osteomyelitis

Adult & Elder III

Pre-Simulation Assignment

Madalene Scenario

Learning Outcomes:

1. Perform a physical assessment with focus on the integumentary system for a patient

with chronic osteomyelitis.

2. Prioritizes nursing care for a patient with osteomyelitis from MRSA infection.

3. Evaluate the patient for signs and symptoms of sepsis.     

4. Demonstrates clean dressing change and wound care assessment.

You receive a new admission from the Emergency Department to the medical-surgical unit. The patient is 64 years old and a paraplegic from an injury at the T12 spinal level during an old motor vehicle accident. They came from a skilled nursing facility where they reside. They are admitted for osteomyelitis, surgical debridement, and IV antibiotics.

1. Describe your initial assessment of this patient upon arrival to the unit.

2. Based on this patient’s history, what do you think caused the osteomyelitis?

3. The patient has activity orders to get out of bed to chair. Based on this patient’s history, explain how you would carry out this order while protecting your body mechanics (include any equipment and/or personnel you would need to assist you).

The patient is ordered Vancomycin 750 mg/250mL 0.9% NS IVPB over two hours Q12h. They last received a dose in the Emergency Department at 2100 last night.

4. When is their next dose due?

5. What rate would you set the pump to?

The patient tests +MRSA and contact precautions are instituted. You walk into the patient’s room and notice they are diaphoretic and breathing rapidly. Their temperature is 39 degrees Celsius. You check the monitor and lab results:

6. Explain, based on these findings, what you think is occurring in the patient.

7. After reporting your findings to the Primary Care Provider, what orders would you expect for this patient?