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John Smith, 15 years old, presents himself at the local medical centre with an infected laceration to his left outer thigh.Four days ago John was mountain bike riding, when he fell off his bike and collided with a large rock, sustaining a deep laceratio Essay Example

Wound healing

  1. Intention of wound healing

Wound healing refers to the process whereby the body cells repair themselves after an injury inside the body or on the skin (Cohen, 2008). There are three types of wound healing intentions namely the primary intention, secondary and tertiary. The primary intention involves dermis and the epidermis but without full penetration of the dermis healing through the process called epithelialisation. The edges of the wound are simply brought together making them adjacent, this minimizes scarring. The tertiary intention is as a result of secondary suture or primary closure delay. The wound is cleaned up and left open for four days before it is closed.

The case needed the secondary intention for healing. The secondary intention is whereby the wound is left to granulate. The surgeon can pack that wound using gauze or drainage system (Cohen, 2008). The wound results to a big scar due to granulation and the process of healing is slow because of the drainage from the infection. The wound was there for four days meaning the possibility of infections was high hence the need for drainage. The collision of his foot with a rock must have left a deep laceration which needed more care.

  1. Describe role of three cells in wound healing

The process of wound healing involves cells. The platelets are usually the first cells which invaded the part of the body that is injured. They initiate the healing process of the wound through the release of growth factors. The growth factors include cytokines (Brown & Nanney, 2009). These are proteins which are like intercellular signals for allowing the cells to communicate between each other. They also stimulate the proliferation and migration of the cells and synthesis of tissues. The growth factors create blood vessels which are used to supply blood to the site and finally promote remodelling.

The macrophages cells are very important for the healing of wounds. They are replacement of the polymorphonuclear neutrophils. They are attracted to the wound by the release of growth factors and other factors like kinins. Their main role is to kill bacteria through the release of free radicals. They aid in wound cleansing by secreting a substance called proteases which breaks down all the damaged tissues. Macrophages also engulf and damages neutrophils which have undergone apoptosis. The main role for the macrophage is to phgocytize all bacteria and the damaged tissues (Frederick et el, 2008).

Fibroblasts are equally important cells in wound healing. They accumulate at the site of the wound between the second and fifth day of the wound. In one week’s time, they become the most predominant cells in the wound. Their main role is to lay the collagen matrix in the site of the wound.

  1. Rationale for swabbing

Wound swabbing is taken to be a very simple procedure by most health practitioners but much attention must be taken to ensure it is done the right way. Health policies emphasizes the importance of using health care procedure that is evidence based and demands that the clinical practice must be founded on scientific evidence. Hygiene is also a very important factor to observe when wound swabbing (Keith &Douglas, 2010). They must ensure they use personal protective equipments like gloves to avoid infecting themselves in case the patient is sick. The health practitioner must clean up the wound first before swabbing especially if it has blood. The cleaning is not always done because it has been proved that moistening the wound before swabbing increases the chances of bacteria multiplication due to the moisture before microbiology culture. The wound swabs must be taken and transported in the correct way (Patricia, 2010).

  1. Sources of contamination and mode of transmission

A wound is vulnerable to infections because it is an open tissue. Wound infection occurs when there is entry of germs in the broken part of the skin (Flanagan, 2000). The germs known as bacteria enter and attach to the wound stopping it from healing. An infected wound is characterized by increased productions of discharge like pus, prolonged healing of the wound, painful wounds, old wounds which easily bleeds, fast heartbeat, low or high temperature, increased swelling around the wound that are red, warm and painful. The sources of the bacteria entering in the wound are soil, air and water. Diseases like diabetes, cancer, liver, kidney conditions delay the healing process of the wound hence subjecting it to infections. Foreign bodies like glass, metal and dirty dressing materials can subject wounds to infection (Flanagan, 2000). Low or poor supply of blood and oxygen are causal factor for wound infections but indirectly because they lead to low blood pressure hence low supply of blood to the wound. Weak immune system can also cause infection because they bacteria in the wound are not dealt with by the microphages.

