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
GERONIMO, Kevin Rae
GODOY, Renlyn Ruth
GOMEZ, Beatriz Faustine Marie
GOMEZ, Fatima Nadine
GOMEZ, Rogina Elaine
GUZMAN, Pearl Karen
HADAP, Florence Paz
HERRERA, Joshua Annmielle
IDLISAN, Shara Jane
IMSON, Francis Miko

1
 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

2
 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.

3
 • 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 attitude
regarding 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

6
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

8
 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

METHODS NORMAL ACTUAL INTERPRETATIO

BODY PART
USED FINDINGS FINDINGS N
a. Head
Skull Proportional to the Proportional to the
Inspection body size, round body size, round Normal
Palpation with prominence in with prominence in
the frontal area the frontal area
anteriorly and the anteriorly and the
occipital area occipital area
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 posteriorly, posteriorly,
symmetrical in all symmetrical in all
planes gently curve planes gently curve
White, clean, free White, free from
from masses, masses, lumps, Dandruff is due
Inspection lumps, scars, nits, scars, nits and to poor personal
Scalp Palpation dandruff and lesion. With hygiene,
lesion presence of especially hair
ample amount of care
dandruff
Black evenly Hair is thick, shiny
distributed and and free from split
Inspection covers the whole ends. It is long in Normal
Hair
Palpation scalp, thick, shiny, length, dyed brown,
free from split ends with streaks of
highlights.
Oblong or oval Oval shaped,
shape symmetrical
symmetrical facial expressions
facial expressions that is dependent
Scars are
that is dependent on the patient’s
caused by
Inspection on the mood or expression. Skin
Face Palpation
chicken pox
true feelings, has scars, but
marks
smooth and free free from
from wrinkles, no wrinkles, no
involuntary involuntary
muscle muscle
movements movements
Parallel and evenly Parallel and evenly
placed placed
symmetrical. Non- symmetrical. Non-
protruding with protruding with
Inspection
Eyes scant amount of scant amount of Normal
secretion. Both secretion. Both
eyes black and eyes black and
clear clear. With 20/20
vision
Black symmetrical, Black symmetrical,
thick can raise thick can raise
eyebrows eyebrows
Inspection symmetrically and symmetrically and
Eyebrows Normal
Palpation without difficulty. without difficulty.
Evenly distributed Evenly distributed
and parallel with and parallel with
each other each other
Black, evenly Black, evenly
Inspection
Eyelashes distributed and distributed, and Normal
turned outward turned outward
Upper lids cover a Upper lids cover a
small portion of the small portion of the
iris, cornea and iris, cornea, and
sclera. When eyes sclera. When eyes
Inspection are closed the lids are closed lids
Lid margin Normal
close completely. covers the eye
Symmetrical color completely.
the same with Symmetrical in
surrounding eyes color the same with
surrounding eyes.
Palpebral fissure Inspection Appears equal Appears equal Normal
10
 when eyes are when eyes are
open open
Salmon pink, shiny, Pale pink, shiny,
Lower palpebral Inspection
moist and moist and Normal
conjunctiva Palpation
transparent transparent
White, clear and White, clear and
Sclera Inspection Normal
moist moist
Proportional to the Proportional to the
size of the eye, size of the eye,
Inspection
Iris round black/brown round and brown in Normal
and symmetrical color and
symmetrical
From pinpoint to Round and
the size of the iris, symmetrical,
round symmetrical. constrict with the
Constrict with increasing light and
Inspection increasing light and accommodation
Pupil Normal
accommodation when the light
when the light comes closely the
comes closely it pupils becomes
constricts the size smaller
of the pupil
Able to see 600 Able to see 600
Inspection superiorly, 900 superiorly, 900
Field of vision Normal
temporarily and 700 temporarily, and
inferiorly 700 inferiorly.
Parallel, Parallel,
symmetrically, symmetrically,
proportion to the proportion to the
size of the head, size of the head,
bean shaped, helix bean shaped, and
Inspection
Ears is in line with the helix is in line with Normal
Palpation
outer canthus of the outer canthus
the eye, skin is the of the eye, skin is
same color as the the same color as
surrounding area the surrounding
and clean area and clean.
Pinkish, clean with Pinkish, clean with
Inspection scant amount of scant amount of
Ear canal Normal
cerumen and a few cerumen and a few
cilia cilia
Able to hear Able to hear
whisper, spoken 2 whisper, spoken 2
Inspection
Hearing acuity ft away. Midline, ft away. Midline, Normal
symmetrical and symmetrical and
patent patent
Midline, Prominent, midline,
Inspection
Nose symmetrical and symmetrical and Normal
Palpation
patent patent
Clean, pinkish with Clean, pinkish with
Internal nares Inspection Normal
few cilia few cilia
Inspection Straight Straight
Septum Normal
Palpation
Pinkish, Brownish pink, Lip color is due
symmetrical. Lips symmetrical. Lips’
Inspection to smoking
Mouth Palpation
margin well margin is well
defined, smooth defined, smooth history
and moist and moist
Gums Inspection Pinkish, smooth, Reddish pink in Gum color is
Palpation no swelling, no color, smooth, no due to smoking
retractions, no swelling, no history.
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 discharge retractions, no
discharge, no
bleeding or sores.
32 permanent 22 permanent
teeth aligned free teeth, yellowish
Patient’s oral
Inspection from carries, no in color, chipped
Teeth hygiene is poor
halitosis 2 frontal teeth,
cavities in both
lower molars
Large, medium, red Large, pinkish in
or pink slightly color. Rough on the
rough on top, top, with white
Inspection smooth along the strains of food,
Tongue Normal
Palpation lateral margins, smooth along the
moist, shiny and lateral margins,
freely movable moist, shiny, freely
movable
Midline, straight Midline, straight
Frenulum Inspection and thin and thin. Moist and Normal
shiny
Pinkish, smooth Pinkish, smooth
and moist and moist. No
Cheeks Inspection Normal
presence of mouth
sore
Palate
Pinkish, smooth Pinkish, smooth Normal
Soft palate Inspection
and moist and moist
Palpation
Light pink, slightly Light pink, slightly Normal
Hard palate
rough rough
Located at the Located at the
center, center,
symmetrical, freely symmetrical, freely Normal
Uvula Inspection
movable, pinkish in movable, pinkish in
color, shiny and color, shiny and
moist moist
Pinkish, non- Pinkish, non-
Normal
Tonsil Inspection Inflammed and no Inflammed and no
exudate exudate
No hoarseness, well No hoarseness, well Normal
Voice Inspection
modulated modulated
Proportional to the Proportional to the
size of the body size of the body
Inspection
Neck and head. and head. Normal
Palpation
Symmetrical in Symmetrical in
position position.
Freely movable Freely movable Difficulty due to
without difficulty without difficulty on the pain caused
unaffected site, but by the ankle
has pain in left sprain and
Inspection
Range of motion thigh to lower leg inflammation of
Palpation
the ankle joint
that has radiated
to the upper
thigh.
Both muscle are Both muscle are
Muscular Inspection symmetrical and symmetrical and
Normal
strength Palpation able to resist able to resist
applied force applied force
Thorax and Lungs Inspection The chest Prominent chest, Normal
Palpation symmetrical and symmetrical and is

