H.G. Gets Central Line for Osteomyelitis Treatment

H.G. is a 46-year-old female who was presented to Kensington hospital for a continuation of IV antibiotic therapy. H.G has been diagnosed with osteomyelitis on her L5 S1 disc-itis along with MRSA bacteraemia. Her body vitals were normal; blood pressure of 156/90, the respiration rate of 15, a pulse of 89, and a body temperature of 36.8 degrees Celsius. Around December 12, 2019. H, G had a central line put in for her antibiotic treatment, and although she had on put in before she did not know how important it was to make sure her central line dress was change and how important it was to bath with chlorhexidine wash every day. H, G has a history of IV drug abuse. She uses drugs like cocaine, fentanyl, and methadone. She is currently diagnosed with hepatitis C. She is a current smoker and an alcohol user. Her drug habits have resulted in a reduced appetite with regular episodes of anorexia nervosa. Consequentially, the patient has lost considerable weight and is not kept in check. The situation is likely to deteriorate. Alcohol and the other substances she uses could have been her etiological cause for osteomyelitis. The continuous use of antibiotics is gradually causing drug resistance, and soon, she will need to be placed on second-line antibiotics for any new infection. She complains of severe back pains, especially during the night time and malaise.

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Patient Learning Need

First, the patient needs to be conversant with PICC, definition, and purpose. The PICC is the abbreviation for Peripherally Inserted Central Catheter. PICC is inserted from either the vein of the arm, leg, or neck and stretches to the large vein in the heart. The PICC line is used as a channel to long time provide nutrition, intravenous antibiotics, medication and collecting blood samples. In many cases, the nurses usually help the patient care for the PICC either through an outpatient clinic, offering them a handout, or patient education. The patient should place a warm pack on the PICC line for approximately 30 minutes with 2 hours intervals during the initial PICC line placement (Pettit, 2007).

The patient should also take ibuprofen, one time three days, in the first three days, minimize the chances of inflammation, and soreness. The ibuprofen can be replaced with Tylenol of the patient is allergic. Keep the dressing dry and flawless. Shower as opposed to washing up approach the medical attendant for an armed defender to keep your arm dry when you shower (Hobeika, Serri,& Albert, 2014). Try not to submerge your PICC line arm in the water. Try not to swim or go in a hot tub with a PICC line. Try not to have blood drawn from the Groshong PICC line. At the point when your pulse is taken, utilize the arm without the PICC line. Keep away from exercises with a great deal of arms development. Additionally, maintain a restful phase and stay distant from strenuous work more than 5 to 10 pounds. Inquire as to whether you have questions.

Behavioural Objective

First, the patient needs to understand and explain back the importance of keeping the PICC line clean and how they intend to do that. General answers will not be accepted, and the patient needs to be as detailed as can be to ensure that they understood what is expected of them. H.G. should come up with a list of disinfectants and procedures of how to maintain and keep the PICC clean at all times.

Secondly, I will make sure the patient understands and explains why it is essential to reduce the consumption of alcohol and other drugs that she was using. I will ask her to explain the effects that the medicine could cause to the maintenance and cleaning of the PICC. In her explanation, I will look out for the idea that alcohol and other drugs might make her forget she has a PICC in the first place only to remember later when the damage is already done. She should also understand that some of these drugs may cause dangerous drug interaction with the prescribed ones. Medication interactions may make your medication less successful, cause unforeseen reactions, or increment of the activity of a specific medication. Some medication connections can even be destructive to you. Perusing the label each time you utilize a nonprescription or professionally prescribed medication and setting aside the effort to find out about medication associations might be essential to your wellbeing. You can diminish the danger of possibly hurtful medication associations and reactions with a smidgen of information and presence of mind (Alpenberg, Joelsson, & Rosengren, 2015).

Thirdly, I want the patient to learn how to tell when there is a mistake with the PICC. Whenever a patient is discharged and has a PICC line, many times, they cannot tell when something is wrong with the track. They tend to think that everything is OK, even when it is not. Being an invasive device, any little defect with the line could be fatal. It is for that reason; I will ensure that H.G. is fully prepared and conversant with the PICC care procedures and can easily pick up a deviation in the minimum time possible.

Nursing Diagnosis

Patient H.G. was diagnosed of osteomyelitis. Osteomyelitis is a bone infection and can be very severe. The condition is infrequent but very fast-spreading as well. When a patient experiences an infection of the blood (sepsis), the bacteria may be disseminated to any part of the body through the circulation system and can infect any bone. Osteomyelitis is not a localized infection as it may move to any body part and in a brief period.

Bacteria primarily cause osteomyelitis. In most cases, the bacteria is Staphylococcus aureus, but in this case study, it is MRSA. Current statistics indicate that out of every 10,000 people, and only 2 get osteomyelitis. The condition does not discriminate against the age as it affects both the young and old. Any term that compromises the immunity of a person significantly increases the risk of getting osteomyelitis. Some of those conditions include diabetes, sickle cell disease, HIV/AIDS, rheumatoid arthritis, alcoholism, and IV drug use (Alpenberg et al., 2015).

