NCP FOR CASE STUDY 42: MUSCULOSKELETIAL SYSTEM.
John Ringer, a 32-year-old patient, is admitted to the medical surgical unit following a
debridement of a right lower leg wound secondary to a gunshot wound. The wound is
infected with Staphylococcus aureus. The patient is diagnosed with osteomyelitis. The
patient's right lower leg is warm to touch and oedematous, and the patient states that the
extremity has a constant pulsating pain that increases with any movement of the leg. The
patient's sedimentation rate and leukocyte rate elevated are elevated. The physician orders the
following for the patient:
Admit to medical unit with
Vital signs every 4 hours
Bed rest
Elevate affected leg on pillows above the level of the heart
Warm sterile saline soaks for 20 minutes three times per day, with wet-to-dry dressing
change
Levofloxacin (Levaquin) 750 mg IVPB every day
Renal profile, CBC with differential in the morning.
Regular diet with high-protein supplements shakes
Vitamin C 250 mg po twice a day
Hydrocodone 1 tablet po every 4 hours as needed for pain
Docusate sodium (Colace) 100 mg b.i.d.
(Learning Objective 6)
MEDICAL DIAGNOSIS: OSTEOMYELITIS
Osteomyelitis is an infection of the bone which becomes infected by the following modes:
Direct bone contamination from bone surgery and open fracture or traumatic injury
Extension of soft tissue infection
Hematogenous spread from other site of infection e.g. infected tonsils, boils
PATHOPHYSIOLOGY
Bone infections starts from the initial response of inflammation which is accompanied by
increased vascularity and edema. After 2-3 days, thrombosis of the blood vessels occurs in
, the area resulting in ischemia with bone necrosis. The infection extends into the medullary
cavity and under the periosteum and may spread into adjacent soft tissues and joints
If the infective process is not treated immediately a bone abscess forms which contains dead
bone tissue which does not easily liquefy and drain. By this the cavity cannot collapse and
heal.
New born growth forms and surrounds the dead bone tissue remains and produces recurring
abscess through the patient’s life, resulting to chronic osteomyelitis (Carek, Dickerson &
Sackier, 2001).
SIGNS AND SYMPTOMS
Fever
Lethargy and general malaise
Pain
Swelling and redness
Chills
Rapid pulse due to septicemia
POTENTIAL COMPLICATIONS
Bone death (osteomyelitis)
Septic arthritis
Impaired bone growth in children
Skin cancer- if the osteomyelitis has resulted to an open sore that is draining pus to
the surrounding skin is a risk of developing squamous cell cancer.
EXPECTED ASSESMENT FINDINGS
Head to toe examination
HEAD
On inspection
Head was symmetrical, round and erect in the midline
No swelling or lesions noted
Hair was normally hard
John Ringer, a 32-year-old patient, is admitted to the medical surgical unit following a
debridement of a right lower leg wound secondary to a gunshot wound. The wound is
infected with Staphylococcus aureus. The patient is diagnosed with osteomyelitis. The
patient's right lower leg is warm to touch and oedematous, and the patient states that the
extremity has a constant pulsating pain that increases with any movement of the leg. The
patient's sedimentation rate and leukocyte rate elevated are elevated. The physician orders the
following for the patient:
Admit to medical unit with
Vital signs every 4 hours
Bed rest
Elevate affected leg on pillows above the level of the heart
Warm sterile saline soaks for 20 minutes three times per day, with wet-to-dry dressing
change
Levofloxacin (Levaquin) 750 mg IVPB every day
Renal profile, CBC with differential in the morning.
Regular diet with high-protein supplements shakes
Vitamin C 250 mg po twice a day
Hydrocodone 1 tablet po every 4 hours as needed for pain
Docusate sodium (Colace) 100 mg b.i.d.
(Learning Objective 6)
MEDICAL DIAGNOSIS: OSTEOMYELITIS
Osteomyelitis is an infection of the bone which becomes infected by the following modes:
Direct bone contamination from bone surgery and open fracture or traumatic injury
Extension of soft tissue infection
Hematogenous spread from other site of infection e.g. infected tonsils, boils
PATHOPHYSIOLOGY
Bone infections starts from the initial response of inflammation which is accompanied by
increased vascularity and edema. After 2-3 days, thrombosis of the blood vessels occurs in
, the area resulting in ischemia with bone necrosis. The infection extends into the medullary
cavity and under the periosteum and may spread into adjacent soft tissues and joints
If the infective process is not treated immediately a bone abscess forms which contains dead
bone tissue which does not easily liquefy and drain. By this the cavity cannot collapse and
heal.
New born growth forms and surrounds the dead bone tissue remains and produces recurring
abscess through the patient’s life, resulting to chronic osteomyelitis (Carek, Dickerson &
Sackier, 2001).
SIGNS AND SYMPTOMS
Fever
Lethargy and general malaise
Pain
Swelling and redness
Chills
Rapid pulse due to septicemia
POTENTIAL COMPLICATIONS
Bone death (osteomyelitis)
Septic arthritis
Impaired bone growth in children
Skin cancer- if the osteomyelitis has resulted to an open sore that is draining pus to
the surrounding skin is a risk of developing squamous cell cancer.
EXPECTED ASSESMENT FINDINGS
Head to toe examination
HEAD
On inspection
Head was symmetrical, round and erect in the midline
No swelling or lesions noted
Hair was normally hard
