Poc Case Study

8/8/2019 Poc Case Study

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In partial fulfilment of

the requirements in RLE 104

CASE STUDY:

LEFT SEPTIC ANKLE

Submitted to:

Flora C. Agajan, R.N., M.A.N.

Submitted by:

GROUP XIII

GAUANG, Jeremy Rose GUZMAN, Pearl Karen

GERONIMO, Kevin Rae HADAP, Florence PazGODOY , Renlyn Ruth HERRERA, Joshua AnnmielleGOMEZ, Beatriz Faustine Marie IDLISAN, Shara JaneGOMEZ, Fatima Nadine IMSON, Francis MikoGOMEZ, Rogina Elaine

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TABLE OF CONTENTS

PAGE

I. Introduction------------------------------------------------------------------------ 3

A. Objectives------------------------------------------------------------------- 4

B. Theoretical framework-------------------------------------------------- 5

II. Patient’s data--------------------------------------------------------------------- 6

A. Medical History----------------------------------------------------------- 7-8

a. History of Present Illness

b. Past Medical History

c. Family Medical History

d. Social History

e. Environmental History

III. Physical Assessment---------------------------------------------------------- 9-

13

IV. Patterns of Functioning------------------------------------------------------- 14-17

V. Anatomy and Physiology----------------------------------------------------- 18

VI. Pathophysiology --------------------------------------------------------------- 19

VII. Laboratory Results------------------------------------------------------------ 20

VIII. Diagnostic Examinations---------------------------------------------------21

X. Interventions------------------------------------------------------------21

IX. Drug study ----------------------------------------------------------------------22

XI. Discharge Planning -----------------------------------------------------------23

XII. Nursing Care Plan ------------------------------------------------------------24-

26

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I. Introduction

Sepsis is a condition in which the body is fighting a severe infection that

has spread via the bloodstream. If a patient becomes "septic," they will likely

be in a state of low blood pressure termed "shock." This condition can

develop either as a result of the body's own defense system or from toxic

substances made by the infecting agent (such as a bacteria, virus, or

fungus).

Many different microbes can cause sepsis. Although bacteria are most

commonly the cause, viruses and fungi can also cause sepsis. Infections in

the lungs (pneumonia), bladder and kidneys (urinary tract infections), skin

(cellulitis), abdomen (such as appendicitis), and other areas (such as

meningitis) can spread and lead to sepsis. Infections that develop after

surgery can also lead to sepsis.

Signs and Symptoms:

• If a person has sepsis, they often will have fever. Sometimes, though,

the body temperature may be normal or even low.

• The individual may also have chills and severe shaking.

• The heart may be beating very fast, and breathing may be rapid low

blood pressure is often observed in septic patients.

• Confusion, disorientation, and agitation may be seen as well as

dizziness and decreased urination.

• Some patients who have sepsis develop a rash on their skin. The rash

may be a reddish discoloration or small dark red dots throughout the

body.

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• You may also develop pain in the joints at your wrists, elbows, back,

hips, knees, and ankles.

A. Objective

GENERAL OBJECTIVE

After nearly two (2) weeks of exposure to the Philippine Orthopedic

Center (POC), our group, Group 13 of Batch 2011 from Capitol Medical

Center Colleges (CMCC) will be able to acquire knowledge, skills and attituderegarding a musculoskeletal disease which have been left untreated and

have complicated to a Left Septic Ankle.

SPECIFIC OBJECTIVES

• We will establish trust and rapport in order to gain cooperation.

• We will encourage to verbally express feelings toward the condition.

• We will encourage active participation while we ask for patterns of

functioning.

• We will actively listen to and note behaviours both verbally and non-

verbally.

• We will perform physical assessment in order to assess if there are any

more problems besides the complaint and final diagnosis.

• We will educate about how the disease/ condition was acquired, its signs

and symptoms, and management.

• We will educate on how to deal with the condition without compromising

the self esteem and activities of daily living.

