NRSG258 Acute Care Nursing


Case Study

Mary, 21 years old, presented to the hospital emergency department with an infected laceration on her left foot. Mary was at a beach resort four days ago, when she trod on a broken glass bottle and sustained a deep 2 cm long jagged laceration over the lateral aspect of her left foot. She used her handkerchief to bandage the wound. This morning the wound was extremely painful, swollen and had a purulent discharge.

On inspection of the wound the following wound observations were made:

  • Painful and swollen,
  • – Red and warm when touched,
  • – Purulent discharge.

A wound swab was taken for culture and sensitivity. A stat dose of ceftriaxone 1g was administered IVI immediately (she did not require a booster tetanus injection as she had already received one three months ago).

She was then commenced on oral cephalexin 500mg to be taken every 6 hours before being sent home.

Answer the following questions:

1.Describe the physiological basis for the appearance of Mary’s wound.
2.Explain TWO (one endogenous and one exogenous) likely sources for the contamination of the wound and the mode of transmission of the microorganism from each source.

Culture and sensitivity test confirmed the microorganism infecting the wound to be Staphylococcus aureus. The drug cephalexin was discontinued and replaced with oral dicloxacillin 500 mg every 6 hours.

3.Explain the rationale for the initial choice of antibiotics, and the subsequent change in antibiotic therapy to dicloxacillin.Discuss the mode of action of this antibiotic, and state any TWO of its common adverse reactions 
4.Describe the process by which Mary’s wound will heal.
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