Case study number 1 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...
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Case study number 1

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.


Case study number 2


Mr. Mendes is an 81-year-old man who speaks only Portuguese. He is quite frail, weighing only 110 pounds. He had a below-the-knee amputation of his left leg two weeks ago. Mr. Mendes has been admitted to the hospital from a rehabilitation center with an acute change in mental status and diminished lung sounds in the left base. Mr. Mendes is diagnosed with left lower lobe pneumonia and antibiotic therapy is pre- scribed. The nurse assigned to care for Mr. Mendes does not speak Portuguese. 

Mr. Mendes requires complete an assistance with activities of daily living (ADLs). A medical interpreter is not assigned to the nursing unit; but, if needed, the nurse can ask a Portuguese-speaking nursing staff member to help interpret what Mr. Mendes is trying to express. However, the nurse still must develop a way of communicating with Mr. Mendes so the nurse can assess Mr. Mendes's level of comfort, provide care, and identify any needs. 

1. Briefly discuss the challenges of developing a nurse-client relationship when a language barrier exists between the client and nurse. 

2. Explain the difference between a medical "interpreter" and a medical "translator." 

3. Family members are often willing to interpret for the client and are more readily available. Discuss the use of medical interpreters and why, legally and ethically, family members (or friends of the client) are not the preferred interpreter(s). 

4. Describe a therapeutic nurse-client relationship. 

5. The nurse nonverbal strategies the nurse can implement to help develop a therapeutic relationship with Mr. Mendes. 

6. Provide the most likely explanation for why Mr. Mendes presented with an acute change in mental status. 

does not speak Portuguese. Discuss 

7. Briefly discuss how Mr. Mendes's past medical history relates to his below-the-knee leg amputation. What is the benefit of having a below-the-knee (B-K) amputation versus an above-the-knee (A-K) amputation? 

8. The interpreter tells the nurse that Mr. Mendes would like the nurse to remove the bed linens from his left foot and raise his leg on pillows. He states, "My foot aches and maybe if you put it up it on some pillows will feel better." Provide a rationale for Mr. Mendes's request. Should the nurse elevate his stump on pillows as requested? Why or why not? 

9. Mr. Mendes has not yet been fit for a prosthesis. The nurse provides care of his stump. Briefly discuss the nursing interventions involved in stump care. What outcome goals does the nurse hope to achieve through proper stump care? 

10. List five nursing diagnoses appropriate to consider for Mr. Mendes's plan of care. 

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