12
 the chest is twice twice as wide as
as wide as deep, deep, the spine is
the spine is straight straight posteriorly.
posteriorly. The The chest wall
chest wall moves moves
symmetrically symmetrically
during respiration. during respiration.
No lumps, masses No lumps, masses
or tenderness, side or tenderness, side
of the thorax of the thorax
expands expands
symmetrically. symmetrically.
Vibrations are Slow, deep
Auscultation prominent over the breathing,
areas near the sometimes abrupt.
bronchi, it No wheezing
increases with the sound, cracking or
intensity of voice. gurgling noise while
No difficulty of breathing
breathing Respiratory rate is
No wheezing 19 breaths per
sound, cracking or minute
gurgling noise while
breathing
Respiratory rate
ranges from 18-20
breaths per minute
Pulsation visible Pulsation extremely
and palpable visible and palpable
2 heart sound 2 heart sound
Inspection audible in all areas, audible in all areas,
Normal
Heart Palpation but loudest at but loudest at
Auscultation apical area cardiac apical area cardiac
rate ranges from rate of 63 beats per
80-100 beats per minute
minute
Skin is Skin is
unblemished, no unblemished,
scar. Color in Color in uniform
uniform or or scapoid,
scapoid, symmetrical.
symmetrical. Movement
Movement caused by
caused by breathing. The
Inspection Scars present
breathing. The umbilicus is flat
Percussion are caused by
Abdomen Palpation
umbilicus is flat or concave,
chicken pox
Auscultation or concave, positions midway
marks
positions midway between the
between the xiphoid process
xiphoid process and the
and the symphisis pubis.
symphisis pubis. Color the same as
Color the same as the surrounding
the surrounding skin. With
skin presence of scars
UPPER Inspection
EXTREMITIES Palpation Skin color varies Skin color is brown,
Arms from brown, dark symmetrical in size, Normal
brown, fair, pinkish. shape. No presence
13
 Symmetrical, of tenderness, no
presence or visible veins. arms
absence of visible are warm, dry and
veins elastic. Muscle
Warm, dry and appears equal with
elastic no areas of good muscle tone
tenderness. Muscle
appears equal with
good muscle tone
Palm pinkish brown Palm slightly pale in From excessive
Palm and dorsal Inspection color, presence of friction in the
surface Palpation callus palm due to
dancing
Transparent, Transparent,
smooth and convex smooth and convex
with pinkish nail with pinkish nail
beds and white beds and white
translucent translucent
Five fingers in each Five fingers in each
hand hand
Inspection Normal
Nails As pressure applied As pressure applied
Palpation
to the nail bed to the nail bed
appears white or appears white or
balance and pink balance and pink
color returns color returns
immediately after immediately after
releasing the releasing the
pressure pressure

