PYOMYOSITIS

INTRODUCTION
BACKGROUND

Pyomyositis is a bacterial infection of the skeletal muscles. Abscesses form that are filled with pus caused by a staph infection. More specifically, the bacterium Staphylococcus aureus is the major problem. Pyomyositis can affect any skeletal muscle. Large muscle groups such as the quadriceps (muscles along the front of the thigh), iliopsoas (muscle deep inside the pelvic cavity that flexes the hip), orgluteal (buttock) muscles are commonly affected. Pyomyositis is rare in healthy individuals. Trauma (sometimes just minor trauma) can start the process that results in pyomyositis. Any immune system problems already present can prevent the body from responding to overcome this infection. People with human immunodeficiency virus infection (HIV), diabetes mellitus, cancer, connective-tissue diseases, and cirrhosis of the liver are at increased risk. Clinical Presentation With painful, tenderness, swelling on muscles Abcess in muscle Fever Infection

DIAGNOSIS Blood culture and sensitivity MRI (Magnetic Resonance Imaging) Abscess aspiration Amputation TREATMENT Medical Care Administration of antibiotics that would help eliminate the needs in surgical drainage. Good choice of antibiotic that would help a lot in identification of the causative organism specially S. aureus. PROGNOSIS Prompt dministration of antibiotics can result in complete resolution.

OBJECTIVES To define pyomyositis. To identify the signs and symptoms manifested by the patient. To determine appropriate medical and nursing management for the patient. To distinguish the factors that triggers this development.

PERSONAL PROFILE

Name: De la Cruz, Angelina Radin Address: Matimyas St. Pinalagad, Valenzuela City Contact Number: 09483291254 Gender: Female Birthday: November 16, 2010 Age: 2 years old Birthplace: Valenzuela City Nationality: Filipino Religion: Roman Catholic Date of Admission: November 12, 2012 at 4:15pm Attending Physician: Dr. Canares

HISTORY

A.FAMILY BACKGROUND Angelina, a 2 years old girl is the second child in their three siblings.

B. EDUCATIONA STATUS She does not go to school yet; her eldest brother is on grade two, and her youngest sibling is almost baby.

C. LIFESTYLE DIET She eats three times a day and taking her bottle feeding in almost 3 times a day, she drinks at least 2 glasses of water every day.

D. FAMILY HISTORY No family history of pyomyositis, tuberculosis, diabetes, hypertension and dont have any other diseases.

E. IMMUNIZATION RECORD With complete record of immunization.

F. PASTHEALTH HISTORY Had fever and pain on the left thigh. No loss of appetite noted, no feeling of nausea and vomiting.

PRESENT HISTORY

3 weeks prior to admission upon waking up, the patient had difficulty in ambulation. The patient cries and cries because of the exquisitely tender, swelling and painful feeling on her thigh particularly on her left thigh. The patient had no consult done prior to the symptoms. And 2 weeks prior to admission the patient take 50mg Mefenamic acid,Co-trimoxaxole and Paracetamol and then admitted.

VITAL SIGNS

Temperature: 38.2 C Pulse rate: 128bpm Respiratory rate: 24 Weight in kg: 10.9 kg

Other physical examination findings:

Skin- febrile skin Swelling with mass on the left thigh

DIAGNOSTIC EXAMS
PHILIPPINE ORTHOPEDIC CENTER Department of Laboratories Hematology Section Lab no: 66 Age: 2 Ward: CW

Name: de la Cruz, Angelina

Date: Nov.20,2012

Component Hemoglobin Mass Hematocrit Leukocyte count Differential count Segmenters Lymphocytes Monocytes Eosinophils Reticulocytes Platelet Count Coagulation studies Protrombin time % activity Activated PTT Blood Type RH Typhing Semi-Quantitative CRP Pheripheral Smear 579 0.59 0.30 0.09 0.02 (F) 124 0.41 19.50

Normal Range 110-158/dl 0.37-0.54 4.5-10x109/L

COMPONENT Incidies MCV MCH MCHC

Normal Range

82-92 ft 28-32 pg 32-38 %

0.50-0.70 0.20-0.40 0.00-0.07 0.00-0.05 0.5-2.0% 150-400x10^9/L

RBC Mhorphology ESR Western Method Children Clotting Time (lee & white) Bleeding Time (Ivys Method) 1-7mins 5-15mins 0-10mm/hr

