PYOMYOSITIS

MEMBERS: BSN3C-C2
PARAGAS, Daniel John
PEREZ, Kirsten Mae
QUIMBA, Moises
RAMOS, Emmanel John
RAMOS, Jaimie Anne
REGATI!!O, Ma" #ristina
REI$A$TE, John Mi%heal
RE!OJO, Sheena Mae
REYES, Sharmaine Jo&
ROMBAO$, Maritoni
ROQUE, Jose Al'onso
I. GOALS AND OBJECTIVES
GOALS:
-This case presenai!n "i## ena$#e he s%&ens ! 'i(e an appr!priae iner(eni!n an&
&e#i(er h!#isic care )!r he paien. This "i## a#s! he#p he n%rsin' s%&ens ! *n!" +!re a$!%
he na%re an& he &isease pr!cess !) p,!+,!siis.
S-ECI.IC OBJECTIVES:
Attit(e
-Esa$#ish a n%rse-paien ineraci!n hr!%'h e/chan'in' !) h!%'hs an& in)!r+ai!n.
Insi%e $!n& $e"een he s%&en n%rse an& he paien.
S)ills
-T! 'i(e an appr!priae +e&ica# an& n%rsin' +ana'e+en )!r he paien "ih
p,!+,!siis.
Kno*le(+e
-De)ine -,!+,!siis.
- Disc%ss he ana!+, an& ph,si!#!', !) he M%sc%#!-s*e#ea# s,se+.
- I&eni), he si'ns an& s,+p!+s +ani)ese& $, he paien.
- Disin'%ish he precipiain' an& pre&isp!sin' )ac!rs ha ri''er his &e(e#!p+en.
- Trace he pah!'enesis $ase& !n he si'ns an& s,+p!+s +ani)ese& $, he paien.
- Be ac0%aine& "ih he &i))eren &r%'s1 is aci!ns1 an& per)!r+ appr!priae n%rsin'
resp!nsi$i#iies )!r each.
- 2se he n%rsin' pr!cess as he )ra+e"!r* )!r he care !) he paien.
- -#an )!r s%ia$#e n%rsin' care.
II. INTROD2CTION
Bac*'r!%n&
--,!+,!siis is an in)#a++ai!n !) +%sc#e iss%e1 %s%a##, !) (!#%nar, +%sc#es
3e/a+p#es are s*e#ea# +%sc#es4 ha res%#s in p%s pr!&%ci!n.
-Once c!nsi&ere& a r!pica# &isease1 i is n!" seen in e+perae c#i+aes as "e##. The
pah!'enesis is %nc#ear1 $% ra%+a1 in)eci!ns 3S. aureus, S. pneumoniae41 an& +a#n%rii!n
ha(e $een i+p#icae&. A#h!%'h +!s cases !) p,!+,!siis !cc%r in hea#h, in&i(i&%a#s1 !her
pah!'eneic )ac!rs inc#%&e n%rii!na# &e)icienc, an& ass!ciae& parasiic in)eci!n in r!pica#
c#i+aes. In he e+perae c#i+aes1 p,!+,!siis is seen +!s c!++!n#, in paiens "ih
&ia$ees1 5IV in)eci!n1 an& +a#i'nanc, $eca%se !) &ecrease& i++%ne s,se+ he, are a
'reaer ris*.
Epi&e+i!#!',
- -,!+,!siis is +!s !)en ca%se& $, he $aceri%+ Staphylococcus aureus. The
in)eci!n can a))ec an, s*e#ea# +%sc#e1 $% +!s !)en in)ecs he #ar'e +%sc#e 'r!%ps s%ch as
he 0%a&riceps !r '#%ea# +%sc#es . M!s paiens are a'e& 2 ! 6 ,ears1 $% in)eci!n +a, !cc%r
in an, a'e 'r!%p. In)eci!n !)en )!##!"s +in!r ra%+a.
C#inica# -resenai!ns
7-resenai!n "ih pain)%#1 en&er1 #!ca#i8e& s"e##in' !(er +%sc#e
7.e(er
7Epi&%ra# a$scess
C!+p#icai!ns
7Li)e-hreaenin' c!+p#icai!ns inc#%&e sepsis an& !/ic sh!c* s,n&r!+e.
Dia'n!sic -r!ce&%re
7CT scan !r MRI &e+!nsraes +%sc#e a$scess.
7Aspirai!n !) a$scess 3$, s%r'er, !r CT92S '%i&e&4 ,ie#&s p%s1 %s%a##, ,ie#&in' S.
aureus.
7Bacere+ia +a, acc!+pan,.
Trea+en
Me(i%al #are
7-r!+p#, a&+iniser s,se+ic ani$i!ics. This c!%#& e#i+inae he nee& )!r s%r'ica#
&raina'e in se#ece& cases.
7The ch!ice !) ani$i!ic is &eer+ine& $, i&eni)icai!n !) he ca%sai(e !r'anis+3C%#%re
