Reason for booster injection
The provision of booster tetanus injection to Mary was to prevent an occurrence or infection of tetanus. Taking the knowledge of the working site that Mary was working on, digging manure in a rose garden, there was a high possibility that she might have been contaminated by infectious microbes causing tetanus. A strong inclination to tetanus infection is the deep 4 cm cut right on her left leg into the calf. An infection of tetanus could lead to intense muscle spasms. These spasms could lead to the jaws of infected people looking. The patient might not be able to open the mouth let alone swallow and suffocation is the end result in case treatment is not done. Other proceeding symptoms include swallowing difficulty and the stiffening of the neck. Abdominal muscles also tend to get rigid thereby causing profuse sweating and fever to infected persons (Bullock & Manias, 2017).
Description of wound observations
The occurrence of the edges of the wound being red and hot to touch is due to the existence of cellulitis. This infection is due to the existence of bacteria on the skin that can potentially be serious to the wound on the skin. Such an infection could rapidly spread around the wound area. A number of areas are susceptible to cellulitis are the face skin and the skin on the lower part of the legs. Cellulitis mostly affects the surface of the skin in many scenarios but infect the deep skin tissues (Craft & Gordon, 2015). Tissues underlying the infected area are prone to the infection thereby the bacteria could affect the lymph nodes together with the bloodstream. Hence the red look and hot feeling. Inspecting Mary’s wound also lead to the observation of swelling on the surrounding tissues. When the tissue of surrounding tissues gets inflamed, the wound is in a process of healing because the white blood cells surround it. After surrounding the wound, protective and curative chemicals are produced to protect the wound from an infection by bacteria or virus. These chemicals cause the swelling. However, chronic inflammation, prolonged swelling, may occur that may damage the tissues around the wound (Elaine & Katja, 2016).
When a wound develops a purulence condition, it is due to the dilation of blood vessels in the early healing stages. The purulent behaviour occurs due to the existence of bacteria in the wound. The body creates a moist surrounding around the wound to heal itself but this makes it easy for germs to infect it. These germs, therefore, get into the wound and spread around the near tissues making the area painful and swells (Adams, Holland, & Bostwick, 2013). More to it is the great possibility of the wound not healing as fast as it should. In relation to the wound odour, the resultant condition is due to the existing necrotic tissue and bacteria in the wound. Other dressings also lead to the development of odours because there are chemical reactions that occur between the wound’s exudate and the dressing itself. The odour may not be harmful to the infected person but it is a bioburden other than providing an indication that the wound is not healing (Gary, 2015).
Explanation of fever
Fever is an indicative measure that the body uses to prove that there is an invasive organism in the body. Fevers in adults are caused by infections, neoplastic and inflammations. Mary’s fever could, therefore, be caused by an infection or the wound’s inflammation. Bacteria infecting tissues underlying the infected area could affect the lymph nodes together with the bloodstream. Inflammation that could have produced the fever is caused by the process of healing because the white blood cells surround the wound (Grossman & Porth, 2014). The symptom is usually accompanied by other specifics discomforts that help in infection identification. Fever, therefore, can lead to the development of headaches together with a decrease of appetite. Whenever the body temperature reaches a temperature of 101 degrees Fahrenheit or more, there is an invasive organism in the body. Hence Mary’s fever was due to an infection in the wound. Fever is also connected to physical discomfort hence many patients feel relieved when the fever subsides (Department of Health, 2017).
Sources of contamination
The skin is an important first defence against invading organisms, however, it also is an endogenous source of wound infection. When abrasions are made on the skin, dirt and micro-organism get under the skin. These can lead to infections majorly around the wound area. Taking the example of Mary being cut while working, the surrounding area was full of dirt and micro-organisms. Given that Mary was busy, possibly knee dip in manure, the structure that made the cut had a great possibility of transferring the dirt and microorganism on the skin around the calf into the body. Hence, Staphylococcus aureus could be present in the manure (Porth & Matfin, 2014). Once the cut was made around the calf, dirt and the Staphylococcus aureus bacteria were deposited under the skin. After Mary consulted the doctor and got treatment, some dirt and microorganisms might have remained under the skin. The continuous movement of the leg led to the grind of dirt and deposit of bacteria to the wound. After some time, the wound got infected hence took the time to heal (Christopher, Judy, Kathryn, Sue, & Valentina, 2014).
An exogenous infection is through direct contact with pathogens via any contaminated item. Mary’s exogenous infection might have happened on-site or off-site. In on-site infection, the area in which the work was being performed could have had sharp objects lying around. Due to the intense concentration in digging or any work she was doing, Mary accidentally injured herself when she got close enough to the sharp contaminated objects. These items contained invasive micro-organisms that were deposited in the wound (Rosenjack & Rosenthal, 2016). Their deposition later leads to infection which was preventing quick healing of the calf even after treatment. In the off-site contamination, there is the possibility of surgical site infection of the wound where there was an introduction of microbes during surgical culturing of the wound. During the culturing and wound cleaning, when a patient is operated on using open techniques microbial organism easily get into the wound. The existence of dirt in the air, nearby objects or the incision instrument can deposit invasive organisms that infect the wound. Hence Mary could have subjected the wound to such contaminative environments that ultimately infected the wound (Shane & Elizabeth, 2016).
Reasons for Augmentin
From the diagnosis that revealed the existence of Staphylococcus aureus in the culture from the wound, it was recognized that the bacteria was sensitive. Also, the diagnosis revealed that there was a skin infection around the wounded calf area. Taking from the previous visitation to the doctor, Mary had already been given tetanus drug but it seemed not to work in that the patient came back complaining of pain in the wound area and febrile feeling. Another complaint was a fever of about 38.2 degrees Celsius. This was an indication that there was a resistance to the drug administered since the wound was not healing. Therefore, the doctor prescribed Augmentin as the most preferred remedy. Reasons being, Augmentin has the ability to treat infections that are a bit more drug resistant causing failed healing of wound infections. This resistance to healing is due to the presence of strongly susceptible bacteria such as Staphylococcus aureus. The drug therefore selects and modifies the antibacterial therapy making it successful. Augmentin is an effective solution to wounds that tend to resist healing such as the one experienced by Mary (Lippincott, 2015).
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