4



• We will instruct on how, when, and what route to take the prescribed

drugs and inform what it is for and how it works in the system.

• We will instruct on how to manage the condition through cleaning of the

affected part, rehabilitative therapeutic exercises for range of motion and

use of assistive devices, such as crutches.

• We will determine through questioning, if the nursing interventions we

have discussed has been understood and applied.

• We will monitor the condition through progressive development and

maintenance of proper self care.

B. Theoretical frame work

Dorothea Elizabeth Orem

'Self Care' Model of Nursing. The Orem model is based upon the

philosophy that all "patients wish to care for themselves".

Orem's theory specifically focuses on the nurse's approach towards

persons who are limited in their ability to take care of

themselves. According to Orem "Individuals take actions to meet others'

health-related needs". Nurses should ultimately provide a therapeutic

human health service.

Since the patient is not able to perform his activities independently

even if he wishes due to his condition, the nurse, or a companion must

always be at bedside, in order to help him in performing such desired

activities cautiously, while not stressing or demanding too much energy so

as to conserve it for rehabilitation purposes.

5



In order to promote total recovery, we must allow the patient to

perform their own self care while with assistance to establish

independence and at the same time prevention of any more injuries.

II.Personal Data

Name: Patient X

Address: Quezon City

Age: 17 years old

Sex: Male

Civil Status: Single

Religion: Roman Catholic

Birthday: January 26, 1993

Birthplace: Pasig City

Occupation: Student / Dancer

Date of Admission: August 3, 2010

Time of Admission: 14:20

Room and Bed No.: Male A Ward Bed 16

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Hospital No.: 123xxx

Attending Physician: Dr. Espinosa

Medical Diagnosis: Left Septic Ankle

Chief Complaint: Left ankle pain to upper thigh

A. Medical history

a. History of Present Illness

Patient was admitted last July 23, 2010 at Philippine Orthopedic Center

due to left ankle pain. Patient was apparently well until 4 months prior to

admission, as the patient states: he is a dancer, together with his dance

troupe they joined a dance contest and then on the later part of the dance he

fell out of balance and the left ankle had slipped off. After the incident he

didn’t mind it and go on to his daily activities.

3 months prior to admission the patient experience pain in the left ankle

and he decided to go to the healers or what they called “mang-hihilot” and

the pain was relieved.

2 months prior to admission, the patient experienced again the pain in his

left ankle and decided again to go to the ‘‘mang-hihilot”.

7



1 month prior to admission, the patient’s ankle developed pus with blood

accompanied by severe pain radiating to the upper thigh.

1 day prior to admission, patient was febrile and had severe ankle pain

with blood and pus, and consulted a physician at Philippine Orthopedic

Center and had laboratory exam done and was advised to have surgery.

On the day of admission, the patient was brought to the operating room

and had gone through arthrotomy debridement at his left ankle.

b. Past medical History

The patient has no known serious conditions in the past. .

c. Family Medical History

The patient’s family has no known serious conditions such as hypertension,

bronchial asthma, diabetes mellitus or cancer.

d. Social History

The patient is able to consume one (1) pack of cigarette per day. He drinks

alcoholic beverages with his friends once a week. He spends his time

practicing with his dance troupe, where they join various dancing competition

in the city. He is also an active member of a brotherhood, a group wherein he

is able to interact, meet and be around different people from different places

with the same group of brotherhood.

e. Environmental History

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The patient lives in V. Luna, Quezon City. His dwelling place is located in a

shanty type of area, considered to be called a squatter’s area, which is

according to him, full with different types of people. There is something he

considers to be an odd description of their place, which is divided in three

parts: the first street is the happy part, wherein good vibes are always

present; second is the dying part, where there are always an incidence of old

people dying; and lastly, the dangerous part, where there are drug addicts,

snatchers and gang wars.