an& sensii(i, es4.
7Ani$i!ics iniia##, are 'i(en inra(en!%s#, %ni# c#inica# i+pr!(e+en is n!e&1 )!##!"e&
$, !ra# ani$i!ics )!r a !a# c!%rse !) 3 "ee*s 3e'1 ce)a8!#in!r ce)ria/!ne IV )!##!"e& $,
cepha#e/in -O4.
Sr+i%al #are
7D%rin' he s%pp%rai(e phase1 a$scess aspirai!n %n&er %#ras!nic !r CT '%i&ance +a,
$e re0%ire&. S%r'ica# &raina'e is especia##, necessar, )!r #ar'e a$scesses.
7C!+p#icae& cases +a, re0%ire )asci!!+ies 3s%r'ica# incisi!n !) he )ascia ! re#ie(e
press%re4 an& &e$ri&e+en 3re+!(a# !) &ea& iss%es4.
Pro+nosis
7-r!+p a&+inisrai!n !) ani$i!ics can res%# in c!+p#ee res!#%i!n.
III. -ATIENT:S -RO.ILE
Bi!'raphic Daa
Na+e: -aien R.1 A.L.R.
A&&ress: ;<-E Jacin! S. Sa. L%cia N!(a#iches1 =.C.
Birh&a,: N!(e+$er ;<1 2<<>
A'e: 2 ,ears !#&
Re#i'i!%s A))i#iai!n: R!+an Cah!#ic
.aher:s Na+e: M!ises Re,es
M!her:s Na+e: Maricris Re,es
Gen&er: .e+a#e
Maria# Sa%s: Sin'#e
5!spia# Daa
5!spia# NO: ?>-3@-@6
A&+issi!n Dae an& Ti+e: .e$r%ar, ;>12<;2A B2:;< a+C
Aen&in' -h,sician: Dr. Ch%a III
IV. 5ISTORD
.AMILD 5ISTORD
- R1 A.L.R.:s )a+i#, c!n&ii!ns ha(e a here&iar, his!r, !) ash+a as "ha her +!her
sae& &%rin' he iner(ie". Oher han he here&iar, iss%es1 )a+i#ies s!+ei+es e/perience&
s!+e +in!r in)ir+i, s%ch as )e(er1 c!%'h1 c!#&s1 an& a+!n' !her ai#in'. Eih pr!per
*n!"#e&'e a$!% he re+e&ies !) hese ri)#in' sic*nesses1 i can $e easi#, c!pe& $, &rin*in'
p#en, !) "aer &ai#,. I is a#s! a&(isa$#e )!r he+ ! c!ns%# heir &!c!r "hene(er c!%'h1 c!#&s1
!r )e(ers !cc%r.
-AST MEDICAL 5ISTORD
A 2 ,ears !) a'e1 he c#ien ha& n! e/perience& an, chi#&h!!& i##nesses !r &iseases s%ch as
chic*en p!/1 +%+ps !r +eas#es. She has a#s! $een )ree !) an, ,pe !) &isease !r i##ness !(er
he pas si/ +!nhs. 5!"e(er1 she has ha& "! sins !) c!#&s $e)!re ha1 an& has a#s! $een
pre(i!%s#, &ia'n!se& "ih i+pei'!. She has n! *n!"n a##er', ! an, ,pe !) )!!&. In er+s !)
her i++%ni8ai!n1 she is a#rea&, c!+p#ee1 as sae& $, he +!her. 5is!r, !) i++%ni8ai!ns is
as )!##!"s:
-RESENT ILLNESS
Chie) C!+p#ain: -ain1 S"e##in'1 Ten&erness !n Ri'h Le'
-r!(isi!na# Dia'n!sis: -,!+,!siis Ri'h Thi'h
V. ACTIVITIES O. DAILD LIVING
VI. -ATTERNS O. .2NCTIONING
VII. -5DSICAL ASSESSMENT
VIII. DIAGNOSTIC EFAMS
IF. CO2RSE IN T5E EARD
.e$r%ar, ;>1 2<;2
The paien "as $r!%'h ! -hi#ippine Orh!pe&ic Cener #as .e$r%ar, ;>1 2<;2
a 2:;< in he +!rnin' $eca%se !) pain1 s"e##in'1 en&erness !n he ri'h #e'. She "as a&+ie&
in he E+er'enc, R!!+ carrie& $, her +!her an& "as seen $, Dr. Ch%a III. Dia'n!sic
e/a+inai!ns inc#%&in' CBC1 ESR1 CR- an& B#!!& T,pin' "ere +a&e. Therape%ics )!r he
c#ien inc#%&es O/aci##in 6<<+' IV 3ANST4 n!" hen 26<+' IV 0? an& -aracea+!# 26<+'96+#
G+# 0G )!r pain an& e+p a$!(e 3H.@. A ;< in he +!rnin' IV. D6 <.6 NACL 6<<+# "as h!!*e&
!n her ri'h ar+ a IVO.
.e$r%ar, 2<1 2<;2
A G p+1 he paien:s IV. "as re+!(e& an& chan'e "ih he sa+e D6 <.3 NACL
6<<+# a IVO.

