Introduction Objectives y Trace the pathogenesis based on the signs and symptoms manifested by the patient.

y Determine appropriate medical and nursing management for the patient. y Use the nursing process as the framework for the care of the patient. Background Pyomyositis is an inflammation of muscle tissue, usually of voluntary muscles that results in pus production. Once considered a tropical disease, it is now seen in temperate climates as well. The pathogenesis is unclear, but trauma, infections (S. aureus, S. pneumoniae), and malnutrition have been implicated. Although most cases of pyomyositis occur in healthy individuals, other pathogenetic factors include nutritional deficiency and associated parasitic infection in tropical climates. In the temperate climates, pyomyositis is seen most commonly in patients with diabetes, HIV infection, and malignancy. Clinical Manifestations experienced by the client: y Presentation with painful, tender, localized swelling over muscle. y A feeling of numbness on the second day. y High fever

Patient s Profile Name: Patient X Age: 4 years old B-day: Oct.22, 2006 Address: B. Sampaloc St. Lower Bicutan, Taguig City Date of Admission: Aug. 29, 2011 Diagnosis: Multifocal Pyomyositis on (R)arm , (R) upper back, (R) gluteal area Mothers Name: Josephine Capillan Occupation: Housewife Fathers Name: Marvin Capillan Occupation: Coconut Vendor Socio economic status: Patient lives with his family History of present illness|injury: The present condition started around seven days prior to admission when patient apparently stumbled and fell on his right side. Patient then went home and disclosed the information to his mother. No initial consult was done and no medications were given. Patient was then brought to a hilot the ff. day were manipulation was done on multiple parts of his right side. That day, patient started to have episodic fever, no consult was still done due to the distant location of their local hospital. Apparently, patient was then unable to ambulate and complained of sever hip and right upper extremity pain. Still no consult was done. Fever was then persistent, but patient was still able to void voluntarily. Due to the persistence of the condition, Patient was then brought to our institution for consult. Past Medical history: Aside from common colds and cough, mother denies any illness. No history of vaccination. Family History: (-)HPN (-)DM (-)CA

Diagnostic Procedure: ss

Complications Life-threatening complications include sepsis and toxic shock syndrome. Diagnosis CT scan or MRI demonstrates muscle abscess. Aspiration of abscess (by surgery or CT/US guided) yields pus, usually yielding S. aureus. Bacteremia may accompany. Treatment Medical Care Promptly administer systemic antibiotics. This could eliminate the need for surgical drainage in selected cases. The choice of antibiotic is determined by identification of the causative organism.

Antibiotics initially are given intravenously until clinical improvement is noted, followed by oral antibiotics for a total course of 3 weeks (eg, cefazolin or ceftriaxone IV followed by cephalexin PO). Surgical Care

During the suppurative phase, abscess aspiration under ultrasonic or CT guidance may be required. Surgical drainage is especially necessary for large abscesses. Complicated cases may require fasciotomies and debridement. Prognosis Prompt administration of antibiotics can result in complete resolution. Specific Objectives: Define Pyomyositis. Identify the signs and symptoms manifested by the patient. Distinguish the precipitating and predisposing factors that trigger this development. Trace the pathogenesis based on the signs and symptoms manifested by the patient. Determine appropriate medical and nursing management for the patient. Use the nursing process as the framework for the care of the patient. Significance of the Study in Nursing Field: Shall have critical thinking skills necessary for providing safe and effective nursing care. Shall have a comprehensive assessment and implement care base on our knowledge and skills of the condition.

Shall have familiarized with effective interpersonal skills to emphasize health promotion and illness prevention. Shall have imparted the learning experience from direct patient care.

PATIENT S PROFILE Name: Baby Dyein Sex: Female Birthday: October 2007 Age: 2 - 3 y/o Religion: Roman Catholic Civil Status: Single Nationality: Filipino Date of Admission: July 27, 2010 Time of Admission: 8:40 PM Admission Diagnosis: Pyomyositis Left Scapular Area Attending Physician: Dr. De Guzman A. Family Background Baby Dyein is the youngest among the four siblings. B. Educational and Socio - Economic Status She does not go to school yet. The rest of the siblings are funded for their educational expenses by one of their mother s rich customers as a laundry woman, except that the eldest child does not go to school anymore as she decided to stop studying and just help work. C. Lifestyle and Diet She eats three times a day and drinks 5-6 glasses of water a day though mostly breastfeed on her mother. D. Family Health History

No family history of pyomyositis, diabetes, hypertension, tuberculosis, diabetes, nor any other diseases reported. E. Immunization Record With complete record of immunization. F. Past Health History Had cough, colds and fever but is only hospitalized once now due to pyomyositis. G. Present Health History One month prior to consultation, patient together with her older brother had a fall as she was given a piggy backride. Patient fell on her left scapular area and complained of pain. Her mother had her massaged by a so-calledm anghihilot. Three weeks prior to consultation, patient still complained of pain and endured of fever and localized swelling on the left scapular area. Anotherhilot session was done and patient was given TSB. But as the swelling and fever still persevered, patient was brought to the nearest clinic. Patient was given Paracetamol and was referred to Philippine Orthopedic Center. Patient was admitted.