Mr

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Mr. Lourde is a 75-year-old man whose wife noticed a lump on his left hip that has uncreased in size over the past two weeks. The skin around the lump is red and swollen. Mr. Lourde complains of increasing discomfort in his left hip. His wife become concerned when he felt warm and his temperature was 101 degree F (38.3 degree C) so she brought him to the hospital. Mr. Lourde is diagnosed with an abscess of his left hip. A needle aspiration of the abscess reveals 30 mL of purulent exudate. Mr. Lourde is admitted for surgical incision and drainage of a suspected recurrence of osteomyelitis for intravenous antibiotic therapy.

 

A surgical incision and drainage is performed to remove necrotic tissue, sequestrum, and surrounding granulation tissue. A bacterial infection is identified as Enterococcus faecalis. The nurse reviews the client's Kardex and notes the dressing change prescribed is a dry sterile dressing to the left hip daily with reinforcement as needed.

The nurse medicates Mr. Lourde with hydrocodone/acetaminophen (Vicodin) thirty minutes prior to the dressing change while changing the hip dressing, the nurse notes there are seven intact sutures along the incision site. The site is slightly swollen, but there are no signs of infection. The HemoVac has drained 30 mL of dark red blood. Mr. Lourde tolerates the dressing change with minimal discomfort. He is afebrile at 98*F (36.7*C).

 

1.     Discuss the time frame within which signs of an infection at the site of a hip replacement usually occur. What possible complications are of concern when a client develops an infection at the site of a hip replacement?

2.     Discuss the pathophysiology of osteomyelitis. Include an explanation of a sequestrum, involucrum, and Brodie's abscess.

3. Discuss the clinical manifestations of osteomyelitis. 

4. The health care provider suspects a recurrence of Mr. Lourde's osteomyelitis. How will the health care provider confirm this diagnosis? 

5. Discuss the treatment options if Mr. Lourde has osteomyelitis of his left hip. 

6. Mr. Lourde will require at least three to eight weeks of high-dose intravenous antibiotic therapy. The health care provider has requested that a PICC be inserted. Explain what a PICC is and the potential complications associated with this device. 

7. What information should be included in the nurse's documentation of the dressing change? 

8. Explain why the nurse does not document the stage of the left hip wound. 

9. Write two expected outcomes for the duration of time that a HemoVac drainage reservoir system is in place. How often should the nurse empty the drain and how will the nurse ensure that the system is working correctly to drain the incision site? 

10. Each of the medications below is prescribed for Mr. Lourde. For each, provide the therapeutic drug classification and discuss the purpose of the medication for Mr. Lourde and potential adverse effect(s) that the nurse should monitor. 

1. Linezolid

2. Fondaparinux

3. Hydrocodone bitartrate/acetaminophen 

4. Acetaminophen

5. Docusate sodium 

11. Help the nurse generate three appropriate nursing diagnoses for Mr. Lourde.