.e$r%ar, 2;1 2<;2
A >:G< a+1 he paien:s IV. "as re+!(e& an& chan'e "ih he sa+e D6 <.3
NACL 6<<+# a IVO.
F. ANATOMD AND -AT5O-5DSIOLOGD
The #!"er #e' is c!+prise& !) "! $!nes1 he i$ia an& he s+a##er )i$%#a. The hi'h $!ne1
!r )e+%r1 is he #ar'e %pper #e' $!ne ha c!nnecs he #!"er #e' $!nes 3*nee J!in4 !
he pe#(ic $!ne 3hip J!in4.
The +ltes me(is 3!r +lt,sme(is41 !ne !) he hree '#%ea# +%sc#es1 is a $r!a&1
hic*1 ra&iain' +%sc#e1 si%ae& !n he !%er s%r)ace !) he pe#(is.
The +ltes ma-ims is he #ar'es an& +!s s%per)icia# !) he hree '#%ea# +%sc#es. I
+a*es %p a #ar'e p!ri!n !) he shape an& appearance !) he $%!c*s.
The .i%e/s 'emoris is a +%sc#e !) he p!seri!r 3he $ac*4 hi'h. B!h hea&s !) he
$iceps )e+!ris per)!r+ *nee )#e/i!n.
The +ra%ilis 3Lain )!r Ks#en&erK4 is he +!s s%per)icia# +%sc#e !n he +e&ia# si&e !) he
hi'h. I is hin an& )#aene&1 $r!a& a$!(e1 narr!" an& aperin' $e#!". The +%sc#e a&&%cs an&
)#e/es he hip as a$!(e1 an& a#s! ai&s in )#e/i!n !) he *nee.
The Sartoris ms%le L he #!n'es +%sc#e in he h%+an $!&, L is a #!n' hin +%sc#e
ha r%ns &!"n he #en'h !) he hi'h. Assiss in )#e/in'1 a$&%ci!n an& #aera# r!ai!n !) hip1
an& )#e/i!n !) *nee.
Plantaris is a (esi'ia# sr%c%re an& !ne !) he s%per)icia# +%sc#es !) he p!seri!r cr%ra#
c!+par+en !) he #e'. I )#e/ he *nee J!in.
Gastro%nemis ms%leis a (er, p!"er)%# s%per)icia# pennae +%sc#e ha is in he $ac*
par !) he #!"er #e'. I is in(!#(e& in san&in'1 "a#*in'1 r%nnin' an& J%+pin'.
2.
FI. ECOLOGIC MODEL
-,!+,!siis is a $aceria# in)eci!n !) he s*e#ea# +%sc#es1 "hich are aache& &irec#, !
he $!nes in he h%+an $!&,.
I is %s%a##, ca%se& $, he $aceria Saph,#!c!cc%s a%re%s1 he sa+e $aceria ha
ca%ses pne%+!nia an& !/ic sh!c* s,n&r!+e.
INTER-RETATION:
The M!&e# sh!"s ha he paien1 "hich is ,!%n' ha& a )a## $eca%se she s#ippe& ! heir
)#!!r "ice in he sa+e &a,. .irs1 is insi&e heir c!+)!r r!!+ an& sec!n&1 is a)er she "en !%
!) he c!+)!r r!!+ an& he )#!!rin' !) heir h!%se are i#e&1 "hich is +!re pr!ne ! s#ip. An& s!1
i ca%ses a ra%+a ! he paien:s +%sc#e 3a he ri'h hi'h4 an& a &a+a'e ! he +%sc#e
ca%ses he i++%ne s,se+ ! "ea*en1 a##!"in' he ca%sai(e a'en a p#ace ! a*e r!!. M!s
pe!p#e ha(e a #eas s!+e Saph,#!c!cc%s a%re%s in heir $!&ies a s!+e p!in in heir #i(es.

