OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

COLLEGE OF NURSING

CASE ANALYSIS:
Chronic Osteomyelitis

In Partial Fulfillment
of the Requirement
for the Related Learning
Experience in Pediatric
Ward

Submitted by: BSN 4-Y1-18G

PONGASE, CARLA MAE JAICTIN
PORGAL, LEECHELLE DELA CRUZ
RABOR, ROWELLA TAPAT
RACASA, ROCHELLE NILA
REYES, JOHN MARK NASIS
REYES, REYGUER TALENTO

Submitted to:
Melba Dela Cruz MAN, RN
 OUR LADY OF FATIMA UNIVERSITY
COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

TABLE OF CONTENTS

Title Page ………………...……………………………………………………………… I

Table of Contents ……………………………………………………………………… II
Introduction ………..……………………………………………………………..……3
Patient Profile ………………………………………………………………………….. 3
Anatomy ………………….…………………………………………………………… 4
Pathophysiology …..…………………………………………………….……………… 6
Demographic profile .…………………………………………………….…………… 6
Diagnostics and Lab examination ……………………………………………….…… 9
Drug study ………………………………………………………………......…............ 10
Nursing Care Plan …………………………………………………………………… 22
Members ………………………………………………………………………………... ii
 OUR LADY OF FATIMA UNIVERSITY
COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

INTRODUCTION

​ Osteomyelitis, an infection of the bone, poses significant clinical challenges, particularly in

pediatric populations. This case study focuses on a 9-year-old male patient diagnosed with osteomyelitis,
specifically affecting the left tibia. The condition often arises following trauma, surgical procedures, or
hematogenous spread, leading to inflammation and potential necrosis of the bone tissue.

In this instance, the patient underwent a surgical intervention involving debridement and irrigation
of the affected tibia. This procedure aims to remove infected and necrotic tissue, thereby promoting
healing and preventing further complications. The case highlights the importance of timely diagnosis and
effective management strategies in treating osteomyelitis, particularly in young patients who may present
with atypical symptoms or challenges in communication regarding their pain and discomfort.

Throughout this case study, we will explore the clinical presentation, diagnostic approaches,
treatment protocols, and post-operative care associated with osteomyelitis in children, emphasizing the
unique considerations that arise in this vulnerable population.

PATIENT’S PROFILE

Patient Initials S.R.E.C

Age 9 y/o

Sex Male

Birth date 09/04/2015

Address Paranaque, Metro Manila

Nationality Filipino

Religion Roman Catholic

Civil Status Single

Occupation Student

Date of Admission 11/25/24

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Time of Admission 7:23 AM

Doctor’s Name Dr. Michelle Noblejas Mangu

Admitting Diagnosis To consider Chronic osteomyelitis

Main Diagnosis Chronic Osteomyelitis

ANATOMY
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Tibial Plateau:
Function: Supports the weight of the body and forms the top of the knee joint for smooth movement
.
Intercondylar Eminence:
Function: Keeps the knee stable by holding important ligaments in place.

Tibial Tuberosity:
Function: Connects to the patellar ligament, helping straighten the leg when you move.

Anterior Border:
Function: Gives strength to the bone and serves as an attachment point for muscles.

Medial Surface:
Function: Provides support for the leg and a place for muscles to attach.

Lateral Surface:
Function: Helps in fine foot movements by anchoring muscles.

Medial Malleolus:
Function: Stabilizes the ankle and connects ligaments for secure movement.

Fibular Notch:
Function: Holds the fibula (the smaller leg bone) in place and helps stabilize the ankle joint.
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COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

PATHOPHYSIOLOGY

DEMOGRAPHIC DATA

-​ CHIEF COMPLAINT
The patient was admitted due to complaints of severe pain in the right leg. The patient stated that
the pain started after frequent engagement in basketball games.

-​ HISTORY OF PRESENT ILLNESS

- Primary Admitting Cause: Basketball Injury
- Pain Scale: 10/10
- Admission Date: November 25, 2024
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COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

-​ HISTORY OF PAST ILLNESS

N/A

-​ HISTORY OF FAMILY ILLNESS

N/A

-​ SOCIAL HISTORY
The patient is a 9-year-old boy who lives with his parents. He has five siblings and shares a close
bond with his family. During his hospital stay, he expressed that he misses his siblings and feels
emotional when discussing them. Patient enjoys playing basketball, which he considers his
favorite hobby, and he also spends time watching cartoons. His active lifestyle may have
contributed to his current condition. He is fully vaccinated, and there are no reported negative
habits such as smoking or alcohol consumption.

