Necrotizing Fasciitis (NF): Causes and Treatment

Necrotizing Fasciitis (NF) Causes and TreatmentAbstractNecrotizing Fasciitis (NF) is a r argon but unrelenting type of bacteriuml transmittance that affects the soft wind and fascia. Be work of how speedily the infection spreads it has a high mortality rate and the separate to a fortunate reco really is early diagnosis and turn toment. Since the discovery of this unsoundness, little progress has been make to decrease the mortality rate, further emphasizing the importance of health fretfulness providers power to detect and treat the infection early so that the patient go out have a fighting chance. This article pass on discuss the history, pathophisiology, clinical manifestations, diagnostics and treatments, and interventions as it relates to the Nurse practitioners role in caring for a patient with NF.History and BackgroundNecrotizing Fasciitis (NF) is a rare but quickly progressing inflammatory infection that results in the extensive destruction of soft create from raw s tuff and fascia. In the earlier stages of the infection muscle and skin are non touch (Ruth-Sahd Gonzalez, 2006). NF involves the superficial fascia, subcutaneous fat (which has nerves and vascular structures) and mystic fascia (Green, Dafoe, Raffin, 1996). Thrombosis of the microvasculature continues but on that point is an absence of myo sphacelus (Giuliano, Lewis, Hadsley, Blaisdel, 1977). NF was first described as a complication of erysipelas by Hippoc judge in the 5th century B.C. (Descamps, Ai consequently, Lee, 1994). During the obliging war confederate army surgeon Joseph Jones described it as infirmary rot in which 46% of the 2,642 soldiers who were septic died from NF complications. The cause of the disease was determine as a bacteriuml infection in 1915. It wasnt until 1952 that the soft meander infection was named necrotic Fasciitis by Wilson (Wilson, 1952). Cases of NF were sporadically give-up the ghostring throughout the 19th and twentieth century but remained restricted to military hospitals during the war with a a few(prenominal) outbreaks occurring in civilian populations.EpidemiologyThe centers for Disease control and Prevention (CDC) reported that rates of NF increased worldwide from the mid 1980s to early 1990s. According to the CDC the increases in the rate and severity of NF are correlated with increase in the preponderance of toxin producing strains of S. Pyogenes (M-1 and M-3 serotypes). The CDC reported approximately 600 cases of NF in the U.S. in 1999 (Hu, 2002).Disease progressionNF develops when bacteria enters the physical structure usually through a minor trauma for manikin a laceration, bruise, or bug bite. Some cases occur after surgeries for practice abdominal surgeries the bacterium enters the surgical incision. The bacteria attacks the soft subcutaneous wind releasing toxins that kill the weave and affect note flow to the infected field of force causing it to become gangrenous. If left untreated the skin, fat, muscle sheath, and afterward the muscle become involved. The infection spreads unseen moving up the affected dust part at a rate of 3 centimeters per instant up to 1 inch of waver per hour (Ruth-Sahd and Gonzales, 2006). Once sphacelus of the tissue occurs that area has to be surgically removed. The bacteria piece of tail too cause the patient to go into systemic shock, which back tooth lead to hypotension, respiratory failure, renal failure, and heart failure. If the infection is severe goal ordure occur within 18 hours (Astorino, Genrich, MacGregor, Victor, Eckhouse, Barbour Barbour, 2009)PathophysiologyTissue destruction is possible once the bacterium has been introduced under the skin via a cut or penetrable wound. The pathogens deject to rapidly multiply spreading from the subcutaneous tissue along fascial planes, and then invading the blood vessels and lymphatic system. The bacteria release toxins that decrease the evasive tissue factors in order to inh ibit the immune systems ability to trash the bacteria. In the bodies attempt to combat the bacteria at the tissue level. The blood vessels in the area begin to disclose due to the effects of the bacteria in the tissue, the immune response becomes hyperactive, which results in blood vessel distension in order to facilitate the immune response to the area affected. unfortunately the cells in the tissue begin to die as the blood vessels leak and decrease the oxygen offer to the cells due to the increase in permeability. Since there is a decrease in blood flow and oxygen supply to the tissue from the infection, tissue necrosis and ischemia occur. As tissue necrosis worsens, nerve damage takes place, which trick be seen, as the patient lead report the decrease or absence of pain at the area affected. As the infection progresses septicemia go away also develop (Astorino, et al. 2009). motivating factorsNF is caused by a bacterium named Streptococcus pyogenes or Group A streptococc us ( attack). GAS can be found in peoples throats or on their skin and they will be asymptomatic. S. pogenes is a cause for non- invasive GAS diseases for example rheumatic fever, strep throat, and skin infections like impetigo. When GAS travels to areas of the body where bacteria isnt found it is called invasive GAS disease example would be blood or lungs. More than 10 million non-invasive GAS cases occur annually. A rare but just about severe case of invasive GAS is NF. These bacterium evolve degradedly and scientist believe that GAS makes proteins that cause the immune system to attack the tissue directly thus the body destroys itself (Hu, 2002). NF has been classified into two types based upon the bacterium identified upon culture. suit 1 in a polymicroial infection including