Pathophysiology and Causes of Wound Infection: Case Study 1
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This essay discusses the pathophysiology and causes of a wound infection in a case study patient. It also identifies nursing priorities for wound care and explains the appropriate nursing management of the patient.
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Running head: ASSESSMENT TASK: CASE STUDY 11 Assessment Task: Case Study 1 Student’s Name Institutional Affiliation
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ASSESSMENT TASK: CASE STUDY 12 Introduction The essay is based on an Italian lady of 49 years old called Mrs. Gina Bacci. Gina visited the hospital two weeks ago for partial amputation following complications from a right foot ulcer. She has a history of type 2 diabetes diagnosed six years ago, Peripheral Vascular Disease (PVD) and obesity. Seven days later after being discharged from the hospital, she visits the hospital for further wound assessment and management. The essay will discuss the pathophysiology and causes of her wound status and identify the main nursing priorities for wound care. Also, it will explain the appropriate and safe nursing management of the patient. Based on the case study, critically analyze and discuss the underlying pathophysiology and causes of the patient’s post-operative wound status. Pathophysiology is defined as the scientific study of abnormal processes which cause an infection (McCance & Huether, 2018). After close examination of Gina's wound and the vital signs, there is an indication that the surgical wound was in the process of healing at the inflammatory phase, but it seems to have been invaded by some bacteria which leads to an infection. The wound shows the sign of infection since the surrounding skin is warm, dark pink and painful to touch. Also, her temperature is very high indicating fever. The wound disarrayed the tissue integrity that commenced the coagulation cascade to desist bleeding. The cellular components which are the platelets aggregated to the wound and because of the platelet’s reaction they released several cytokines. These cytokines entail the Insulin-Like Growth Factor-1 (IGF-1), Epidermal Growth Factor (EGF), and Platelet Derived Growth Factor (PDGF) along with the Fibroblast Growth Factor (FGF) (Park, Hwang & Yoon, 2017). Furthermore, serotonin was dispensed and working jointly with histamine which is released by mast cells kindled an adjustable opening of the junctions amid the endothelial cells.
ASSESSMENT TASK: CASE STUDY 13 Serotonin and histamine allow the monocytes along with neutrophils to pass which become macrophages to the site of the wound. The huge cellular movement to the site of the wound is triggered by the cytokines generated by the platelets and by an added chemotactic cytokines made by the macrophages at the wound site (Zhao, Liang, Clarke, Jackson & Xue, 2016). They entail the Transforming Growth Factor alpha (TGF-α) and the Transforming Growth Factor beta (TGF-β). Correspondingly, the inflammatory exudate that comprises of macrophages, red blood cells, plasma proteins together with neutrophils including coagulation cascade proteins as well as fibrin strands fill the wound (De Oliveira, Rosowski & Huttenlocher, 2016). Not only does the macrophages scavenge but are also predominant to the process of wound healing because of the production of their cytokines. When Gina Bacci's vital signs are taken, the blood pressure, pulse rate, and the respiratory rate are standard except the temperature and the blood glucose level. Since Gina has a history of type 2 diabetes, it is clear that diabetes made it difficult for her body to control her blood glucose level. When the blood glucose level remained habitually very high, it impaired the operation of the white blood cells resulting in the inability to fight microorganisms (Sorisky, 2017). For a post-operative surgical wound infection to occur the person’s skin is the most common bacterial source. Looking at Gina, there are triggers which resulted in her present condition. The infection of the wound was caused by germs either from the skin or from her operational instruments. Most of the surgical wound infections are as a result of the individual’s bacterial flora and the most common bacterial causing surgical wound infection are Staphylococcus, Streptococcus along with Pseudomonas (Brook, 2016). The skin is the body’s first line of defense that is
