Bioscience 2 Nursing: A Case Study on Post-operative Wound Infection

This nursing assignment presents a case study focused on post-operative wound contamination. It delves into the physiological basis of wound observations, including the roles of local host impairment, systemic trauma, and bacterial infection. The assignment identifies potential endogenous and exogenous sources of contamination, detailing modes of transmission such as direct contact with carriers and indirect contact with contaminated environments. The rationale behind antibiotic choices, including ceftriaxone, cephalexin, and dicloxacillin, is thoroughly explained, considering their mechanisms of action and potential adverse reactions. Finally, the assignment outlines the four stages of wound healing: hemostasis, inflammation, proliferation, and maturation, explaining the key processes involved in each stage. This comprehensive analysis provides a detailed understanding of wound management in a nursing context. Desklib offers a wealth of similar assignments and study resources for nursing students.

Running head: NURSING ASSIGNMENT 1
Nursing Assignment
Student’s Name
Institutional Affiliation

NURSING ASSIGNMENT 2
This template must be used to answer the case study.
(Please type your answers within the box underneath each question)
Student name (LAST NAME first name):
Student number:
Campus:
Tutorial session (time and room no.):
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1. Physiological basis of the wound observations (Total: 10 marks)
The evidence of postoperative laceration contamination has a tri-factorial
basis; the local host impairment associated with both the injury and the operation,
the overall systemic trauma and the other impacts of premorbidity along with the
bacterial infection of the laceration (Bertesteanu et al., 2014). The amount of the
factor of host damage as a result of operation and injury could be directly
influenced by a surgeon who should make sure that his surgical mechanisms are
non-aggressive and in line with the present knowledge. However, the factor of
overall systemic trauma and the other impacts of premorbidity are moderately open
to intervention (Bertesteanu et al., 2014).
The two aspects are in direct connection to the hypothesis that every injury
is capable of tolerating some local host impairment and some bacterial inoculum
with no indication of contamination. Furthermore, it is also directly related to the
hypothesis that the bacterial laceration flora is the outcome of the bacterial
infringement force together with the local laceration state (Bertesteanu et al.,
2014).

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The factor of intraoperative bacterial inoculum could be improved through
hygiene observation (Bertesteanu et al., 2014). The bacterial laceration flora along
with the local situation of the injury is interrelated, and if either of the factors
transcends the endurable threshold, the infection becomes manifest. This means
that there will exist an unmanageable multiplication of microorganisms and the
degree of the breaking point will reckon particular systemic host factors like
immunodeficiency, age or even diabetes. Consequently, the contamination
hindrance should concentrate concurrently on reducing the local bacterial inoculum
and enhancing local injury condition (Bertesteanu et al., 2014).
2. Possible sources of contamination and modes of transmission (Total: 10
marks)
2.1 Name one endogenous source of contamination and discuss the mode of
transmission from the source to the new host. (5 marks)
The primary endogenous root of infection is the victim's carriers (Glassing,
Dowd, Galandiuk, Davis & Chiodini, 2016). An estimation of fifty percent of the
population is colonized with microorganism like Staphylococci aureus in the
anterior nasal passages. Over time, this rate has reduced as a result of changes in
socioeconomic class, smaller families along with excellent personal hygiene
(Glassing, Dowd, Galandiuk, Davis & Chiodini, 2016). The mode of transmission is
direct contact. Pathogens gain access to the underlying bloodstream and blood
tissue and are transferred to the injury resulting in infection (Manaia, 2017).
2.2 Name one exogenous source of contamination and discuss the mode of
transmission from the source to the new host. (5 marks)
The exogenous root of contamination is the surrounding (Glassing, Dowd,

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Galandiuk, Davis & Chiodini, 2016). The contact with the environment whereby the
pathogens are in the air, sharp objects or those introduced by traumatic accident.
The mode of infection transmission is via an indirect connection which happens in
case contaminated objects with bacteria transfer the microorganisms to the host by
coming into contact (Manaia, 2017).
3. Rationale for choices of antibiotics (Total 10 Marks)
3.1 Rationale for the stat dose of ceftriaxone administered IVI immediately. (3
marks)
The stat dose of ceftriaxone was delivered directly to hinder the growth of
microorganisms (Zaheer & Latif, 2017). This drug stops the pathogens from
developing so that they may not lead to infection after surgery is conducted. Its
choice is selected because the preceding step will be a medical procedure for the
laceration so that after the operation there is a low peril of infection. Ceftriaxone
only stops the microbes from reproducing but does not eliminate the organisms'
cell wall hence discontinued, and cephalexin is introduced (Zaheer & Latif, 2017).
3.2 Rationale for the oral cephalexin. (2 marks)
The purpose of the administration of oral cephalexin was to interfere with
the creation of the microbe’s cell wall and also to rupture and kill the
microorganisms (Rao et al., 2014). Its selection was based on the fact that the
initial antibiotic was incapable of destroying the bacteria and it is discontinued
because of its inefficacy against diseases caused by microorganisms such as
Staphylococcus aureus.

