Case Study Analysis: Wound Management, Infection, and Treatment

This case study analyzes the wound management of a 50-year-old woman, Mary, who sustained a cut while gardening. The study explores the administration of a tetanus booster due to the risk of infection, particularly given her exposure to soil and manure. It delves into wound assessment using the triangle wound assessment strategy, identifying signs of infection like swelling, redness, and exudates. The study further discusses the physiological response to infection, including fever, and differentiates between exogenous and endogenous contamination. The primary focus is on the treatment with Augmentin, an antibiotic effective against Staphylococcus aureus infections, considering its resistance to methicillin. References from medical journals and textbooks are included to support the analysis.

Running head: WOUND MANAGEMENT CASE STUDY
Wound management case study
Name of the student:
Name of the university:
Author Note:

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Table of Contents
Question 01: 2
Question 2: 2
Question 3: 3
Question 4: 4
Question 5: 5

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Question 01:
Tetanus is an inactive vaccine, also known as tetanus toxoid, is order to prevent tetanus
infection. This vaccine is given 11 times as a precautionary measure in the lifetime of a human
being, five doses in the childhood and six in the period of adolescence. However, as tetanus is an
infection that is very easily acquired, hence the medical practitioners recommend additional
doses of this vaccine every ten year to positively avoid any possibility of acquiring tetanus.
However, in case of a patient that has not followed through this immunization schedule and has
sustained an injury with high risk of tetanus infection, a booster dose is recommended within 48
hours of the patient sustaining the said injury (Bullock & Manias 2013).
As explained in the case study selected for this assignment, Mary is a 50 year old woman
who had sustained a four cm long cut in her calf while working for her rose garden. Now it has
to be mentioned that tetanus immunization was introduced in the mid 1900s and there are a lot of
older individuals who had not been properly immunized. Along with that, it also must not escape
notice that she had been working with soil and manure which had increased the probability of
infection multiple folds which had manifested as the swelling in the wound site, hence a booster
dose of tetanus vaccination had been administered to Mary (Craft et al., 2015).
Question 2:
Incision wounds are generally caused by any sharp object sliding into the skin tissue,
although normal cuts and bruises are a normal occurrences in everyday life, the ones that exposes
tissue or intersects blood vessels can have far more complicated physiological significance.
Microflora are ubiquitous, they are present almost everywhere, and a vast variety of this
microflora are pathogenic and cause infection in human body. Wounds and incisions provide a

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perfect entry site for the microorganisms and if not assessed and secured the wound site
appropriately it can significantly cause infections. Hence in clinical practices, when presented
with a wound infection, the wound site is examined using the triangle wound assessment strategy
(Krezalek et al., 2017). For instance in the cases study, the patient Mary had suffered a 4 cm long
incision while working in the garden, and with the contact to soil and manure had gotten an
infection in her wound site. The first physical assessment in this case is done focussed on the
wound bed, looking for any granulation, reddening or discoloration. The surrounding tissue of
the wound site for the patient had been swollen which indicates the presence of infection. The
second assessment is done for the wound edge to check for any exudation, local warmth of the
wound and the colour, in cas4e of the patient the wound had been red and hot to touch which
indicates the presence of infection, and the third assessment for the wound is check for any
exudates, and as for the patient purulent and odorous the presence of subsequent infection is
further confirmed (Krezalek et al., 2017).
Question 3:
Fever is one of the moist common physiological responds of the body to any uncommon or
abnormal phenomenon occurring in the body. Now it needs to be mentioned that fever is caused
by the accumulation of the pyrogens in the body, and these pyrogens can be exogenous in origin
as well. According to many research studies, elevated body temperatures are known to stimulate
the innate immune response of the body to any infectious microorganisms spreading inside the
body (Lee & Bishop, 2013). This stimulation is caused by the recruitment, activation and
bacteriolytic activity of the natural killers of the human body, the neutrophils. Now the adaptive
immune response in the body is also triggered by the elevation levels in the body temperature,
increasing the circulation and proliferation of the T cells. Hence the elevated temperature is the

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signalling mechanism in the body that triggers the immune mechanism of the body to take into
account the invasion and infection of the microorganism (Lee & Bishop, 2013).
In case of infections, the occurrence of fevers has been found to be highly effective and
the lack of increase in the body temperature has been associated with disrupted clearance of
the pathogens in the body. Hence, it can be stated that fever is beneficial for the tenure of the
infection to be passed more quickly, the two marked benefits of the fever in inf4ections can
be:
 Alerting the innate immune response of the body to detect the presence of pathogen in
the body
 Triggering the blood flow from the skin to the vascular pools to avoid the heat loss
from the body parts (Marieb & Hoehn, 2014)
Question 4:
Contamination is one of the greatest causes of wound infections in humans that facilitates the
entry of the pathogen into the body and causes the infection. However, the contamination can be
of various kinds, it can either be exogenous or it can be endogenous. Exogenous contamination is
caused when the wound or incision sites in contaminated by the pathogens of the outside
environment by the means of direct physical contact. On the other hand, the endogenous
infection is caused by the pathogens that are already present in the body however they had been
in the phase of dormancy previously (Marieb & Hoehn, 2014). In case of the case study, it
represents the older woman getting an infection in the calf while working in the garden with the
soil and manure. Hence the possible exogenous route to the infection can be described from the

