Learning Outcomes
Mary’s wound is red and warm when touched. It is painful and swollen along with purulent discharge. A wound tends to be warmer to touch due to inflammation. During inflammation, the blood vessels surrounding the wound dilate in order to bring more fluid and white blood cells in the affected area in order to promote faster healing of wound. This process increases the flow of blood in the affected area and thereby increasing the temperature of that particular region. The appearance of red wound signifies that the wound is getting proper blood supply in order to promote fast healing. Increase in the colonization of the blood cells surrounding the wound signifies that there is increase in the colonization of the red blood cells surrounding the wound and thus the wound appears red (Knottenbelt, 2013).
The purulent drainage is a type of fluid discharge that occurs from the wound. It is often milky white to yellow in appearance and in the majority of the cases provides signs of wound infection through bacterial colonization. In medical terms, purulent discharge symbolises pus and is a form of inflammatory exudate which contains high concentration of leucocyte mainly neutrophill, lyzozymes and macrophages and other proteolytic enzymes. This milky discharge is of thick consistency and has distinct bad odour (Knottenbelt, 2013). The drainage of fluid from wound is common and it mainly results from the dilating blood vessels, which tends to make the surrounding of the wound moist in order to promote faster healing of the wound. However, when the discharge of fluid occurs in terms of purulent discharge and is associated with bad odour then it is a signs of infection. It is regarded as a sign of unhealthy wound and demands immediate treatment. Purulent discharge is also associated with pain along with swallowing. This kind of purulent discharge when associated with pain, it increases the tendency of bacterial colonization surrounding the wound and thus decreasing the overall healing process of the wound. Bacterial colonization increases infiltration of the macrophages an neutrophill in order to conduct phagocytosis and thereby increasing the pain in the surrounding area (Craft & Gordon, 2015).
2.Possible sources of contamination and modes of transmission (Total: 10 marks)
2.1Name one endogenous source of contaminationand discuss the mode of transmission from the source to the new host.(5 marks)
The endogenous source of wound contamination includes the endogenous bacterial present in the skin. The main endogenous bacteria which are present within skin include Staphylococci and Corynebacteria. The main bacteria under the genre of Staphylococci include Staphylococcus epidermidis, Staphylococcus aureus and Streptococcus pyogenes (Knottenbelt 2013). Staphylococcus epidermidis can adapt under diverse environments human host. S. aureus is a harmful pathogen. It is one of the leading causes of bacterial disease transmission in humans. It can be transmitted through nasal membranes of an asymptomatic carrier to any susceptible host. The endogenous bacteria generate wound infection by two different mechanisms. One mechanism is the direct implantation of bacteria (primary lodgement) and second mechanism occurs by wound serving as a locus minoris resistentiae. Thus it can be said that the endogenous bacteria that is present within the skin might gave come into the contact of the wound leading to contamination as the wound is open and has direct contact with the air water and blood vessels (Knottenbelt 2013).
Physiological Changes in the Body due to Health Breakdown
2.2Name one exogenous source of contamination and discuss the mode of transmission from the source to the new host.(5 marks)
The exogenous mode of bacterial infection mainly occurs from the bacteria present within the surround environment. In case of Mary it can occur from the handkerchief which Mary has used to bandage her wound. The bacteria that can be present within the handkerchief include respiratory tract microbes or other airborne microbers or microbes present with in skin of palms. This might cause the exogenous source of bacterial infection. The common bacteria include Streptococcus pyogenes (Knottenbelt, 2013). While using the handkerchief in order to cover the wound, the bacteria present within the napkin might have come into close contact with the open wound. Exposure of the bacteria with the open wound and the blood vessels lead to the colonization of the bacteria over the wound and thereby increasing the susceptibly of the wound infection (Knottenbelt, 2013).
3.Rationale for choices of antibiotics (Total 10 Marks)
3.1Rationale for the stat dose of ceftriaxone administered IVI immediately.(3 marks)
The stat dose of ceftriaxone or the immediate dose of ceftriaxone signifies immediate inhibition of bacterial colony propagation and thereby helping to reduce the overall bacterial colonization. Ceftriaxone is a broad spectrum cephalosporin antibiotic with a very long half-life and high penetrability. It is mainly used for the treatment of infection that is cause by bacteria includes S. pneumonia, H. influenza, staphylococci, S. pyogenes (group A beta-hemolytic streptococci), E. coli and Klebsiella and Coagulase negative staphylococcus. The main mode of action of this beta-lactum antibiotic is to inhibit the mucopeptide synthesis of the bacterial cell wall. It mainly binds with the carboxypeptidases and endopeptidases and transpeptidases present within the bacterial cytoplasmic member (Bullock & Manias, 2017). All these peptidases are involved in the cell-wall synthesis of the bacteria. So binding of the antibiotic with these cell-wall peptidases inhibits the bacterial cell-wall formation and thereby inhibiting the propagation of the bacterial infection. Thus, intravenous injection of the antibiotic ensures prompt action via immediately coming in close contact with the blood and thus initiating is bactericidal actions (Bullock & Manias, 2017).