III. Physical assessment

- Received patient awake on bed with an ongoing IVF on D5LRx1l, regulated at

21 gtt/min;

- Conscious and coherent;

- Ambulatory with crutches;

- With vital signs of: BP= 110/70; Temp.= 36.0; PR= 63 beats/min ; and RR=18

beats/min

- Weight= 52 kgs. and Height= 5’3’’ feet

BODY PARTa. Head

METHODS

USED

NORMAL

FINDINGS

ACTUAL

FINDINGS

INTERPRETATIO

N

SkullInspectionPalpation

Proportional to thebody size, roundwith prominence inthe frontal areaanteriorly and theoccipital area

Proportional to thebody size, roundwith prominence inthe frontal areaanteriorly and theoccipital area

Normal

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posteriorly,symmetrical in allplanes gently curve

posteriorly,symmetrical in allplanes gently curve

ScalpInspectionPalpation

White, clean, freefrom masses,lumps, scars, nits,dandruff andlesion

White, free frommasses, lumps,scars, nits andlesion. Withpresence of ample amount of dandruff

Dandruff is dueto poor personal

hygiene,especially hair

care

HairInspectionPalpation

Black evenlydistributed andcovers the wholescalp, thick, shiny,free from split ends

Hair is thick, shinyand free from splitends. It is long inlength, dyed brown,with streaks of highlights.

Normal

FaceInspectionPalpation

Oblong or ovalshapesymmetricalfacial expressions

that is dependenton the mood ortrue feelings,smooth and freefrom wrinkles, noinvoluntarymusclemovements

Oval shaped,symmetricalfacial expressionsthat is dependent

on the patient’sexpression. Skinhas scars, butfree fromwrinkles, noinvoluntarymusclemovements

Scars are

caused bychicken pox

marks

EyesInspection

Parallel and evenlyplacedsymmetrical. Non-protruding withscant amount of secretion. Both

eyes black andclear

Parallel and evenlyplacedsymmetrical. Non-protruding withscant amount of secretion. Both

eyes black andclear. With 20/20vision

Normal

EyebrowsInspectionPalpation

Black symmetrical,thick can raiseeyebrowssymmetrically andwithout difficulty.Evenly distributedand parallel witheach other

Black symmetrical,thick can raiseeyebrowssymmetrically andwithout difficulty.Evenly distributedand parallel witheach other

Normal

EyelashesInspection

Black, evenlydistributed andturned outward

Black, evenlydistributed, andturned outward

Normal

Lid marginInspection

Upper lids cover asmall portion of theiris, cornea andsclera. When eyesare closed the lidsclose completely.Symmetrical colorthe same withsurrounding eyes

Upper lids cover asmall portion of theiris, cornea, andsclera. When eyesare closed lidscovers the eyecompletely.Symmetrical incolor the same withsurrounding eyes.

Normal

Palpebral fissure Inspection Appears equal Appears equal Normal

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when eyes areopen

when eyes areopen

Lower palpebralconjunctiva

InspectionPalpation

Salmon pink, shiny,moist andtransparent

Pale pink, shiny,moist andtransparent

Normal

Sclera InspectionWhite, clear andmoist

White, clear andmoist

Normal

IrisInspection

Proportional to thesize of the eye,round black/brownand symmetrical

Proportional to thesize of the eye,round and brown incolor andsymmetrical

Normal

PupilInspection

From pinpoint tothe size of the iris,round symmetrical.Constrict withincreasing light andaccommodationwhen the lightcomes closely itconstricts the sizeof the pupil

Round andsymmetrical,constrict with theincreasing light andaccommodationwhen the lightcomes closely thepupils becomessmaller

Normal

Field of visionInspection

Able to see 600

superiorly, 900

temporarily and 700

inferiorly

Able to see 600

superiorly, 900

temporarily, and700 inferiorly.

