WOUND 6 Essay Example

  • Category:
    Nursing
  • Document type:
    Case Study
  • Level:
    Undergraduate
  • Page:
    2
  • Words:
    1370

Topic: Wound

7th August 2011

Questions

  1. The wound would heal by third intention. This is based on the fact that four days after the wound was treated it has become extremely painful and has a smelly discharge with swollen and red edges and a purulent discharge (Mulder et al., 2001). Hence, the first reason through which the wound would heal by third intention is that the third intention is important for managing such types of wounds that are contaminated heavily for primary closure. Such wounds may appear well vascularised and clean after duration of open observation which takes 4-5 days (Cohen, 1998). The second reason why the wound would heal by third intention is that wound is unhealthy and highly infected with a very high content of bacteria which causes a smelly discharge. Such a wound has a long lapse time since the patient was injured. The wound may also have a considerable devitalization of the tissue or a significant crush component (Cohen, 1998).

  2. Several types of cells are involved in the process of wound healing. They include platelets, fibroblasts and macrophages. Platelets play a crucial role of because they are first cells that invade the site of the wound. They initiate the process of healing because they release the much needed growth factors (Krombach et al, 1997). Macrophages cells are also crucial in the healing process of the wound because they remove pathogens and cellular debris by digesting and engulfing them from the wounded site. They also play the role of stimulating the immune cells and lymphocytes which deal with pathogens. Fibroblasts helps in the process of activating fibrocytes and it helps significantly in repairing the affected tissues in the wounded area and in the process fibroblasts helps in contracting the injury in the wounded area (Cohen, 1998).

  3. Swabbing the wound is important in order to carry out a microbiological investigation which is required to identify the infection of the wound. It was also important and served as a screening program used to identify whether John Smith (the patient) was carrying any form of infection that made the wound painful and have a smelly discharge (Krombach et al, 1997).

  4. The contamination of the wound occurs when germs enter into the wound. The germs are also referred to as bacteria and they result into delayed healing of the wound. They may also cause other symptoms and signs to appear such as smelly discharges from the wound and this is the case with John Smith. One of the possible sources of contamination of the wound is the materials used to treat the wound such as bandages and water used to clean the wound. This is particularly true if such materials are not disinfected and the water used to clean the wound is not sterilized (Krombach et al, 1997). The germs in the water and bandages remain in the wound and cause wound contamination. The second possible source of wound contamination is the object that caused the wound. For example, the large rock which Smith collided with after falling from his bike might have had germs or bacteria which is not stick to the affected area or the to the wound and unless they are killed through proper treatment they cause wound contamination.

  5. Escherichia coli is a bacteria that causes a number of infections including bacteremia, cholecystitis and cholangitis. It is also responsible for other infections such as diarrhoea and urinary infections in human beings. One of the reasons why the drug was changed to Gentamicin sulphate after Escherichia coli was confirmed as the microorganism infecting the wound was that Gentamicin sulphate is able to treat a number of infections because it is a broad spectrum antibiotic for treating a wide range of infections including any infections that occur in the skin. Gentamicin sulphate acts very fast and it is transported actively and fast across the cell membrane of any bacteria and it prevents any form of synthesis of protein that may accelerate the multiplication of bacteria in the affected area. Gentamicin is also rapidly absorbed in the affected area and this is particularly true with Gentamicin cream (Mulder et al., 2001). Hence, the rationale for changing the drug to Gentamicin sulphate was to ensure that all forms of infections that had occurred around the affected area or in the wound would be eliminated within the shortest time possible due to the rapid absorption rate of Gentamicin sulphate. In addition, research studies indicate that for children above 1 year the drug was effective and since John Smith was 15 years of age it means that the drug would prove effective in the healing the wound.

  6. Gentamicin sulphate is prescribed as an important drug in the treatment infections that are severe and caused by gentamicin sensitive organisms such as gram-negative bacteria or organisms. It acts or functions by destroying bacteria that are gram- negative by blocking synthesis of protein and binding bacteria ribosome to 30S subunits (Mulder et al., 2001). Aminoglycoside is one of the elements contained in Gentamicin sulphate drug and it is transported throughout the cell membrane of the bacteria (Mulder et al., 2001). When this element is transported into the bacteria cell membrane then it blocks synthesis of protein. The result is that non-functional proteins are produced when misreading of DNA occurs in the cell membrane and thus the process of protein synthesis is inhibited. Hence, the chemical group referred to as aminoglycosides is the active ingredient in Gentamicin sulphate that necessitates the fight against bacterial infections in the wounds. It is important to realize that aminoglycosides can be termed as bactericidal while many known antibiotics that help in the process of inhibiting synthesis of protein can be referred to as bacteriostatic. As mentioned above, Gentamicin is not easily absorbed in areas where the skin is intact rather it is absorbed in granulating, burned and denuded areas. One of the most common adverse reactions caused by Gentamicin sulphate is hypersensitivity which causes redness, itching, swelling and other irritation signs which occur before the process of therapy (Mulder et al., 2001). The other adverse reaction experienced from the use of Gentamicin sulphate include CNS which comprises of dizziness, tremors, vertigo, depression, numbness, lethargy, confusion, paresthesia, headache, seizures, neuromuscular blockade and neurotoxicity. The alternative drug that could be used instead of Gentamicin sulphate is hydrocortisone acetate. Hydrocortisone acetate is also a drug that is used to treat skin infections because it suppresses bacterial inflammatory responses that occur in the affected area or in the wound (Mulder et al., 2001). It is also an important drug in treating local pain as well as treating swelling that may occur in the affected or wounded area. Smith had a swollen, red and a gaping wound and thus Hydrocortisone acetate would be beneficial in treating the swollen parts of the wound as well as treating infections in the wound.

  7. The use of sterile gloves is one of infection control measures that nurses need to use to ensure that wounds are out of danger of bacterial infections. The use of sterile gloves ensures that no bacteria or germs are transmitted to the wound during washing, stitching or banding of the wound. This avoids further infections of the wound and necessitates the process of healing. For example, when administering Benzyl penicillin sodium 1.2 or Gentamicin Sulphate on Smith’s wound there is need to use sterile gloves to prevent transmission of germs of bacteria to the wound. The second infection control measure is the use of antiseptic ointment such as polymixcin B and bacitracin into the affected areas (Mulder et al., 2001). The antiseptic ointments help to keep germs out of the affected area or out of the wound after bleeding has stopped and the wound is thoroughly cleaned. Antiseptic ointments also help to ensure that the wound is not affected by dryness.

References

Cohen, I. (1998). A brief history of wound healing. 1st ed. Yardley, PA: Oxford Clinical Communications Inc.

Krombach, F., et al. (1997). «Cell size of alveolar macrophages: an interspecies comparison». Environ. Health Perspect.
105 Supply 5: 1261–3

Mulder, G., et al. (2001). Clinicians’ pocket guide to chronic wound repair. 4th ed. Springhouse, PA: Springhouse Corporation; 85.

Zinn, P. (2001). Wound care and Healing. http://www.medstudentlc.com/page.php?id=67