3.2 Rationale for theoral cephalexin. (2 marks)
Cephalexin belongs to the class of cephalosporin antibiotic and is similar in actions like that of penicillin. They stop or slow down the growth of the bacterial cells via preventing bacterial from forming the cell wall. Inability of the bacterial to from the bacterial cell wall leads to death of the bacterial colony and thereby causing bactericidal effects. The oral dosage of cephalexin ensures slow release of the antibiotic via getting it absorbed from the gastro-intestinal tract and thereby causing slow action and gradual bacterial effects (Lee & Bishop, 2016).
Preventative Strategies in Health Breakdown
3.3Rationale for the change to oral dicloxacillin.(4 marks)
The reason behind change in the drug to oral dicloxacillin is comprehensive eradication of the bacterial invasion inside the wound. Dicloxacillin is one of the penicillins which is resistant to penicillinanse. It mainly helps to exert a bactericidal action against penicillin-susceptible micro-organisms. Dicloxacillin specifically binds with the specific penicillin-binding proteins (PBPs) which are located inside the bacterial cell wall. Upon binding with the PBPs, dicloxacillin inhibits the third and last stage of the bacterial cell wall synthesis and thereby causing bacterial cell lysis under the action of autolysins. Research suggests that dicloxacillin mainly interferes with the autolysin inhibitor. Thus changing to dicloxacillin leads to complete eradication of the bacteria which are resistant to cephalosporin group of antibiotic (Nissen et al., 2013).
3.4State two adverse reactions to dicloxacillin.(1 mark)
Two adverse reaction of Dicloxacillin includes: Severe pain in the stomach along with watery diarrhea along with little or no urination. The diarrhea leads to excessive excretion of the water or fluid from the body and thereby causing dehydration and thus causing lack of proper urination. This eventually leads to renal impairment (Nissen et al., 2013).
4.Process by which Mary’s wound will heal (Total: 5 marks)
There are four stages of wound healing. The first stage is hemostasis, which is defined as process of wound closing via clotting it starts when the blood first leaks out of the body in response to the rupture of the blood vessels. The second stage of wound healing is known as inflammatory phase. Under this phase, the injured blood vessels leak transduate and thereby causing localized swelling. Inflammation controls both bleeding and prevention of infection. This phase s crucial for Mary, as the antibiotic will lead to the destruction of the bacterial growth and thereby causing initiation of a proper inflammatory stage of wound healing. The third stage is proliferative phase, which is characterized by rebuilding of the tissue with the help to collagen and extracellular matrix leading to closure of the wound. The fourth and the final stage is maturation stage or remodelling of the wound. Under this stage, the collagen is remodelled and leads to complete sealing of the exposed surface with the fresh set of tissues (Knottenbelt, 2013; Marieb & Hoehn, 2016).
References
Bullock, S., & Manias, E. (2017). Fundamentals of pharmacology (8th ed.). Frenchs Forest, Australia: Pearson Australia
Craft, J., & Gordon, C. (Eds.). (2015). Understanding pathophysiology (2nd Australian and New Zealand ed.). Chatswood, Australia: Elsevier.
Knottenbelt, D. C. (2013). Handbook of Equine Wound Management E-Book. Elsevier Health Sciences. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=zeStAAAAQBAJ&oi=fnd&pg=PP7&dq=Knottenbelt,+D.+C.+(2013).+Handbook+of+Equine+Wound+Management+E-Book.+Elsevier+Health+Sciences.&ots=vxGvEXJanF&sig=JWdzEUPDftnv9u5oD7xXZu3SmUg#v=onepage&q=Knottenbelt%2C%20D.%20C.%20(2013).%20Handbook%20of%20Equine%20Wound%20Management%20E-Book.%20Elsevier%20Health%20Sciences.&f=false
Lee, G., & Bishop, P. (Eds.). (2016). Microbiology and infection control for health professionals (6th ed.). Melbourne, Victoria: Pearson Australia.
Marieb, E.N., & Hoehn, K. (2016). Human anatomy & physiology (10th global ed.). Harlow, United Kingdom: Pearson Education
Nissen, J.L., Skov, R., Knudsen, J.D., Østergaard, C., Schønheyder, H.C., Frimodt-Møller, N. and Benfield, T., 2013. Effectiveness of penicillin, dicloxacillin and cefuroxime for penicillin-susceptible Staphylococcus aureus bacteraemia: a retrospective, propensity-score-adjusted case–control and cohort analysis. Journal of Antimicrobial Chemotherapy, 68(8), pp.1894-1900. https://doi.org/10.1093/jac/dkt108
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