Normal

EarsInspectionPalpation

Parallel,symmetrically,proportion to thesize of the head,bean shaped, helixis in line with theouter canthus of the eye, skin is thesame color as thesurrounding area

and clean

Parallel,symmetrically,proportion to thesize of the head,bean shaped, andhelix is in line withthe outer canthusof the eye, skin isthe same color asthe surrounding

area and clean.

Normal

Ear canalInspection

Pinkish, clean withscant amount of cerumen and a fewcilia

Pinkish, clean withscant amount of cerumen and a fewcilia

Normal

Hearing acuityInspection

Able to hearwhisper, spoken 2ft away. Midline,symmetrical andpatent

Able to hearwhisper, spoken 2ft away. Midline,symmetrical andpatent

Normal

NoseInspectionPalpation

Midline,symmetrical andpatent

Prominent, midline,symmetrical andpatent

Normal

Internal nares InspectionClean, pinkish withfew cilia

Clean, pinkish withfew cilia

Normal

Septum InspectionPalpation

Straight Straight Normal

MouthInspectionPalpation

Pinkish,symmetrical. Lipsmargin welldefined, smoothand moist

Brownish pink,symmetrical. Lips’margin is welldefined, smoothand moist

Lip color is dueto smoking

history

Gums InspectionPalpation

Pinkish, smooth,no swelling, noretractions, no

Reddish pink incolor, smooth, noswelling, no

Gum color isdue to smoking

history.

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discharge retractions, nodischarge, nobleeding or sores.

TeethInspection

32 permanentteeth aligned freefrom carries, no

halitosis

22 permanentteeth, yellowishin color, chipped

2 frontal teeth,cavities in bothlower molars

Patient’s oralhygiene is poor

TongueInspectionPalpation

Large, medium, redor pink slightlyrough on top,smooth along thelateral margins,moist, shiny andfreely movable

Large, pinkish incolor. Rough on thetop, with whitestrains of food,smooth along thelateral margins,moist, shiny, freelymovable

Normal

Frenulum InspectionMidline, straightand thin

Midline, straightand thin. Moist andshiny

Normal

Cheeks Inspection

Pinkish, smooth

and moist

Pinkish, smooth

and moist. Nopresence of mouthsore

Normal

PalateSoft palate

Hard palate

InspectionPalpation

Pinkish, smoothand moistLight pink, slightlyrough

Pinkish, smoothand moistLight pink, slightlyrough

Normal

Normal

Uvula Inspection

Located at thecenter,symmetrical, freelymovable, pinkish incolor, shiny andmoist

Located at thecenter,symmetrical, freelymovable, pinkish incolor, shiny andmoist

Normal

Tonsil Inspection Pinkish, non-Inflammed and noexudate

Pinkish, non-Inflammed and noexudate

Normal

Voice InspectionNo hoarseness, wellmodulated

No hoarseness, wellmodulated

Normal

Neck InspectionPalpation

Proportional to thesize of the bodyand head.Symmetrical inposition

Proportional to thesize of the bodyand head.Symmetrical inposition.

Normal

Range of motionInspection

Palpation

Freely movablewithout difficulty

Freely movablewithout difficulty onunaffected site, buthas pain in leftthigh to lower leg

Difficulty due tothe pain caused

by the anklesprain and

inflammation of

the ankle jointthat has radiated

to the upperthigh.

Muscularstrength

InspectionPalpation

Both muscle aresymmetrical andable to resistapplied force

Both muscle aresymmetrical andable to resistapplied force

Normal

Thorax and Lungs InspectionPalpation

The chestsymmetrical and

Prominent chest,symmetrical and is

Normal

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Auscultation

the chest is twiceas wide as deep,the spine is straightposteriorly. Thechest wall movessymmetricallyduring respiration.

No lumps, massesor tenderness, sideof the thoraxexpandssymmetrically.Vibrations areprominent over theareas near thebronchi, itincreases with theintensity of voice.No difficulty of breathingNo wheezingsound, cracking or

gurgling noise whilebreathingRespiratory rateranges from 18-20breaths per minute

twice as wide asdeep, the spine isstraight posteriorly. The chest wallmovessymmetricallyduring respiration.

