Laceration wounds mainly refer to the torn or jagged wounds that occur mainly because of sharp objects. The soft tissues are seen to be torn and this increases the chance of the wound being infected by bacteria as well as debris from the objects that had resulted in the cut (Zhou et al., 2018).
It has been seen that the wound of the patient named Mary had become red and warm when touched. Researchers are of the opinion that some form of redness is normal at the wound site but this redness should diminish over time. However, even when the wound continues to be red and exhibit radiating streaks known as lymphangitis, this can be one of the warning sign of wound infection (Bullock & Manias, 2017). It is necessary for the redness to go away during the initial phases of the wound healing process. However, if it does not go, then affected individuals should consult professionals. The patient named Mary might have infected her wound due to improper dressing and cleaning of wound. Therefore, she needs support now. The infection of Mary was seen to be warm. Researchers are of the opinion that when infection develops in the wound, the body sends infection fighting blood cells towards the location. This makes the wound feel warm to touch.
Another important physiological symptom that had been found is the purulent discharge. It is mainly the liquid or the discharge that is seen to ooze out from the wound. Purulent discharge mainly gives the symptoms that the wound has become infected and that certain bacteria are mainly present at the wound site. Mainly, wound drainage occurs during the time of dilation of the blood vessels during the early stages of wound healing. However, the nature of the wound drainage might change when infections come into play. Often purulent discharge is seen to have a thick consistency, milky appearance and foul distinct odour. Therefore, the healthcare professionals need to identify the nature of wound discharge as well as the coloration and temperature surrounding the wound to make an idea whether the wound is infected or not.
Endogenous infection can be defined as the infectious agent that is already present in the in the body but remain in the dormant and in-apparent situation. Endogenous bacteria are often referred to as the bacterial flora that naturally lives inside the closed systems. Disorders can occur when such bacteria can enter into the sterile area of the body parts getting an opportunity for infection (Craft et al., 2015). In the case study, it was seen that the patient had faced laceration in her left feet and one of the ways by which microorganisms might have infected her wound are direct transmission of the wounds from the skin to that of the wounds. Many types of germs remain present on skin that might have entered into the wound when the cut has occurred. Staphylococcus aureus and Streptococcus pyogene can be such microorganisms that follow the endogenous mode of infection. The healthcare professionals might consider that the patient is having such infection on the skin or the germs might have colonized the patient due to certain reasons. The wound has given them the opportunities for infection making her live poor quality life mainly by entering the wound directly from the skin.
Exogenous mode of infection mainly refers to the mode of infection when microbes do not harbor in the external surface of internally within the body of the affected patients but have mainly came from outside world inside the closed system of the body. They can come from different types of sources like that of air, water, soil and even from the atmosphere (Zhan et al., 2015). These types of micro-organisms can enter the body through pathways like respiratory as well as air borne faecal-oral mediums, parental as well as trans-cutaneous, vector borne as well as sexual transmission and many other modes. The patient in the case named Mary was seen to suffer from laceration when she was holidaying in the beach resort. Therefore, one of the exogenous modes of infection is the transmission of the infection from the broken surface of the glass object. Moreover, she had tied the wound with handkerchief. This increases the chance of any exogenous microorganisms to have been transferred from the handkerchief to the wound directly when she tied the handkerchief around the wound. Again, Mary was walking on the sandy beach when she faced the laceration with the glass objects. Therefore, there is also chance that microbes might have entered the wound from the soil or the sand on which she was walking. Therefore, these are the sources and mod of transmission for exogenous infections (Holmes et al., 2015).
Ceftriaxone medication is mainly provided for treatment of infection and acts as anti-bacterial drug for treatment of conditions like that of lower tract infection in respiratory system, skin and skin structures, pelvic inflammatory disorders, bacterial septicemia, meningitis, joint infections and many others. it is a broad spectrum antibiotic which kills variety of bacteria like Borrelia burgdorferi, Enterobacter spp, Anaerobic cocci, Bacteroides fragilis, Clostridium spp, Streptococcus pneumoniae, Streptococcus pyogene, Staphylococcus aureus, and others. They mainly act by the inhibition of the cell wall synthesis by the binding to one or more penicillin binding proteins and exerts antimicrobial effects by interfering with their cell wall peptido-glycan component. Bacteria get lysed as activity of cell-wall autolytic enzymes is seen to continue while cell wall assembly is arrested (Lee et al., 2012). As infectious microbe in the wound cannot be identified, hence this broad spectrum drug was used.