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direct contact to soil or manure. The skin or the gastrointestinal tract of the patient can be the
possible cause for endogenous contamination of the pathogen inside the body of the Mary.
Question 5:
Bacterial infections are best treated by broad spectrum antibiotics, however not all antibiotics
are effective in case of different kinds of infections. Amoxycillin however is a highly functional
and effective antibiotic that is used in case of many severe infections. For instance this antibiotic
is used for many of the Staphylococcus aureus infection. According to many exploratory
research studies, augmentin is an antibiotic that targets even the methicillin resistant strains of S
aureus as well if used in high concentrations. Augmentin is an antibiotic that combines methicilli
and clavulanic acid together, and that is the reason it can actively target the strains of the bacteris
that are resistant to methicillin (Newman et al., 2014). This medication can be taken orally in the
form of pills for the adults, hence the administration of this medication is easy and hassle free.
Hence it is the most prized choice for the physicians and is considered as the workhorses when it
comes to antibiotics. Most of the S. aureus strains nowadays are methicillin or penicillin
resistant, and administration of augmentin is much easier and safe. In case of the case study, the
patient Mary had acquired a wound infection by Staphylococcus aureus and had been showing
all signs of severe infection along with fever. Hence she was administered augmentin in order to
ensure that the infection can be actively suppressed or diminished (Pastar et al., 2013).

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References:
Bullock, S., & Manias, E. (2017). Fundamentals of pharmacology (8th ed.). Frenchs Forest,
Australia: Pearson Australia.
Craft, J., Gordon, C., Huether, S. E., McCance, K. L., & Brashers, V. L. (2015). Understanding
pathophysiology-ANZ adaptation. Elsevier Health Sciences.
Krezalek, M. A., Hyoju, S., Zaborin, A., Okafor, E., Chandrasekar, L., Bindokas, V., ... & Boyle-
Vavra, S. (2017). Can Methicillin-resistant Staphylococcus aureus Silently Travel From
the Gut to the Wound and Cause Postoperative Infection? Modeling the" Trojan Horse
Hypothesis". Annals of Surgery. DOI:10.1097/SLA.0000000000002173. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/28187042
Lee, G., & Bishop, P. (2013). Microbiology and infection control for health professionals .
Frenchs Forest.
Marieb, E., & Hoehn, K. (2014). Anatomie et physiologie humaines: Livre+ eText+ plateforme
numérique MonLab-Licence étudiant 60 mois. Pearson Education France.
Newman, E. T., Watters, T. S., Lewis, J. S., Jennings, J. M., Wellman, S. S., Attarian, D. E., ... &
Bolognesi, M. P. (2014). Impact of perioperative allogeneic and autologous blood
transfusion on acute wound infection following total knee and total hip
arthroplasty. JBJS, 96(4), 279-284., DOI: 10.2106/JBJS.L.01041. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/24553883
Pastar, I., Nusbaum, A. G., Gil, J., Patel, S. B., Chen, J., Valdes, J., ... & Davis, S. C. (2013).
Interactions of methicillin resistant Staphylococcus aureus USA300 and Pseudomonas

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aeruginosa in polymicrobial wound infection. PloS one, 8(2), e56846. Retrieved from
https://doi.org/10.1371/journal.pone.0056846
Pinkney, T. D., Calvert, M., Bartlett, D. C., Gheorghe, A., Redman, V., Dowswell, G., ... &
Hornby, S. (2013). Impact of wound edge protection devices on surgical site infection
after laparotomy: multicentre randomised controlled trial (ROSSINI Trial). Bmj, 347,
f4305. DOI: https://doi.org/10.1136/bmj.f4305. Retrieved from
http://www.bmj.com/content/347/bmj.f4305
Rose, T., Verbeken, G., De Vos, D., Merabishvili, M., Vaneechoutte, M., Lavigne, R., ... &
Pirnay, J. P. (2014). Experimental phage therapy of burn wound infection: difficult first
steps. International journal of burns and trauma, 4(2), 66-73. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212884/
Turner, K. H., Everett, J., Trivedi, U., Rumbaugh, K. P., & Whiteley, M. (2014). Requirements
for Pseudomonas aeruginosa acute burn and chronic surgical wound infection. PLoS
genetics, 10(7), e1004518. Retrieved from https://doi.org/10.1371/journal.pgen.1004518