Wound Essay Example

  • Category:
    Nursing
  • Document type:
    Case Study
  • Level:
    Undergraduate
  • Page:
    2
  • Words:
    1496

The wound is likely to heal by primary intention. This is because wound closure had already been carried out by use of stitches meaning that the edges of the wound could be approximated hence the edges would be closed. Healing will thus be allowed to take place by epithelialization due to the laceration being well repaired (Keast & Orsted , 2011).

Phagocytotic cells will bring about the proliferative phase being realized. Phagocytotic cells clean up of the wound site and remove any dead tissues at the site hence allowing new tissues to be formed. On the other hand, the growth factor cells cause re-epithelialization to occur. The re-epithelialization will be achieved through enhancing re-growth of the epithelial tissue. Fibroblastic cells will be cause angiogenesis and granulation process to take place. Fibroblasts will achieve this by secretion of collagen, ground substance and growth factors. Collagens lead to formation of granulation tissues whereas Growth factors stimulate and regulate regeneration of new blood vessels that will supply the area of the wound with nutrients as well as oxygen that will enhance the healing to take place (Keast & Orsted , 2011).

Swabbing was done to the wound to enable the culture of the oozing material to be done. This is because of the oozing indicating the highest possibility of the wound having been contaminated by harmful microorganisms which if not identified and managed on time could result in entire gangrene of the foot of even the patient going into septic shock when over whelmed by the infection. Culture will enable the choice of the most effective medication to be chosen basing on the sensitivity of the infecting microorganism (Harris et al, 2006).

Classification of wounds basing on the levels of contamination of wounds employs the use a scoring system or the asepsis score. Wounds will either be clean, meaning have no contamination. They could also be clean contaminated meaning there is minimal contamination of the wound. Contaminated wounds on the other hand would have moderate contamination whereas dirty wounds would be totally aseptic. Since the wound was to heal by primary intention, there was a high possibility of foreign material or bacteria being enclosed within the wound. The possible sources of contamination in this case would be through the foreign materials which could still have been within the site of the wound which could lead to infection with an abscess formation. The presence of foreign materials is what normally leads to pain, damage to tissues and abscess formation like in this case. Contamination could also have been acquired due to the wound coming in contact with the external environment during the initial hospital since e coli is one of the microorganisms notorious in causing nosocommial infections (Keast & Orsted , 2011).

Escherichia Coli is a gram negative microorganisms and are responsible for the production of beta lactamase enzyme which is responsible for the resistance against beta lactam antibiotics such as penicillin’s, cephamycin and carbapenems. These antibiotics have common elements within their molecular structures having a four atom ring (beta lactam) which is normally broken open by the lactamase enzyme causing the deactivation of the molecules antimicrobial capacities hence rendering them inactive (Maysaa El Sayed Zaki, 2007).

Escherichia Coli produces beta lactamase which acts on the beta lactam chain in the antimicrobial agents rendering them to be ineffective against them. The beta lactamase thus gives Escherichia Coli resistance against various antimicrobial agents such as those made for penicillin’s, cephamycin and carbapenems. Changing of drugs was therefore based on the sensitivity of the microorganism that had infected the wound. Escherichia Coli is more sensitive to Gentamycin sulfate and hence the drug would be more efficient due to covering e coli more effectively hence (Maysaa El Sayed Zaki, 2007).

Gentamycin mechanisms of action

Gentamycin is actively transported across the membrane of the bacterial microorganisms and will end up binding to specific receptors proteins which are found on the 30S ribosomal subunit on the bacteria. The binding of the ribosomal subunit by Gentamycin brings about the interference of initiation complex which is normally between Messenger ribosomal nucleic acid mRNA and the 30S ribosomal subunit on the bacteria. This interference is what eventually leads to the inhibition in the synthesis of proteins. As a result of this, the deoxyribonucleic acid may be misread resulting in the production of non functional proteins due to the inability of the polyribosomes to synthesis proteins. Gentamycin effect of causing bacteria not to be able to synthesis proteins is what makes Gentamycin to be bactericidal (Maysaa El Sayed Zaki, 2007).