-​ ALLERGIES
NKA

ASSESSMENT

-​ PHYSICAL ASSESSMENT Adult Head to Toe Assessment

GENERAL: Vital Signs

Temp: 36.7
O2: 96
HR: 122
RR: 23
BP: 130/80
Pain Scale: 7/10

GENERAL APPEARANCE AND CONDITION: ●​ Appears uncomfortable

●​ Reports pain in the left leg, particularly
when touched
●​ Unable to ambulate
●​ Shows facial grimace and teary eyes due
to pain
●​ Complains of poor sleep quality attributed
to pain in the extremities

INTEGUMENTARY: ●​ No edema noted

●​ Good capillary refill within 2 seconds
●​ Normal skin color

RESPIRATORY: ●​ Clear Breath Sounds (CBS)

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120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

●​ Symmetrical Chest Expansion (SGE)

GASTROINTESTINAL: ●​ Flat
●​ Non Distended
●​ Soft to palpitation

NEUROLOGICAL: ●​ Conscious and coherent

●​ GCS of 15

-​ GORDON FUNCTIONAL HEALTH PATTERN

HEALTH PERCEPTION The patient expresses optimism regarding his

quick recuperation post-surgery. He has affirmed
his adherence to the prescribed medication
regimen, dietary guidelines, and physical therapy
exercises as ordered by his physician in order to
have better progress towards his recovery.

NUTRITIONAL-METABOLIC The patient is on a DAT diet. He also stated that

before and after his operation, the doctor put him
under NPO to prepare for his surgery.

PATTERN OF ELIMINATION In the span of 24 hours the patient had urinated

approximately 1750 cc and has defecated twice.

PATTERN OF ACTIVITY The patient reported playing basketball regularly

prior to hospitalization.

PATTERN OF SLEEP The patient sleeps at 8 PM at night and wakes up

at 5 AM to wake up his mother and father

COGNITIVE PERCEPTUAL Patient has no sensory deficiencies. He can hear

and see well, is oriented to people, time, and
place.

SELF-PERCEPTION The patient experiences feelings of guilt when

reflecting on playing basketball, perceiving it as
the primary cause of his hospitalization.

RELATIONSHIP PATTERN The patient expresses nostalgia for his three

friends, lamenting their absence during his
hospitalization. When reminiscing about his
siblings, he becomes visibly emotional and started
crying while sharing cherished memories.

ROLES OF SEXUALITY (Not Applicable)

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COPING STRESS The patient mentioned playing the game Mobile

Legends to manage stress prior to hospitalization.
Currently, he is unable to play as both arms are
connected to intravenous (IV) fluids.

RELIGIOUS PATTERN The patient’s religion is Roman Catholic

DIAGNOSTIC PROCEDURE AND LABORATORY EXAMINATIONS

DIAGNOSTIC TEST RESULT

Xpert MTB/RIF Ultra MTB NOT DETECTED

TEST NAME SI CONVENTIONAL METHOD

RESULT REF. RANGE RESULT REF. RANGE

Intact-PTH 0.69 1.20-8.40 6.5 11.1-79.5 Direct

pmol/L pmol/L pg/mL pg/mL Chemiluminescence,
Direct Sandwich

ABG

pH 7. 5 pCO2 27 pO2 83 HCO3 23.5

ABE -1.9 SaO2 97.1 ctCO2 21.9

RESULTS
Measured 37.0 °C Co-Oximetry

Na+ 128 mmol/L +Hb 6.3 g/dL

K+ 1.9 mmol/L O2Hb 96.6 %
Cl- 99 mmol/L CoHb 1.9 %
Ca++ 1.81 mmol/L MetHb 0.8 %
Lac 1.3 mmol/L HHb 0.8 %
SO2 99.2 %

Derived

TCO2 21.9 mmol/L

BE (B) -1.9 mmol/L
P/F ratio 395 mmHg
SO2 (C) 97.1 %
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HCO3 -std 23. 5 mmol/L