ASSESSMENT TASK: CASE STUDY 14 shielded by a thin, acid film secreted by the sebaceous glands known as the acid mantle. The acid mantle adjusts the skin’s pH and keeps the normal flora which aids prevent bacteria from entering the body. When the skin is ruptured, the protection is no longer there, and any bacteria are colonizing the skin cause infection. Another cause of surgical wound infections is the bacteria found in the environment around the person (Streeter & Katouli, 2016). Whenever these germs come in contact with the person, they are introduced to the site of the wound, and it colonizes it causing an infection. Finally, bacteria from the hospital setting cause post-operative infections (Deshpande, Someshwaran & Gnanaprakash, 2016). For instance, during the time of Gina’s surgery, the instruments used might have had bacteria and might have been transferred to the wound site. Also, the surgeon's body has bacteria, and if he did not perform hand hygiene before operating the germs might have been spread to the surgical site hence causing an infection. Identify two main nursing priorities of care for this patient and provide justification and rationale for each. The reason behind Gina’s present situation at the hospital is the bacteria which has colonized her wound causing an infection. Also, the sloughy tissue seen on the wound bed must be harboring some bacteria which might have contributed to the epidemic. Gina’s wound has some dehiscence along the suture line which is a complication as a result of an infection. The primary nursing priorities are the removal of the sloughy tissue and confirming the species of bacteria present in the wound bed through taking wound swabs for culture and sensitivity so that the correct treatment can be identified (Chhugani, Jacob & James, 2017). The sloughy tissue can act as a focal point for microorganisms and the peri-wound protected as the exudate can be high. The sloughy tissue can delay the process of wound healing,
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ASSESSMENT TASK: CASE STUDY 15 and it is frequently necessary for the devitalized tissue to be removed before any progress towards cure can be made. This removal of the sloughy tissue is known as debridement and can be performed surgically or using non-surgical methods like utilizing enzymes to eat up the dead tissue. To make sure that Gina’s problem is solved, the treatment goals must be ascertained, and steps are taken to obtain the desired results. The accurate information about the species of bacteria present in the wound bed must be confirmed, and then the correct antibiotic is given to fasten the healing process. Antibiotics work in two ways; they either eliminate the microbes by ceasing the mechanism accountable for building their cell walls or they block the breeding of the bacteria. If bacteria such as streptococcus are present and responsible for the infection Amoxicillin antibiotics will be appropriate for dealing with them (Surahio, Talpur, SalamMemon, Junejo & Laghari, 2017). Amoxicillin will not kill the microbe directly, but it will destroy the cell wall hence preventing the bacteria from making proteins which are necessary for them to grow and survive hence the goal of avoiding the infection will have been met. From your identified priorities, outline and justify the appropriate and safe nursing management of the patient during this time. To meet the patient’s treatment goals, actions need to be implemented. The clinical nurse has to take care of the wound complication, that is, the dehiscence. He should wash out the wound using saline and then do simple wound care like packing the wound with absorbent ribbon gauze. Since the dehiscence is along the suture line, the nurse should treat the suture line with a dressing that will control the anticipated early inflammatory exudate, and it will also provide a waterproof covering (Smart & Acton, 2016). Here, a thorough assessment should be
ASSESSMENT TASK: CASE STUDY 16 done on the structures of the dehisced wound and the presence of any foreign bodies. Since the surrounding skin is painful to touch, the health care professional should make sure that adequate measures are taken to make the patient comfortable. This will be achievable if the nurses administer the correct drugs to reduce the pain. The removal of the sloughy tissue can be performed either mechanically through a surgical incision, sharp debridement, and bio-surgery or non-mechanically via enzymatic, autolytic and through the use of polysaccharide dressings (Percival & Suleman, 2015). If the nurse is performing autolytic debridement and the wound is too wet or too dry, he should use the appropriate dressing such as hydrogels along with occlusive dressings to rehydrate dry slough to create a moist environment. This is appropriate since autolysis relies on a humid environment. Moreover, he should utilize hydrofibres, calcium alginates together with semi-permeable dressings to absorb excess exudate in wetter wounds (Percival & Suleman, 2015). If surgical debridement is done, the surgeon must visually