Case study 1 Adi: Adi is a 22 year old woman who was on holiday camping when she noticed a blister on her right ankle. She covered it with waterproof plaster so that she was able to swim in the lake. Over a two day period the blister became increasingly reddened and swollen. After becoming increasingly unwell Adi presents at the emergency department distressed, pale, shivering and clammy. Lo1
1: discuss the clinical reasoning for white blood cell count. White blood cells play an important role in the body’s defence system against infections. As a result, completing a white blood cell count for Adi will provide a good indication of the presence of infection. There are five types of white blood cells; neutrophils, basophils, lymphocytes, monocytes, and eosinophils. In particular, high white blood cell count known as leukocytosis is an indicator for infection (most commonly bacterial/viral). Although WBC count cannot determine the exact underlying cause, it can help diagnose infection or the inflammatory process. 2: what are the risks of Adi’s current health issues and the complications for them with rational.
3. Explain how Adi’s injury has led to her current status
Based on Adi’s presenting symptoms, the most probable explanation of her current status is sepsis. This process occurs after the entry of an organism in the bloodstream through the skin or the respiratory, genitourinary or GI tract. Organisms include bacteria, yeast, viruses and/or parasites. In Adi’s case, she had a blister on her right ankle which although she had covered with a waterproof plaster, had swum in a nearby lake and the wound had later then become infected. We can assume that some kind of bacteria from the lake had been exposed to the wound site and thus entered Adi’s bloodstream, triggering the infection and thus sepsis. Sepsis, is a complex syndrome characterised by simultaneous activation of the inflammatory response and coagulation in response to microbial insult in the body system. Although the body should naturally produce a non-specific defensive response to inflammation, sepsis produces an exaggerated, excessive inflammatory response throughout the body. A variety of mediators such as histamine, cytokines, and prostaglandins are released into the circulation. This causes widespread vasodilation causing blood pressure to plummet. Capillaries become more permeable, allowing fluid to leak out into interstitial spaces producing hypovolaemia (further lowering blood pressure). This reduced blood flow causes the pale and clammy appearance.
4. What nursing interventions would you provide for Adi’s current status - administer appropriate medications such as a broad spectrum antibiotic within one hour of diagnosis to treat cause of the sepsis which is wound infection. Non-steroidal inflammatory medicine may also be helpful in decreasing swelling and pain or fever. - clean and dress the wound to minimise infection and assist in wound healing. Complete a wound assessment to observe any wound exudate, wound depth etc. and at the same time complete a wound culture swab to determine what bacteria/organism Adi is dealing with. This will determine a specific antibiotic to treat the infection. - Fluid replacement via administration of IV fluids— to reduce hypotension and prevent dehydration. - Complete a blood test to determine extent of sepsis. For example, during sepsis, the coagulation system also becomes activated and small blood clots (microthrombi) form in small blood vessels. These interfere with blood flow to the tissues and organs, and in combination with hypotension and hypovolaemia, can lead to organ failure. 5. Give the rational for the appropriate interventions
* Treating the underlying cause
* Fluids and antibiotics – Volume resuscitation
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