December 22 2024:​ ​ December 28 2024:

Crea 56.60 CBC Coagulation
BUN 6.30
Na 143.10 WBC 4.45 PT (or INR) 11.50 seconds
K 2.10 Hbg 104 Platelet count 109.60 x10⁹/L
Cl 104.80 HCT 0.32
iCa 2.53 Platelet 153 aPTT 0.42 seconds
Fibrinogen 26.50 g/L

DRUG STUDY
DRUG STUDY 1

Drugs Dosage/freq Mechanis Indication Contraindicati Side Nursing

Name uency/Rout m of on Effects Considerati
e Action on

Inhibits - UTI; -Hypersensitivi - Injection - If large

Brand Dosage: cell-wall Lower ty or allergy to site doses are
Name: 1225mg synthesis, respiratory the drug or reactions given,
Rocephin promotin tract, other such as therapy is
Frequency: g osmotic gynecologic cephalosporins. swelling, prolonged,
Generic Every 12 instability , bone or redness, or the
Name: hours ; usually joint, - Use with pain, a patient is at
Ceftriaxone bactericid intra-abdom caution in hard lump, high risk,
sodium Route: IV al inal, skin, patients or soreness monitor
or hypersensitive patient for
Classificati skin-structu to penicillin - Pain signs and
on: re infection; because of symptoms
Cephalospo septicemia possible - Diarrhea of
rin cross-sensitivit superinfecti
Antibiotics y with other - Rash on.
- Meningitis beta-lactam
antibiotics. - Increased - Monitor
- Acute blood Prothrombi
bacterial - Use platelets n Time (PT)
otitis media cautiously in (thromboc and
patient with a ytosis) Internationa
- history of l
Perioperativ colitis, renal - Elevated Normalized
e insufficiency, liver Ratio (INR)
Prophylaxis or GI or in patients
transamina
gallbladder with
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120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

- disease. ses impaired

Uncompens vitamin K
ated - Low synthesis or
gonococcal - Alert: May low vitamin
white
vulvovagini cause K stores.
tis superinfection blood cell Vitamin K
and mild to count therapy may
fatal (leukopeni be needed.
Clostridium a)
Difficile-associ - Monitor
ated Diarrhea - Increased patients for
(CDAD). If superinfecti
blood urea
suspected, on, diarrhea,
manage nitrogen and anemia
appropriately (BUN) and treat
and discontinue appropriatel
the drug if y.
needed.

- Alert: May ○
cause
hemolytic
anemia. If
anemia
develops, stop
the drug.

Drug Study 2
Drug Name Dosage/fre Mechanism Indication Contraindi Side Effects Nursing
quency/Ro of Action cation Considerati
ute on

Inhibits Septicemia: Hypersensi

Generic Dosage: bacterial Bloodstrea tivity to Common - Assess the
Name: 330mg protein m infections Clindamyci Side infection
synthesis by caused by n or Effects: site for
Clindamyci Frequency: binding to susceptible Lincomyci signs such
n Every 8 the 50S bacteria. n: Patients Gastrointes as redness,
hours ribosomal Intra-abdo with a tinal swelling,
Brand subunit, minal known Issues: pain, and
Names: Route: IV preventing Infections: allergy to drainage.
peptide Such as clindamycin Nausea and Obtain
- Cleocin bond peritonitis , Vomiting:. cultures
formation and lincomycin, before
- Dalacin and halting intra-abdom or any Diarrhea: initiating
bacterial inal components Can vary therapy to
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COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