  1. Justify use of Gentamicin

Gentamicin is an antibiotic that is largely used for the treatment of bacterial infections. It treats infections caused by the gram positive kind of bacteria except neisseria gonorrhoea because the patient maybe in the risk of getting into shock due to the endotoxin lipid found mainly in the gram negative bacteria. It acts on the following pseudomonas, serratia, proteus and staphylococcus (Mulder et el, 2008). It is one of the few antibiotics which remain active even after autoclaving. This is why it is used for the preparation of cultures for the growth media of microorganism.

  1. Mode of action of Gentamicin. Alternative drug suggested with justification.

Gentamicin has many potential mechanism of antibiotic. Some inhibits synthesis of proteins. They interfere with the formation and functioning of the cell membranes of the bacteria leading to the death of bacteria. They bid to the ribosomal subunit of the bacteria. By doing so, they hinder the growth of the bacteria ensuring they either die or by preventing their multiplication hence the body cells microphages are able to fight them (Gregory et el, 2004). Gentamicin causes stinging or mild burning on the wound. It cause swelling on the mouth, tongue, face, lips and face. It also leads to changes in one’s vision, pain on the eyes, swelling, redness and irritation. Hypersensitivity is associated with Gentamicin especially anaphylactoid form of reactions as well as oedema. Some reactions of Gentamicin occur with sodium metabisulfite preservative. Fever and Splenomegaly are other reactions associated with the use of Gentamicin. Most antibiotic are associated with dizziness, numbness, increased thirst, nausea, rashes and loss of appetite.

Apart from Gentamicin, ointment can be used for the prevention of infection. Orals antibiotic are used for the wounds which are not severely infected but for the most infected, then ointment is advisable. Examples of the ointment used are Neosporin and bacitracin. They provided a long lasting moisturizer effect on the wound ensuring the bacteria are trapped and killed by the antibiotic effect (Flanagan, 2000). The ointment is very advisable for the wounds which are very seriously infected because due to the direct application, most of the bacteria are killed instantly unlike when the patient has to take the oral tablets.

  1. Two infection control measures and justification

Proper hygiene is a very important factor for the control of wound infection. As long as hygiene is observed, channel of transmission like portal of entry which is the wound is distanced from the microbe. If the wound was cleaned and covered the portal of entry would be covered ensuring no infectious organism gain entry in the body. The wound must be washed regularly with clean water and disinfected. In cases where there is no disinfection, then the person can use boiled and salty water to clean the wound. The equipments used for washing the wound like the basin and also the hand or gloves must be clean to ensure any organism causing infection are killed.(David et el, 2000).

Proper use of medication and observing a good diet to ensure the immune system of the body is increased. Low immune system of the body means prolonged healing process of the wound hence increasing the possibilities of infection (Michael et el, 1996). The use of antibiotics helps in killing with any bacteria that maybe on the wound. This helps the body to build up the immune system that is capable of fighting the infectious organism in the body. The white blood cells will be manufacture faster hence ensuring they fight with all the infections around the wound hence preventing it from getting worse.

REFERENCE

Brown, G., & Nanney, J. (2009). Enhancement of wound healing by tropical treatment with epidermal growth factor. The New England Journal of Medicine, 321(1), 76-79.

Cohen, I. (2008). A Brief History of Wound Healing. Yardley, PA: Oxford Clinical Communications Inc.

David, V., Rodeck, J. & Keith, R. (2000). Skin and wound infection. London: Routledge

Federick, G., Rupert, E. & Laura, B. (2008). Distribution of wound fobronectin during healing in vivo. Journal of Investigative Dermatology, 76(1), 181-189.

Flanagan, M. (2000). Wound infection. New York: EMAP Healthcare.

Gregory, S., Warren, C. & Scott, D. 2004. EGF and TGF –α in wound healing repair: Journal of Cellular Biochemistry, 45(4), 346-354.

Keith, H., & Douglas, Q. (2010). International wound repair. International Wound Journal, 29(3), 3.

Michael, J., John, W. & Charles, M. (1996). Biostimulation of wound healing by low-energy laser irradiation a review. Journal of Clinical Periodontology, 23(5), 492-496.

Mulder ,G., Haberer, P. & Jeter, K. (2008). Clinicians’ Pocket Guide to Chronic Wound Repair, 4th Ed. Springhouse, PA: Springhouse Corporation.

Patricia, A. (2010). Wound repair and regeneration. The International Journal of Tissue Repair and Regeneration, 88(177), 36-55.