both gram-positive and gram- negative bacteria that can be anaerobic or aerobic. Type 1 is the some common, making up 90% of all the cases, striking abdominal or peritoneal tissue. Underlying risk facto rs include postoperative, advanced age, or diabetes (McGee, 2005). Type 2 also known as the Flesh eating bacteria is the rarest out of the two making up about 10% of the cases. It is the most dangerous of the infections usually affecting the arms or legs and involves the Group A (beta)- hemolytic streptococcus with or without staphylococcus aureus. Type 2 does not discriminate on age, race, or sex (Astorino, et al. 2009).Signs and SymptomsEarly detection of NF is crucial it can be the difference between life and death. Health manage providers need to be knowledgeable about the signs and symptoms of NF so that treatment can be started right away. Initial signs whitethorn be vague and are often confused with cellulitis, signs include pain, edema, erythema, and fever. A definitive diagnosis can be made by visualization and dissection of the necrotic fascia. A key factor of NF is pain, which is disproportionate to the amount of redness. If suspected cellulitis fails to respond to ant ibiotics within 24-48 hours NF should be considered (Varma and Stashower, 2006). Early symptoms including pain, malaise, fever, and thirst occur within the first 24 hours of attack of bacteria. This is the time NF is usually misdiagnosed because progression of the disease is not visible until tissue destruction has already stated (McGee, 2005). Walter (2004) states that the hallmark of NF is erythema that spreads quickly with a permissiveness of redness that extends to normal skin and is not raised. Advance symptoms occur 48-72 hours afterwards and are characterized by substantive pain at the wound site, increase erythema, edema, and warmth. The skin tissue then becomes discolored and deteriorates further. The redness turns to dusky or grubby and bullae (vesicles) appear. These bullae enlarge and then rupture leaking out dishwater pus a repellent smelling, thin dirty gray liquid (Kessenich, 2004) (Ruth-Sahd and Gonzales, 2008). 4-5 days after behavior of the first symptoms p atients can begin to demonstrate critical symptoms ranging from numbness and hypotension to harmful shock and unconsciousness. From there the patient can develop gangrene, sepsis, and then death may occur (McGee, 2005). When the initial symptoms are found it can be difficult to differentiate between NF and celluitis thus it is important to remember the hallmark of NF. After 3-5 days of onset when there is skin breakdown, bullae, and cutaneous gangrene present which are definitive signs of NF and the involved area is usually not painful due to the are becoming anesthetic secondary to thrombosis of handsome vessels and nerve destruction located in the necrotic subcutaneous tissue Mandell, Bennett, and Dolin, 2005).Laboratory and Imaging StudiesCommon laboratory studies used in name NF include complete blood cell count with differential ( blood profile), Electrolytes, bloodline urea nitrogen (BUN), Creatinine phoshokinase (CPK), rapid streptococcus test, and a culture and sensitivi ty. CBC may show an increase in WBC greater than 14,000/ul and the electrolytes may show a sodium level less than 135 mmol/L, which are both indicative of NF (Schwartz, 2006). The BUN may also be proud to 15 mg/ml and the CPK may be elevated, indicating the presence of tissue breakdown. A C S with a Gram stain can determine whether the infection is Type 1 or Type 2, which will help to determine what antibiotics to prescribe. Computed tomography (CT) scan and magnetic resonance imaging (MRI) can be used to help diagnose NF. Ct scans can visualize the subcutaneous air and find the anatomic site of interest group by detecting necrosis with asymmetric fascial thickening (Maynor, 2006). MRI is laborsaving with guided rapid debridement of the wounds.TreatmentIn order to counteract significant disfigurement and/or death in the patient with NF is a quick diagnosis and very aggressive treatment is needed from the start. Broad spectrum antibiotics that treat gram-positive and negative a erobes and anaerobes are dictate around the clock until the particular strain of the bacteria can be identified and treated appropriately. collectible to the amount of antibiotics being administered and possible toxicity involved, Kidney and Liver function should be monitored during therapy. The patient will also need intravenous fluids, pain management, and possibly TPN. All necrotic tissue on the patient needs to be debrided with diligence in removing fascia, skin and subcutaneous tissue involved as early as possible, which may need to be performed multiple generation to effectively remove all necrotic tissue. Hyperbaric therapy may be prescribed as an additional therapy.Role of the NPThe NP needs to be able to recognize the early symptoms of NF so that he or she will be able to begin treatment quickly. A collaborative multidisciplinary care approach needs to be used for the care of this type of patient. The care team will need to include Critical/Acute care, Dietitian, stron g-arm therapy, and Wound care Nurse. The patient will need a fate of education and psychological support as well.ConclusionNecrotizing Fasciitis is a very aggressive and debilitating disease that has a very rapid progression. Since the disease is very easily transmitted into the body with the potential of detection not until later stages due to the similarities to cellulitis. Rapid diagnosis and treatment is essential to prevent severe dismemberment and or death. So this makes the Nurse Practitioner working(a) in ambulatory care the first line of defense against this rapidly debilitating disease.