The previous medication is highly effective for gram-negative bacteria but has low efficacy for gram-positive bacteria although they are not entirely ineffective and has higher efficacy to resistant organisms. They act in a stable manner in presence of beta lactamases like penicillase and cephalosporinases for gram-negative bacteria and gram-positive bacteria respectively. However they are broad spectrum and are not that much effective as that of Dicloxacillin. This is mainly a narrow spectrum β-lactam antibiotic belonging to the penicillin class (Marieb & Hoehn, 2016). It is helpful for the treatment of the infections caused by susceptible (non-resistant) Gram-positive bacteria. Staphylococcus aureus is a gram positive bacterium which is resistant to most of the penicillin and is difficult to be treated but this medication is giggly effective against this beta-lactamase-producing organisms like Staphylococcus microns. The bacterium is seen to be resistant to penicillinase of most of the penicillin but this drug is form of penicillin which helps in killing the bacterium as this is not resistant to the drug. Therefore, this medication is the gold standard treatment.
Mary had already gone through the hemostasis phase of wound healing where the body tries to undertake the blooding clotting system and helps in forming a dam for blocking the drainage. Fibrin mesh is formed and platelet clumps in a stable mesh. The patient is now the inflammatory phase which focuses on destruction of bacteria and removal of debris for preparation of the wound bed for the growth of the new tissues. Macrophage and neutrophils along with other cells help in tissue repair but they need nutrient for action (Portou et al., 2015). In case of Mary the germs have absorbed the nutrients making the procedures slow and ineffective. Therefore, once drugs are provided, the germs will be killed and procedure will initiate again. The next stage is the proliferative stage which will include three stages like filling of the wound, contraction of the wound margins and covering of the wound with epithelialization. Next would be the maturation phase when new tissues develop and gains strength and flexibility. Collagen fibers are seen to reorganize, tissues remodel and mature and there is healing of wounds.
References:
Bullock, S & Manias, E. (2017). Fundamentals of Pharmacology (8th edition) French forest , Austrlai: Pearson Australia
Craft, J., Gordon, C., Huether, S. E., McCance, K. L., & Brashers, V. L. (2015). Understanding pathophysiology-ANZ adaptation. Elsevier Health Sciences.
Holmes, C. J., Plichta, J. K., Gamelli, R. L., & Radek, K. A. (2015). Dynamic role of host stress responses in modulating the cutaneous microbiome: implications for wound healing and infection. Advances in wound care, 4(1), 24-37. https://www.liebertpub.com/doi/abs/10.1089/wound.2014.0546
Lee, G., & Bishop, P. (2012). Microbiology and infection control for health professionals. Pearson Higher Education AU. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=qhTiBAAAQBAJ&oi=fnd&pg=PP1&dq=microbiology+and+infection+control+for+health+professionals+Lee&ots=hxQ7f6LZ-a&sig=RawVyNsKPSO_Q5MGLvvqtHYtSvc#v=onepage&q=microbiology%20and%20infection%20control%20for%20health%20professionals%20Lee&f=false
Marieb, E. N., & Hoehn, K. (2016). Human anatomy & physiology: Harlow: Pearson Education Limited, 2016.
Portou, M. J., Baker, D., Abraham, D., & Tsui, J. (2015). The innate immune system, toll-like receptors and dermal wound healing: a review. Vascular Pharmacology, 71, 31-36. https://doi.org/10.1016/j.vph.2015.02.007
Zhan, L. X., Branco, B. C., Armstrong, D. G., & Mills Sr, J. L. (2015). The Society for Vascular Surgery lower extremity threatened limb classification system based on Wound, Ischemia, and foot Infection (WIfI) correlates with risk of major amputation and time to wound healing. Journal of vascular surgery, 61(4), 939-944. https://doi.org/10.1016/j.jvs.2014.11.045
Zhou, J., Yao, D., Qian, Z., Hou, S., Li, L., Jenkins, A. T. A., & Fan, Y. (2018). Bacteria-responsive intelligent wound dressing: Simultaneous In situ detection and inhibition of bacterial infection for accelerated wound healing. Biomaterials, 161, 11-23. https://doi.org/10.1016/j.biomaterials.2018.01.024
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