- Clindagel growth. abscesses. of the from mild identify the

formulation to severe; causative
- Clinsol Lower should organism.
Respirator avoid its Abdominal
Classificati y Tract use.​ Pain or - Review
on: Infections: Cramps: the patient's
Including History of May occur medical
Pharmacol pneumonia, Pseudome during history for
ogical empyema, mbranous treatment. allergies,
Class: and lung Colitis or particularly
Lincosamid abscesses. Ulcerative Taste to
e antibiotic Colitis: Due Disturbanc clindamycin
Gynecologi to the e: Metallic or
Therapeuti cal increased Taste lincomycin,
c Class: Infections: risk of and any
Antibacteria Such as severe Skin history of
l agent endometritis gastrointesti Reactions: gastrointesti
, pelvic nal side nal diseases
cellulitis, effects, Rash or like colitis.
and including Itching:
bacterial Clostridium Mild skin - Monitor
vaginosis. difficile-ass rashes or the IV site
ociated itching may for signs of
Bone and diarrhea develop. phlebitis or
Joint (CDAD).​ irritation.
Infections: Vaginal
Including Severe Issues: - Observe
osteomyeliti Liver for signs of
s and septic Impairmen Vaginal hypersensiti
arthritis. t: Itching or vity,
Clindamyci Discharge: including
Skin and n is rash,
Soft Tissue metabolized Serious itching, or
Infections: by the liver; Side anaphylaxis.
Such as thus, Effects: Discontinue
cellulitis, patients the
abscesses, with severe Clostridioi medication
and infected hepatic des and seek
wounds. dysfunction difficile-ass medical
should use ociated attention if
Streptococc it Diarrhea these occur.
al cautiously, (CDAD):
Pharyngitis with - Inform
Severe patients
: As an appropriate
Diarrhea: about
alternative monitoring.​
Severe potential
in
diarrhea and side effects,
penicillin-al Atopic
including
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COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

lergic Dermatitis: colitis. gastrointesti

patients. Special care nal
must be Allergic disturbances
Acne taken in Reactions: , and advise
Vulgaris: patients them to
Topical with atopic Anaphylaxi report
formulation dermatitis s: Though severe or
s are used as rare, severe persistent
for colonization allergic symptoms.
treatment. is more reactions
prevalent in characterize - Encourage
Bacterial this patient d by adequate
Vaginosis: population difficulty fluid intake
As a vaginal breathing, to help
cream or CAUTION swelling, prevent
suppository. : and rash can esophageal
occur. irritation
Severe Elderly and
Pelvic Patients: Skin maintain
Inflammat They may Reactions: hydration,
ory be more Serious especially if
Disease: susceptible conditions diarrhea
Often in to like occurs.
combination antibiotic-as Stevens-Joh
with other sociated nson
antibiotics. colitis. syndrome or
toxic
Individuals epidermal
with necrolysis
Gastrointes
tinal Liver
Disorders: Dysfunctio
Those with n:
a history of Jaundice
gastrointesti
nal diseases Elevated
should be Liver
monitored Enzymes:
closely due Liver
to the function
potential for tests may
severe show
diarrhea. abnormaliti
es.

Blood
Disorders:
Leukopenia:
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Thrombocyt
openia:

Renal
Dysfunctio
n:
Decreased
Urination

Drug Study 3
Drug Name Dosage/fre Mechanism Indication Contraindi Side Effects Nursing
quency/Ro of Action cation Considerati
ute on

Generic Dosage: Paracetamol - Fever - Caution is •​ - Assess the

name: 300 g has a central advised if Severe patient’s
Paracetamol analgesic - Colds and you have Dizziness pain level
Frequency: effect that is flu Diabetes , before
•​
Brand q4 - q6 mediated phenylketon Trouble administerin
name: through - Headaches uria (PKU), Breathing g the
Panadol Route: activation of or any other medication.
Intravenous descending - Toothache condition •​
Drug serotonergic or sprains that requires Rash - Assess
Class: pathways. you to overall
•​
Therapeuti Debate limit/avoid health status
Itching/Swe
c: analgesic exists about these lling and alcohol
and its primary substances usage
antipyretic site of in your diet. before
action, If you have administerin
Pharmacol which may any of these g
ogic: be conditions, acetaminop
inhibits inhibition of ask your hen.
prostaglandi prostaglandi doctor or
n synthesis n (PG) pharmacist - Assess the
by reducing synthesis or about using patient’s
the active through an these pain level
form of active products using
COX-1 and metabolite safely. appropriate
COX-2 influencing tools.
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enzymes cannabinoid -Drug

receptors. interactions - Assess the
may change amount,
how your frequency,
medications and type of
work or drugs taken
increase in patients
your risk for self-medicat
serious side ing,
effects. This especially
document with OTC
does not drugs.
contain all
possible - Monitor
drug the patient’s
interactions. response to
Keep a list the
of all the medication.
products
you use - Assess the
(including patient’s
prescription allergies
/nonprescrip and
tion drugs previous
and herbal reactions to
products) medications
and share it before
with your administerin
doctor and g
pharmacist. acetaminop
Do not start, hen.
stop, or
change the - Monitor
dosage of patients
any with liver or
medicines kidney
without dysfunction
your for potential
doctor's adverse
approval. effects and
adjust the
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COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

Some dosage
products accordingly.
that may
interact with - Assess
this drug fever; note
are: the presence
ketoconazol of
e, associated
levoketocon signs
azole. (diaphoresis
,tachycardia
This , and
medication malaise).
may
interfere
with certain
lab tests,
possibly
causing
false test
results.
Make sure
lab
personnel
and all your
doctors
know you
use this
drug.