No lumps, massesor tenderness, sideof the thoraxexpandssymmetrically.Slow, deepbreathing,sometimes abrupt.No wheezingsound, cracking orgurgling noise whilebreathingRespiratory rate is19 breaths perminute

HeartInspectionPalpation

Auscultation

Pulsation visibleand palpable2 heart soundaudible in all areas,but loudest atapical area cardiacrate ranges from80-100 beats perminute

Pulsation extremelyvisible and palpable2 heart soundaudible in all areas,but loudest atapical area cardiacrate of 63 beats perminute

Normal

Abdomen

InspectionPercussionPalpation

Auscultation

Skin isunblemished, noscar. Color inuniform orscapoid,symmetrical.Movementcaused bybreathing. Theumbilicus is flator concave,positions midwaybetween the

xiphoid processand thesymphisis pubis.Color the same asthe surroundingskin

Skin isunblemished,Color in uniformor scapoid,symmetrical.Movementcaused bybreathing. Theumbilicus is flator concave,positions midwaybetween thexiphoid process

and thesymphisis pubis.Color the same asthe surroundingskin. Withpresence of scars

Scars presentare caused bychicken pox

marks

UPPEREXTREMITIES

Arms

InspectionPalpation Skin color varies

from brown, darkbrown, fair, pinkish.

Skin color is brown,symmetrical in size,shape. No presence

Normal

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Symmetrical,presence orabsence of visibleveinsWarm, dry andelastic no areas of tenderness. Muscle

appears equal withgood muscle tone

of tenderness, novisible veins. armsare warm, dry andelastic. Muscleappears equal withgood muscle tone

Palm and dorsalsurface

InspectionPalpation

Palm pinkish brown Palm slightly pale incolor, presence of callus

From excessivefriction in thepalm due to

dancing

NailsInspectionPalpation

Transparent,smooth and convexwith pinkish nailbeds and whitetranslucentFive fingers in eachhandAs pressure appliedto the nail bed

appears white orbalance and pinkcolor returnsimmediately afterreleasing thepressure

Transparent,smooth and convexwith pinkish nailbeds and whitetranslucentFive fingers in eachhandAs pressure appliedto the nail bed

appears white orbalance and pinkcolor returnsimmediately afterreleasing thepressure

Normal

Manipulation-Process of

moving the partbeing examined

Shoulder

Arms

Elbows

Hand and wrist

InspectionPalpation

InspectionPalpation

InspectionPalpation

InspectionPalpation

Perform on ease

Performs on ease

Performs on ease

Perform on ease

Perform on ease

Performs on ease

Performs on ease

Performs limited,on ease; with IVFon right hand withsplint

Normal

Normal

Normal

Normal; limitedmanipulation due

to splint

LOWEREXTREMITIES

Legs

InspectionPalpation Skin color varies

from pinkish, tan,fair, dark brown.Skin is smooth,

fine hair evenlydistributed.Absence of varicose veins,musclesymmetrical,length issymmetrical.Muscle appears

Skin color darkbrown.Skin is dry, fewfine hair

distributed.Absence of varicose veins,musclesymmetrical,length issymmetrical. Leftleg is with shortleg posterior

Short legposterior mold

was used due toa compound

affection in theankle of the the

left foot

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equal, warm totouch and withgood muscle tone

mold

Toes InspectionPalpation

Five toes in eachfoot, smooth withpink nail beds

and white tips

Five toes in eachfoot, smooth withpinkish white nail

beds and whitetips. Takes 3seconds on lefttoe afterreleasingpressure

Poor bloodcirculation in the

left lower

extremity due tothe limited

movement inthe affected

area

IV. Patterns of Functioning

Patterns of

Functioning

Before

Hospitalizatio

n

During

Hospitalizatio

n

Nursing

Theory

Analysis/Interpreta

tion

15



1. Health

Perception/Hea

lth

Management

The patient

does not give

much priority

with his

health; he

self medicates,

goes to the

“quack

doctor” for

intervention,

and does not

prioritize

regular

check-ups

with aphysician.

