Management of Cellulitis and Nursing Care

 

 
 
1. Bridie is a 63-year-old woman who has spent the last three weeks in the hospital after a fall where she sustained a complicate fracture of her left tibia and fibula. A few days after discharge from hospital Bridie developed cellulitis of her right forearm associated with pain, redness, warmth and swelling. 
a)  Name the microorganism commonly associated with cellulitis and describes the general structure of this type of organism
b)  Explain the process of inflammation leading to the pain, redness, warmth and swelling. 
c)  Why would Bridie develop cellulitis? List two reasons and provide rationale for your answer
2. Gerry is a 78-year old gentleman with a history of an Anterior ST Elevation Myocardial Infarction (STEMI) and severe Left Ventricular Failure (LVF). Gerry has also smoked 15 cigarettes per day for the last 30 years. His additional history includes type II Diabetes Mellitus and hyperlipidaemia. Gerry was admitted to the medical ward in the hospital last night with an exacerbation of his LVF, worsening breathlessness and orthopnoea. It is now 0800 in the morning and you as his nurse come to check his blood pressure, pulse rate and SpO2 
 
a)  Explain  what  is  meant  by  the  term  “blood  pressure”  and  describe  the  factors  that  determine  blood pressure? 
b)  What causes the ‘pulse’ and what is the origin of the heart sounds S1 and S2? 
c)  Explain the physiology behind the oxyhaemoglobin dissociation curve.
d)  Explain what is meant by the term ‘SpO2’?  
e)  Describe the process of gas exchange related to ventilation, external and internal respiration. 
f)  What  factors  influence  the  ability  of  oxygen  to  enter  the  blood  from  the  lungs,  and  then  enter the tissues from the blood?  
3. Simon works as a high angle tree lopper. He presents to the Emergency Department after falling more than 15 meters when his harness failed. He has sustained a large bruise and hematoma on his right side, and presents with a sinus tachycardia and obvious difficulty breathing. After assessment and a computerized tomography (CT) scan, the emergency physician tells you he has fractured his right ribs 7 through 10, has a right pneumothorax, a lacerated liver and contused right kidney. He also has haematuria. 
a)  Describe  (NOT  list)  in  detail  five  (5)  functions  of  the  liver?  Why might liver injury lead to coagulation problems? 
b)  Define  and  outline  the  criteria  for  normal  sinus  rhythm,  and  describe  the  autonomic  control  of  heart rate? 
c)  Why is Simon having difficulty breathing ?
d)  Why would Simon have haematuria? Describe the functions of the kidney.  
4.  Arthur is an 81 - year old man with a medical history of type II Diabetes Mellitus, gout and Atrial Fibrillation. Arthur was admitted to the medical ward in the Ritz Medical Centre last night with severe diarrhoea and vomiting. As a result of his past medical history, Arthur has been taking oral glibenclamide, digoxin and warfarin. It is now 0800 in the morning; you and your buddy nurse come to check his vital signs. 
a)  Design a concept map that explains and describes the regulation of blood glucose levels. 
b)  Explain  in  detail  how  diarrhoea  and  vomiting  may  affect  the  absorption  and  effect  of  Arthur’s  oral medications. 
 

 

Answer to question 1 :- 

 

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1. Bridie is a 63-year-old woman who has spent the last three weeks in the hospital after a fall where she sustained a complicate fracture of her left tibia and fibula. A few days after discharge from hospital Bridie developed cellulitis of her right forearm associated with pain, redness, warmth and swelling. 
a)  Name the microorganism commonly associated with cellulitis and describes the general structure of this type of organism.  
Cellulitis is an intense, spreading, pyogenic irritation of the lower dermis and related subcutaneous tissue. It is a skin and delicate tissue contamination that outcomes in high bleakness and extreme budgetary expenses (Phoenix et al., 2012). Cellulitis is overseen by a few clinical masters including essential consideration doctors, specialists, general surgeons, and dermatologists. Cellulitis is consistently happening by the intrusion of Staphylococcus (S aureus) and Streptococcus microorganisms. The cell mass of S. aureus is made of murein, teichoic acids and divider related surface proteins. Murein comprises of glycan strands that are cross-connected by peptide spans supplying the basic uprightness of the sacculus. The sugar antigen is a teichoic corrosive which in S. aureus is a polymer of N-acetylglucosamine and polyribitol phosphate. The protein part of the cell divider incorporates protein A which responds with IgG of typical human serum. Lysozyme, a N-acetylmuramidase that cuts the glycan strands, discharges protein An atoms as a range of sections with changing masses because of the nearness of connected peptidoglycan pieces of various sizes. Glycan chains are cross-connected by short cell divider peptides and produce a three-dimensional sub-atomic system that keeps up the uprightness of the bacterium.