11-15secs 22-45secs

<6mg/L

Due @12am

ANATOMY AND PHYSIOLOGY The femur the longest and strongest bone in the skeleton is almost perfectly cylindrical in the greater part of its extent. In the erect posture it is not vertical, being separated above from its fellow by a considerable interval, which corresponds to the breadth of the pelvis, but inclining gradually downward and medial ward, so as to approach its fellow toward its lower part, for the purpose of bringing the knee-joint near the line of gravity of the body. The degree of this inclination varies in different persons, and is greater in the female than in the male, on account of the greater breadth of the pelvis. The femur, like other long bones, is divisible into a body and two extremities.
The Head (caput femoris).The head which is globular and forms rather More than a hemisphere, is directed upward, medial ward, and a little forward, the greater part of its convexity being above and in front. The Neck (collum femoris).The neck is a flattened pyramidal process of bone, connecting the head with the body and forming with the latter a wide angle opening medialward. The Trochanters. trochanters prominent processes which afford to the muscles that rotate the thigh on its axis. They are two in number, below. the greater and the lesser. Body or Shaft (corpus femoris). The body, almost cylindrical in form,is a little broader above than in the center, broadest and somewhat flattened from before backward.

OssificationThe femur is ossified from five centers: one for the body, one for the head, one for each trochanter, and one for the lower extremity. Of all the long bones, except the clavicle, it is the first to show traces of ossification; this commences in the middle of the body, at about the seventh week of fetal life, and rapidly extends upward and downward. The centers in the epiphyses appear in the following order: in the lower end of the bone, at the ninth month of fetal life (from this center the condyles and epicondyles are formed); in the head, at the end of the first year after birth; in the greater trochanter, during the fourth year; and in the lesser trochanter, between the thirteenth and fourteenth years. The order in which the epiphyses are joined to the body is the reverse of that of their appearance; they are not united until after puberty, the lesser trochanter being first joined, then the greater, then the head, and, lastly, the inferior

PATHOPHYSIOLOGY
PRECIPITATING FACTORS Traumatic Injury Poorly Nourished Obese Engaged to Extraneous Activities Impaired immune and post -op

Bacterial Invasion: Staphylococcus aureus

Inflammation

Growth of Organism

Thrombosis of blood vessels

Thrombosis of Blood Vessels

Decreased Oxygenation and Food Supply

Open/closed Ischemia

Infection extends to Medullary Cavity and under the Peritoneum

Abscess formation Sudden Onset: If Untreated chills, high fever,increased rapid pulse

PYOMYOSITIS

DISCHARGE SUMMARY Medications. Compliance on the prescribed take home medications with the right generic name, right dosage and preparation, right route and time of administration. Exercise. Active ROM but prevent massaging nor any other traumatic pressure on the affected area. Treatment. Compliance on the prescribed treatment. Cover the affected area with a wound gauze as pt has underwent surgery. Instructed proper wound care. Health teachings. Emphasized proper hand washing and encouraged non pharmacological measures for fracture once re encountered (Rest, Ice or Cold Compress, Compression bandage, Elevate affected part) ODutpatient follow up visit. Attend on the scheduled outpatient follow up visit. iet. Consume foods rich in Vitamin C such as fruits for boosting of immunity, protein such as meats for tissue repair, and calcium or phosphorus such as milk and other dairy products for bone growth.

REFFERENCES:
http://www.scribd.com/doc/36958077/Pyomyositis http://education.yahoo.com/reference/gray/subjects/subject/59

http://google.com.ph/imgres?q=ANATOMY+of+FEMUR&hl=fil&tbo=d&bi w=1034&bih=576&tbm=isch&tbnid=WfuobrSuSQENOM:&imgrefurl= Textbook of Medical surgical Nursing 11th edition by Joyce Young Johnson Nurses Pocket Guide: Nursing Diagnosis with Interventions, 4th Edition.

Lipa City Colleges Bachelor of Science in Nursing #10 G.A. Solis St. Lipa City, Batangas 4217 SY: 2012-2013

In Partial Fulfillment for the Requirements in NCM 104

PYOMYOSITIS
Case Study

Submitted to: Mrs.Elizabeth Raymundo Clinical Instructor Philippine Orthopedic Center

Submitted by: Marvie C. Gonzalvo BSN-IIIA, LCC