Osteomyelitis Exercise 2 - Virtual Hospital Activity

Osteomyelitis Exercise 2 - Virtual Hospital Activity  Sign in to work at Pacific View Regional Hospital for Period of Care 1. (Note: If you are already in the virtual hospital from a previous exercise, click on Leave the Floor and then on Restart the Program to get to the sign-in window.)  From the Patient List, select Harry George (Room 401).  Click on Go to Nurses’ Station.  Click on Chart and then on 401.  Click on History and Physical. Exercise 2 - Question 1 Identify the clinical manifestations of local and systemic osteomyelitis below. Using the History and Physical, place an asterisk by the symptoms manifested in Harry George. Your Answer: Thin legs. Pulses present on right. Unable to palpate pulses in left dorsal pedis or posterior tibial, because of swelling. Adequate popliteal and femoral on left. Left foot edematous, reddened with serous exudate. Did not test gait. ROM normal in cervical spine, shoulders and upper arms. "I have so much pain in my left foot, and it is bigger than my right foot." Local  bone pain*  swelling*  erythema*  warmth at infection site  restricted movement Systemic  fever*  night sweats  chills  restlessness  nausea  malaise Question 2 Not yet graded / 1 pts Exercise 2 - Question 2 Based on what you have read, identify the source of Harry George’s osteomyelitis and the type (category) of invasion responsible for it. Explain the rationale for your conclusion. Your Answer: Infection and inflammation that increase muscularity and edema. Diabetic oteomelitis can occur without any external wounds. Microvascular and macrovascualr pathophysiologic changes, along with an impaired immune response by patients with diabetic who have poor glycemic control can exarcebate the spread of infection. Harry George’s history reveals problems with pain and swelling over the past 4 years since he suffered fractures in his foot. Although he has never been told he had a bone infection, the possibility of an infection occurring at the time of the open fracture does exist; thus this infection could be categorized as exogenous in nature. However, it could also be that the infection is contiguous in nature because the patient does have a documented cellulitis of his left foot. This would be supported by the lack of documentation for a previous bone infection. Question 3 Not yet graded / 1 pts Exercise 2 - Question 3 What factors in Harry George’s history may have contributed to the development of osteomyelitis? (Hint: See Chapter 50 in your textbook.) Your Answer: Older adult and poor nourished, obese, impaired immune system, chronic illness (Diabetic). Alcohol abuse, type 2 diabetes mellitus PartialQuestion 4 0.33 / 1 pts  Click on Physician's Orders. Exercise 2 - Question 4 The following diagnostic tests are useful in the diagnosis and evaluation of osteomyelitis. Match each test with its corresponding description. (A) Used to determine causative organism (B) Identifies most cases of osteomyelitis (C) Elevated results of this test indicate infection (D) Radiologic test that is more sensitive than traditional bone scanning in the diagnosis of osteomyelitis (E) Changes with this test do not appear early in the course of the disease (F) May be normal early in disease course but rises and remains elevated for up to 3 months after drug therapy is discontinued Magnetic resonance imaging (MRI) Blood culture White blood cell count (WBC) X-ray of affected extremity Radionuclide bone scan Erythrocyte sedimentation rate (ESR) IncorrectQuestion 5 0 / 1 pts Exercise 2 - Question 5 The most common tool used to assess bone mineral density (BMD) is ____________. Question 6 Not yet graded / 1 pts Exercise 2 - Question 6 Which of the tests listed in question 4 were ordered for Harry George? Which tests were not ordered? Your Answer: Dual energ Ordered: Culture and sensitivity of wound site. Blood culture from 2 different sites. CXR and xray of left foot. Not ordered: Radioisotopevbone scan, MIR Tests ordered  Blood culture  White blood cell count  X-ray of affected extremity  Erythrocyte sedimentation rate (ESR)