Pharmacological Questionings
These pharmacological inquiries focus on a 62-year-old patient whom I will refer to as Bob Smith. Bob was medevac’d to OHSU from his home in Grants Pass, Oregon. He has been a paraplegic since the age of 19 after a motor vehicle accident. His current diagnosis happened as a result of falling and being left for three days. He has extensive pressure ulcers that were infected and needed immediate surgery. Bob also has type 2 diabetes.
Bob has a current prescription list of 31 medications. After reviewing his chart, I have decided to focus on the role vitamins play in his wound healing, how Lovenox dosings vary based on his sex and age, and if Piperacillin/tazobactam is the preferred course of antibiotics. The questions I will be researching are as follows: (a) How are ascorbic acid supplements contributing to his wound healing? (b) Based on patient’s Vancomycin-Resistant Enterococci infection, is this patient on the correct course of antibiotics? and (c) What are the influences of gender on wound healing?
Research Findings
Vitamin C’s role in wound healing
Traditionally, vitamin C has been thought to be a cure for many ailments. In wound healing vitamin C helps to rebuild collagen. “Vitamin C is a co-factor in proline and lysine hydroxylation, a necessary step in the formation of collagen. Hydroxyproline and hydroxylysine are essential for stabilizing the triple helix structure of collagen with strong hydrogen bonds and crosslinks.” (Collins, 2009) Vitamin C gives tensile strength to this newly laid down collagen. This is crucial for pressure ulcer healing because then the regeneration of skin will not tear as easily.
However, more recent research challenges these assumptions. A randomized double-blin...
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...c effects on wound healing may lead to a pharmaceutical outcome of prescribing estrogen creams. “Topical and systemic estrogen treatments have been shown to increase the rate of acute healing in men, and particularly in elderly women, by reducing the inflammatory response.” (Gilliver et al., 2007, p. 56)
Conclusion
Based on my research findings an appropriate course of action for Mr. Smith would be to continue the piperacillin/tazobactam as an effective and non-bacteria resistant forming antibiotic. Further, Mr. Smith should also continue Vitamin C in conjunction with other supplements and protein to promote maximum wound healing. Based on Mr. Smith’s stagnant wound healing and the potential gain he could receive seeing as he is a male, an appropriate next step in pharmaceutical care would be to look into the potential benefits he might gain from topical estrogen.
The patient is a 30 year old male with an active bacterial infection on his right leg attacking his Integumentary system. The patient is from Tanzania, Africa but came back to work in a factory that produces plastic. If he has Cellulitis, it can get bad enough to travel to other organs like the Liver and Kidney and cause failure. If this happens, Edema can form, usually on one half of the body; this is the Urinary system being attacked. The main system being attacked is the Lymphatic system because Cellulitis attacks the lymphatic draining system. For Cellulitis to travel to organs, it had to go through the blood, so the cardiovascular system is also in effect.
When a patient is seen in the ED for a wound, the doctor generally starts the patient on antibiotics before the results of the wound cultures are in. Once these results are in, the PVRN is responsible for making sure the antibiotic is appropriate to treat the patient. If it is not, the PVRN must contact the patient’s primary care physician who is then responsible for making sure the patient is put on the correct antibiotics. Unfortunately, there are some primary care providers who refuse to do this because they were not the ones that ordered the test. The PVRN must then explain to the primary care physician that they are responsible for the patient’s overall health and should be the ones to address the issue. The PVRN must also explain that it is often not possible for the doctor who ordered the test to follow up with the patient due to the differing schedules of the ED doctors. This means that if the PVRN were to get the new orders from an ED doctor, it would likely be one that has never seen the patient. Therefore, in order to ensure the best quality of care for the patient, the primary physician should arrange the treatment. If the primary care physician still refuses to take action, then the PVRN must inform the ED Medical Director of the situation so that it can be
Wounds is a broad term that includes many other types. It is very important to know the proper and scientific method to care for wounds as well as knowing the types of them. Moreover, nurses must familiar with each type of wound, risk factors, prevention, and treatment. However, wounds may have a different range in skin breaks such as trauma, injury, cut, incision, and laceration. Skin prevention is the first step of preventing any break to occur in the skin. The various types of wounds, method of treatment and healing are mainly depending on their conditions. This assignment will include chronic wounds, which are diabetic ulcer, venous ulcer, and pressure ulcers.
