Osteomyelitis

2. Diagnosis: Osteomyelitis

3. Condition:

4. Vital signs: qid. Call physician if BP <90/60; T >38.5°C

5. Activity: Bed rest with bathroom privileges.

6. Nursing: Keep involved extremity elevated. Range of motion exercises of upper and lower extremities tid.

7. Diet: Regular, high fiber.

8. IV Fluids: Heparin lock with flush q shift.

9. Special Medications: Adult Empiric Therapy:

-Nafcillin or oxacillin 2 gm IV q4h OR -Cefazolin (Ancef) 1-2 gm IV q8h OR -Vancomycin 1 gm IV q12h (1 gm in 250 cc D5W over 1h). -Add 3rd generation cephalosporin if gram negative bacilli on Gram stain. Treat for 4-6 weeks.

Post Operative or Post Trauma:

-Vancomycin 1 gm IV q12h AND ceftazidime (Fortaz) 1-2 gm IV q8h. -Imipenem/cilastatin (Primaxin)(single-drug treatment) 0.5-1.0 gm IV q6-8h. -Ticarcillin/clavulanate (Timentin)(single-drug treatment) 3.1 gm IV q4-6h. -Ciprofloxacin (Cipro) 500-750 mg PO bid or 400 mg IV q12h AND Rifampin 600 mg PO qd. Osteomyelitis with Decubitus Ulcer: -Cefoxitin (Mefoxin), 2 gm IV q6-8h. -Ciprofloxacin (Cipro) and metronidazole 500 mg IV q8h. -Imipenem/cilastatin (Primaxin), see dosage above. -Nafcillin, gentamicin and clindamycin; see dosage above.

10. Symptomatic Medications:

-Meperidine (Demerol) 50-100 mg IM q3-4h prn pain. -Docusate sodium (Colace) 100 mg PO qhs. -Heparin 5000 U SQ bid.

11. Extras: Technetium/gallium bone scans, multiple X-ray views, CT/MRI.

12. Labs: CBC with differential, SMA 7, blood C&S x 3, MIC, MBC, UA with micro, C&S. Needle biopsy of bone for C&S; trough antibiotic levels.

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