Pre- and post-operative nursing care for a person with a bone infection in the right humerus through home follow-up and the implementation of ICTs

Abstract

Introduction: Chronic osteomyelitis remains a significant therapeutic challenge due to its prolonged course, high recurrence rates, and functional impact on quality of life. Within this context, specialized and tailored nursing care is critical. Implementing Information and Communication Technologies (ICT) in pre- and postoperative follow-up ensures continuity of care, fosters self-care agency, integrates the primary caregiver, and enhances treatment adherence. Objective: To implement a holistic nursing care plan integrating home visits and ICT support during the pre- and postoperative phases of a patient with chronic osteomyelitis of the right humerus. Methodology: A descriptive qualitative case study of a 29-year-old male with chronic right humeral osteomyelitis. At initial contact, the patient presented with an active fistula and was scheduled at the Instituto Nacional de Rehabilitación for fistulectomy, biopsy and culture sampling, sequestrectomy, and medullary canal reaming. Relevant medical history included non-specific immunodeficiency, recurrent pediatric infectious and inflammatory episodes, reactive depression, and generalized anxiety. A two-month follow-up protocol was established, consisting of three home visits and continuous ICT monitoring. Baseline assessment revealed an active 1×1 cm fistula on the lateral aspect of the right arm with scarce serosanguineous drainage, diffuse chronic neuropathic pain (4/10 on the Visual Analog Scale [VAS], increasing to 6/10 upon palpation and weight-bearing), occasional paresthesia, and radiating electric-shock sensations toward the third and fourth phalanges. Superficial and deep hypoesthesia was noted in the peripheral zone of the fistula. Standardized assessment instruments indicated functional impairment (DASH score: 74), severe sleep disturbance (Pittsburgh Sleep Quality Index [PSQI]: 14), and high psychological distress (Goldberg scale: 12). Nursing interventions focused on:

• Preoperative Phase: Preventing skin injury complications via serial wound care; mitigating pain through combined pharmacological and non-pharmacological strategies; providing neurosensory rehabilitation and limb protection; enhancing emotional well-being; and optimizing functionality, sleep hygiene, and dietary-hygienic habits.
• Postoperative Phase: Managing somatic pain; ensuring therapeutic adherence; promoting self-care practices to optimize wound healing; educating on the correct use of soft orthoses and progressive mobility to prevent disuse atrophy; implementing sleep hygiene and emotional support techniques; and coordinating a mental health referral.

Results: Following the two-month intervention, the patient reported decreased neuropathic pain (2/10 VAS) and controlled postoperative somatic pain (3/10 VAS), alongside proper utilization of the soft orthosis. The surgical wound healed progressively without signs of infection or complications. Sleep quality improved significantly, with the PSQI score dropping to 5 points. Physical mobility progressed steadily through pendular exercises, reducing the DASH score to 50 points. The emotional domain remained restricted due to the prioritisation of physical care. Conclusions: Home visits combined with ICT tools (video calls, Google Forms, Google Meet, and audiovisual resources) proved to be an effective strategy to maintain continuous communication, reinforce health education, guarantee continuity of care, and improve therapeutic adherence. These findings underscore the clinical value of comprehensive nursing interventions in the preoperative phase and subsequent postoperative follow-up for working-age adults with right humeral osteomyelitis. Keywords: Chronic osteomyelitis, young adult, orthopedic nursing, nursing care process, self-care.