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3.3 Rationale for the change to oral dicloxacillin. (4 marks)
The change of antibiotics to dicloxacillin is because this antibiotic operates
versus microbes which are resistant to other penicillins such as Staphylococcus
aureus. Also, dicloxacillin assists in clearing up the contamination of the
microorganisms via inhibiting their growth (Chu et al., 2016). Its selection was
based on its lower peril of antibiotic-induced liver injury and also because it does
not have cautions on the hazard of severe cholestasis hepatitis. Consequently,
dicloxacillin react through impeding the synthesis of bacterial cell walls. It impedes
cross-linkage amidst the linear peptidoglycan polymer chains that constitute a
significant element of the Gram-positive bacterial cell wall (Chu et al., 2016).
3.4 State two adverse reactions to dicloxacillin. (1 mark)
The adverse reactions of dicloxacillin more so when administered orally will
result in signs of gastrointestinal irritation such as vomiting and diarrhea (Macy &
Chen, 2017).
4. Process by which Mary’s wound will heal (Total: 5 marks)
Hemostasis stage is the initial stage which begins once the wound starts to
bleed and its work is to close the laceration through clotting. Once blood is limited
to flow platelets join to block the break in the blood vessel wall, then clotting occurs

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and support the platelet plug with fibrin threads which operate as a molecular
binding agent (Olczyk, Mencner & Komosinska-Vassev, 2014). In the second stage
called inflammatory phase, the injured victim starts to feel the physical
repercussions of the injury like redness, warmth, and tenderness. This stage is
essential since it controls bleeding and averts contamination (Olczyk, Mencner &
Komosinska-Vassev, 2014).
Proliferation stage is the preliminary phase where the laceration starts to be
restored with new and healthy tissues and is achieved through an adequate supply
of oxygen together with nutrients. The newly created membrane is made of
collagen along with extracellular matrix which permits the growth of new blood
vessel connection to restore the weary ones (Olczyk, Mencner & Komosinska-
Vassev, 2014). Finally, in the maturation stage, the collagen is remodeled and the
laceration closes completely. The cells utilized to rebuild the injury and not required
anymore are replaced by programmed cell death or apoptosis (Olczyk, Mencner &
Komosinska-Vassev, 2014).

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References
Bertesteanu, S., Triaridis, S., Stankovic, M., Lazar, V., Chifiriuc, M. C., Vlad, M., &
Grigore, R. (2014). Polymicrobial wound infections: pathophysiology and current
therapeutic approaches. International Journal of Pharmaceutics, 463(2), 119-
126.
Chu, J., Vila-Farres, X., Inoyama, D., Ternei, M., Cohen, L. J., Gordon, E. A., ... &
Jaskowski, M. (2016). Discovery of MRSA active antibiotics using the primary
sequence from the human microbiome. Nature chemical biology, 12(12), 1004-
1006.
Glassing, A., Dowd, S. E., Galandiuk, S., Davis, B., & Chiodini, R. J. (2016). Inherent
bacterial DNA contamination of extraction and sequencing reagents may affect
the interpretation of microbiota in low bacterial biomass samples. Gut
Pathogens, 8(1), 24.
Macy, E. M., & Chen, L. H. (2017). The incidence of anaphylaxis associated with oral
and parenteral penicillin-class antibiotic exposures. Journal of Allergy and
Clinical Immunology, 139(2), AB33.
Manaia, C. M. (2017). Assessing the risk of antibiotic resistance transmission from the
environment to humans: non-direct proportionality between abundance and
risk. Trends in Microbiology, 25(3), 173-181.

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Olczyk, P., Mencner, Ł., & Komosinska-Vassev, K. (2014). The role of the extracellular
matrix components in cutaneous wound healing. BioMed research
international, 2014.
Rao, B. B., Mukherji, R., Shitre, G., Alam, F., Prabhune, A. A., & Kale, S. N. (2014).
Controlled release of antimicrobial Cephalexin drug from silica
microparticles. Materials Science and Engineering: C, 34, 9-14.
Zaheer, A., & Latif, Z. (2017). METABOLIC FINGERPRINTING OF BACTERIAL
STRAINS ISOLATED FROM NORTHERN AREAS OF PAKISTAN. PAKISTAN
JOURNAL OF BOTANY, 49(4), 1509-1516.