The patient

relied and

depended on

the health

care

providersregarding his

health. He

followed the

guidelines

given to him

by his

physician for

the condition

that was

diagnosedwith.

There is a change

in the patient’s

health perception.

It was improved

because of the

knowledge hegained from the

health care

providers in the

hospital regarding

the importance of

health.

2. Nutritional/

Metabolic

The patient

eats all kinds

of food with

rice. He is fond

of eating

chicken and

red meat

(beef) and

drinking soft

drinks (coke).He doesn’t

have any

pattern of

healthy diet

and right time

in eating.

Usually, at

breakfast, he

eats a cup of

rice and egg

with tuyo or

kamatis. At

lunch time,

rice with

monggo and

meat, together

with RC soda,

2 glasses. And

during dinner,

The patient is

on a DAT

diet, or diet

as tolerated.

He is being

served with

rice and fish

every meal,

most of thetime, Bangus

in various

styles of

cooking,

vegetables

as side dish.

Abraham

Maslow’s

Hierarchy of

Needs

(Physiologica

l needs)

The patients’

eating pattern has

changed regarding

his food choices

and time of eating.

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he eats 2 cups

of rice and

tilapia or

beefsteak,

whatever

viand is

available, as

long as

partnered with

rice

3. Elimination The patient

defecates

twice a day

and voids

five (5) to six

(6) times a

day withoutdifficulty.

The patient

defecates

semi formed

stool twice a

day and

urinates clear

yellow urineabout 8x a

day

The patient’s

elimination pattern

changed, due to an

increased intake of

oral fluids and

parenteral intake

of 2250ml in thehospital

4. Activity

Exercise

The patient is

a dancer and

he also

engages in

physical

activities and

sports, like

basketball

Patient

always gets

out of bed

and loiters

around the

room to chat

with his co-

patients. He

jumps around

when out of

his bed, due

to difficulty in

using the

crutches

The patient’s

activity and

exercise pattern

has changed. He

has limited

physical activity

due to his current

condition.

5. Sleep- Rest

Pattern

The patient

sleeps eight

(8) to ten

(10) hours in

a day without

difficulty.

The patient

sleeps four

(4) to five (5)

hours in a

day with

difficulty, due

to the noise

and in and

out of visitors

The patient’s

Sleep-rest pattern

has changed due

to uncontrolled

noise in the area.

17



in the ward.

6. Cognitive

Perceptual

The The

patient isconscious

and

coherent,

responsive

and is

enthusiastic

when talking

with people.

He converses

andcomprehends

well; he

actively

responds

whenever he

is being

talked to, has

good

memory and

can make

decisions

independentl

y.

The patient is

stillresponding

actively and

enthusiastica

lly to

whenever he

is being

talked to.

Jean Piaget’s

CognitiveTheory of

Developmen

t

(Formal

Operational

Stage)

The patient’s

cognitive-perceptual pattern

did not change. His

condition did not

change his ability

to understand.

7. Self-

Perception/

Self Concept

The patient

feels good

and

comfortable

about himself

even if he

experiences

pain he

thinks the

pain will

subside in

time

The patient is

now aware of

the

seriousness

of his

fracture. He

feels bad to

be seen in

crutches

when he

returns

home.

However, his self

esteem lowered, in

fear that his

friends and

neighbours will

laugh at him, when

they see a dancer

in crutches.

18



8. Role

Relationship

The patient

the 3rd

among 4

children. He

is the

youngest boyin the family.

He is not that

close with his

family. He

has little time

in spending

with his

mother and

father. he

often hangs

out in dance

practice or

just spending

time with his

friends.