Manipulation-
Process of
moving the part
being examined Perform on ease Perform on ease Normal
Inspection
Shoulder Palpation
Performs on ease Performs on ease Normal
Inspection
Arms Palpation
Performs on ease Performs on ease Normal
Inspection
Elbows Palpation
Perform on ease Performs limited, Normal; limited
Inspection on ease; with IVF manipulation due
Hand and wrist Palpation on right hand with to splint
splint
LOWER Inspection
EXTREMITIES Palpation Skin color varies Skin color dark Short leg
Legs from pinkish, tan, brown. posterior mold
fair, dark brown. Skin is dry, few was used due to
Skin is smooth, fine hair a compound
fine hair evenly distributed. affection in the
distributed. Absence of ankle of the the
Absence of varicose veins, left foot
varicose veins, muscle
muscle symmetrical,
symmetrical, length is
length is symmetrical. Left
symmetrical. leg is with short
Muscle appears leg posterior

14
 equal, warm to mold
touch and with
good muscle tone
Five toes in each Five toes in each
Poor blood
foot, smooth with foot, smooth with
circulation in the
pink nail beds pinkish white nail
left lower
and white tips beds and white
Inspection extremity due to
Toes Palpation
tips. Takes 3
the limited
seconds on left
movement in
toe after
the affected
releasing
area
pressure

IV. Patterns of Functioning

Before During
Patterns of Hospitalizatio Hospitalizatio Nursing Analysis/Interpreta
Functioning n n Theory tion

15
1. Health The patient The patient There is a change
Perception/Hea does not give relied and in the patient’s
lth much priority depended on health perception.
Management with his the health It was improved
health; he care because of the
self providers knowledge he
medicates, regarding his gained from the
goes to the health. He health care
“quack followed the providers in the
doctor” for guidelines hospital regarding
intervention, given to him the importance of
and does not by his health.
prioritize physician for
regular the condition
check-ups that was
with a diagnosed
physician. with.

2. Nutritional/ The patient The patient is Abraham The patients’

Metabolic eats all kinds on a DAT Maslow’s eating pattern has
of food with diet, or diet Hierarchy of changed regarding
rice. He is fond as tolerated. Needs his food choices
of eating
He is being and time of eating.
chicken and
served with
red meat
(beef) and rice and fish (Physiologica
drinking soft every meal, l needs)
drinks (coke). most of the
He doesn’t time, Bangus
have any in various
pattern of styles of
healthy diet cooking,
and right time
vegetables
in eating.
as side dish.
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,
16
 he eats 2 cups
of rice and
tilapia or
beefsteak,
whatever
viand is
available, as
long as
partnered with
rice

3. Elimination The patient The patient The patient’s

defecates defecates elimination pattern
twice a day semi formed changed, due to an
and voids stool twice a increased intake of
five (5) to six day and oral fluids and
(6) times a urinates clear parenteral intake
day without yellow urine of 2250ml in the
difficulty. about 8x a hospital
day

4. Activity The patient is Patient The patient’s

Exercise a dancer and always gets activity and
he also out of bed exercise pattern
engages in and loiters has changed. He
physical around the has limited
activities and room to chat physical activity
sports, like with his co- due to his current
basketball patients. He condition.
jumps around
when out of
his bed, due
to difficulty in
using the
crutches

5. Sleep- Rest The patient The patient The patient’s

Pattern sleeps eight sleeps four Sleep-rest pattern
(8) to ten (4) to five (5) has changed due
(10) hours in hours in a to uncontrolled
a day without day with noise in the area.
difficulty. difficulty, due
to the noise
and in and
out of visitors

17
 in the ward.

