Health Breakdown Assignment Discussion Paper

Learning Outcomes For The Unit Are Outlined Below.

1.1What is the organism that causes tetanus and why is it of concern in this situation?

Mary has suffered a rather deep cut while working in the garden and the wound might be contaminated with soil. Clostridium tetani, the bacterium that causes tetanus can occur in the soil in the form of endospores, it is a Gram-positive bacterium and can live anaerobically once it infects tissues. The bacterium causes tetanus due to the release of two protein toxins, tetanospasmin which is a neurotoxin and tetanolysin which is a hemolysin. Tetanus is a painful condition that causes muscle spasms and even prove to be fatal (Immunise.health.gov.au, 2017).

1.2According to the guidelines in the “The Australian Immunisation Handbook” (Dept. of health, 2017) on administering a tetanus booster, discuss the rationale for giving Mary the tetanus booster

According to the Australian Immunisation Handbook, a person who reaches 50 years of age should be given a tetanus booster, if he or she has not received one during the past 10 years. Mary is 50 years of age and therefore she should receive the booster. But her injury which has been exposed to garden soil makes the booster all the more necessary. Besides there have been cases where a booster within the last ten years has not been able to prevent tetanus in patients with seemingly minor injuries. So, it is necessary that Mary receive one soon after the occurrence of the injury. It will increase the concentration of circulating antibodies and offer adequate protection from tetanus (Immunise.health.gov.au, 2017)Health Breakdown Assignment Discussion Paper.

2.1For each of the three wound observations indicate, and provide a rationale, as to whether it is a sign or a symptom.

The three wound observations when Mary reported after 48 hours of the injury at the hospital were, hot and red edges of the wound, swelling in the tissue surrounding the injury and purulent and odorous discharge from the wound. Hot and red edges of the wound are a sign that an inflammatory process is underway, swelling around the wound is a sign that capillary exudate has collected in the tissue, while the associated pain is a symptom. Purulent and odorous discharge is a symptom of bacterial infection in the wound.

2.2Discuss the physiological basis of the first observation.

An acute inflammation occurs as soon as the injury occurs due to the release of compounds that cause the inflammation. These are prostaglandins, histamines, complement, leukotrienes, kinins, chemotactic factors, nitric oxide, platelet activating factors, cytokines and interferons. Many of these cause the arterioles to dilate and increase their permeability so that cells can extravasate and reach the injury site and kill the pathogens through phagocytosis. There is an increase in the flow of blood to the area due to vasodilation of arterioles, so the edges appear red. The temperature of the tissue surrounding the injury increases, this raises the metabolic rate of the cells, causing the edges to appear hot (Marieb & Hoehn, 2014).

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2.3Discuss the physiological basis of the second observation.

Swelling in the tissue surrounding the injury occurred due to collection of fluid that may have oozed out from the capillaries. The fluid that is rich in proteinaceous matter collects in the spaces around the tissues and is known in medical terminology as edema. The swelling is usually associated with pain. Occurrence of pain discourages the patient from moving the affected area and this helps during the process of healing (Marieb & Hoehn, 2014).

2.4Discuss the physiological basis of the third observation.

The wound produces a purulent exudate that has a malodour. This is a sign that the wound is infected. The fever is another symptom that points at the infection. Although Staphylococcus aureus lives on the skin as part of normal skin flora, once it infects the wound, it derives nutrition from the subcutaneous tissue and becomes pathogenic. It can be treated with appropriate antibiotic therapy. An infected wound is painful and does not heal unless the infectious bacterium is eliminated (Lee, 2016)Health Breakdown Assignment Discussion Paper.

3.1How did Mary’s fever develop?

Mary’s fever developed due to the inflammatory response to the infected wound. The pathogenic bacteria release endotoxins that act as exogenous pyrogens and trigger the release of endogenous pyrogens from the inflamed tissue. The pyrogens include cytokines, tumor necrosis factor-α, interleukin-1, interleukin-6 and some interferons. The pyrogens elicit the release of  three important chemicals that trigger the febrile response. These are prostaglandin E2, endothelin I and the corticotrophin-releasing factor. The effect of these factors onthe preoptic area of the anterior hypothalamus that is involved in thermoregulation, causes fever.The body begins to heat, the peripheral vessels constrict and loss of heat is conserved. The core body temperature begins to rise beyond the normal temperature of 37oC and fever occurs (Craft, 2015).