The patient

had no

companion

around, his

father and

mother leftdue to an

immediate

family crisis.

Erik

Erikson’s

Psychosocial

theory of

Developmen

t

(Identity vs.

Role

Confusion)

There is no change

in his role-

relationship

pattern. Even

though he is not

always togetherwith his family, the

patient says he

loves his family

and friends even if

they are not with

him at his current

condition; however

he stated that he

feels alone that no

one is there to be

with him.

9. Sexuality

Reproductive

The patient is

an adolescent

who is at the

peak of his

puberty. He is

engaged in a

long distance

relationship

with his

girlfriend of 6

months.

However, he is

not in any

intimate

contact with

her. They text

a lot, talkthrough the

phone, despite

the distance.

The patient

did not

inform his

girlfriend

about hiscurrent

condition. He

is afraid that

his girl might

get worried

and might

not be able

to

concentrate

on her

studies

Erik

Erikson’s

Psychosocial

theory of

Development

(Identity vs.

Role

Confusion)

There is a change

in the patient’s

sexuality-

reproductive

pattern. He usedthe distance to not

be able to inform

his girlfriend about

his condition to

lessen her worries.

19



10. Coping/

Stress

Tolerance

The patient

copes with

his stress

and problems

in life

throughexpressing it

in dancing

and drinking,

spending

time with his

friends

The patient

has a

positive

attitude he

keeps

himself busythrough

texting and

chatting with

his co-

patients in

the ward.

There is a change

in the patient’s

coping/ stress

tolerance pattern,

since he is not able

to express hisfeelings through

dancing.

11. Value/

Belief

The patient

rarely visits

the church to

attend mass,but said that

he has faith

in God.

The patient

prays to the

Lord for

fasterrecovery.

The patient’s value/

belief pattern

changed. He learned

to ask for help fromGod for faster

recovery because he

thinks it’s God’s way

of punishment for

not being able to

going to church and

renewing his faith.

V. Anatomy and Physiology

Medial Lateral Anterior Posterior

The ankle is made up of two joints: The ankle joint and the subtalar joint. The ankle joint includes two bones (the tibia and the fibula) that form a joint that allows the

20



foot to bend up and down. Two bones of the foot (the talus and the calcaneus)connect to make the subtalar joint that allows the foot to move side to side. Thetarsal bones connect to the 5 long bones of the foot - the metatarsals

VI. Pathophysiology

Pathophysiology of Septic Ankle

Predisposing Factors Precipitating Factors

-Age (Adolescent, 17) - Lifestyle

-Gender (Male) (smoker, alcoholicdrinker)

- Injury/ Trauma

21



(ankle sprain due to slip)

- Strenuous Activities(Dancing/ dancingpractice)

- Consultation to a quackdoctor (“Manghihilot”)

TWISTED ANKLE

TRAUMA ON AFFECTED SITE

LIGAMENTS THAT SUPPORT ANKLE IS TORN

SWELLING, INFLAMMATION, BRUISING

BACTERIAL INFECTION PENETRATES IN THE AFFECTED AREA

(Staphylococcus aureus)

POOR HYGIENE

CELLULITIS

22



JOINT SWELLING, JOINT PAIN, PUS FORMATION, LOW-GRADE FEVER, REDNESS

SEPTIC ANKLE

VII. Laboratory Results

Hematology

Test Result Unit ReferenceHemoglobin 132 g/L M 127-183

F 120-150Hematocrit 0.41 F 0.37-0.45

M 0.37-0.54Leukocytes Count 10.2 q/L 10-48x109

IndicesMCV 85 F1 82-92

MCH L 27 Pg 28-32MCHC 32 % 32-38DifferentialCountSegmenters 0.66 0.5-0.7Lymphocytes 0.25 0.2-0.4Monocytes 0.05 0.0-0.7Eosinophils 0.04 0-0.5

Platelet Count 470 /L 150-400x109

• Bacteriology Sec. (Aug 2,

2010)

Examination Desired: Gram

Stain Right Ankle

Specimen Submitted: Wound

Preliminary Report:

*RBC +

*WBC few

*No Microorganism seen

*No Spore-forming Bacilli

seen Final Report: *No growth after

72hrs of incubation.

