Question

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Mr. Morgan is a 19-year-old African-American college student with a past medical history that is significant for sickle cell disease. Several days ago, Mr. Morgan was attacked by a large dog that bit his left lower leg, leaving a puncture injury. Today, he presents to the ED with a fever of 102° F and swelling and redness around the wound. He is admitted to the hospital for treatment with a diagnosis of acute osteomyelitis.

1. What type of precautions should the nurse institute?

Mr. Morgan states that his leg hurts tremendously. The nurse notices that he grimaces as he changes positions, and has tears in his eyes.

2. What are appropriate nursing interventions for management of Mr. Morgan’s pain?

Mr. Morgan’s condition has improved over 3 days. He will be discharged to home to continue receiving the course of IV antibiotics that have been prescribed. Mr. Morgan’s mother tells the nurse, “The social worker said that a home health care nurse will give his antibiotics when he is at home. Is there anything else we have to do to help him get well?”

3. What patient teaching should the nurse provide?

Three weeks later, Mr. Morgan returns to the ED. Mr. Morgan presents with left leg pain of 10 on a scale of 1 to 10). He describes it as constant, throbbing, and increases with movement. The left leg is erythematous and hot/painful to touch. The bite wound is open and draining.

4. What healthcare team members may be involved in Mr. Morgan’s care?

Answer 1

Sickle cell anaemia leads to vasoocclusive crisis during ischemia. This is reason for more common occurrence of osteomyelitis in these cases useless even if a small trauma is treated vigerously.

The number of people who suffer from heavy musculoskeletal infections; for a wide range of evaluation it requires a multidisciplinary team approach that consists of as well as the hospital staff and services, pediatricians, orthopedists and infectious diseases specialists

The main objectives of nursing care; to avoid possible complications, reduce pain, to inform the children and their families about the process of the disease and the treatment management. In the acute stage of the disease, restriction of movement may be observed in the affected joints. However, by supporting the affected joint, the child will be in a comfortable position. Cautiously and gently moving the patient will reduce the pain. Pain treatment will relieve the patient. Vital findings are taken and recorded. If important changes may occur in the measurements, then this is shared with the team members

In the antibiotic treatment, careful observation should be performed; the vascular pathway area and the intravenous sets should be observed. Generally, several antibiotics are used together. One should consider that the used drugs are compatible with each other. The use of drugs that are not compatible should be avoided. For long-term antibiotics treatment, intermittent infusion devices or a central catheter (PICC) with peripheral input is used. The antibiotics therapy is often continued at home

Isolation should be applied to children with an open wound. In wound care, the prescribed medicines are used. In addition, the insertion of antibiotic solutions into the wound care is very effective

The received-removed fluid amount is continuously measured and recorded. Moreover, the wound drainage is also recorded. The state of healing of the wound tissue is evaluated and recorded

To provide immobility, plaster is used and in such cases, routine plaster maintenance is performed

The following are among nursing initiatives: Teaching the child to walk with crutches when necessary, ensuring that the child is kept away from slippery floors, preventing the child from moving in an uncontrolled manner during risk of insufficient mobility due to the plaster, and during the Risk of Trauma due to the dangers of walking with crutches Again, when necessary, supporting and observing the child during his/her walk and ensuring that the parents carry their children in or to safe environments. The family must be informed about the weight of the plaster and advised to adjust the body mechanics carefully while carrying the child or while giving position to him/her. The family must be warned not to take support from the plaster while lifting the child. Protecting the extremity in plaster from impacts is also among important nursing initiatives

Risk of Deficiency in the Integrity of the Skin as a result of the plaster applying a pressure on the skin surface and its being among important nursing initiatives, the nurses have to prevent the use of heating or cooling devices to dry the plaster because there is the risk of burning the skin under the plaster. Other nursing initiatives are as follows: observing the skin on the side of the plaster every day to see whether there is redness or not. Applying massage to these areas to prevent skin deficiencies. Placing cotton in these areas to prevent skin irritations. Explaining to the small children why they should not put pencils or other objects to the plaster. Elevating the extremity with plaster in order to prevent edema due to the pressure of the plaster. Following the extremity with plaster to see whether there are coldness, color change, edema, pain or numbness or not being able to check the pulse in the distal of the extremity and making neurovascular assessments

Supporting the child to use his/her extremity without plaster in case of a Lack of Self-Care as a result of the limitations in movement due to the plaster is also among nursing initiatives. It may be necessary to explain to the parents and to the child that the plaster will not prevent the daily care activities such as toilet need in the morning and general body cleaning

Nursing Initiatives in Lack of Entertainment Activities [as a result of the limitations in movement due to the plaster are: Determining the entertainment activities of the child, ensuring that s/he plays chess or computer games, reads books, listens to music, draws pictures with the nurse or his/her parents or friends coming to visit if the child is bedbound

In Management of the Therapeutical Regime without Effects [15,19], the important factors are, the maintenance of the plaster, the symptoms and findings of the complications, information on the use of helping-supporting devices. The relevant Nursing Initiatives are: If the plaster gets wet, its function will be disabled, therefore ensuring that the cleaning of the child with a piece of cloth is provided; keeping the plaster dry and clean; preventing the spill of food or drinks on the child by making him/her wear a pinafore; cleaning the pinafore if any food or drink is spilt. In case an area under the plaster itches, ensuring that cold air is blown is another nursing initiative. In case bad smell comes from below the plaster or the drainage area, its possibility of being a clue for an infection must be explained to the parents of the child. The knowledge that if the neurological and circulatory functions are broken, this might cause to permanent paralysis in extremities, to ischemia or damage in the nerves must be given to the parents. The information that, in case the plaster is near the perineum area, the plaster must not get dirty with the feces or the urine must be given to the parents as well. In addition, the parents must be informed about the situation when the plaster is removed, there might be dryness and peeling on the skin

The affected area, whether in plaster or not is evaluated for color, edema, heat and sensitivity

In the first stage of the treatment the child has no appetite. For a healthy diet, until the patient feels better, one is encouraged to consume high calorie liquids, fruit juice, ice cream and jelly. In order to have bone growth and healing, an adequate nutrition has to be provided

After the treatment in the acute stage, the child will feel better. As a result of this, the appetite of the child will increase, and s/he will communicate socially. For this reason, the nurse may start entertaining and curative activities for the children in this period. However, these activities should be mostly in bed. Because resting of the child usually after the acute period is imperative. However, when isolation and bed-rest may not be required for a long term, moving in a wheelchair may be allowed

The role of nurses is to provide information to patients and caregivers about the treatment, to support and to help for the treatment plan

For providing the patient to go through the hospitalization period as comfortable as possible they are encouraged to share their fears and concerns

Psychosocial evaluation leads to the possibility of self-recognition, coping mechanisms and to reveal the sources of motivation of the patient. This is for the creation of an appropriate and effective care-plan by the whole team. The patient should be informed about the contents of the processes, that the infection could not be eliminated successfully, risk factors like the development of a new infection, problems related to prolonged bed-rest and regarding a secondary reconstructive surgery. Patients that have become aware of being not sufficiently informed or being not included in the decision taking will be prone to depression. Regarding the information given, feedback from patients and caregivers should be taken. The preparation of the treatment facilities should be presented; and plenty of opportunities should be given to ask questions frequently