b)  Explain the process of inflammation leading to the pain, redness, warmth and swelling. 
The inflammation process includes the tissue invasion and harm of S arues. Microbial intrusion in skin or delicate tissues impels changes in vascular tone to expand blood stream to the harmed site. Extra changes in microvasculature advance and help the extravasations of plasma proteins and leukocytes. These cells and proteins move, aggregate and are actuated at the site of harm. With enactment, cells phagocytize and obliterate remote matter, dead tissue or microorganisms. Certain pyrogenic cytokines or exotoxins cause the febrile reaction (Ki and Rotstein, 2008). Inevitably, S aureus produces harmful substances; subsequently, irritation might be the wellspring of continuous tissue harm. The aggregation of liquids inside the kindled area could bring about swelling, erythyma and pain
c)  Why would Bridie develop cellulitis? List two reasons and provide rationale for your answer
Bacterial skin diseases will probably emerge if the surface of the skin is harmed, making it less demanding for microscopic organisms to enter. Skin conditions like dermatitis, impetigo, parasitic diseases or bruises can in the way all build the possibility of contamination. Likewise, a debilitated safe framework can make it particularly simple for microorganisms. In the present case. Bridie was experienced for surgery so the microorganisms may have entered the hidden tissue making her to create cellulitis.

 

Answer to question 2:- 

 

 

 
2. Gerry is a 78-year old gentleman with a history of an Anterior ST Elevation Myocardial Infarction (STEMI) and severe Left Ventricular Failure (LVF). Gerry has also smoked 15 cigarettes per day for the last 30 years. His additional history includes type II Diabetes Mellitus and hyperlipidaemia. Gerry was admitted to the medical ward in the hospital last night with an exacerbation of his LVF, worsening breathlessness and orthopnoea. It is now 0800 in the morning and you as his nurse come to check his blood pressure, pulse rate and SpO2  
a)  Explain  what  is  meant  by  the  term  “blood  pressure”  and  describe  the  factors  that  determine  blood pressure? 
The pressure applied by blood on the lateral walls of blood vessels during the circulation of blood is referred as blood pressure and is described as systolic blood pressure (occur when the heart pumps the blood into arteries) and diastolic blood pressure (occur when heart is relaxing) (Lakshminarayan, et al., 2007). The following are the factors that influence the blood pressure
?    Emotional State: Stress can cause large increases in blood pressure. 
?    Talking: Talking to the nurse/doctor while having the measurement of blood pressure, can increase the systolic blood pressure.
?    Smoking: Tobacco products contain nicotine which will temporarily increase blood pressure.
?    Caffeine: Caffeine causes blood pressure levels to spike
?    Temperature: Cold environment can increase blood pressure
?    Full bladder: The blood pressure increases with gradually fill of bladder
?    Diet: Diet rich in fat can influence the elastic properties of blood vessel due to atherosclerosis and hence affects the blood pressure
b)  What causes the ‘pulse’ and what is the origin of the heart sounds S1 and S2? 
The constriction of heart muscle results in pumping of blood into vessel and these waves can be felt as throbs in courses near the skin surface E.g., those in the wrist and neck. The sound, S1 results from the conclusion of mitral and tricuspid valve though S2 results from the conclusion of aortic and pulmonic valves
c)  Explain the physiology behind the oxyhaemoglobin dissociation curve
The hemoglobin-oxygen partition curve is a sigmoid twist, which relates the fragmentary weight of oxygen separated in the blood to the rate submersion of hemoglobin. It grants us to perceive how hemoglobin willingly binds to oxygen in the high partial weights within the alveoli at the tissue level. The key perceives how hemoglobin works, and that there is pleasant tying meaning the more oxygen that attaches to Hb, the more molecules can bind and the opposite happens when O2 starts to move a long way from the Hb. It clears up why there is a 'slippery inclination' once the Hb drenching falls lower than 92%. The coupling of oxygen to hemoglobin continues to some degree for weights underneath around 60 mmHg, as oxygen fragmentary weights lessen in this dubious zone of the twist, the oxygen is exhausted to periphery tissue expeditiously as the hemoglobin's proclivity diminishes.
d)  Explain what is meant by the term ‘SpO2’?  
Oxygen immersion (SpO2) is characterized as the proportion of oxy-hemoglobin to the aggregate grouping of hemoglobin present in the blood. It means that impression of the level of oxygen accessible in the individual blood. Oxygen immersion values acquired from heartbeat oximetry (SpO2) are one a player in a complete evaluation of the patient's oxygenation status and are not a substitute for estimation of blood vessel incomplete weight of oxygen (PaO2,) or of ventilation
e)  Describe the process of gas exchange related to ventilation, external and internal respiration. 
The external breath includes taking of air into the body keeping in mind the end goal to supply the lungs with oxygen, and (utilized) air is ousted from the lungs so as to expel carbon dioxide from to body. Gas trade happens down a weight angle, by means of a procedure known as "dissemination" The gasses each have a weight identified with their fixation inside the gas blend. These individual weights are termed incomplete weights. Contrasts in the fractional weights between the gasses in the alveoli and blood make a weight angle over the respiratory layer. On the off chance that the weight on every side of the film were the same there would be no trade of O2 and CO2. Where the fractional weights of O2 and CO2 are distinctive gas trade happens. Gasses move from a territory of high focus a zone of low fixation. As the newly enlivened air in the alveoli is high in O2, the O2 diffuses over the respiratory layer into the blood where the grouping of O2 is low. This blood is currently "oxygenated" and is sent to the tissues of the body for use. Inner Respiration alludes to the gas trade in the middle of tissue and blood. It happens in the distal respiratory tree down an inclination
f)  What  factors  influence  the  ability  of  oxygen  to  enter  the  blood  from  the  lungs,  and  then  enter the tissues from the blood?  
?    Partial weight inclinations and gas solvency: A precarious fractional weight slope (PO2 alv = 104 mm Hg, PO2 top = 40 mm Hg) exists between blood in the pneumonic supply routes and alveoli, and O2 diffuses quickly from the alveoli into the blood. 
?    Ventilation-Perfusion Coupling: It guarantees a nearby match between the measure of gas achieving the alveoli and the blood stream in the aspiratory vessels. 
?    Thickness and surface zone of the respiratory film: The respiratory layer is regularly thin, and shows a tremendous surface zone for productive gas trade.