Drug Study 4
Drugs Dosage/fr Mechani Indicatio Contraind Side Effects Nursing
Name equency/R sm of n ication Consideration
oute Action

Binds - -Hypersens - CNS - Reassess

Brand Dosage: with Moderate itivity or Effects: patient’s level of
Name: 5mg opioid to severe allergy to drowsiness pain at least 15
Nubain receptors pain the drug or or sedation, and 30 minutes
in the (non-opioi its dizziness, after parenteral
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COLLEGE OF NURSING
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Frequenc CNS, d tolerant component nervousness, administration.

Generic y:Q6hrs altering patients) and in depression,
Name: perceptio those with restlessness, - Monitor vital
Nalbuphine n of and - Adjunct significant crying, signs, pain level,
hydrochlori Route: IV emotiona to respiratory euphoria, respiratory status.
de l balanced depression, floating,
response anesthesia known or hostility, - Watch for sign
Therapeuti to pain. ; suspected unusual and symptoms of
c class: preoperati GI dreams, serotonin
Opioids ve and obstruction confusion, syndrome
analgesics postoperat . faintness, (agitation,
ive hallucination hallucination,
Pharmacol analgesic; - Use s, dysphoria, rapid HR, fever,
ogic class: obstetric cautiously feeling of excessive
Opioids analgesia and at low heaviness, sweating,
agonist-anta during doses in numbness, shivering or
gonists labor and patients tingling, shaking, stiffness,
opioid delivery with unreality nausea, vomiting,
partial preexisting diarrhea).
agonists respiratory -Cardiovascu Discontinue
compromis lar: opioids if
e. Hypertension serotonin
, syndrome is
hypotension, suspected.
bradycardia,
tachycardia - When tapering
opioids, monitor
-Gastrointest closely for signs
inal: Nausea, and symptoms of
vomiting, opioid withdrawal
constipation, (restlessness,
cramps, lacrimation,
dyspepsia, rhinorrhea,
bitter taste yawning,
perspiration,
- chills, myalgia,
Respiratory: mydriasis,
Depression, irritability,
dyspnea, anxiety,
asthma weakness, back
pain, insomnia,
-Dermatologi anorexia,
c: Itching, increased BP or
burning, HR).
urticaria
- Constipation is
commonly severe
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COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

with maintenance
therapy,make sure
○​ stool softener or
other stimulant
laxative is
ordered.

Drug Study 5
Drugs Dosage/freq Mechanis Indication Contraindicati Side Nursing
Name uency/Rout m of on Effects Considerati
e Action on

Hinders - Serious or -Hypersensitivi - Reddish - Obtain

Brand Dosage: 490 bacterial severe ty or allergy to rash on hearing
Name: mg cell-wall infections the drug or its face and evaluation
Firvanq, synthesis, when other components. upper body before and
Vancocin damaging antibiotics (red man during
Frequency: the are - Use syndrome) prolonged
Generic Q 6 hrs bacterial ineffective cautiously in therapy.
Name: plasma or patients - Fever
Vancomycin membran contraindica receiving other - Monitor
hydrochlori Route: IV e and ted neurotoxic, patient’s
- Chills
de making including nephrotoxic, or fluid
the cell those ototoxic drugs; balance and
Therapeuti more caused by in patients with - Nausea watch for
c class: vulnerabl MRSA, impaired and oliguria and
Antibiotics e to staphylococ hepatic or renal vomiting cloudy urine
osmotic cus function,
Pharmacol pressure. epidermidis, hearing loss or - Bitter - Monitor
ogic class: Also or allergies to for red-man
taste
Glycopeptid interferes diphtheroid other syndrome,
es with RNA organisms. antibiotics. which can
synthesis. - Fatigue occur if
- drug is
Clostridium - Swelling infused
difficile-ass of hands rapidly. s/s:
ociated and feet maculopapu
Diarrhea lar rash on
(CDAD) face, neck,
- trunk, and
- Inflammati limbs and
Staphylococ on of a pruritus,
cal vein and
enterocolitis (phlebitis) hypotension
.
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- Damage
to the inner - Assess
ear renal
(especially function
for large (BUN,
doses) creatinine
level)
before and
during
therapy.

