A case study with a series of short answer questions Essay Example

  • Category:
    Nursing
  • Document type:
    Case Study
  • Level:
    Undergraduate
  • Page:
    2
  • Words:
    1495

Question one

It is evident from the case study that John Smith sustained the injury four days ago when he was mountain biking and subsequently he was rushed to hospital. However, this morning the wound was extremely painful and had a smelly discharge which means that the wound is infected (Tidball & Wehling-Henricks, 2007). This kind of wound would heal through the secondary intention because it seems that there are post operative complications. Such complications include infection of the wound.

The infection might have been introduced during the surgical procedure. It is imperative to note that this wound might take a longer time through the secondary healing procedure that it would have taken through the primary intention. In case sutures were used before complications developed resulting into excessive pain and discharge as witnessed in John Smith’s case, such sutures should be removed in order to allow granulation tissue to develop in the outward side of the wound from the bottom side (Tidball & Wehling-Henricks, 2007).

Question two

Platelets

One of the specific cells involved in the healing of the wound is the platelets. A series of events occur before the wound heals. For example, further damage of the affected area is reduced and clotting of the wound area also occurs (Pleass, 2009, p. 296-299). Platelets cells serve as the agents that help in blood clotting. In order to further aid in blood clotting platelets reproduce in the area around the wound,

This is made possible by the “platelet plug” which is formed in the area around the wound (Pleass, 2009, p 297). This serves also as a signal that attracts other cells into the damaged area to help in blood clotting. Glycoproteins are also expressed on the surface of the platelets. This enables the glycoprotein to stick together in order to form a layer that enhances clotting of blood.

Neutrophils

The second specific cell involved in wound healing is Neutrophils. These types of cells exist in the affected area for a short duration of time such as one or two days. After this period they transform into macrophages (Hickey & Kubes, 2009). Neutrophils are attracted in the damaged area or in the wounded area by other cells such as fibronectin. Other elements that attract neutrophils in the wounded area include kinins and growth factors.

Through the respiratory burst process, the neutrophils perform the role of destroying bacteria, pathogens and cellular debris from the wounded area (Fernandez & Griffiths, 2008). They do this by engulfing the bacteria and the pathogens present in the wounded area. Oxygen radicals are also released by the neutrophils in the wounded area. After the phagocytic function the neutrophils’s term and purpose comes to end.

Macrophages

These are found within tissues and they are a form of white blood cells. They are produced through monocytes division. Macrophages performs several riles in the process of wound healing. One of the roles of macrophages is to destroy bacteria, cellular debris and pathogens by engulfing and digesting them (David & Justin, 2008). In this regard, macrophages are said to phagocytose the pathogens, bacteria and the cellular debris in order to ensure that the wound is free from any form of infections. The second role played by the macrophages is to stimulate immune cells and lymphocytes so that they can also respond at once to the bacteria, pathogens and cellular debris that might have invaded the damaged or the wounded area.

Question three

In order to accelerate the process of healing of the wounded area medical practitioners sterilise the wound. This technique is called swabbing the wound. It is important to note that John Smith had an infected wound which resulted into excessive pain and it also resulted into a discharge from the wound. The rationale for swabbing the wound is to stop any form of infection during clinical procedures that would obstruct the process of wound healing. Swabbing helps to destroy any pathogens or bacteria that might have invaded the wound.

Question four

Contamination of the wound may occur from a number of sources. Contamination of the wound affects the process of wound healing just as is the case with John Smith. It is evident that Smith’s wound might have been contaminated resulting into a discharge and excessive pain after four days (Schultz & Wysocki, 2009). One of the common sources of wound contaminations hands.

During clinical procedures the clinician may transfer pathogens and bacteria into the wound site if his/her hands are not well sterilised. This might also occur from the equipments used by the clinician. The second common way of wound contamination is through touching by the patient (Schultz & Wysocki, 2009). In the process of healing an itching effect is felt in the damaged area. When the patient uses his/her bear and unsterilized hands to scratch the damaged area germs are transmitted into the wound from his hands. Hence, the patient is the second source of wound contamination and germs are transmitted by scratching the affected area.

