Wound Management Case Study: Clinical Decision Making

This case study focuses on the management of a cutaneous abscess caused by MRSA, highlighting a conflict between a surgeon's recommendation for Betadine and a nurse's skepticism. The essay references research comparing honey dressings to povidone-iodine, and studies indicating Betadine's potential toxicity. It also discusses the impact of drug use, such as heroin, and malnutrition on wound healing, supporting the nurse's decision. References include studies on Betadine's effects on cells and the influence of factors like vitamin deficiencies on wound closure. The study provides a clinical analysis of wound care protocols and the rationale behind nursing interventions.

Running head: WOUND MANAGEMENT
Wound management Case Scenario
Name of the Student
Name of the University
Author Note

1WOUND MANAGEMENT
Wound management involves a successful assessment of the size, depth and appearance
of the wound and its effective treatment (Stevens et al., 2014). This essay will focus on a wound
management case study.
Betadine is an antiseptic medicine made up of povidone-iodine used to treat minor skin
infections and wounds (Ward Sr & Corey, 2014). In the case scenario, Mr. Jones wound needs to
be treated post a surgical lancing of a 12*11mm cutaneous abscess, formed due to action of
MRSA bacteria.
However, the nurse disagrees with the recommendation of the surgeon for using betadine
for wound healing. A randomized controlled trial conducted among 22 subjects tested the
outcomes of honey dressing and povdione-iodine dressings and measured the healing at an
interval of 6 weeks. 7 subjects showed complete healing in honey dressing group compared to
none in the betadine group (Gulati et al., 2014). Further, studies have shown conflicting results
that suggest that betadine creates toxic effects on mucous membranes and large open wounds
(Huynh et al., 2014). The toxic effects of betadine were demonstrated on epithelia HeLa cells an
increase in toxicity was exhibited in the form of upregulation in apoptosis at concentrations that
were low than the clinical doses (Sato et al., 2014).
Drugs like heroin and morphine, among others although provides pain relief but they
affect the immune system. Individuals who take drugs suffer from insufficient wound closure
and are highly susceptible to infection. Heroin addicted patients suffer from infected non-healin
wounds. Immunosuppression delays the recruitment of immune cells and further delaying wound
closure and bacterial clearance (Abavare & Abavare, 2012). Malnutrition causes metabolic

2WOUND MANAGEMENT
alterations that affect wound healing. Vitamin C and A are required for collagen synthesis and
epitheliazation, while zinc is necessary for cell mitosis and proliferation (Deer & Stewart, 2016).
Thus, from the above evidences it can be concluded that the nurse has displayed a good
behavior in not adhering to the instructions of using betadine for wound healing owing to its
toxic effects on tissues.

3WOUND MANAGEMENT
References
Abavare, L., & Abavare, C. (2012). Wound botulism resulting from heroin abuse: can you
recognize it?. Journal of Emergency Nursing, 38(3), 301-303.
Deer, T. R., & Stewart, C. D. (2016). Wound healing. In Atlas of Implantable Therapies for Pain
Management (pp. 89-92). Springer New York.
Gulati, S., Qureshi, A., Srivastava, A., Kataria, K., Kumar, P., & Ji, A. B. (2014). A prospective
randomized study to compare the effectiveness of honey dressing vs. povidone iodine
dressing in chronic wound healing. Indian Journal of Surgery, 76(3), 193-198.
Huynh, E., Tran, P., Pham, P., Hamood, A., Mitchell, K., & Reid, T. W. (2014). 5% Betadine
solution in not effective in inhibiting the growth of different Gram Negative and Gram
Positive Pathogens in vitro. Investigative Ophthalmology & Visual Science, 55(13), 5787-
5787.
Liu, J. X., Werner, J. A., Buza III, J. A., Kirsch, T., Zuckerman, J. D., & Virk, M. S. (2017).
Povidone-iodine solutions inhibit cell migration and survival of osteoblasts, fibroblasts,
and myoblasts. Spine. doi: 10.1097/BRS.0000000000002224
Sato, S., Miyake, M., Hazama, A., & Omori, K. (2014). Povidone-iodine-induced cell death in
cultured human epithelial HeLa cells and rat oral mucosal tissue. Drug and chemical
toxicology, 37(3), 268-275.
Stevens, D. L., Bisno, A. L., Chambers, H. F., Dellinger, E. P., Goldstein, E. J., Gorbach, S.
L., ... & Wade, J. C. (2014). Practice guidelines for the diagnosis and management of skin

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and soft tissue infections: 2014 update by the Infectious Diseases Society of
America. Clinical infectious diseases, 59(2), e10-e52.
Ward Sr, W. G., & Corey, R. M. (2014). To Wash or Not to Wash: That Is the Question:
Commentary on an article by SJ van Meurs, MD, et al.:“Selection of an Optimal
Antiseptic Solution for Intraoperative Irrigation. An in Vitro Study”. JBJS, 96(4), e34.