3.2Discuss two ways in which fever is beneficial.

Fever occurs when the rectal temperature of the body is equal to or more than 380C. It has protective benefits because pathogens cannot multiply at higher body temperatures. Another benefit of fever is that it lowers the concentrations of minerals in the serum, such as copper, zinc and iron. These minerals are vital for multiplication of pathogens and so their rate of multiplication slows down (Marieb & Hoehn, 2014).

4.1Name one endogenous source of contamination and discuss the mode of transmission from the source to the new host.

Staphylococcus aureus is easily transmitted through the endogenous due to the reason that it is a part of normal skin flora and mucosal membranes of the oral, nasal and vaginal orifices. Its transmission to the site of injury can occur through contaminated hands of the patient or those of a care giver. Nasal carriage is often a frequent source of endogenous infection and nosocomial infections of surgical wounds in hospitals. It is estimated that more than 80% of Staphylococcus aureus infections are endogenous in origin (Van den Berg, de Vogel, van Belkum, & Bakker-Woudenberg, 2015).

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4.2Name one exogenous source of contamination and discuss the mode of transmission from the source to the new host.

An exogenous source of contamination of wound site and the mode of transmission from source to a new host in Mary’s case could be through hands of the persons who were involved in her healthcare. Although the wound was contaminated with soil, most soil bacteria cannot survive in the environment of a wound (Lee, 2016)Health Breakdown Assignment Discussion Paper. Maintaining good hand hygiene is an important step that can be taken to controlexogenous transmission of bacterial pathogens to wound sites.

5.1Given the colonizing organism was Staphylococcus aureus, discuss why Augmentin is an appropriate prescription?

According to the report of the culture test, Augmentin is the most appropriate prescription because the culture sensitivity test was also reported as being sensitive to the antibiotic Amoxycillin which is one of the two components of Augmentin. Besides, the treatment of an infected wound requires the administration of an oral antibiotic (Bullock & Manias, 2017).

5.2Describe the added benefits that Augmentin provides, with reference to the role of the major ingredients in Augmentin.

Augmentin is a combination of Amoxycillin and clavulenic acid. While Amoxycillin is a beta lactam antibiotic, clavulenic acid is a lactamase inhibitor. Staphylococcus aureus strains are known to be resistant to several antibiotics. The mode of action of Amoxycillin involves blocking of the formation of the peptidoglycan cell wall of bacteria. As a result the multiplication of bacteria is not possible in the presence of Amoxycillin. But the resistant bacteria are able to synthesize an enzyme called beta lactamase that breaks down the beta lactam ring and allows the synthesis of the peptidoglycan cell wall to occur even in the presence of Amoxycillin. Clavulenic acid inhibits the beta lactamase enzyme of the resistant bacteria so that they remain sensitive to the bactericidal action of Amoxycillin. Thus Augmentin is effective in killing pathogenic S. aureus even in cases where the bacteria are resistant to Amoxycillin (Bullock & Manias, 2017)Health Breakdown Assignment Discussion Paper.

6.1Referencing in-text and in reference list conforms to APA 6th Ed. referencing style.

6.2Critique supported by relevant literature as prescribed.

6.3Correct sentence structure, paragraph, grammatical construction, spelling, punctuation and presentation.

References

Bullock, S., & Manias, E. (2017). Fundamentals of pharmacology (8th ed.). Frenchs Forest, Australia: Pearson Australia.

Craft, J. &. (2015). Understanding pathophysiology (2nd Australian and New Zealand ed.). . Chatswood, Australia: Elsevier.

Immunise.health.gov.au. (2017, August 1). /Aus-Imm-Handbook.pdf. Retrieved from https://immunise.health.gov.au: https://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/7B28E87511E08905CA257D4D001DB1F8/$File/Aus-Imm-Handbook.pdf

Lee, G. &. (2016). Microbiology and infection control for health professionals (6th ed.). . Melbourne, Victoria : Pearson Australia.

Marieb, E., & Hoehn, K. (2014). Human Anatomy & Physiology, Global Edition. Pearson Education Limited.

Van den Berg, S., de Vogel, C. P., van Belkum, A., & Bakker-Woudenberg, I. A. (2015). Mild Staphylococcus aureus Skin Infection Improves the Course of Subsequent Endogenous S. aureus Bacteremia in Mice. PLoS ONE, , 10(6), e0129150. https://doi.org/10.1 Health Breakdown Assignment Discussion Paper