Physiological Basis Of Wound Infections And Antibiotic Treatment

Physiological basis of the wound observations

Question 1:

Mary was seen to develop a laceration wound after cutting her left feet with a broken piece of glass on the sand. This type of wound that is mainly produced by the tearing of the soft tissue and is usually irregular and jagged. Researchers are of the opinion that laceration is contaminated with the bacteria as well as the debris from the various objects that cause the cut. Mary was seen to have purulent discharge from the wound.

Studies suggest that purulent discharge that comes out from the wound can help the nursing professionals to identify the condition of the wound and understand what kind of intervention should be applied. Purulent discharge mainly occurs when the blood vessels try to dilate during the early stages of the healing. Bacteria remain present at this time (Holmes et al., 2015). The body is seen to create a moist environment around the wound during this time with an attempt for healing itself. Researchers are of the opinion that when drainage becomes purulent, there is high chance that the wound has become infected. It becomes easier for the germs to get inside the skin when such condition develops. The germs are seen to spread under these affected tissues and can cause the infection (Zhan et al., 2015). This stage makes the tissues swollen and painful. Studies also suggest that such discharge implies that the wound will not heal quickly as germs have increased chances in getting in the wounds because of its surface area. Therefore, there is high chance that the wound developed by Mary is infected with germs.

Another important physiological symptom that can also help the nursing professionals to identify the condition of the wound is the red and warm condition of the wound when touched. Studies have shown that when wounds become infected, they become painful with redness occurring around the edges of the skin and this red area feels warm or hot. When infections are seen to spread further, the redness is seen to keep spreading to more of the areas of the skin and this situation results in increase of temperature along with fevers and aches (Drisfke et al., 2015). The wound of the patient named Mary is seen to develop such redness around the wound and the wound is warm when touched. Therefore, the wound can be stated to be infected and requires immediate nursing intervention.

Possible sources of contamination and modes of transmission

Question 2:

Endogenous infection can be defined as the infectious agent that remains present in the body but in the dormant or the in-apparent stage. Often self-contamination of the wound might be the one of the reason by which the condition of the wound had worsened in the patient named Mary. Many of the researchers are of the opinion that physical migration of the endogenous flora of the patient, which are present on the skin, mucous membranes as well as gastrointestinal tract, can result in worsening of the infections (Zhou et al., 2018). In this case, study, it might have happened that the microns present on the skin of the patient near her wound might have entered into it making the situation worse. Studies have suggested when wounds occur on the skin surfaces, the normal flora of bacteria that might comprise of Staphylococcus species and many others can enter the wound. They might take one of the endogenous source and pathway to travel to the wounds causing infection.

Exogenous source of infection mainly includes those microorganisms that are introduced to the close biological system from the external world and are mainly seen to exist in the aquatic and terrestrial environments and even in the atmosphere. Two important suspected sources can be considered here which might have helped the microorganisms to enter into the wounds of the patient. Mary has been in a beach resort and therefore bacterial present in the soil or the sand may have affected the wound causing severe infection. Researchers are of the opinion that about 60000 microorganisms resides in the wounds out of which many are pathogenic (Portou et al., 2015). Therefore, this can be one of the sources of infection. Another source of infection is the handkerchief that she had used to wrap the wound. The handkerchief might have been contaminated with different exogenic and pathogenic bacteria that could have contributed to the contamination of the wound.

Question 3:

The initial dose of Ceftriaxone was given to Mary intravenously. This is the medication, which was used by the nursing professionals for treatment of the wound initially in the patient. Researchers are of the opinion that this medication is given for treatment of the various types of conditions like that of the urinary tract infections, infection in the years as well as lungs and meningitis that are caused by the bacteria. It is helpful in treating bacterial meningitis, bacterial septicemia, gonococcal infection, urinary tract infection, pneumonia, and bone and joint infections (Bullock and Manis et al., 2017). Apart from the various types of infection in which this medication issued, it is also skin and structure infection. Studies show that this medication can be helpful in treating cellulites, wound infection as well as cutaneous abscesses that are caused by Streptococcus pyogenes as well as Staphylococcus aureus. The patient in the case study is also seen to have developed severe wound infection and therefore the nurses are seen to have injected this infection. The effect of this medication stays for 24 hours and is seen to work rapidly after intravenous or intramuscular routes of administration are provided ad kill broad ranges of bacteria. Therefore, the professionals initially give this medication.

Endogenous and exogenous sources of contamination

Cephalexin can be described as the cephalosporin antibiotic that mainly helps in fighting with bacteria and are helpful in the treatment of infections. They are helpful in treating bacteria caused by the upper respiratory infection, ear infections as well as skin infections and urinary tract infections. Initially, before the identification of the particular type of bacteria that had infected the wound, the professionals gave it to the patient. Researchers are of the opinion that this medication helps in treatment of skin structure infections which are mainly caused by the different types of susceptible isolates of the following gram positive bacteria like that of Staphylococcus aureus and Streptococcus pyogene (Craft et al., 2015). Since, Mary had developed wound in her feet that showed signs of bacterial infection, therefore nurses have given this medication until the man microbe for infection is not identified.

The pathologist ultimately identified that the microorganism that contributed to the disorder was Staphylococcus aureus. The medication named cephalexin that was provided initially was a broad-spectrum disorder that helped in fighting bacteria of various types and was not specific to one microbe (Han & Ceilley, 2017). However, dicloxacillin is a narrow spectrum betalactam antibiotic that belongs to the penicillin class. It has proved to be extremely helpful for treatment infections that are caused by non-resistant and susceptible gram-positive bacteria. It is extremely powerful in acting against microbes that produces beta lactamase that are otherwise resistant to the other penicillin (Lee & Bishop, 2012). Since this medication is a narrow spectrum medication which have proved to be extremely helpful in the treatment of mild-to-moderate staphylococcal infections, therefore the medication was exchanged from a broad spectrum drug to that of the narrow spectrum drug because of its increased success in treatment of the beta-lactamase producing enzymes. It is the penicillinase-resistant working penicillin and as Staphylococcus aureus is penicilinase-resistant because of the role of beta lactamase, this medication is considered the gold standards for the treatment.

The adverse effects of the medication of dicloxacillin are stomach illness causing nausea, digestive problems and vomiting. It also results in bleeding as well as blood clotting disorder and even liver and kidney disorders.

Question 4:

The first stage of wound healing is the homeostasis phase when the blood starts clotting at the wounded site. In this step, blood vessels constrict for restricting the flow of the blood. In Mary, this stage has passed and the infection had disrupted the next phase which is called the inflammatory phase. This stage occurs when blood vessels leak transudate causing localized swelling. During this stage, the damaged cells as well as the pathogens and bacteria will be removed from the wound area and the medication will help in killing the bacteria as well. The white blood cells, growth factors as well as nutrients and enzymes may create swelling and is commonly seen during this stage (Marieb et al., 2016). Then her wound will enter in the proliferative stage where would be rebuilt with new tissues made up of the collagen and extracellular matrix. Then she will enter into the remodeling stage of wound healing when collagen would be remodeled into type1 from type 3 and the wound will fully close.

References:

Bullock, S & Manias, E. (2017). Fundamentals of Pharmacology (8^th 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.

Dreifke, M. B., Jayasuriya, A. A., & Jayasuriya, A. C. (2015). Current wound healing procedures and potential care. Materials Science and Engineering: C, 48, 651-662. https://doi.org/10.1016/j.msec.2014.12.068

Han, G., & Ceilley, R. (2017). Chronic wound healing: a review of current management and treatments. Advances in therapy, 34(3), 599-610. https://doi.org/10.1007/s12325-017-0478-y

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