Unit 3 Case 1

Question 1

What is Unit 3 Case 1 about?

Answer 1

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.

Question 2

What is cellulitis?

Answer 2

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

Question 3

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

Answer 3

Neuroendocrine immune pathway

Sympathetic nervous system pathway

Question 4

What is the neuroendocrine-immune pathway to stress?

Answer 4

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.

Question 5

What is the sympathetic nervous system pathway to stress?

Answer 5

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

Question 6

What are typical ranges for arterial blood pressure?

Answer 6

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

Question 7

What is systolic pressure?

Answer 7

The pressure when your heart pushes blood out

Question 8

What is diastolic pressure?

Answer 8

The pressure when your heart rests between beats

Question 9

What are typical ranges for heart rate?

Answer 9

60-100 beats per minute

Question 10

What are typical ranges for arterial O2 saturation?

Answer 10

Above 96%

Question 11

What are the typical ranges for breathing rate?

Answer 11

12-18 breaths per minute

Question 12

What are the typical ranges for temperature?

Answer 12

36.5-37.2 degrees celsius (oral temperature)

Question 13

What is sepsis and how does it occur?

Answer 13

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

Question 14

What is the sepsis six?

Answer 14

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

Question 15

What is septic shock?

Answer 15

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

Question 16

What is in pus?

Answer 16

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

Question 17

By which tests are bacteria identified?

Answer 17

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

Question 18

What is meant by gram-positive or negative?

Answer 18

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

Question 19

What is meant by catalase-positive or negative?

Answer 19

Catalase is an enzyme which detoxifies H2O2 into H2O and 02

-the test identifies whether the bacteria can produce this enzyme

Question 20

How is the catalase test done?

Answer 20

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

Question 21

What is meant by coagulase-positive or negative?

Answer 21

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

Question 22

How is the coagulase test done?

Answer 22

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

Question 23

What is meant by mannitol positive or negative?

Answer 23

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

Question 24

How is the mannitol test done?

Answer 24

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

Question 25

What is the mechanism of action of co-amoxiclav?

Answer 25

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

Question 26

What is the mechanism of action of flucloxacillin?

Answer 26

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.

Question 27

What is the Glasgow coma scale?

Answer 27

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)

Question 28

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

Answer 28

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

Question 29

Why are oral antibiotics sometimes used over IV antibiotics?

Answer 29

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

Question 30

What does the sepsis six consist of?

Answer 30

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

Question 31

How would you track someone's improvement with sepsis?

Answer 31

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

Question 32

Are there any further complications with sepsis and kidney function?

Answer 32

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

Question 33

What is the recovery period of sepsis?

Answer 33

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

Question 34

What is post-sepsis syndrome?

Answer 34

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

Question 35

What is a zero-hours contract?

Answer 35

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

Question 36

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

Answer 36

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

Question 37

What are the major barriers to accessing health care?

Answer 37

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

Question 38

What are the 4 major barrier to health?

Answer 38

Economic stability Education Social and community context Environment