- Monitor
○ for s/s of
superinfecti
on (fever,
chills,
sweating,
cough,
shortness of
breath,
nasal
congestion,
sore throat,
leukocytosis
).

- Watch for
CDAD as
this can
occur up to
2 months
after
therapy
ends.

Drug Study 6
Drugs Dosage/fre Mechanism Indication Contraindi Side Effects Nursing
Name quency/Ro of Action cation Considerati
ute on

Brand Adult: 3g/ Inhibit Osteomyelit Patients Headache Monitor

Name: 0.375 every cell-wall is and septic bypersensiti Insomnia patient for
Zosyn 6hrs, by IV synthesis arthritis. ve to drug Fever diarhea and
infusion during Seizures initiate
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Generic bacterial Pneumonia Drug can Agitation therapeutic

Name: Children: if multiplicati cause Anxiety measures as
Piperacillin- 40kg with on. Peritonitis, CDAD in Dizziness needed.
Tazobactam normal appendicitis all patient Pain Drug may
renal and who present Chest pain need to be
Classificatio function abscesses. with Edema stopped.
n: diarrhea HTN
Antibiotic, : 3g every after Tachycardia
Beta-lacta 6hrs by Iv antibiotics Rhinitis If rash
m/beta-lact infusion. use. Diarrhea develop
amase rash monitor
inhibitor Patient with patient
bleeding, closely, and
uremia,hypo discontinue
kalemia, if lesion
and allergic progress
to other
drugs. Monitor
patient
sodium
intake and
electrolytes
level.

Monitor
hematologic
and
coagulation
parameters.

Drug Study 7
Drugs Dosage/fre Mechanism Indication Contraindi Side Effects Nursing
Name quency/Ro of Action cation Considerati
ute on

Brand Route: Inhibit Impetigo -Patients CNS: Drug is not

Name: topical bacterial Traumatic hypersentiv Headache for
Centany intranasal protein skin lesions e to drugs EENT:Rhini opthalmic
synthesis by To tis or internal
Generic 2-3 times reversibly eradicate -Impaired Pharyngitis use.
Name: daily and nasal renal Burning or
Mupirocin specifically colonization function stinging Discontinue
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binding to by MRSA with drug if

Classificati bacterial in adult intranasl sensitization
on: Topical isoleucyl patients use. or severe
Antibiotic transfer- GI: Taste local
RNA perversion, irritation
synthetase. nausea occurs
Respiratory:
Cough with Prolonged
intranasal used may
use cause
Skin: overgrowth
Burning, of
erythema nonsuscepti
with topical ble bacteria
use, and fungi.
pain,pruritu
s,rash,stingi
ng.

Drug Study 8
Drugs Dosage/fre Mechanism Indication Contraindi Side Effects Nursing
Name quency/Ro of Action cation Considerati
ute on

Brand Route: PO, Inhibit -Oropharyn -Anaphylaxi Headache Serious

Name: IV fungal geal s Dizziness hepatotoxici
Diflucan Dosage: CYP450 candidiasis -Hypersensi Nausea tu has
(responsible tive to drug Vomiting occurred.
Generic Injection: for fungal -esophageal -With Abdominal Monitor
Name: 100mg/50m sterol candidiasis CYP3A4 pain LFTs and
Fluconazole l, synthesis: substrates Diarrhea discontinue
200mg/100 weakwns -Vulvovagin may lead to Dyspepsia drug if
Classificati ml,400mg/2 fungal cell al QT interval Taste hepatic
on: 00ml walls. candidiasis prolongatio perversion dyrsfunctio
Antifungal, -systemic n. rash n develops.
Triazole Powder for candidiasis
oral -Cryptococc Closely
suspension: al monitor
50mg/5ml, meningitis patients
200mg/5ml -candida-rel who
ated develop
Tablets: peritonits mild rash
50mg,100m UTI stop if
g,150,mg,20 lesion is
0mg progress.
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120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

Monitor
renal
function
during
treatment;
dosage
adjustment
may be
necessary

Monitor
potassium
level.