inspect the tissue, ascertain what tissue is viable and then remove the tissue which is not salvageable. Using a sharp instrument, the surgeon should cut away the bad tissue and try to preserve as much good tissue as possible (Percival & Suleman, 2015). On the other hand, if the health professional chooses the type of debridement using enzymes, he should use the enzyme solutions and combine with a dressing which is changed frequently that softens the tissue and enables for the lousy tissue to be removed when the dressing is removed. When confirming the type of bacteria, wound swabs are taken for culture and sensitivity, and it needs some nursing management. The health professional should perform hand hygiene, assemble the instruments, wear sterile gloves and irrigate the wound site using sodium chloride
ASSESSMENT TASK: CASE STUDY 17 and then by use of a gauze pad, swab the wound smoothly. When the swab is moist, it will be possible to obtain the correct information concerning the bacteria (Assadian et al., 2018). Since this wound culture must be collected from a clean tissue, the nurses should identify an unstained area of a feasible tissue and turn the swab on it for better results. The best and effective therapy for Gina is topical antibiotics since the infection is localized. However, if the infection was systemic, the treatment could be changed to oral antibiotics. Amoxicillin fights the bacteria and stops them from developing through preventing them from forming cell walls (Lobanovska & Pilla, 2017). Through this mechanism, the bacteria are killed, and the infection is eventually eradicated. The removal of the sloughy assists in the effectiveness of the topical antibiotics. Conclusion A surgical wound can develop an infection at its inflammatory stage of healing and if a slough tissue develops it can harbor some microbes leading to an infection. During this time, the health professionals must make sure that the sloughy tissue is removed to prevent further infection and then take a wound swab for culture to determine the bacteria present in the wound bed that is causing the infection. When taking care of the wound, the nurses have to practice hand hygiene, use the correct instruments for obtaining wound swabs and use the proper dressings during debridement.
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ASSESSMENT TASK: CASE STUDY 18 References Assadian, O., Kammerlander, G., Geyrhofer, C., Luch, G., Doppler, S., Tuchmann, F., & Leaper, D. (2018). Use of wet-to-moist cleansing with different irrigation solutions to reduce bacterial bioburden in chronic wounds.Journal of wound care,27(Sup10), S10-S16. Brook, I. (2016). Spectrum and treatment of anaerobic infections.Journal of Infection and Chemotherapy,22(1), 1-13. Chhugani, M., Jacob, S. M., & James, M. M. (2017). Nursing Care: Making a Big Difference in Stage 3 Bed Sore.Int. J. Nurs. Midwif. Res,4(4), 4. De Oliveira, S., Rosowski, E. E., & Huttenlocher, A. (2016). Neutrophil migration in infection and wound repair: going forward in reverse.Nature Reviews Immunology,16(6), 378. Deshpande, S. A., Someshwaran, R., & Gnanaprakash, K. (2016). A Bacteriological Study of Post-Operative Wound Infections and its Antibiotic Sensitivity Pattern from a Tertiary Care Hospital, Coimbatore, India.International J. Current Microbiology and Applied Sciences,5(8), 629-634. Lobanovska, M., & Pilla, G. (2017). Focus: Drug Development: Penicillin’s Discovery and Antibiotic Resistance: Lessons for the Future?.The Yale journal of biology and medicine,90(1), 135. McCance, K. L., & Huether, S. E. (2018).Pathophysiology: The biologic basis for disease in adults and children. Elsevier Health Sciences. Park, J., Hwang, S., & Yoon, I. S. (2017). Advanced growth factor delivery systems in wound management and skin regeneration.Molecules,22(8), 1259.
ASSESSMENT TASK: CASE STUDY 19 Percival, S. L., & Suleman, L. (2015). Slough and biofilm: removal of barriers to wound healing by desloughing.Journal of wound care,24(11), 498-510. Smart, L., & Acton, C. (2016). Wound dressings: surgical dressings.Dermatological Nursing,15(2), 36-40. Sorisky, A. (2017). Effect of high glucose levels on white adipose cells and adipokines—Fuel for the fire.International journal of molecular sciences,18(5), 944. Streeter, K., & Katouli, M. (2016). Pseudomonas aeruginosa: A review of their Pathogenesis and Prevalence in Clinical Settings and the Environment.Infection, Epidemiology, and Microbiology,2(1), 25-32. Surahio, A. R., Talpur, A. A., SalamMemon, A., Junejo, A., & Laghari, A. A. (2017). Surgical site infections.The Professional Medical Journal,24(01), 57-63. Zhao, R., Liang, H., Clarke, E., Jackson, C., & Xue, M. (2016). Inflammation in chronic wounds.International journal of molecular sciences,17(12), 2085.