RECOMMENDATION:
The a$scesses "ihin he +%sc#e +%s $e &raine& s%r'ica##, 3n! a## paien re0%ire
s%r'er, i) here is n! a$scess4. Ani$i!ics sh!%#& $e 'i(en acc!r&in' ! &!c!r:s !r&er an&
"ach !% )!r !her c!+p#icai!ns #i*e !/ic sh!c* s,n&r!+e1 an& sepsis "hich is #i)e
hreaenin'. I) )e(er persis1 app#, a Tepi& sp!n'e $ah an& Gi(e an anip,reic +e&icai!n "ih
&!c!r:s !r&er. C!ns%+e )!!&s rich in Via+in C s%ch as )r%is )!r $!!sin' !) i++%ni,1 pr!ein
s%ch as +eas )!r iss%e repair1 an& ca#ci%+ !r ph!sph!r%s s%ch as +i#* an& !her
&air, pr!&%cs )!r $!ne 'r!"h.
FII. DR2G ST2DD
FIII. -ROBLEM LIST
FIV. -RIORITOMATION
FV. N2RSING CARE -LAN
C#ien: A.L.R.
A'e: 2 ,ears !#&
Gen&er: .e+a#e
Me&ica# Dia'n!sis: -,!+,!siis
-ri!ri, N;: Ac%e -ain re#ae& ! ra%+a !n he ri'h hi'h area
FVI. DISC5ARGE -LAN
Me&icai!ns. C!+p#iance !n he prescri$e& a*e h!+e +e&icai!ns "ih he ri'h
'eneric na+e1 ri'h &!sa'e an& preparai!n1 ri'h r!%e an& i+e !) a&+inisrai!n.
E/ercise. Aci(e ROM $% pre(en +assa'in' n!r an, !her ra%+aic press%re !n
he a))ece& area.

Trea+en.C!+p#iance !n he prescri$e& rea+en.C!(er he a))ece& area "ih a
"!%n& 'a%8easp has %n&er"en s%r'er,. Insr%ce& pr!per "!%n& care.

0ea#h eachin's.E+phasi8e& pr!per han&"ashin' an& enc!%ra'e& n!n
phar+ac!#!'ica# +eas%res )!r )rac%re !nce re enc!%nere& 3Res1 Ice !r C!#&
C!+press1C!+pressi!n $an&a'e1E#e(ae a))ece& par4

O%paien )!##!" %p (isi. Aen& !n he sche&%#e& !%paien )!##!" %p (isi.

Die.C!ns%+e )!!&s rich in Via+inC s%ch as )r%is )!r $!!sin' !) i++%ni,1 pr!ein
s%ch as +eas )!r iss%e repair1 an& ca#ci%+ !r ph!sph!r%s s%ch as +i#* an& !her &air,
pr!&%cs )!r $!ne 'r!"h.
Spiri%a#i,. Enc!%ra'e he +!her ! each he c#ien !n h!" ! sren'hen her )aih an&
enc!%ra'e ! aen& +ass !r re#i'i!%s aci(i,.