Necrotizing Fasciitis

Question 1

what is necrotizing fasciitis?

Answer 1

progressive, rapidly spreading inflammatory infection of the skin, subQ tissue, deep fascia, and muscle

Question 2

does necrotizing fasciitis have a high mortality rate?

Answer 2

yes (80%)

Question 3

what is type 1 necrotizing fasciitis

Answer 3

mixed infection involving aerobic and anaerobic bacteria

usually occurs after trauma or surgery

Question 4

what is type 2 necrotizing fasciitis

Answer 4

single infection due to group A beta-hemolytic streptococci

mostly commonly called a flesh eating bacteria

usually enters the body by a minor cut or scrape

Question 5

necrotizing fasciitis pathophysiology

Answer 5

-infecting bacteria enters host through local tissue injury or mucous membrane barrier
-organisms proliferate in an environment of tissue hypoxia
-superficial nerves are destroyed resulting in necrosis of surrounding tissue
-fascia and fat are destroyed
-bacteria spreads through tissue & enters bloodstream
-leads to shock, causing vital organs to shut down, potentially leading to coma or death

Question 6

what is the most problematic thing about necrotizing fasciitis?

Answer 6

presents like other infections so its hard to treat and diagnose early

Question 7

necrotizing fasciitis risk factors

Answer 7

-trauma
-skin breach
-mucosal breach
-recent surgery
-advanced age
-obesity
-malnutrition
-DM
-immunosuppression
-PVD
-alcoholism
-malignancy
-CKD
-liver disease
-IV drug use (b/c it breaks the skin)
-smoking

Question 8

average age necrotizing fasciitis occurs

Answer 8

38-44

Question 9

what sex does necrotizing fasciitis affect more?

Answer 9

male

Question 10

necrotizing fasciitis complications

Answer 10

-kidney failure
-septic shock
-scarring and cosmetic deformities
-myositis
-myonecrosis
-amputation
-vision loss
-often have anuria

Question 11

necrotizing fasciitis assessment - history

Answer 11

-associated risk factors
-pain
-tissue injury
-malaise
-anorexia (N/V/D)
-initial flulike symptoms, such as chills and malaise

Question 12

necrotizing fasciitis assessment - physical findings

Answer 12

-rapid progressive erythema at the site of insult, progressing to a dusky purple color
-bullae with clear, hemorrhagic, or foul smelling drainage
-large areas or gangrenous skin (5-7 days)
-crepitus in the area
-“woody” feel on palpation
-extensive necrosis of the SQ tissue
-fever
-sepsis
-hypovolemia
-hypotension
-diaphoresis
-respiratory insufficeincy
-deterioration level of consciousness

Question 13

necrotizing fasciitis lab tests/results

Answer 13

-CBC may reveal leukocytosis or anemia
-BUN & creatinine might be elevated
-decreased sodium level
-elevated LFTs
-c-reative protein, glucose, creatinine kinase might be elevated
-tissue biopsy shows level of infiltration

Question 14

what will imaging of necrotizing fasciitis show you?

Answer 14

shows SQ gas and necrosis

Question 15

finger test

Answer 15

slit area of wound & put finger in it

if it’s not bleeding, there’s no resistance, & grey fluid that means NF

Question 16

necrotizing fasciitis general treatment

Answer 16

-wound care consultation
-VTE prophylaxis

Question 17

necrotizing fasciitis diet

Answer 17

-high protein, high calorie diet
-increased fluid intake

Question 18

necrotizing fasciitis activity

Answer 18

-bed rest until treatment is effective
-progressive mobilization

Question 19

necrotizing fasciitis medications

Answer 19

-broad-spectrum antimicrobials
-immune globulin IV
-tetanus prophylaxis
-analgesics
-IV fluid and electrolyte replacement
-O2

Question 20

necrotizing fasciitis procedures

Answer 20

-negative pressure wound therapy
-hyperbaric O2 therapy

Question 21

necrotizing fasciitis surgery

Answer 21

debridement, fasciestomy & amputation

Question 22

most common areas for necrotizing fasciitis?

Answer 22

lower extremities

Question 23

necrotizing fasciitis nursing interventions

Answer 23

-IV access
-administer prescribed meds
-assess heart & lung sounds, incentive spirometer, cough, & deep breathing
-hemodynamic monitoring
-apply antiembolism stockings or sequential compression stockings
-obtain lab specimens
-administer prescribed IV fluid and electrolyte therapy
-assess pain & treat
-evaluate treatment response
-avoid ice-packs
-evaluate affected area
-inspect wound for color, size, appearance & changes
-perform wound care
-administer supplemental O2
-provide supportive care
-turn & reposition
-educate, support & prepare patient for interventions
-skin care

Question 24

monitoring

Answer 24

-signs and symptoms of complications
-VS
-mental and psychological status
-wound status
-pain level and effectiveness of interventions
-cardiac status
-fluid and electrolyte balance
-peripheral tissue perfusion
-hemodynamic status