Nursing care for deep neck infections patients with septicemia: Case study

Abstract

The deep neck infections patients with septicemia were considered as critical patients because the patients will have the symptoms with airway obstruction. If the patients were not treated immediately, disease severity will be increased, leading to danger to life.

The male patient, 51 year olds, was sent from a community hospital to admit at King Narai Hospital on 6 March 2019. The patient has symptoms of pain and swollen on both sides of the chin, a little opening the mouth and fever for 4 days before admission. The patient had a congenital disease with diabetes. Doctor diagnosed that the patient had a deep neck infection. Form the CT neck results, the fluid collection right parapharyngeal space extended to right masticator space was found. In addition, the pressure from inflammation of throat resulted in narrowing down of the oropharynx and hypopharynx space. Nurses took care of fixing the hypoxia and septicemia, following the blood sugar levels, and preparation for pus drainage surgery. After surgery, the patient was inserted the trachea tube into a ventilator and observed vital signs in a crisis. The patient received antibiotics, Tazocin 4.5 gm, by Intravenous every 6 hours. From wound culture, Klebsiella Pneumoniae was observed. From chest x-ray results, right lung infiltration was found. It was found Pseudomonas Aeruginosa in phlegm culture results. The complication with gastrointestinal bleeding was observed. The patient was receiving blood transfusions, NG lavage and antacids until no repeated bleeding and normal blood sugar levels. After surgery for 3 days, the patient was removed the ventilator. The wound at right chin and buccal cavity had less pus. The swollen of right cheek was reduced. The patient was receiving wound care and pain treatment. Recurrent infection during wound care was not found. The patient was discharged on 23 March 2019 (total of hospital admission for 17 days).

Nurses have the important role for nursing care of the admission patient with beginning, in critical period, recovery period and discharging. Nurses must have expertise in nursing care the patient during insertion of the trachea tube, using a ventilator, drug administration with high risk, prevention of complications such as respiratory infection and gastrointestinal bleeding. Nurses are important people who prepare the readiness of patients and family. The good discharging planning resulted in the problem of patient was fixed. Thus the patient is cured from the disease and not return treatment.