WOUND Essay Example

  • Category:
    Nursing
  • Document type:
    Case Study
  • Level:
    Undergraduate
  • Page:
    3
  • Words:
    1507

WOUND: CASE STUDY

  1. By which intention would this wound heal? provide two reasons to explain why

It was probable that the wound would eventually be healed through delayed primary healing. Delayed primary healing occurs in contaminated wounds as is in this case. According to Song, Nguyen, and Pietramaggiori, et al (2010), wound healing by third intention applies for infected wounds whose edges are approximated to be 3-4 days. The wound in this case had been treated four days earlier but got infected. The second reason why this wound will heal via this intention is because there is no surgical intervention. Only Benzyl penicillin sodium was administered parenterally.

  1. Name three specific cells involved in wound healing. Describe the role each cell plays in wound healing.

Wound healing is a process in which the skin undergoes repair after an injury or damage (Sorensen, et al. 2006). Under normal circumstance, the epidermis, also known as the outermost layer of the skin, and the dermis, which is the deeper layer, exhibit a steady state of equilibrium hence protecting the body against the external environmental factors. However, when the skin sustains some injuries, the immediate process of healing is normally set in motion. The general process of wound healing is sub-divided into four sequential, though overlapping stages. These stages are hemostasis, inflammatory, proliferative and remodeling. There are various cells that play significant roles in the wound healing process. The platelets for instance are released immediately after the injury is sustained. The platelets instigate the wound healing process through the release of the growth factors. The platelets initiate the formation of a fibrin clot that controls active bleeding (Song et al., 2010). Neutrophils cells also take an active role in the wound healing process. They are considered as an essential component of an individual’s innate host defense. These cells accumulate at the site of infection and provide defense against the most attacking micro-organisms.

Macrophages are another type of cells that play a significant role in the wound healing process. Basically, these are white blood cells formed as a result of the monocytes differentiation in tissues (David and Justin, 2008). They release soluble substances that initiate the proliferation, growth, differentiation, repair and regeneration of the damaged part. Macrophages play a role in the production of cytokines and wound debridement that are necessary for angiogenesis and the formation of matrix (Tidball and Wehling-Henricks, 2007). The proliferation of fibroblast and angiogenesis lead to the deposition of extracellular matrix material and the formation of the granulation tissues such as proteoglycans, fibronectin and collagen (Hinz, 2006). Research indicates that lack of macrophages impair the wound healing process significantly.

  1. Explain the rationale for swabbing the wound.

Basically, wound swabs help in guiding the appropriate antibiotic therapy that will be administered (Mitchell et al., 2007). It is apparent that not all wounds are caused by the same type of injury and therefore the kind of attention required varies as well. It is therefore important that health care practitioners conduct wound swabbing in order to determine the type of remedy that will be required in dealing with the situation. In addition, swabbing the wound helps in removing contaminants. However, studies highlight that the wound is often susceptible to contaminants which may slow down the healing process, or may even lead to further infections. It is therefore necessary to conduct the swabbing process to get rid of all contaminants.

  1. Name two possible sources of contamination of the wound and explain the mode of transmission of the microorganism from each source.

Wound contamination is defined as the presence or availability of non-replicating organisms within the wound area (Nguyen et al., 2009). It is important to note that research indicates that approximately all chronic wounds are contaminated by bacteria, and that the process of wound healing often takes place in the presence of such bacteria since there are certain bacteria that help in process of healing. However, it is not the presence of the bacteria that aids the process of healing, but their interface with the patient that establishes their influence on the overall process of wound healing.

Wound contaminants come from the environment and from the indigenous micro flora (Song et al., 2010). These contaminants gain access to the wound through direct contact, for instance the transfer from the patient’s hands to the wound or from the nurse to the wound. They can also be transferred through airborne dispersal whereby the pathogens deposited in the air gain access to the wound especially where the patient is exposed to unhealthy living environment. Contaminants can also be transferred through self contamination, and this is basically determined by an individual’s hygiene. If the individual does not take care of the wound and keeps it dirty then there is a higher probability that the wound will be contaminated (Keymer et al., 2006). Poor hand washing techniques of both the health care practitioners and the patients may lead to wound contamination.