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• Bacteriology Sec. (Aug 2,

2010)

Penicillin Oxacillin (S)

Pen G/ Amoxicillin (R)

Glycopeptide Vancomycin (S)

Cephalosphorin (S)

Gentamycin (S)

Final Organism:

Staphyloccoccus Aureus

→ moderate to heavy growth

Analysis:

> MEAN CORPUSCULAR HEMOGLOBIN

• It is a calculation of the amount of oxygen-carrying hemoglobin inside the

RBCs.

• Decreased MCH occurs in microcytic anemia or hypochromic anemia.

VIII.Diagnostic Examinations

Blood culture

- performed to isolate and aid identification of the pathogens in bacteremia

(bacterial invasion of the bloodstream) and septicemia (systemic spread of such

infection). It requires inoculating a culture medium with a blood sample and

incubating it.

Joint fluid analysis and culture

- Joint fluid analysis is a test to look at joint fluid under a microscope for problems

such as infection, gout, pseudogout, inflammation, or bleeding. The test can help

find the cause of joint pain or swelling

X-ray of the Left Ankle

- Indirect visualization of the left ankle to determine site of

inflammation, and other injury on the affected site.

IX. Interventions

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http://www.umm.edu/ency/article/003744.htm



http://arthritis.webmd.com/joint-fluid-analysis

http://www.webmd.com/hw-popup/gout-8045

http://www.webmd.com/hw-popup/pseudogout

http://www.webmd.com/hw-popup/inflammation

http://www.webmd.com/hw-popup/joint





http://arthritis.webmd.com/joint-fluid-analysis

http://www.webmd.com/hw-popup/gout-8045

http://www.webmd.com/hw-popup/pseudogout

http://www.webmd.com/hw-popup/inflammation

http://www.webmd.com/hw-popup/joint




A. Medical

- Diagnostic examinations (Blood culture, C/S, X-ray of Ankle)

- Medications (as said in the Drug Study)

- IVF Therapy (D5LRx1L @21gtt/min)

B. Surgical

- Arthotomy Debridement of left ankle (removal of necrotic tissue in the

damaged joint)

X. Discharge Planning

Medications:

1. Oxacillin (oxapen) 500mg IV q6; Ketorolac (trometamol) 30mgIV q6; Ranitidine (hydrochloride)

50mg IV q8; and Nalbuphine 5mg IV q6

Exercise:

Strengthening and range of motion exercises. This will help your patient regain its strength and

flexibility; Gentle exercises to prevent stiffness

Treatment:

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Hot compresses and splinting the joint to provide it with rest and support can help relieve pain; Septic

ankle must be diagnosed quickly and treated with antibiotics.

Health Teachings:

Patient should be aware that they should see gradual improvement in symptoms over time; Patient will

often minimize weight bearing and may only be able to perform passive range of motion prior to more

active exercises; Patient should finish all their antibiotics as ordered; Maintain general hygiene; Avoid

activities that will affect the ankle (walking, running and etc); Elevate and maintain affected area

(ankle); and use supportive devices such as crutches when moving (use it on the unaffected side).

Out-patient:

Follow-up appointments made ensure patient is aware of details.

Diet:

Eat a variety of foods. (healthy foods,fruits,vegetables); maintain ideal weight; avoid too much fat and cholesterol;

avoid too much sugar; and eat foods with enough starch and fiber.

Spiritual/Social:

Encourage patient to believe in a higher power to lessen anxiety; encourage patient to meet and enjoy support

persons to lessen anxiety.

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Poc Case Study

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