RESUMO
Patients with orthopaedic infections may require admission to the intensive care unit (ICU). Necrotizing fasciitis and clostridial myonecrosis (gas gangrene) are serious soft tissue infections that may cause life-threatening complications. Patients suffering from infectious arthritis, osteomyelitis, or prosthetic joint infections may be seen in the ICU as a result of a previous injury, surgery, or delayed infectious processes. This article introduces the ICU nurse to the pathophysiology, clinical presentation, and management of a variety of orthopaedic infections.
Assuntos
Cuidados Críticos/métodos , Fasciite Necrosante/enfermagem , Gangrena Gasosa/enfermagem , Enfermagem Ortopédica/métodos , Osteomielite/enfermagem , Humanos , Controle de Infecções/métodosRESUMO
Gas gangrene is a rare, serious infection. Untreated, it can rapidly be fatal. Accurate nursing assessments and timely interventions are needed to prevent loss of limb and potential loss of life.
Assuntos
Criança Hospitalizada/psicologia , Gangrena Gasosa/enfermagem , Adaptação Psicológica , Adolescente , Criança , Terapia Combinada , Gangrena Gasosa/terapia , Humanos , Masculino , Avaliação em EnfermagemRESUMO
Anaerobic necrotizing soft tissue infections are known for their devastating effects of tissue destruction and death. These infections may occur as a result of trauma, surgical intervention or occur spontaneously in predisposed individuals. They are caused by a wide range of anaerobic organisms and may be categorised according to the tissue involvement as Necrotizing Fasciitis and Myonecrosis. A five year review of patients admitted for hyperbaric oxygen (HBO) therapy and requiring intensive care revealed a patient group numbering 25, roughly equally divided between the two classifications of tissue involvement. Trauma was an aetiological factor in 5 of these cases. Cancer and diabetes mellitus were also prominent aetiological factors. Treatment consisted of the triad of early selective/aggressive surgery, high dose antibiotic therapy and HBO therapy. The mortality of the group was 25%. Delay in treatment was associated with increased mortality. Nursing care, for this particular patient group is demanding, requiring particular attention to wound care, analgesia, transport, psychosocial care of patient with mutilating wounds, nutrition and temperature homeostasis. It is a cause for concern that two cases occurred after elective orthopaedic procedures requiring the application of plaster of paris (POP) cast over a leg.
Assuntos
Fasciite , Gangrena Gasosa , Adolescente , Adulto , Idoso , Criança , Fasciite/epidemiologia , Fasciite/enfermagem , Fasciite/terapia , Feminino , Gangrena Gasosa/epidemiologia , Gangrena Gasosa/enfermagem , Gangrena Gasosa/terapia , Mortalidade Hospitalar , Humanos , Oxigenoterapia Hiperbárica , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Necrose , New South Wales/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Clostridia are organisms which, in the right environment, can cause a rapidly spreading, fulminant myonecrosis. Early diagnosis and a combined management program are clearly paramount to a successful outcome. Knowledge of this disease and ongoing meticulous assessment are the tools that a nurse must use when dealing with patients who have gas gangrene or are at high risk of developing it. In the face of radical disfigurements that may follow therapeutic measures, the potential transfer to a distant center for treatment, and a deteriorating prognosis, the nurse must remain alert to patient and family psychologic needs.