6. Cognitive The The The patient is Jean Piaget’s The patient’s

Perceptual patient is still Cognitive cognitive-
conscious responding Theory of perceptual pattern
and actively and Developmen did not change. His
coherent, enthusiastica t condition did not
responsive lly to change his ability
and is whenever he to understand.
enthusiastic is being (Formal
when talking talked to. Operational
with people. Stage)
He converses
and
comprehends
well; he
actively
responds
whenever he
is being
talked to, has
good
memory and
can make
decisions
independentl
y.

7. Self- The patient The patient is However, his self

Perception/ feels good now aware of esteem lowered, in
Self Concept and the fear that his
comfortable seriousness friends and
about himself of his neighbours will
even if he fracture. He laugh at him, when
experiences feels bad to they see a dancer
pain he be seen in in crutches.
thinks the crutches
pain will when he
subside in returns
time home.

18
8. Role The patient The patient Erik There is no change
Relationship the 3rd had no Erikson’s in his role-
among 4 companion Psychosocial relationship
children. He around, his theory of pattern. Even
is the father and Developmen though he is not
youngest boy mother left t always together
in the family. due to an with his family, the
He is not that immediate (Identity vs. patient says he
close with his family crisis. Role loves his family
family. He Confusion) and friends even if
has little time they are not with
in spending him at his current
with his condition; however
mother and he stated that he
father. he feels alone that no
often hangs one is there to be
out in dance with him.
practice or
just spending
time with his
friends.

9. Sexuality The patient is The patient Erik There is a change

Reproductive an adolescent did not Erikson’s in the patient’s
who is at the inform his Psychosocial sexuality-
peak of his girlfriend theory of reproductive
puberty. He is
about his Developmen pattern. He used
engaged in a
current t the distance to not
long distance
relationship condition. He be able to inform
is afraid that (Identity vs. his girlfriend about
with his
his girl might Role his condition to
girlfriend of 6
months. get worried Confusion) lessen her worries.
However, he is and might
not in any not be able
intimate to
contact with
concentrate
her. They text
on her
a lot, talk
studies
through the
phone, despite
the distance.

19
10. Coping/ The patient The patient There is a change
Stress copes with has a in the patient’s
Tolerance his stress positive coping/ stress
and problems attitude he tolerance pattern,
in life keeps since he is not able
through himself busy to express his
expressing it through feelings through
in dancing texting and dancing.
and drinking, chatting with
spending his co-
time with his patients in
friends the ward.

11. Value/ The patient The patient The patient’s value/

Belief rarely visits prays to the belief pattern
the church to Lord for changed. He learned
attend mass, faster to ask for help from
God for faster
but said that recovery.
recovery because he
he has faith
thinks it’s God’s way
in God. 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. The
tarsal 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, alcoholic

drinker)

- Injury/ Trauma

21
 (ankle sprain due to slip)

- Strenuous Activities
(Dancing/ dancing
practice)

- Consultation to a quack
doctor (“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 Reference
Hemoglobin 132 g/L M 127-183
F 120-150
Hematocrit 0.41 F 0.37-0.45
M 0.37-0.54
Leukocytes Count 10.2 q/L 10-48x109
Indices
MCV 85 F1 82-92
MCH L 27 Pg 28-32
MCHC 32 % 32-38
Differential
Count
Segmenters 0.66 0.5-0.7
Lymphocytes 0.25 0.2-0.4
Monocytes 0.05 0.0-0.7
Eosinophils 0.04 0-0.5
Platelet Count 470 /L 150-400x109

• Bacteriology Sec. (Aug 2, *WBC few

2010)
Examination Desired: Gram
Stain Right Ankle
Specimen Submitted: Wound
Preliminary Report:
*RBC +
*No Microorganism seen
*No Spore-forming Bacilli
seen Final Report: *No growth after
72hrs of incubation.
23
 • Bacteriology Sec. (Aug 2, Cephalosphorin (S)
2010) Gentamycin (S)
Penicillin Oxacillin (S) Final Organism:
Pen G/ Amoxicillin (R) Staphyloccoccus Aureus
Glycopeptide Vancomycin (S) → 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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 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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