 

Answer to question 3:-

 


3. Simon works as a high angle tree lopper. He presents to the Emergency Department after falling more than 15 meters when his harness failed. He has sustained a large
bruise and hematoma on his right side, and presents with a sinus tachycardia and obvious difficulty breathing. After assessment and a computerized tomography (CT) scan, the emergency physician tells you he has fractured his right ribs 7 through 10, has a right pneumothorax, a lacerated liver and contused right kidney. He also has haematuria. 
a)  Describe  (NOT  list)  in  detail  five  (5)  functions  of  the  liver?  Why might liver injury lead to coagulation problems? 
The liver coordinates most blend levels in the blood and responsible for the release of bile and aid in fat digestion. Most of the blood leaving the stomach and absorption frameworks experiences the liver. The liver systems this blood and isolates, and makes supplements for the body to use. It in like manner metabolizes drugs in the blood into structures that are less requesting for the body to use. The essential limits joins era of bile (sponsorships in absorption) and certain proteins for blood plasma; formation of cholesterol and unprecedented proteins to bring fats through the body. Liver stores the landing of glucose as required; change of dangerous soluble base to urea; overseeing blood thickening (Wang et al.; 2015). The liver assumes a key part in the formation of coagulating segments and also RBC era. A part of the proteins coordinated by the liver fuse coagulation elements including fibrinogen, prothrombin, element V, VII, VIII, IX, X, XI, XIII, and furthermore protein C, protein S and antithrombin. Since liver creates various elements, the harm can influence the generation of thickening elements subsequently it postures coagulation issues 
b)  Define  and  outline  the  criteria  for  normal  sinus  rhythm,  and  describe  the  autonomic  control  of  heart rate? 
Sinus rhythm refers to the normal musicality of the heart where electrical helps are begun in the sinoatrial (SA) center point and are then coordinated through the atrio-ventricular (AV) center and pile of His, gathering branches and Purkinje fibers. This results in a general, tight complex heart beat at 60-100 bpm. Each QRS complex is gone before by a normal P wave. P waves should be upright in leads I and II, switched in aVR. The PR between time stays steady. QRS buildings are<100 ms wide (unless a simultaneous entomb ventricular conduction put off is accessible) (Henry, 2015).
The pacemaker development in consistently controls heart rate responsive to unconstrained changes in Ca++, Na+, and K+ conductance (Horn et al., 2016). Heart rate is lessened underneath the common rate primarily by activation of the vagus nerve innervating the SA center. Regularly, still, there is paramount vagal tone on the SA center point so that the resting heart rate is some place around 60 and 80 throbs/min. The withdrawal of vagal tone and a start of sympathetic nerves innervating the SA center point can grow the heart rate. These exercises are mediated by method for coursing catecholamine that catches up on β1-adrenoceptors arranged on SA nodal cells.
c)  Why is Simon having difficulty breathing ?
Simon suffers with breathlessness due to damage to ribs and intercostals muscles. Right ribs 7 through 10 have been fractured. The muscles withdrawal pulls the rib confine both upward and outward amid inward breath. Because of crack of ribs, Simon lost the contractility of intercostals muscles. Along these lines, he was in trouble in relaxing.
d)  Why would Simon have haematuria? Describe the functions of the kidney.  
Kidney damage happens producing after a prompt results to the lower back extent. The mischance causes the harm of kidney with an extreme agony and blood in the pee hematuria). The elements of kidney incorporate (i) release of waste for instance, lethal substances excess salts, and urea, a nitrogen-based waste made by cell assimilation framework. (ii) Water level altering by changing the water release. (iii) Blood weight regulation by method for renin-angiotensin system (iv) Red platelet regulation by method for erythropoietin creation and (v) corrosive base equalization by discharge (Gowda et al., 2010)
4.  Arthur is an 81 - year old man with a medical history of type II Diabetes Mellitus, gout and Atrial Fibrillation. Arthur was admitted to the medical ward in the Ritz Medical Centre last night with severe diarrhoea and vomiting. As a result of his past medical history, Arthur has been taking oral glibenclamide, digoxin and warfarin. It is now 0800 in the morning; you and your buddy nurse come to check his vital signs.
 
