Question

A client is diagnosed with a wound infection which is quite painful. Which of the following is true? a. An antibiotic should be started immediately. The client can return for a wound culture when the wound is less painful. b. Antibiotic therapy will be withheld until the culture and sensitivity report is available. c. A wound culture is obtained first, after which a broad spectrum antibiotic is started. d. The culture report will identify the correct antibiotic to use to treat the infection.

Short answer

The correct answer is c. A wound culture is obtained first, after which a broad-spectrum antibiotic is started.

Step-by-step solution

Identify the Best Immediate Action

When a client has a wound infection that is painful, the priority is to address the infection and pain promptly. Immediate initiation of a broad-spectrum antibiotic is often done empirically while waiting for culture results, which tailor the antibiotic therapy later on.

Understand the Role of Wound Culture

A wound culture is essential for identifying the specific causative organisms of the infection. This allows healthcare providers to adjust antibiotic therapy based on sensitivity reports to ensure the most effective treatment.

Recognize the Sequence of Events

Given the situation, the most effective sequence of care would start with obtaining a wound culture followed by starting empirical antibiotic therapy while awaiting results. Option c accurately describes this process.

Evaluate Incorrect Options

Options a and b are not ideal practices as they either delay necessary care or initiate antibiotics without proper investigation of the infective organism. Option d is a statement of fact and not an immediate action.

Key concepts

Wound Culture Procedure

When dealing with a wound infection, it's critical to quickly identify the cause to determine the appropriate treatment. The wound culture procedure plays an essential role in this process. By taking a sample of the tissue or discharge from the wound, healthcare providers can grow the bacteria in a lab to identify the specific pathogens responsible for the infection.

The procedure starts with cleaning the skin around the wound to prevent contamination of the sample by skin flora. A sterile swab is then used to collect the specimen from the area of the wound that appears to be most infected. Sometimes, a syringe may be necessary to aspirate fluid from deeper infections. It’s crucial to carefully label the specimen and promptly send it to the laboratory for culturing.

Key Steps in Wound Culture:

• Prepare and sterilize the wound area.
• Collect the specimen with a sterile swab or syringe.
• Label and transport the specimen properly to the lab.

These actions help ensure an accurate diagnosis and are the first critical steps in infection management on the NCLEX-RN.

Empirical Antibiotic Therapy

Until the culture and sensitivity report is available, a patient with a wound infection is often started on empirical antibiotic therapy. This means the selection of an antibiotic is made based on the clinician's educated guess as to which bacteria might be causing the infection, considering factors like the type of wound, patient history, and local resistance patterns.

Empirical therapy typically involves broad-spectrum antibiotics that are effective against a wide range of bacteria. The goal is to start treatment immediately to control the infection and to prevent it from spreading or becoming more severe. Once the lab results are in, the therapy may be adjusted to target the specific bacteria present, ensuring a more effective and targeted approach.

Benefits of Empirical Therapy:

• Quick initiation of treatment.
• Prevents infection progression.
• May be refined later for targeted treatment based on culture results.

The NCLEX-RN ensures nurses understand the rationale and timing for empirical therapy, a crucial component of early wound infection management.

Culture and Sensitivity Report

The culture and sensitivity report is the result of the laboratory testing of the wound culture. This report not only confirms the presence of infectious agents but also indicates which antibiotics are effective against them, guiding healthcare professionals in selecting the most appropriate antibiotic therapy.

Once available, this report allows for the refinement of antibiotic treatment, which can then be tailored to target the specific bacteria discovered. This is crucial for ensuring that the patient receives the most effective antibiotic while also minimizing the risk of antibiotic resistance.

Key Components of the Report:

• Identification of infectious organism(s).
• List of antibiotics the organism is sensitive to.
• List of antibiotics the organism is resistant to.

The NCLEX-RN includes questions on interpreting these reports to ensure that future nurses can make informed decisions about antibiotic therapy, a vital aspect of patient care for those with wound infections.