Mr Smith is a former truck driver who is a 63 year old male, for the last 20 years he has been taking medication for both hypertension and diabetes however his administration has not been consistent.
Jimmy Jones is a 56-year-old patient who is admitted to your unit with a s/p abdominal surgery. In assessing his pain level, Mr. Jones complains a 6 out of 10 pain. When the nurse looks into the physician’s order, there are several pain medications to choose from in the patient’s medical administration record (MAR). The pain medications that are ordered are listed as follows:
Williams, L. Leaper, D. “Nutrition and Wound healing”, 2006, Clinical Nutrition Update, vol. 5, no.1, pp.3-5.
Due to the fact that people with chronic wounds are generally seen on a weekly basis in a clinic, the
Vitamin E oil is effective and should be used to rub the skin. This reduces the irritation and also heals the skin. The marks and scars fade away by using the oil.
African American man named K.O. came to the clinic for a head to toe assessment. Patient has no present illness and has seasonal allergies to grass pollen and lactose intolerance. Patient states that they had all childhood immunization. Patient stated in 1999 he had surgery n his right ankle at NYU hospital. Patient states that their health is okay and denies fever, weakness, weight loss and weight gain. Patient current medication regimen is an occasional over the counter ibuprofen (Advil) for headache. Reports smoking marijuana at least 2-5 times weekly. Reports that he has been smoking for more than 16 years and currently smoke one and a half a pack of cigarette a day. Family medical history of hypertension, drug and alcohol dependency on mother's side and father died of end stage renal failure (ESRF). Review of systems patient states he has occasional migraines.
Patient comes in with a complaint of chronic right lower extremity pain due to a surgery that he had back in 2011. He apparently does have hardware in the proximal tibial area and apparently, this has been chronically infected. He is supposed to have this hardware removed by his orthopedic surgeon but he got incarcerated prior to having that done. He is also following with infectious disease. He states he has had an infection in there for at least 2-3 years and currently is on Bactrim suppression therapy. He also has some acne on his face that he would like to try Cleocin for which has worked well in the past. Otherwise, his pain has been his biggest issue. He understands that we cannot prescribe narcotics but he states that
The ability to become reflective in practice has become a necessary skill for health professionals. This is to ensure that health professionals are continuing with their daily learning and improving their practice. Reflective practice plays a big part in healthcare today and is becoming increasingly noticed.
Beyond the need for knowledge of dressings, the nurse must have the knowledge of types of wounds, and factors affecting healing. Wounds needing to be addressed may be acute, or chronic (existing for more than twelve weeks) (Casey, 2012). The wounds will need to advance through all four stages of healing: inflammation, proliferation, re-epithelialization, and maturation (Casey, 2012). In order for a wound to heal, it must be kept open, healing from the inside out.
...l and cod liver oil that is effective for all kinds of wounds and abrasion.
...s expressed by most treating physicians if best treatment is not possible. Most of those wound are sadly sent to a community nurse for dressing change without the patient coming back to the treating physician for assessment of "maintenance wound" treatment.
Vitamin C also known as ascorbic acid is needed for growth and maintenance of healthy tissues, especially skin, blood vessels, bones, gums, teeth. Vitamin C aids in resistance against infection and healing of wounds. It also helps the body absorb iron from food. Vitamin C can be found in green vegetables, potatoes, tomatoes and citrus fruits such as oranges and lemon. A lack of vitamin C can cause scurvy, iron deficiency and poor wound healing. A healthy diet should include a high amount of vitamin C because the human body cannot produce its own vitamin C.