] assess abdomen, bowel habits, swallowing 
[ ] bowel sounds, comfort [*]
[ x ] no
noproblem
problem
MMMMMMMMMMMMMM

ÊAʽ!½ ! MMMMMMMMMMMMMM
[ ] pain [ ]] urine
urine color [ ] vaginal
[ ] color bleeding
[ ] vaginal bleeding MMMMMMMMMMMMMM
[ ] hematuria [ ] discharge [ ] nucturia
MMMMMMMMMMMMMM
[ ] assess urine frequency, control, color, odor, comfort è
MMMMMMMMMMMMMM
&&
(
[ ] hearing loss Comments ³ Maayo man wala [*] glasses [ ] languages
man problema [ ] contact lens [ ] hearing aide
[ ] visual changes sa akong pandungog R L
ug panlantaw´ Pupil size: 3mm [] speech difficulties
[ ] denied Reaction: Pupils equally round and reactive to light
accommodation
* 
(
[ ] dyspnea Comments ³wala man ko gi-ubo, Resp. [x] regular [ ] irregular
[ ] smoking history Describe: the pt¶s respiration is regular 19cpm
dili pud kow galiusud ug ginhawa, R Right lung is symmetrical to left lung
ug dili pud kow tig panigarilyo´ L Left lung symmetrical to right lung
NONE _
[]cough
[]sputum
[ ]denied
 
(
[ ] chest pain Comments ³Binhod lang akong Heart Rhythm [ ] regular [x] irregular
kamot¶¶ Ankle Edema : presence of non-pitting edema at left
[ ] leg pain foot
[*]numbness of Pulse Car. Rad. DP. FEM*
extremities R + 52bpm 55 Not Obtain
[]denied L + 52bpm 61 Not Obtain
Comments Upon palpitation pulses were strong and
palpable, weak dorsalis pedis pulse
*if applicable
(
Diet : Low salt and low sugar diet [*] dentures [] none
[ ] N [ ] V Comments ³wala man pud
Character problema sa akong pagkaon´ Full Partial W/ Patient
[ ] recent change in
weight, appetite Upper [*] [B []
[ ] swallowing
difficulty Lower [] [] []
[*] denied
&
( Comments: ___________ Bowel sounds Normo-active
Usual bowel pattern [] urinary frequency Patient¶s bowel pattern 2-3 per minute
once a day _6-8 x a day________ Is normal and is not
[ ] constipation [ ] urgency constipated _______ Abdominal distention
remedy [ ] dysuria ________ Present [] yes [*] no
none [ ] hematuria Urine* (color,
Date of Last BM [ ] incontinence ___________________ consistency, odor)
November 24, 2010 [ ] polyuria ____________________ Straw amber,
[ ] Diarrhea [ ] foley in place aromatic
character [ ] denied ____________________ ________________
None *if they are in place?
$   
@Ê(
[*] alcohol [] denied Briefly describe the patient¶s ability to follow treatments
(amount, frequency) (diet, meds, etc.) for chronic health problems (if present).
Started drinking at an early age, frequent drinker
[ ] SBE Last Pap Smear None________________ The pt was able to follow his diet and prescribed
LMP: Not applicable_____________________ medications

è
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 Ê (
[*] dry Comments: ³naa lage koy samad [*] dry [] cold [] pale
sa akong tuong tiil [] flushed [] warm
na dili gaka ayo´ [] moist [] cyanotic
[] itching *rashes, ulcers, decubitus (describe size, location,
[] other drainage) presence of rashes in entire body,
[] denied wound has lesions in different sizes, unble to determine
specific size
½ +<
(
[ ] convulsion Comments: "medyo mag kiang [] LOC and orientation : the patient is oriented to the
" kiang ko paglakaw place, date, time, person.
[]dizziness sa asking tuong Gait: [] walker [] cane [*] other
tiil kay sakit´
[x] limited motion [*] steady [] unsteady ____________
Of joints [] sensory and motor losses in face or extremities
Limitation in ability to The patient has no sensory or motor losses in face or
[ ] ambulate extremities
[ ] bathe self
[ ]other [ *] ROM limitations: the patient has limited range of
[*] denied motion at right lower extremity
&<%<½3
(
[*] pain Comment ³di ko katulog ug [*] facial grimaces
tarong,ga sige ra ko mata- [ ] guarding
mata,dili ko comfortable [ ] other signs
matulog sa hospital´ ________________________________________
frequency
Remedies) [ ] siderail release from signed (60 + years)
[ ] nocturia ____No siderails available______
[*] sleep difficulties
[ ] denied
% (
Occupation: Retiree in Delmonte Inc. (Jr. Supervisor Observed non-verbal behavior Patient is shy and anxious
Leadman) with his condition especially with female nurses
Member of household: 6 (six) The person and his phone number that can be reached
Most supportive person: R .J .(Wife) any time Confidential