NURSING CARE PLAN

Nursing Care Plan 1

ASSESSMENT DIAGNOSI PLANNING INTERVENTI RATIONALE EVALUATION
S ON

Subjective: Disturbed After 4 hours Independent: Independent: • After series of

- “Hindi po ako Sleep of nursing 1. Pain nursing
makatulog ng pattern intervention, 1. Assess the assessment interventions
maayos po dahil related to the patient location, helps determine within 4 hours,
ang sakit ng paa pain will report a intensity, and the the patient's pain
ko po”, as secondary to pain level of quality of pain at effectiveness of scale decreased
verbalized by the osteomyeliti 3/10 and regular intervals interventions and report
patient. s as demonstrate 2. Provide a and guides the increased sense
evidenced increased calm and quiet adjustment of of well being
- Patient’s pain by patient relaxation, environment to the pain and feeling
scale is 7/10 report of allowing him minimize management rested.
difficulty to rest more stimulation. plan.
Objective: sleeping. comfortably 3. Assist the 2. Pain • Goal Met
●​ The patient in finding assessment
patient a comfortable helps determine
displays position that the
a facial minimizes effectiveness of
grimace. pressure on the interventions
affected area. and guides the
[Link] adjustment of
deep breathing the pain
exercises and management
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COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

relaxation plan.
techniques to 3. Proper
help the patient positioning can
cope with pain help alleviate
pain and
discomfort,
Dependent: contributing to
1. Collaborate improved sleep
with the quality.
healthcare 4. Deep
provider to breathing and
determine relaxation
appropriate pain techniques
medication and promote
dosage. relaxation,
reduce muscle
Collaborative: tension, and
1. Consult with distract the
the healthcare patient from
provider to pain.
discuss
alternative pain Dependent:
management [Link]
strategies if the with the
current treatment healthcare
is ineffective. provider
ensures the
selection of the
most
appropriate pain
medication and
dosage based
on the patient's
condition.

Collaborative:
[Link]
with the
healthcare
provider is
essential to
explore
alternative pain
management
options if the
current
interventions
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COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

are ineffective.

Nursing Care Plan 2

ASSESSMENT DIAGNOSIS PLANNING INTERVENTI RATIONALE EVALUATION
ON

Subjective: Acute Pain After 3 hours of Independent: 1. Regular After a series of

"Masakit po yung related to nursing intervention, 1. Assess pain assessment nursing
paa at kamay ko inflammatory the patient will: levels regularly. ensures timely interventions within
sumasakit din po responses and 2. Provide identification of 3 hours, the patient
yung t'yan ko" as bone infection ●​ Report a distraction pain and was able to:
verbalized by the as evidenced reduction in techniques such effectiveness of
patient. by verbal pain levels to as storytelling, interventions. ●​ Reported a
reports of 3/10. playing music, 2. Distraction reduction in
Pain Scale: 7/10 pain, facial ●​ Demonstrate or watching helps divert the pain levels
grimacing, non-verbal cartoons. patient's to 3/10
Objective: and restricted signs of 3. Reposition attention from ●​ Facial
●​ Facial movement. comfort, such the patient pain and grimacing
grimace as relaxed carefully and promotes decreased,
noted. facial frequently to relaxation. and the
●​ Defensive expressions avoid pressure 3. Proper patient
behavior and improved on painful positioning appeared
when cooperation areas. helps reduce more
touched, during care. discomfort and relaxed.
especially Dependent: prevents ●​ Goal met.
around the 1. Administer complications
affected prescribed like pressure
area. analgesics sores.
●​ Restricted 2. Administer
movement antibiotics as 1. Pain
due to pain. prescribed medications
●​ Guarding 3. Assist in help manage
posture diagnostic and reduce pain
observed. procedures, levels,
such as blood improving the
tests or patient’s overall
imaging, as comfort.
ordered by the 2. Antibiotics
physician. target the
underlying
infection
Collaborative: causing the
1. Coordinate inflammatory
with the process and
physical pain.
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COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

therapist for 3. Diagnostic

appropriate tests help
mobility monitor the
exercises. patient’s
2. Work with condition and
the healthcare guide further
team to adjust treatment.
the pain
management 1. Collaboration
plan based on with a physical
the patient’s therapist helps
response. improve the
3. Involve the patient’s
patient’s family mobility and
in the care plan prevents muscle
by providing atrophy.
emotional 2. A
support and multidisciplinar
education. y approach
ensures that the
patient receives
comprehensive
care tailored to
their needs.
3. Family
involvement
enhances the
patient’s
emotional
well-being and
ensures
continuity of
care at home.

