Necrotizing Fasciitis

Necrotizing fasciitis (NF) is often referred to as a "flesh-eating" bacteria because the bacterial infection spreads quickly, killing all of the tissue that it can get a hold of. NF can be the result of a number of different bacteria, most often Streptococcus pyogenes. S. pyogenes is the culprit in other, somewhat benign infections such as strep throat or impetigo. (Though, if you've ever had strep throat, I'm sure that you would not call it "benign." Compare it to NF, however, and I think that you'll agree that it is quite less troublesome. What causes the change? For some unknown reason, the bacteria in NF produces a toxin that kills surrounding tissue. There are other bacteria that are guilty of such "mass murdering," they include Vibrio vulnificus and different bacteria from the colon & small intestine. There typically are other, more stable underlying conditions, such as cirrhosis or diabetes, that are present when these latter bacteria take over, though. http://www.webmd.com/hw/infection/hw140408.asp

Some expected lab findings for necrotizing faciitis would be increased WBC, ESR due to the infection.

Three expected Nursing Diagnoses:

Three appropriate interventions for each diagnosis:

1. Acute pain r/t toxins interfering with blood flow.
   1. Determine whether the client is experiencing pain at the time of the initial interview. If so, intervene at that time to provide pain relief. Assess and document the intensity, character, onset, duration, and aggravating and relieving factors of pain during the initial evaluation of the client.
   2. Administer analgesics as physician has ordered.
   3. Teach the patient relaxation therapy to reduce pain in between medication doses, if needed.
2. Hyperthermia r/t presence of infection.
   1. Measure and record the client's temperature at least every 4 to 6 hours or whenever a change in condition occurs.
   2. Administer antipyretic medication per physician orders.
   3. Assess fluid loss and facilitate oral intake or administer IV fluids to accomplish fluid replacement.
3. Fear r/t possible fatal outcome of disease.
   1. Encourage the client to explore underlying feeling that may be contributing to the fear.
   2. Stay with the client when he/she is expressing fear; providing verbal and nonverbal reassurances.
   3. Explore coping skills used previously by the client to deal with fear; reinforce these skills and explore other outlets.

Major Concepts related to client's age/developmental level:

1. Erickson: Integrity vs. Despair: This stage of older adulthood begins about the time of retirement and continues throughout one's life. Reaching this stage is a sign of maturity while failing to reach this stage is an indication of poor development in prior stages through the life course. The most important event at this stage is achieving ego integrity. That means coming to accept one's whole life and reflecting on it in a positive manner. According to Erikson, achieving a sense of integrity means fully accepting oneself and coming to terms with death. Accepting responsibility for your life and being able to undo the past and achieve satisfaction with one's "self" is essential. The inability to do this results in a feeling of despair and this individual will begin to fear death.
2. Piaget: The formal operational stage is the fourth and final stage in Piaget's theory. It begins at approximately 11 to 12 years of age, and continues throughout adulthood; although Piaget does point out that some people may never reach this stage of cognitive development. The formal operational stage is characterized by the ability to formulate hypotheses and systematically test them to arrive at an answer to a problem. The individual in the formal stage is also able to think abstractly and to understand the form or structure of a mathematical problem. Another characteristic of the individual is their ability to reason contrary to fact. That is, if they are given a statement and asked to use it as the basis of an argument they are capable of accomplishing the task. For example, they can deal with the statement "what would happen if snow were black".
3. Kohlberg: Postconventional: the attainment of true morality. Think in rational terms, valuing the will of the majority and the welfare of society. His contention is that the attainment of Postconventional moral reasoning is associated with optimal personal and social adjustment. A sense of obligation to law because of one's social contract to make and laws for the welfare of all and for the protection of all people's rights. A feeling of contractual commitment, freely entered upon, to family, friendship, trust, and work obligations.