Discuss the significance of understanding the following items in relation to clinical practice as an advanced practice nurse. Consider the following two situations in addressing your assigned roles:

QUESTION

Discuss the significance of understanding the following items in relation to clinical practice as an advanced practice nurse. Consider the following two situations in addressing your assigned roles:

A 32-year-old Asian American construction worker visits his primary care physician with a 2-inch cut on the anterior aspect of his right hand. He lacerated his hand while fixing a barbed-wire fence 5 days ago. He told his wife that he did not have time to go to his primary care provider for such a small cut. The primary care provider noted the wound bed to be erythemic, swollen, and with a small amount of purulent greenish drainage on the Band-Aid, the wife had placed on cut. The patient had an oral temperature of 100°F. The primary care provider cleaned the wound, applied a clean dressing, administered Tdap, and called in a prescription for 10 day-courses of an antibiotic.

A 5-year old was playing on his family’s farm when he accidentally tripped over a fallen fence suffering a similar injury as the first patient. This child suffered a 2-inch cut to the anterior aspect of his right hand. His father cleaned the wound, covered the site, and made an appointment for the following week (about 3 days later) to see the pediatrician. The pediatrician examined the wound and noted the wound bed to be erythemic, swollen, and with a small amount of purulent drainage on the Band-Aid, the father had placed on the cut. The patient had an oral temperature of 100°F. The primary care provider cleaned the wound, applied a clean dressing, administered DTaP, and called in a prescription for 10 day-course of an antibiotic.
In your initial post:

1. Identify some potential concerns based on the findings of the wounds and provide a rationale for the healthcare provider’s treatment choices. Include the mechanism of wounds healing in your discussion. In addition, briefly discuss this individual’s risk for shock and what type of shock he is at most risk for based on the information presented.
Explain your rationale for your choices, citing resources from the literature.

2. What are the key data and assessment information needed if you are caring for this patient? List your plan of care for this individual. Describe modifications (if any) to the plan of care that you would use when caring for a 32-year-old, married Asian American male versus a 5-year-old male child who is very active outdoors.

ANSWER

Potential Concerns and Rationale for Treatment Choices

Based on the findings of the wounds described in both cases, there are several potential concerns that need to be addressed. The presence of erythema, swelling, and purulent drainage indicates an inflammatory response, suggesting the possibility of infection in both patients. The fact that the wounds were not promptly evaluated and treated raises concerns about delayed wound healing and increased risk of complications.In both cases, the healthcare providers appropriately cleaned the wounds and applied clean dressings to promote a clean and moist wound environment, which is crucial for optimal wound healing. The administration of antibiotics is justified to prevent or treat infection. However, it is essential to consider the potential for antibiotic resistance and select appropriate antibiotics based on the likely pathogens involved.

The mechanism of wound healing involves four overlapping phases: hemostasis, inflammation, proliferation, and remodeling. Hemostasis involves platelet aggregation and the formation of a fibrin clot to control bleeding. Inflammation is characterized by an immune response, with neutrophils and macrophages clearing debris and pathogens from the wound site. The proliferative phase involves granulation tissue formation, re-epithelialization, and angiogenesis. Finally, remodeling leads to the maturation and remodeling of the new tissue.

Both patients are at risk of developing septic shock, a life-threatening condition resulting from a systemic inflammatory response to infection. The presence of an oral temperature of 100°F, along with signs of infection and purulent drainage, suggests an ongoing inflammatory process. Septic shock is characterized by hypoperfusion, organ dysfunction, and circulatory collapse. In this case, the patients are at risk for septic shock due to delayed treatment and potential wound infection.

 Key Data and Assessment Information and Plan of Care

For both patients, the key data and assessment information needed include:

Detailed wound assessment: Assess the wound size, depth, presence of foreign bodies, signs of infection (such as erythema, swelling, and purulent drainage), and the need for debridement.

Vital signs: Monitor temperature, heart rate, blood pressure, and respiratory rate to assess for signs of systemic infection, sepsis, or shock.

Pain assessment: Evaluate the level of pain experienced by the patient using appropriate pain scales to ensure adequate pain management.

Medical history: Obtain information regarding allergies, chronic illnesses, medications, and immunization history to guide treatment choices and assess the patient’s overall health status.

Plan of Care

For the 32-year-old Asian American construction worker:

Wound care: Continue with proper wound cleaning, dressing changes, and monitoring for signs of infection. Consider wound cultures if infection worsens or fails to improve with initial treatment.

Antibiotic therapy: Administer the prescribed antibiotic course and educate the patient on the importance of adherence and potential side effects.

Pain management: Assess and manage pain appropriately using analgesics as needed.

Education: Provide instructions on wound care, signs of infection, and the importance of seeking prompt medical attention for future injuries.

Modifications for a 5-year-old child who is very active outdoors

Wound care: Due to the child’s age and activity level, extra precautions should be taken to protect the wound. Consider the use of appropriate dressings, splints, or protective coverings to prevent further injury.

Communication and education: Adapt communication to the child’s age and developmental level. Engage the child and parents in the wound care process, emphasizing the importance of keeping the wound clean and avoiding activities that may hinder healing.

Follow-up: Schedule closer follow-up appointments to monitor wound healing progress and ensure appropriate management.

In both cases, cultural considerations should be taken into account. For the 32-year-old Asian American male, it is important to respect cultural beliefs and practices related to healthcare decision-making and treatment preferences. Clear communication and cultural sensitivity should be employed to facilitate understanding and compliance with the recommended plan of care.