Question five

One of the bacteria that cause infections in the wounded area is the Escherichia coli bacteria. This bacterium is also common because it causes other infections such as urinary infection and diarrhoea. The rationale for changing the drug is that as an aminoglycoside antibiotic Gentamicin Sulphate can be used to treat diverse types of infections such as those caused by the Escherichia coli bacteria (Lee & Bishop, 2010). It is regarded as a broad spectrum antibiotic.

This antibiotic also penetrates the cell membrane of the bacteria faster than any other antibiotic thus killing and eliminating bacteria and pathogens from the wounded area. Gentamicin Sulphate is also advisable because it is absorbed fast in the wounded area and due to this synthesis of proteins which encourages bacteria and other pathogens to multiply in the affected area is inhibited (Lee & Bishop, 2010).

Question six

As stated there above, Gentamicin Sulphate acts through inhibiting synthesis of protein in the damaged area. Through this mechanism Gentamicin Sulphate binds itself to the 30S unit bacteria ribosome thus disrupting the process of synthesis of protein. As mentioned above, bacteria and other pathogens synthesis proteins in order to survive and grow in the wounded area. Without protein synthesis the bacteria and the pathogens cannot survive in the affected area.

The second mechanism through which Gentamicin Sulphate acts is through the use of aminoglycosides which is a chemical element that helps in killing bacteria in the wound. Hypersensitiveness is one of the common adverse effects associated with Gentamicin Sulphate. This cause intense itching, redness, irritation and swelling of the wounded area. Other adverse reactions from the use of Gentamicin Sulphate include numbness, paresthesia, confusion, depression, vertigo, tremors, dizziness, seizures, neurotoxicity (to mention a few). One of the alternatives that might be use instead of Gentamicin Sulphate is the streptomycin which is also in the aminoglycosidesgroup of antibiotics (Lucas & Greaves, 2008). This antibiotic has less adverse reactions as compared to Gentamicin Sulphate.

Question seven

One of the common infection control measures that nurses would have used during the dressing of the wound would be sterilising all equipments used in the process. Dressing of the wound involves the use of a number of equipments such as gloves and pins. Sterilising such equipments using antiseptic ointments would be important in order to eliminate any pathogens and bacteria that would be transmitted into the wound (Fernande & Griffiths, 2008)

The second measure would be drying up wet hands completely before beginning the process of dressing the wound. Recent studies have shown that wet hands transmit germs into the affected area faster than dry hands. Thus, it would be important to use alcohol rubs in order to sterilize hands and then dry up the hands in order to avoid any form of germ transmission into the affected area (Fernande & Griffiths, 2008). Hence, washing hands in antiseptic ointments or alcohol rubs as well as sterilizing equipments such as gloves and other equipments would help to prevent the transmission of germs.

References

David, M. & Justin, P. (2008).” Exploring the full spectrum of macrophage activation”. Nature Reviews Immunology
8: 958-969.

Fernande, R., Griffiths, R. (2008). «Water for wound cleansing». Cochrane Database Syst Rev (1): CD003861.

Hickey, M., Kubes, P. (2009). «Intravascular immunity: the host–pathogen encounter in blood vessels». Nature Reviews Immunology (Nature Publishing Group) 9 ((5)): 364–75.

Lee, G., & Bishop, P. (2010). Microbiology Infection control for health professionals (4 ed.).

French Forest, N.S.W.: Prentice-Hall.

Lucas, A., & Greaves, D. (2008). «Atherosclerosis: role of chemokines and macrophages». Expert Rev Mol Med
3 (25): 1–18.

Pleass, R. (2009). «Platelet power: sticky problems for sticky parasites?». Trends Parasitol.
25 (7): 296–9

Schultz, G.S. & Wysocki, A. (2009). Interactions between extracellular matrix and growth factors in wound healing. Wound Repair And Regeneration, 17(2): 153-62

Tidball, J., & Wehling-Henricks, M. (2007). «Macrophages promote muscle membrane repair and muscle fibre growth and regeneration during modified muscle loading in mice in vivo». The Journal of Physiology
578 (Pt 1): 327–336.