"ʽ#"½ÊÊ$½Ê
N/A Daily weight PT/OT N/A
140/80 BP q shift


 
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,  
 
 I.V. 
 
*
&  Fluids/Blood

CBC, Blood #1 PNSS 1L@


11-17-10 typing, 11-17-10 11-17-10 10gtts/min 11-18-10
Chemistry
PNSS 1L @
11-18-10 Cross matching 11-18-10 11-18-10 20gtts/min 11-18-10

#1 Blood
11-18-10 HGT 11-18-10 11-18-10 Transfusion 11-18-10
packed RBC

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type-O (450 ml)

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Ê ʽ Ê( Impaired physical mobility related to pain or discomfort.



:"$(Patient will state relief from pain. Patient will begin to accept
limitations imposed by immobility and accompany lifestyle changes.
ACTIONS/INTERVENTIONS RATIONALE
— Encourage patient to verbalize ë This aid the assessment of the
pain and discomfort. Observe for
location, quality and intensity of pain.
non-verbal cues of pain, including
favoring a body part and
grimacing.
— Perform the prescribed treatment
ë To assess the effectiveness of the
regimen for the underlying
condition producive pain or treatment.
discomfort.
— Encourage patient in active ë To increase the muscle tone of and
movements by using assistive
increase patient¶s feeling and self-
devices.
— Implement ROM excersises every esteem.
shift after pain medication unless
medically contraindicated; progress
ë This prevents joint contracture and
from passive as tolerated.
— Reposition patient every 2 hours muscle atrophy.
and provide meticoulous skin care. ë To prevent skin breakdown.
— Encouraged patient to verbalize
feelings and concerns about his
ë To reduce anxiety and promote
altered state of mobility.
compliance.

èü
Ê  ʽ Ê( Impaired skin integrity related to internal (somatic) and
external (environmental) factor.


:"$(patient will exhibit improve or healed lesions or wound.
ACTIONS/INTERVENTIONS RATIONALE

— Inspect patient skin every shift,


ë This provides evidence of the
describe and document skin
condition and report changes. effectiveness of the skin care
— Maintain proper enviromental regimen.
conditions including room
ë Providing a comfortable environment
temperature and ventilation.
promote a sense of well being.
— Remind or warned patient not to
scrath or tampering with the wound ë To avoid potential for infection.
or dressing.

— Position patient for comfort and


minimmal pressure. Change ë This measures reduce pressure,
position every at least 2 hours.
promote circulation and avoid skin
breakdown.
— Explain the therapy to patient and
family members.
ë To encourage compliance.

 
Ê ʽ Ê(Acute pain related to biological or chemical agent.


:" $( Patient will state and carry out appropriate interventions for
pain relief. Patient will decrease amount and frequency of pain medication needed.
Patient will express feeling of comfort and relief from pain.
ACTIONS/INTERVENTIONS RATIONALE
— Assess patient¶s signs and ë Assessment allows for care plan
symptoms of pain and adminster
modification as needed.
medication as prescribed.
Monitored and record medications
effectiveness and adverse effect.
— Perform comfort measures to
ë This measure reduce muscle tension
promote relaxation such as
massage and bathing, repostioning ort spasm, redistribute pressure on
and relaxation technique. body parts, and help patient focus on
non-pain- related subjects.
ë To help patient focus and non-pain
— Plan activites with patient to
provide distraction such as related matters.
reading, crafts, television and visit.
— Help patient into a comfortable
ë To reduce muscle tension and
position and use pillows to splint or
support painful areas as spasm and to redistribute pressure
appropriate. on body parts.