The defining characteristics of osteomyelitis include irritability, fatigue, fever, nausea, redness, and swelling. In severe cases, some people may experience derailed sense of motion and have the desire to stay in a stationary position for a long time (Sharpe, Pettit & Ellsbury, 2013).

Short- and Long-Term Goals

Overseeing individual cleanliness needs should be the first short term and immediate goal. The arm with the PICC ought not to be drenched in water. Therefore, swimming and washing ought to be kept away from. Anyway, showering with a PICC is OK given you to place your arm in a plastic sack, which is verified over the PICC addition site and expelled after your shower. Development (movement) of the PICC from its area can be brought about by strenuous hacking, visit heaving or regurgitating, hard work, more than once raising your arm above your shoulder, and vigorous exercise. A long-term goal is working on self-reliability.

While in the medical clinic, you ought to maintain a strategic distance from the utilization of self-improvement shafts. Once at home, maintain a strategic distance from exercises or types of activity that may cause the PICC to move, for example, hanging out washing, golf, and so on. On occasion, you might be away from your ordinary specialist or medical caretaker also, require help with dealing with your PICC. As a few therapeutic and nursing staff might be new to the utilization of PICC lines, the accompanying bearings will assist them with helping you (Sharpe, Pettit & Ellsbury, 2013).

Teaching Intervention and Rationale

Forestall contamination. Utilize great hand cleanliness by following the rules on this sheet. Try not to contact the catheter or dressing except if you have to. Furthermore, in every case, clean your hands when you interact with any piece of the PICC. Your parental figures, relatives, and any guests should utilize great hand cleanliness, as well (Venkataraman, 2018).

Keep the PICC dry. The catheter and dressing must remain dry. Try not to clean up, go swimming, utilize a hot tub, or do different things that could get the PICC wet. Wash up to abstain from getting your catheter wet, except if your social insurance supplier reveals to you in any case. Get some information about an ideal approach to keep your catheter dry when washing or showering. On the off chance that the dressing gets wet, change it just if you have been indicated how. Something else, summon your social insurance group directly for help.

Stay away from harm. Try not to utilize any sharp or pointy questions around the catheter, such as scissors, pins, blades, razors, or whatever else that could cut it or put an opening in it (cut it). Additionally, don't allow anything to pull or rub on the catheter, for example, dress. Watch for indications of issues. Focus on the amount of the catheter that stands out from your skin (Venkataraman, 2018). On the off chance that these progressions by any means, let your human services supplier know. Likewise, watch for breaks, spills, or other harm. On the off chance that the dressing gets messy, free, or wet, change it.

Evaluation of Learning

Once taught to the patient, I will evaluate the much content she has picked up from my teaching in two ways; orally and practically. I will request her to explain to me some of the concepts that she has grasped and explained the reason behind them. I will then come up with a short-structured exam and ask her to fill it in for an assessment. Finally, I will ask the nurses to restrain from attending to her for a day to see how well she would take care of herself.

Conclusion

A PICC can give germs access to your body; this can prompt genuine, and at times destructive diseases. To forestall illness, it's significant that you, your parental figures, and others around you utilize proper hand cleanliness. This implies washing your hands well with cleanser and water and cleaning them with a alcohol-based hand gel as coordinated. Never contact the PICC or dressing without first guaranteeing they are spotless.Care and upkeep of a PICC line incorporates evaluating the site for signs and indications of disease, including redness, delicacy, or growing. To watch out for any expanding, the patient's arm boundary can be contrasted and the pattern estimation taken before PICC line inclusion.

Evaluate the dressing and ensure that it's perfect and unblemished. On the off chance that the edges begin to strip away or are dirty or bloodied, the dressing may should be changed. Survey your office's strategy and system for PICC line dressing changes; a few emergency clinics order that the dressing be changed at any rate once per week.

Segments of the dressing ordinarily incorporate an antimicrobial fix, a cement gadget to keep it set up, and a straightforward dressing. Check your office's strategy and technique to figure out which things are required with the dressing. Evaluate for good blood stream on yearning and simplicity of flushing. You ought to have the option to effortlessly flush the line and downside blood with no obstruction.

References

Alpenberg, S., Joelsson, G., & Rosengren, K. (2015). Feeling Confident in Using PICC Lines. Home Health Care Management & Practice, 27(3), 119-125. doi: 10.1177/1084822314566300

Hobeika, J., Serri, K., & Albert, M. (2014). Development of a standardized method of peripherally inserted central catheter (PICC-line) bedside installation. Critical Care, 18(Suppl 1), P128. doi: 10.1186/cc13318

Pettit, J. (2007). Technological Advances for PICC Placement and Management. Advances in Neonatal Care, 7(3), 122-131. doi: 10.1097/01.anc.0000278210. 18639.fd

Sharpe, E., Pettit, J., & Ellsbury, D. (2013). A National Survey of Ne...