Nursing Care Plan 3

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective Risk of fall - The patient - Pull up side - Utilization of - Patient

Data: related to will report an rails of the bed the side rails of reported a
“Hindi ko po impaired alleviated pain - Teach the the bed decreased pain
maigalaw ng physical scale of 3/10 patient and the decreases the scale to a
maayos po mobility or lower. patient’s chances of fall manageable
yung katawan secondary to - The patient mother proper of the patient. level of 3/10
 OUR LADY OF FATIMA UNIVERSITY
COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

ko kasi osteomyelitis and the positioning - Proper - Patient and

sobrang sakit” patient’s and encourage positioning can the patient’s
- Pain scale of mother will be the use of help reduce guardians
7/10 educated of the supportive pain and understood the
Objective proper devices (e.g., prevent further importance of
Data: positioning to pillows, foam complications. proper
- The patient is avoid fall and wedges). - Proper positioning
positioned to alleviate the - Perform positioning can and utilization
improperly due pain of the regular pain also help of assistive
to the mother patient assessments decrease devices in
sleeping beside using a occurrence of helping the
the patient. standardized fall. patient manage
- The patient pain scale. - Regular pain the pain and
displayed - Administer assessments minimizing the
facial grimace prescribed pain allow for risk of fall
- Restricted medications as timely - No incident
movement due per doctor's adjustments in of fall
to pain order pain occurred
management during
interventions. hospitalization.

DISCHARGE PLAN

MEDICATIONS
●​ Complete the full course of prescribed
antibiotics (e.g., Ceftriaxone,
Clindamycin, Piperacillin-tazobactam,
Vancomycin).
●​ Apply Mupirocin ointment as instructed
to prevent infection at the wound site.
●​ Administer Paracetamol for pain
management as needed, following the
prescribed dosage.

HEALTH TEACHING
●​ Educate the patient and family on
recognizing signs of infection, such as
fever, redness, swelling, or increased pain.
●​ Emphasize the importance of adhering to
the medication regimen to ensure
complete recovery.
●​ Instruct on proper wound care techniques
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COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

to prevent secondary infections.

●​ Encourage good hand hygiene to
minimize infection risks.

OUT-PATIENT DEPARTMENT
●​ Schedule follow-up appointments with the
pediatric orthopedist and infectious
disease specialist.
●​ Ensure regular monitoring through
radiologic imaging (e.g., X-rays, MRI) to
assess bone healing.
●​ Coordinate physical therapy sessions to
support gradual mobility improvement.

DIET
●​ Encourage a balanced diet rich in protein,
calcium, and vitamins to promote bone
healing.
●​ Ensure the patient stays hydrated to
support overall health.
●​ Limit sugary and processed foods to avoid
compromising the immune system.

LIFESTYLE CHANGES
●​ Limit weight-bearing activities until
cleared by the healthcare provider.
●​ Gradually reintroduce physical activities,
including basketball, under medical
supervision.
●​ Encourage light, non-strenuous activities
to prevent muscle atrophy.
●​ Promote adequate rest and sleep to aid in
recovery.
●​ Encourage emotional support through
family bonding and therapeutic activities
to help the patient cope with the
hospitalization experience.
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COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

MEMBERS:
PONGASE, CARLA MAE JAICTIN

PORGAL, LEECHELLE DELA CRUZ

 OUR LADY OF FATIMA UNIVERSITY
COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

RABOR, ROWELLA TAPAT

RACASA, ROCHELLE NILA

 OUR LADY OF FATIMA UNIVERSITY
COLLEGE OF NURSING
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila

REYES, JOHN MARK NASIS

REYES, REYGUER TALENTO