Question

2. Francesca Christoff, 6 years old, is brought to the clinic by her grandmother because of redness, swelling, and tenderness of her right calf just below her knee. Francesca’s vital signs are T 38.5°C; respirations 21 breaths per minute; pulse 112 beats per minute; blood pressure 107/69. The grandmother reports that Francesca “stubbed” her right great toe and “limped for a day or two” but that she had not injured her knee in any way. (Learning Objective 1)

a. How could the nurse explain to the grandmother that Francesca got the infection in her bone after injuring her toe?

b. What teaching should the nurse do with Francesca and her grandmother on the diagnostic tests that would be ordered?

Francesca is diagnosed with osteomyelitis and admitted to the pediatric unit for intravenous therapy.

c. What nursing interventions would be important to include in Francesca’s care?

Francesca is being discharged home with a central line for administration of intravenous antibiotics at home.

d. What would be important to include in Francesca’s discharge teaching?

Answer 1

Osteomyelitis

An infection of the bone is called Osteomyelitis.

a) Nurse can explain to Francesca's Grand mother that Osteomyelitis is an infection of the bone that may spread from nearby tissue to different parts of the bone through blood stream. An open wound or surgery over a bone are the risk factors for Osteomyelitis . Francesca's injury on her great toe became infected and spread to the legs, even though the legs were not injured.

The common causative agents are Staphylococcus, Enterobacteriaceae and Pseudomonas bacteria.

b) Diagnostic tests

Osteomyelitis can be diagnosed by the Physical examination of area that affected and the wound, by Doctor. The other diagnostic tests are:

* Blood tests: Increased amount of White blood cells may indicate the presence of infection.Blood culture done to determine which organism causes the infection.

* X- ray( damage to the bone)

* MRI (Magnetic Resonance imaging) and CT (computerised Tomography): to reveal the depth of damage to bones and soft tissue around the infection.

* Bone biopsy ( to know the type of bacteria)

c) Nursing interventions

* Monitor vital signs

* Protect the affected areas by supporting the leg below and above the affected area.

* Administer antibiotics as per physician's order

* Provide a high protein diet along with Vitamin C and D rich foods

* Wound care should be aseptic( warm saline soaks, wet to dry dressing)

d).Discharge teaching

* Keep the area of central line catheter clean and dry

* Notify the healthcare provider about the signs of inflammation around the IV site( redness and swelling along with fever and chills)

* Complete the course of antibiotic. Do not stop the medication and take it in the right time, even if the child feels better.

* Do the follow up regularly

* Report if any( high fever, swelling and drainage at the affected areas