Adverse effects of Gentamycin sulfate

Nephrotoxicity

This mainly occurs in patients with renal impairments of patients who have been treated with Gentamycin sulfate over for long durations or time. Nephrotoxicity will be characterized by the presence of casts, cells or proteins in urine and in some cases elevated levels of serum creatinine and oliguria being reported (Maysaa El Sayed Zaki, 2007).

Neurotoxicity

Gentamycin sulfate will also have serious adverse effects on both the auditory as well as the vestibular branches of the eighth cranial nerves. This condition will be characteristic in patients on high doses or prolonged therapy. This effect would eventually result in hearing loss in some patients (Maysaa El Sayed Zaki, 2007).

The alternative drugs to Gentamycin sulfate will include those drugs with susceptibility to Escherichia Coli such as imipem, cefotaxime and cefoperazone (Maysaa El Sayed Zaki, 2007).

Infections within the hospital set up can be transmitted through various means. This could be from patients to hospital staff or even to other patients within the hospital. Transmission could occur during treatment and the receptor will thus become the new reservoir of the microorganism. The Escherichia Coli bacteria will be transmitted through direct contact with the patients (hands, saliva or other body fluids), the air (and this would include dust or contaminated droplets contaminated by the patient), or from the staff members while attending to the patients) and the objects or equipments used being contaminated by the patient. Visitors could also be a source of infection within the hospital when they are infected and come in contact with the staff or the patients within the hospital (Harris, 2008).

The staff could control the spread of infection from the patient by monitoring aseptic techniques including hand washing as well as isolation of the patient within the hospital. The nurses should be able to initiate the isolation of the infected patient and also going ahead to order for culture of the specimens from the patients. The patients will also be limited on the exposure to other people such as the visitors, hospital staff, other patients and the equipments to be used on such patients. The equipment used should also be decontaminated with the appropriate sterilization measures according to the equipment. Hygiene standards should also be practiced within the hospital accompanied with good nursing practices for instance the cleaning of the cleaning of spillages and body fluids that are potentially infected (Boyce, 2007).

While cleaning, the staff should also wear protective gear such as gloves to avoid becoming contaminated. The hospital should also have adequate routine care, cleaning as well as disinfection of environmental surfaces being regularly done. Any defaulting of treatment by such patients should be immediately reported to avoid the patient developing a more resistant strain of the microorganisms. Nurses should also ensure that they use their appropriate protective clothing for this will offer them contamination from infectious microorganisms which could result from the spillage or splashing of fluids from the infected patients. Care should be taken to avoid using the equipment from the infected patients in the patients who do not have the infection. Proper waste disposal mechanisms should be instituted to prevent exposure to infections to health care personnel as well as waste handlers. Care should also be taken while using the various equipments such as scalpels when attending to the patients who are infected to avoid any forms of injuries that might predispose one to contamination or infection (Rice, 2006).

References

Maysaa El Sayed Zaki, (2007). Extended Spectrum β-Lactamases among Gram-negative bacteria from an Egyptian pediatric hospital; A two-year experience, Clinical Pathology, Mansoura University, Egypt.

Keast D & Orsted H, (2011).The basic principles of wound healing. Retrieved from http://www.cawc.net/open/conference/best-practice-series/Wound-Healing.pdf on 18th August, 2011.

Harris A., et al, (2006). What Infection Control Interventions Should Be Undertaken to Control Multidrug-Resistant Gram-Negative Bacteria? Div. of Healthcare Outcomes Research, Dept. of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore,USA.

Rice L., (2006). Hospital-Based Strategies for Combating Resistance, Medical Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Oxford University press.

Harris A., (2008).How Important Is the Environment in the Emergence of Nosocommial Antimicrobial-Resistant Bacteria?, Div. of Healthcare Outcomes Research, Dept. of Epidemiology and Preventive Medicine, University of Maryland, Baltimore.

Boyce JM., (2007). Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 65(Suppl 2):50-4, Infectious Diseases Section, Hospital of Saint Raphael, New Haven, USA.National Center for Biotechnology Information
, U.S. National Library of Medicine, Bethesda
MD,USA.