Transcript
Chapter 9: Complex Wound Management
Critical Thinking Checkpoint Case Studies
Mr. A, a 54-year-old male, had a cyst on his right lower extremity (RLE) that got progressively worse and looked infected, so he went to his local Emergency Department. The cyst was incised and drained. The patient was placed on oral antibiotics and sent home with dressing changes. One week later he returned to the Emergency Department complaining of severe leg pain. He has a medical history of hypertension, type 2 diabetes mellitus, and IV drug abuse. His vital signs were 180/65 mm Hg, HR 90/min, temperature 100.9°F, and RR 16 bpm.
This activity contains 4 questions.
1. Serum labs are drawn, including WBC, sodium, hemoglobin, creatinine, and glucose. If Mr. A has NF, what results would you anticipate?
Answers: If Mr. A has NF, you would expect lab results similar to the following:
WBC 26,000 cells/mm3
Sodium 125 mEq/L
Hemoglobin 11.2 mg/dL
Creatinine 0.6 mg/dL
Glucose 2,229 mg/dL
2. Wound cultures are taken. Results reveal the presence of Streptococcus A and Staphylococcus aureus. What antibiotics would you anticipate and what organisms would they cover?
Answer: Patients with NF are placed on antibiotic therapy. Antibiotic therapy typically consists of intravenous administration of penicillin for gram-positive cocci, an aminoglycoside for gram-negative aerobes, and metronidazole for anaerobes. However Mr. A's wound cultures revealed Streptococcus A and Staphylococcus aureus. Therefore, he was not placed on metronidazole or an aminoglycoside. Mr. A was placed on clindamycin and vancomycin. Clindamycin is effective for the streptococci and vancomycin is effective against the Staphylococcus aureus.
3. Mr. A's leg has a surgical debridement of his wound. What is the goal of debridement?
Answer: In debridement the goal is to remove all nonviable tissue. The wound bed would appear clean. There would be no areas of necrosis around the wound bed, so the wound can now begin to contract.
4. Mr. A. returns to the high-acuity unit postoperatively with a NPWT system. What is the purpose of this type of dressing?
Answer: NPWT systems use a polyurethane foam that is placed into the wound, then the dressing and the suction tubing are sealed to the skin with transparent film dressing and connected to a canister that collects the wound exudate. NPWT provides subatmospheric pressure to the wound bed (-125 mm Hg). NPWT improves local wound perfusion by decreasing edema and bacterial contamination and improves neovascularization, granulation, and wound contraction. NPWT allows for accurate measurement of wound drainage and decreases the time spent doing dressing changes.
