Septic Superficial Incision Post CABG

Septic Superficial Incision Post CABG

Introduction

Coronary artery bypass graft CABG is a type of surgery done to people suffering from coronary heart disease. It is done when there is a buildup of cholesterol and fats in the coronary artery, which supplies oxygen-rich blood to the heart. In grafting, a healthy vein bypasses the affected artery to improve blood flow to the heart. Often, purulent discharge post CABG indicates sternal wound sepsis, which complicates cardiac surgeries. Patients undergoing different forms of operations and, more so, cardiac sternotomy risks acquiring infections in the sternal wounds. The SSI is eradicated with the use of appropriate antibiotics combined with proper wound care. The paper will analyze wound infections post CABG responsible for purulent discharge and the importance of an interdisciplinary approach in enhancing care while improving patients’ outcomes.

Pathophysiology and Tests

Often, following CABG surgery, the incision site may take time to heal, which leads to the development of infections. Wound infections range from superficial to the invasion of mediastinitis that overruns the heart, sternum, and the great vessels (Abdou et al., 2018). Sternal infections contribute to the high disease burden post-surgery and remain to be the leading cause of mortality rates across the globe. As such, various tests carried out on the patient help care providers to determine the reasons for the delayed wound healing process.

Blood cultures persist in being the most significant diagnostic tests for sternal wound infections following anastomosis. The diagnostic tests that a health care provider expects to see include positive cultures. Which gives the diagnosis, and often, the pathogens involved consist of staphylococcus, Enterococcus species, among others. Blood cells count aids in the assessments of the markers of infections such as leukocytosis, fever, C-reactive protein (Sharif et al., 2019). Also, blood counts aids in assessing risks of blood diseases such as anemia or leukocytosis, checking on the patient metabolic rate. The patient nutrition should also be monitored to determine the levels of protein serum in the blood and the albumin content. Similarly, for the case, the patient should undergo other tests such as coagulation to assess coagulation patterns. Swabs done on the abscess or wound on the surgical site provides a sample for gram stains and wound culture that aids in the identification of the causative agent.  Diagnosis based on radiological and findings from the laboratory, together with the signs and symptoms, should be carried out following a specific criterion. Tests related to microbiology often, cultures performed to determine the clinical diagnosis.

Implications for Self-care

In essence, following CABG surgery, patients require to manage aspects of their self-care. Often, self-care tasks seem difficult for the individuals in the homes and hospital settings owing to the disease. It is because the surgery limits the physical functionality of most patients as they have to maintain a period of bed rest to haste recovery. Therefore, the nurse ought to initiate drainage training incorporated with counseling services to aid in the development of self-care for the patients. Besides, individuals who develop purulent discharge possess a lower mean score of self-care to healthy individuals. Thus, the administration of antibiotics to be administered, appropriate wound care, and hygienic practices ought to be maintained to reduce the rate of infections and hence improve the patients’ self-care outcomes. Besides, CABG wounds with purulent drainage produce serous or sanguineous in differing amounts. Wound infections result from poor hygienic practices and a lack of knowledge by the patients. Therefore, nurses ought to assess the wound conditions and utilize appropriate formulation in cleaning the wounds. It is essential as it aids in reducing the discomforts associated with purulent discharge in the patient.

Maslow’s hierarchy of needs states the five levels of needs that comprise deficiency and growth needs. The safety, love, and belonging, esteem needs often refers to the deficiency needs while self-actualization; the top level is the growth needs. Deficiency needs results from deprivation that motivates individuals to their unmet needs. As such, during sick periods, patients’ motivation to fulfill their esteem needs, that is, the need for self-care strengthens. Similarly, for individuals to have a sound mind, they should maintain psychological self-care and physical care. Physical self-care, i.e., wound care for patients following CABG surgery, remains of great importance as it facilitates quick recovery for the patients (Karimi-Dehkordi, 2017). Also, balanced diets, taking enough rest, and the avoidance of straining

activities remain beneficial.

Dorothea Orem describes the nursing systems based on the patients’ abilities to undertake the care of themselves. As for the case, a supportive educative nursing system applies, which entails the delivery of a favorable level of care. It applies in situations whereby patients need assistance in the performance of self-care activities. For the case, the role of the nurse entails offering education to sustain the patient’s self-care abilities.

Patient Education

Education interventions persist in being the most effective in promoting recovery for the patient. A series of patient education and strategies aid in reinforcing health information (Jones & Villavaso, 2017). For the patient, he should be enlightened on surgical site infection that contributed to the purulent discharge. Improved health understanding for the patient will aid the patient make better choices that help in reducing contamination. Notably, lack of information on wound care, among other factors, leads to the infection. As per the effects of the disease on self-care, the patient should be offered education on the drainage of the discharge that aids in countering epidemic. Similarly, patient education on the importance of drug adherence aids in improved health outcomes

Interdisciplinary Collaboration

Health care providers work in collaboration to ensure that the needs of the patients come before others. Health providers hold a significant impact on the patient’s outcomes, and their support remains beneficial in preventing and countering surgical site infections. The active participatory role of different caregivers, including nurses, surgeons, doctors, anesthetists during the surgical process, influences patient’s commitment to preventing further SSI and promoting recovery through adherence to the prescribed drugs (Jones & Villavaso, 2017). Often, lack of engagement and appropriate communication results in misinformation that is likely to worsen the patient’s condition. Therefore, health care providers ought to avail of an environment where patients are educated and practice surgical wound care for better health outcomes. Ultimately, empowering patients pre and post-surgery facilitates knowledge on the importance of safe practices necessary to promote health while preventing SSI.

Conclusion

Surgical site infections are among the most causes of hospital readmissions for different individuals’ post-surgery. As with the 58-year-old electrician, the purulent discharge indicates surgical site infection. The diagnosis for the disease necessitates various blood tests and other laboratory findings. Surgical site infections reduce individuals’ self-care performance. Therefore, nurses ought to collaborate with other practitioners in coming up with suitable strategies and patient education to help in managing the condition.

References

Abdou, E., Westercamp, M., Girgis, S., Sabry, M., Sayyouh, O., & Talaat, M. (2018). Sternal surgical site infection in Egypt following coronary artery bypass graft surgery: incidence and risk factors. Journal of Hospital Infection, 100(4), 456-458.

Sharif, M., Wong, C. H. M., & Harky, A. (2019). Sternal wound infections, risk factors and management–How far are we? A literature review. Heart, Lung and Circulation.

Jones, N. J., & Villavaso, C. D. (2017). An interprofessional team approach to decreasing surgical site infection after coronary artery bypass graft surgery. Critical Care Nursing Clinics, 29(1), 1-13.

Karimi-Dehkordi, M. (2017). The Influence of Heart Failure Patients’ Values on Self-Care Decision-Making.