b)  Explain  in  detail  how  diarrhoea  and  vomiting  may  affect  the  absorption  and  effect  of  Arthur’s  oral medications. 
Diarrhea refers to the evacuation of bowels in loose form due to defects in absorption and electrolyte secretion. Such an unhinging can be the after effect of either an osmotic power that demonstrations in the lumen to drive water into the gut or the consequence of a dynamic secretary state prompted in the entrecotes. Heaving persuasively impels the gastrointestinal substance to out. Hence, any stuff that is available in GI tract can't be retained because of short habitation time. The supplements likewise demonstrate low no retention in such a brutal condition. Additionally, tranquilizes that are taken by Arthur's likewise not ingested into framework and are either removed out or cleared by means of inside
References
Craig, F (18-Apr-2016) How Diabetes Works Retrieved from http://health.howstuffworks.com/diseases-conditions/diabetes/diabetes.htm
Gowda, S., Desai, P. B., Kulkarni, S. S., Hull, V. V., Math, A. A. K., & Vernekar, S. N. (2010). Markers of renal function tests. North American Journal of Medical Sciences, 2(4), 170–173.
Henry K.O.N (30-Dec-2015) What is the difference between external and internal respiration? Retrieved from https://www.quora.com/What-is-the-difference-between-external-and-internal-respiration
Horn, MA., Bode, EF., Borland, SJ., Kirkwood, GJ., Briston, SJ., Richards, MA., Dibb, KM & Trafford, AW (2015) Temporal development of autonomic dysfunction in heart failure: Effects of age in an ovine rapid-pacing model. J Gerontol A Biol Sci Med Sci. pii: glv217
Ki, V., & Rotstein, C. (2008). Bacterial skin and soft tissue infections in adults: A review of their epidemiology, pathogenesis, diagnosis, treatment and site of care. The Canadian Journal of Infectious Diseases & Medical Microbiology,19(2), 173–184.
Lakshminarayan K, Anderson DC, Borbas C, Duval S, Luepker RV. Blood Pressure Management in Acute Ischemic Stroke. Journal of clinical hypertension (Greenwich, Conn). 2007;9(6):444-453.
Phoenix, G., Das, S., & Joshi, M (2012) Diagnosis and management of cellulitis.  BMJ. 345:e4955
Wang, G., Bonkovsky, HL., de Lemos, A., & Burczynski, FJ (2015) Recent insights into the biological functions of liver fatty acid binding protein. J Lipid Res. 56(12) 2238-47
 

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