Question: Care Scenario #12: Ethan Ethan Is A Healthy 2-month-old Baby Who Was Born At Term, Along With His Twin Brother Owen. Ethan Was The Larger Twin (7lb) And Has Been Healthy Since Birth. He Is Breastfed And Received His First Course Of Vaccines Last Week. Ethan’s Mother Brings Him To See His Family Doctor Because He Has Become Very Fussy And Is Not Moving …

Care Scenario #12: Ethan Ethan is a healthy 2-month-old baby who was born at term, along with his twin brother Owen. Ethan was the larger twin (7lb) and has been healthy since birth. He is breastfed and received his first course of vaccines last week. Ethan’s mother brings him to see his family doctor because he has become very fussy and is not moving his right arm at all. In the doctor’s office, the child is found to have a rectal temperature of 39.5 C. Ethan cries whenever his right arm is touched, and he does not move his arm spontaneously. Ethan has not received any injuries to this arm, and the vaccine he received was given on the other side. The family doctor sends him to hospital In the hospital blood cultures are drawn, and he is started on antibiotics (IV ampicillin and IV gentamicin). He continues to be febrile and feeds poorly. An x-ray of the right arm is reported to be normal. After 12 hours his blood cultures are reported to show Gram-positive cocci in groups. His antibiotics are changed to cefazolin IV. By the next morning his temperature is coming down. That afternoon, a bone scan is performed and shows evidence of osteomyelitis in his right arm. Blood cultures grow Staphylococcus aureus. He continues to improve and is sent home with a PICC line and instructions to continue with IV antibiotics for a total of 6 weeks. Ethan’s mother is concerned, she wants to know how he got this infection, and if Owen is at risk of developing this infection. She also wonders why Ethan needs to be treated with antibiotics for so long Suggested Objectives • What is osteomyelitis? How did Ethan develop this infection? • What patient populations are most at risk for this type of infection? Why? • What is Staphylococcus aureus? How does it relate to the normal flora? • Is Owen at risk for this infection as well? • What was the purpose of the prescribed orders? Why did the antibiotic therapy change? • What is the rationale for IV therapy? What is the rationale for 6 weeks of therapy? • What steps could have been taken to reduce the risk of Ethan acquiring this infection? Care Scenario #12: Ethan Ethan is a healthy 2-month-old baby who was born at term, along with his twin brother Owen. Ethan was the larger twin (7lb) and has been healthy since birth. He is breastfed and received his first course of vaccines last week. Ethan’s mother brings him to see his family doctor because he has become very fussy and is not moving his right arm at all. In the doctor’s office, the child is found to have a rectal temperature of 39.5 C. Ethan cries whenever his right arm is touched, and he does not move his arm spontaneously. Ethan has not received any injuries to this arm, and the vaccine he received was given on the other side. The family doctor sends him to hospital In the hospital blood cultures are drawn, and he is started on antibiotics (IV ampicillin and IV gentamicin). He continues to be febrile and feeds poorly. An x-ray of the right arm is reported to be normal. After 12 hours his blood cultures are reported to show Gram-positive cocci in groups. His antibiotics are changed to cefazolin IV. By the next morning his temperature is coming down. That afternoon, a bone scan is performed and shows evidence of osteomyelitis in his right arm. Blood cultures grow Staphylococcus aureus. He continues to improve and is sent home with a PICC line and instructions to continue with IV antibiotics for a total of 6 weeks. Ethan’s mother is concerned, she wants to know how he got this infection, and if Owen is at risk of developing this infection. She also wonders why Ethan needs to be treated with antibiotics for so long Suggested Objectives • What is osteomyelitis? How did Ethan develop this infection? • What patient populations are most at risk for this type of infection? Why? • What is Staphylococcus aureus? How does it relate to the normal flora? • Is Owen at risk for this infection as well? • What was the purpose of the prescribed orders? Why did the antibiotic therapy change? • What is the rationale for IV therapy? What is the rationale for 6 weeks of therapy? • What steps could have been taken to reduce the risk of Ethan acquiring this infection?