ë To minimize or relieve pain.


— Apply heat and cold compress

 c
Ê  ʽ Ê( Bone infection related to infection that has migrated to bone
tissue.


:"$(Patient response to antibiotic therapy, as evidence by normal
WBC, negative wound culture findings.
½Ê<ÊÊ ½Ê½#
 
— Assess affected area for signs and ë Assessment allows for care plan
symptoms of infection. modification as needed.
— Assess lab values, especially WBC ë To evaluate further abnormalities.
and sedimentation rate.
— Assess bones scan finding. ë To aid in establishing diagnosis.
— Obtain appropriate cultures and;
sensitivities; blood; aspirate from ë Wound cultures are necessary to

bone abscess if present. identify causative agent.



— Administer IV antibiotics as ordered. ë Aggressive antibiotic treatment is
the primary therapy.

— Provide fluids. ë To prevent dehydration in febrile

 state.


— Ensure sterile technique during ë to prevent close contamination

dressing

 è
Ê  ʽ Ê( Impaired bone tissue perfusion related to continuation
infectious process.

:" $( Patient¶s condition of impaired tissue will improves as
evidence by decreased redness, swelling and pain.
½Ê<ÊÊ ½Ê½#
 
— Apply continuous or intermittent wet ë To reduce intensity of
dressings. inflammation.
— Discourage rubbing and scratching
then provide gloves if necessary. ë To prevent further injury and
— Provide medicated soaks in open delayed healing.
wound as ordered.
 ë To treat skin and tissue infections.
— Administer IV antibiotics as ordered
 ë To treat infection.

— encourage early ambulation, when


possible ë To enhance venous return.


— Elevate the legs when sitting,
avoiding sharp angulation at the ë To maximize tissue perfusion.

lower extremities.

— Discourage sitting/standing for long
periods, wearing constrictive ë To prevent further injury.

clothing, crossing legs.

  
 ½½#Ê ½"#½

 ³medyo mag kiang-kiang ko paglakaw sa akong toung tiil kay sakit.´

-tingling sensations at wound area


 -verbalization of pain pain scale: 4/10
-impaired mobility at right leg


Impaired physical mobility related to pain due to the presence of wound.
½



At the end of 3 hours patient will be able to be independent in performing
" activities of daily living within capabilities and utilizes energy conservation
techniques.

c   " 


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0/
"

0
"
0
"
 
0 " / 
Ê 3. Placed a table within patient¶s reach with common necessities.
4. Encouraged patient to elevate the lower leg.
5. Encouraged patient to use cratches
6. Instructed patient to perform passive ROM exercises.
7. Administered pain reliever (Celecoxib) as ordered

At the end of 3 hours of nursing interventions patient was able to be independent


and utilized energy conservation techniques.


 
-none


-tingling sensations at wound site


-complaints of numbness
 -Hemoglobin result: 112mg/dl
-edema ; non-pitting at lower right leg
-weak dorsalis pedis pulse


Altered tissue perfusion; peripheral RT decreased oxygen carrying capacity
½ of blood.


%

  )    *
 

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After 3 days the patient was able to achieve a normal hemoglobin level
 As of CBC result dated 11/20/10 ;123mg/dl






 
 ³binhod lang akong kamot´

-tingling sensation at wound area





Acute Pain RT tissue injury on right lower leg
½


%

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$ $
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  4
 

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     8  

After 30 mins. Of nursing interventions patient¶ pain was reduced.



 
³naa lage koy samad sa akong tuong tiil na dili gaka ayo´


-open wound on the lower right leg


 -WBC result


Infection RT ; inadequate primary defenses, broken skin
½
Secondary defenses; immunocompromised


%

  ) cè 
 

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Ê   % 


  
  " * 
 


  
  
 

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 %
 
 
 +  
 %
    % 
  

After the intervention was done, the goal was met. The patient was able
to stay afebrile throughout the whole shift.






