According to Keast & Orsted (2001), Clinically inflammation, the second stage of wound healing presents as erythema, swelling and warmth often associated with pain, the classic “rubor (erythema) et tumor (swelling) cum calore (heat) et dolore (pain)”. This stage usually lasts up to 4 days post injury. Cessation of blood flow from the wound is achieved by vasoconstriction of the wound site and clot formation (hemostasis).
Immediately following injury, platelets, endothelial cells, fibrin, and fibronectin aggregate and release coagulation factors, cytokines, and growth factors that are vital for hemostasis and initiation of the wound healing process. In the wound healing analogy the first job to be done once the utilities are capped is to clean up the debris. This is a job for non-skilled laborers. These non-skilled laborers in a wound are the neutrophils or PMN’s (polymorphonucleocytes). The inflammatory response causes the blood vessels to become leaky releasing plasma and PMN’s into the surrounding tissue4.
The neutrophils phagocytize debris and microorganisms and provide the first line of defense against infection. They are aided by local mast cells. As fibrin is broken down as part of this clean-up the degradation products attract the next cell involved. The task of rebuilding a house is complex and requires someone to direct this activity or a contractor. The cell which acts as “contractor” in wound healing is the macrophage. Macrophages are able to phagocytize bacteria and provide a second line of defense. Question 2.
Explain the rationale why the wound was swabbed for culture and sensitivity. The wound was swabbed for culture and sensitivity in order to identify the organism responsible for Mrs. Stone’s wound infection. We can say that Mrs. Stone is infected 48 hours after the accident because she was already febrile, and some of her vital signs were also increasing. As we all know, fever is a compensatory mechanism of the body to regulate the body’s “thermostat”. In order to keep up with this change in temperature, cardiac rate, blood pressure and respiratory rate increases.
According to Nordenson (2007), to enable healing and prevent the spread of infection to other body tissues, the infecting microorganisms must be killed. A wound culture discovers which type of microorganism is causing the infection and the best antibiotic with which to kill it. According to Cuzzell (1993), a wound culture should be done, especially, for immunocompromised patients, such as those with AIDS or cancer, in whom the nor mal clinical signs of invasive wound infection are masked or absent,and paterns of microbe resistance to antibiotics change rapidly.
A wound should be cultured, when the amount, consistency or odor of drainage changes significantly, suggesting an infectious process; when a patient is soon to be discharged (especially if wound status changes suddenly or the patient is at high rsk for complications); and when a newly transferred patient’s wound is draining. A sample of skin, tissue, or fluid is collected from the affected area and placed in a container with a substance (called growth medium or culture medium) that helps organisms grow. If nothing important grows, the culture is negative.
If something that can cause infection grows, the culture is positive. The type of organisms will be identified with a microscope, chemical tests, or both. If a skin or wound culture is positive, other tests may be done to help choose the best medicine to treat the infection. Question 3 a. ) Explain the possible sources of the contamination of the wound and the mode of transmission of the micro organism. Sources of the contamination of the wound include the manure which Mrs. Stone was digging into her rosebush and the soil which contains many microorganisms, which largely contain anaerobes.