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PBL > Unit 3 Case 1 > Flashcards

Unit 3 Case 1 Flashcards

1
Q

What is Unit 3 Case 1 about?

A

Mark works as a warehouse assistant on a zero-hour contract. He cuts himself at work and the wound becomes infected with Staphylococcus aureus leading to him developing cellulitis. The infection then worsens and he develops sepsis.

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2
Q

What is cellulitis?

A

Cellulitis is an infection caused by bacteria getting into the deeper layers of the skin, e.g the dermis
-this results in inflammation of the affected area

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3
Q

What are the 2 pathways in the physiological response to stress?

A

Neuroendocrine immune pathway

Sympathetic nervous system pathway

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4
Q

What is the neuroendocrine-immune pathway to stress?

A

Stressor activates the release of CRH from the hypothalamus. This causes the synthesis and release of ACTH from the pituitary gland. Activates the release of cortisol from the adrenal glands. Cortisol acts as an anti-inflammatory, decreasing the immune system activity.

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5
Q

What is the sympathetic nervous system pathway to stress?

A

Stressor activates the hypothalamus, which activates the autonomic nervous system (ANS) and then the sympathetic nervous system (SNS). This activates the adrenal glands which secrete adrenaline and noradrenaline- increases blood pressure

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6
Q

What are typical ranges for arterial blood pressure?

A

Systolic : 90-120 mmHg
Diastolic: 60-80 mmHg
-usually given as systolic/diastolic e.g 120/70 mmHg

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7
Q

What is systolic pressure?

A

The pressure when your heart pushes blood out

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8
Q

What is diastolic pressure?

A

The pressure when your heart rests between beats

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9
Q

What are typical ranges for heart rate?

A

60-100 beats per minute

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10
Q

What are typical ranges for arterial O2 saturation?

A

Above 96%

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11
Q

What are the typical ranges for breathing rate?

A

12-18 breaths per minute

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12
Q

What are the typical ranges for temperature?

A

36.5-37.2 degrees celsius (oral temperature)

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13
Q

What is sepsis and how does it occur?

A

Sepsis occurs when there is a failure of host defence mechanisms to contain an infectious agent. Which can lead to the infection becoming systemic, which results in systemic inflammatory response syndrome (SIRS). Also known as sepsis

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14
Q

What is the sepsis six?

A

The sepsis six is the name given a bundle of medical therapies deigned to reduce mortality in patients with sepsis

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15
Q

What is septic shock?

A

Septic shock is a life-threatening condition that happens when your blood pressure drops to a dangerously low level after an infection

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16
Q

What is in pus?

A

Pus is a mixture of dead leukocytes, pathogen cells, tissue debris and tissue fluid

17
Q

By which tests are bacteria identified?

A

Gram-positive or negative
Catalase positive or negative
Coagulase positive or negative
Mannitol positive or negative

18
Q

What is meant by gram-positive or negative?

A

Different types of bacteria cell wall

-Gram-positive consist of an inner membrane and a thick peptidoglycan layer, which is identified on a gram stain

19
Q

What is meant by catalase-positive or negative?

A

Catalase is an enzyme which detoxifies H2O2 into H2O and 02

-the test identifies whether the bacteria can produce this enzyme

20
Q

How is the catalase test done?

A

H202 is added to a sample of the bacteria- bubbles indicate catalase-positive (e.g staphylococcus)

21
Q

What is meant by coagulase-positive or negative?

A

Coagulase is an enzyme that converts fibrinogen into insoluble fibrin
-the test identifies whether the bacteria can produce this enzyme

22
Q

How is the coagulase test done?

A

The sample is mixed with plasma- coagulase-positive bacteria show agglutination when mixed

23
Q

What is meant by mannitol positive or negative?

A

Bacteria are grown on mannitol salt agar (MSA) containing mannitol and a pH indicator
-the test identifies whether the bacteria can metabolise mannitol

24
Q

How is the mannitol test done?

A

The sample of bacteria is grown in mannitol salt agar (MSA), containing mannitol and a pH indicator.
- If the bacteria can metabolise mannitol it produces acidic products, which cause a colour change in the pH indicator

25
Q

What is the mechanism of action of co-amoxiclav?

A

A combination therapy containing amoxicillin and clavulanic acid. This is a broad-spectrum beta-lactam antibiotic which inhibits transpeptidase enzymes and hence inhibiting cell wall formation. It does this by being a structural analogue of its substrate D-Ala-D-Ala and irreversibly binds and blocks the active site. The clavulanic acid prevents the bacteria from breaking down the amoxicillin

26
Q

What is the mechanism of action of flucloxacillin?

A

Flucloxacillin is a penicillin beta-lactam antibiotic. It binds to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall, inhibiting the third and last stage of bacterial cell wall synthesis, leading the cell lysis.

27
Q

What is the Glasgow coma scale?

A

The Glasgow coma scale is a neurological scale which aims to give a reliable and objective way of recording the state of a person’s consciousness.
-scored on eye-opening, verbal, and motor responses, the total of them scores determines the consciousness of the patient (scaled from 3 to 15)

28
Q

Why are IV antibiotics better than oral antibiotics in some situations?

A

IV antibiotics are used in more severe and life-threatening situations, as they allow a high concentration of antibiotic at the infection site and enter the site faster. Used if the patient cant absorb oral antibiotics e.g vomiting

29
Q

Why are oral antibiotics sometimes used over IV antibiotics?

A

As soon as possible it is recommended to switch to oral antibiotics from IV. This is to avoid possible complications such as cannula infection, as well as lowering cost and increase the possibility for earlier discharge from hospital

30
Q

What does the sepsis six consist of?

A
  1. Give O2 to bring the saturation above 94%
  2. Administer IV fluids up to 20mL/kg
  3. Give IV antibiotics
  4. Take blood cultures
  5. Measure lactate and white cell count
  6. Monitor urine output, commence fluid balance chart
31
Q

How would you track someone’s improvement with sepsis?

A

Repeat vital sign measurements, if they normalise and remain normal then he is improving

32
Q

Are there any further complications with sepsis and kidney function?

A

It is estimated 65% of patients with septic shock develop AKI. Septic acute kidney injury (AKI) is a syndrome of acute loss of renal function, which the cause is not fully understood

33
Q

What is the recovery period of sepsis?

A

It depends on the severity of any further complications, but most people recover in a matter of days. However, sometimes there are long term effects, such as post-sepsis syndrome, which can take months to fully recover

34
Q

What is post-sepsis syndrome?

A

Post sepsis syndrome is a condition that affects up to 50% of sepsis survivors. They are left with physical and/or psychological long term effects such as insomnia, nightmares, hallucinations, panic attacks, joint pain

35
Q

What is a zero-hours contract?

A

A contract with no fixed work hours, this is normally used for short term or on-call people.

36
Q

How does the health belief model affect Mark in this case?

A

Perceived severity is low- mark believes that the wound will heal on its own and the pain is bearable.
Perceived barriers are high- he can’t go to his GP appointment due to work-related barriers.
-This makes him less likely to seek help

37
Q

What are the major barriers to accessing health care?

A
  1. Physical barriers- accessibility
  2. Psychological barriers- fear of dentists, hospitals
  3. Financial barriers- paying for transport or prescriptions
  4. Geographical barriers- living far away from health care or with poor transport links
  5. Culteral and language barriers
  6. Resource barriers- some trusts don’t have money/staff for all services to be available
38
Q

What are the 4 major barrier to health?

A

Economic stability
Education
Social and community context
Environment

PBL (12 decks)

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