  1. Following confirmation that the microorganism infecting the wound was Escherichia coli, the drug was changed to Gentamicin sulfate. Explain why this drug was more appropriate

Having confirmed that the wound was infected with Escherichia coli the drug had to be changed to Gentamicin sulfate, which is a more appropriate medication. Gentamicin sulfate is a bactericidal agent which is functional in the cure of wounds infected with bacteria when preceded by drainage and incision to allow sufficient contact between the infecting bacteria and the antibiotic (Song et al., 2010). Research indicates that the antibiotic is appropriate for the treatment of infected abrasions and lacerations, minor surgeries and wounds. Considering the case above, it is apparent that the wound was infected with bacteria that could not be treated by Benzyl penicillin sodium, which is basically used for relieving pain but is not effective in the treatment of bacterial infections. It was therefore necessary to prescribe Gentamicin sulfate to help in the treatment of bacterial infections.

  1. Discuss the mode of action of Gentamicin sulfate and name two common adverse reactions. Suggest and justify an alternative drug to Gentamicin sulfate that would be effective against E.coli.

Gentamicin sulfate permits adequate contact between the infecting bacteria and the antibiotic. The antibiotic basically reacts with the infection in the wound to facilitate the process or wound healing. Like any other medication, gentamicin sulfate contains adverse reactions. For instance, patients with dermatoses and treated with this drug may experience some irritation or sensitization. There is also a possibility of photosensitization, which comes as a result of exposure to the ultraviolet radiation. An alternative drug to Gentamicin sulfate that would be effective against E.coli is neomycin (Song et al., 2010). This is an antibiotic that could as well be applied in the treatment of infected wounds. However, this drug can work well for those patients who are not sensitive to topical antibiotics.

  1. Name two infection control measures that the nursing staff would have used during the dressing of the wound. Justify how each one breaks the chain of infection and relate it to the case study.

The nursing staff ought to have ensured the wound is disinfected with antibiotics before it was dressed. This would have ensured the wound dose not get infected with the E.coli bacteria. The other control measure the nursing staff ought to have undertaken is to provide information to John Smith on how to take effective care of the wound to prevent it from getting bacterial infections. It was also important that a wound swab be taken for analysis to determine the appropriate therapy for the wound. In such a way, it could be easily established which medication to use in the treatment of this wound.

References

David, Mosser and Justin, Edwards (2008). «Exploring the full spectrum of macrophage activation». Nature Reviews Immunology 8: 958-969.

Hinz, B, (2006). «Masters and servants of the force: the role of matrix adhesions in myofibroblast force perception and transmission». European journal of cell biology 85 (3–4): 175–81.

Keymer, E., P. Galajda, C. Muldoon R., and R. Austin (2006). «Bacterial metapopulations in nanofabricated landscapes». PNAS 103 (46):

Mitchell, S., Kumar, V., Abbas, A, and Fausto, N, (2007). Robbins Basic Pathology. Philadelphia: Saunders.

Nguyen, D., Orgill D, and Murphy G. (2009). The Pathophysiologic Basis for Wound Healing and Cutaneous Regeneration. Biomaterials For Treating Skin Loss. Cambridge: Woodhead Publishing

Song, G., Nguyen, T., Pietramaggiori, G., Scherer, S., Chen, B., Zhan, Q., Ogawa, R, and Yannas, IV (2010). «Use of the parabiotic model in studies of cutaneous wound healing to define the participation of circulating cells». Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society 18 (4): 426–432.

Sorensen, E., Thapa, R., Roupe, K., Valore, V., Sjobring, U., Roberts, A., Schmidtchen, A., and Ganz, T. (2006). «Injury-induced innate immune response in human skin mediated by transactivation of the epidermal growth factor receptor». The Journal of clinical investigation 116 (7): 1878–85.

Tidball, G, and 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

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