 å
³di ko katulog ug tarong,ga sige ra ko mata- mata,dili ko comfortable
 matulog sa hospital´

-Yawning
 -sunken eyeballs
-complaints of lack of sleep


,% "
+&
&
½

At the end 12 hours of nursing interventions, the patient will be able to


" report improvement in sleep/ rest pattern.

c % 


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è +

 


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  "

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    8

 4 " 
 % 


 
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.
  " 
  

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After the nursing interventions, the goal was met, the patient verbalized
improvement in sleep pattern.









 A
ÊÊÊ ½#½##?9"
$ʽÊ
ë Instructe patient to continue home medication as ordered by the
physician. Taught the appropriate dosage, timing, therapeutic effect and
possible side-effects of the medications and evaluate the client¶s
knowledge and understanding of the proper regimen.
ë Instructed to take the medications religiously per doctor¶s order. Such as
Calcium Ascorbate 1 capsule two times a day; Clelecoxiib 20 mg 1
capsule twice daily for pain
:Ê
ë Encouraged to continue active exercises within cardiac tolerance.
ë Instructe to resume activity of daily living with minimal assistance then
gradually he¶ll regain independence.
ë Instructe the patient to have adequate rest period at their home, limit of
activities that exhaust him and could enhance complications.
ë Limit stressful activities as much as possible.
ë Instructed to keep the wound clean and dry.
ë Instructed to perform regular wound dressing.


"½ÊC D9"E
ë Instructed to have follow-up check-up at Puerto community Hospital 1
week after discharge to his physician for additional instructions and for
continuous therapy.
ë Instructed client to report any signs of fever or reoccurrence of the
condition to his physician as soon as possible.
Ê
ë Encouraged to maintain prescribed diet low salt, low sugar diet.
ë Instructed to increased foods high in protein such as meat, fish and
vegetables.
ë Encouraged to increased foods high in vitamin C such as orange and
pineapples and other foods that give energy.

 ü
Ê: ½#½Ê½Ê$"#ʽÊ

This care study was made a beneficial tool to us as a nursing student¶s. To learn
from each cases we handle and how to intervene to such diseases if ever we encounter
one. After conducting this care study, we were able to appreciate more the essence of
utilizing the nursing process in the care and management of our patient. It was indeed a
tough job on conducting this study yet, it gave us a big impact regarding how useful it is
in our chosen profession. Nursing really demands a tender loving care attitude. It
demands patience and it is calling that cannot be merely taken for granted.
This study will serve as a reference material in rendering competent care to our
clients especially to those with similar situation. Through this, we will be able to develop
our knowledge as well as our skills and attitudes in applying the prescribed procedure to
improve the health status of the patient. This serves as an evaluation guide on how far
we have gone through in the management of our client¶s health.
Moreover, this care study taught us to stand on our own by not depending on others
just to make this. This provides us students, a big learning regarding on how well we
take care of or patients in the real clinical setting. Most of all, this study teaches the
students to provide clients care more efficiently and competently to achieve an effective
and quality nursing care.
The case study paved the way for the students to identify and determine issues
related to Osteomyelitis. Through this, the importance of following treatment regimen
must be exercised to prevent complications. This study provided the nursing students
with essential information on disease prevention, health promotion, and health
maintenance.






:  Ê #Ê ½" !

D(

Lippincott: Manual of Nursing Practice, 8th Edition, volume 1, pp. 493-497
Nursing Care Plans, 7th Edition, Marilyn E. Doenges, pp 72-80

Nursing Care Plans Guidelines for Individualizing Client Care Across the Life Span
Edition, Marilynn E. Doenges, Mary Frances Moorhouse, Alice C. Murr, pp. 38-115

Textbook Medical Surgical Nursing 11th Edition, Suzanne C. Smeltzer, Brenda G. Bane,
Janice L. Hinkle, Kerry H. Cheever pp. 778-858

Pathophysiology Made Incredibly Visual, Lippincott Williams & Wilkins, Wolters Kluwer
pp 30-31

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