Share an experience about an animal or human bite (not insect) that you treated or to which you were subjected. Include the importance of proper wound care and prescribing the appropriate antibiotic. Explain if a tetanus shot was needed.
Example of Assignment
A 24-year-old patient presented to the clinic with complaints of a cat bite to her right hand that occurred two days before the clinical visit. The cat was not a stray, it belonged to her elderly neighbor whom she was helping to get back inside her house. She stated that when she reached out to pick up the cat it bit her hand. The bite was deep enough to cause some scant bleeding. She stated she cleansed the wound with soap and water but did not seek immediate medical care. The morning after the incident occurred, she noticed redness around the wound and thought it was normal. On the morning of the clinical visit, she noticed that the redness spread from the wound to her wrist, swelling, and mild pain. She denied fever or chills. She denied any allergies. She denied health problems. She denied the use of daily medications or over the counter (OTC) medications. She reported that her last tetanus shot was in 2019.
On examination, two pinpoint puncture wounds, mild edema, erythema that streaked to the wrist, and mild tenderness to palpation was observed to the posterior right hand and wrist. A culture of the wound was obtained. I cleaned the wound with normal saline. I prescribed Amoxicillin–clavulanic acid 875 mg/125 mg by mouth twice daily for seven days. I informed the patient she could use OTC Ibuprofen as needed for pain. I informed the patient to keep the wound open to prevent infection. I informed the patient to clean the wound soap and water and dry to prevent infection. I informed the patient elevating her hand would help with the swelling. I educated the patient on the risk of approaching any unknown animal stray or domestic. I informed that patient she would receive a call regarding her wound culture if treatment changes are required. I informed the patient to follow-up in two to three days or sooner if symptoms worsen.
According to O’Neill and Jennings (2017), providers should irrigate the wound with normal saline and remove damaged tissue. The wound should be washed immediately with soap and water or 1% povidone-iodine solution if the animal is suspected of having rabies (O’Neill & Jennings, 2017, p. 257). O’Neill and Jennings (2017), stated that most cat bites and bites to the hand should be left open to prevent infection.
O’Neill and Jennings (2017), stated that patients with cat bites and hand bites from any animal should receive prophylaxis treatment. According to O’Neill and Jennings (2017), Amoxicillin–clavulanic acid 875 mg/125 mg twice daily for five or seven days is most effective for fresh bites or prophylactic therapy. Clindamycin 300 mg orally three times daily with Doxycycline 100 mg orally twice daily, double-strength trimethoprim-sulfamethoxazole taken twice daily, or Moxifloxacin could be prescribed for patients with a penicillin allergy. A patient who has not had a tetanus toxoid and diphtheria (Td) booster within the past five years should receive a Td or diphtheria toxoid and acellular pertussis (Tdap) vaccination (O’Neill & Jennings, 2017, p. 257). For suspected rabies patients should receive immunization with 20 IU/kg of human rabies immune globulin (HRIG) or purified chick embryo cell vaccine (PCECV) (O’Neill & Jennings, 2017, p. 257).
A 20 year old lady presented to the clinic with a wound on her left leg. She explained that the wound was from a dog bite. The incident had occurred the day before the clinic visit. The wound area was red and tender to touch. The dog was astray, and the lady did not know the dog’s owner. According to the lady, the dog was foaming at the mouth and acting erratically. Dog bites need immediate treatment because they can cause several complications. Some of the complications include nerve damage and rabies. In the case of a deep bite, blood vessels, muscles and nerves under the skin can get damaged (Jakeman et al., 2020). This can occur even when the wound appears to be small. Rabies is a viral condition that usually affects the central nervous system. Rabies can lead to death within a few days of infection if left untreated. Dogs can also carry Methicillin-resistant Staphylococcus aureus.
In this case, considering how the dog was behaving and the fact that the lady did not know the dog’s owner, there was a high possibility that the dog had not been inoculated against rabies. I did a physical examination of the wound and also carried out a full examination of the vitals, including pain assessment. I also measured the wound to be in a better position of classifying it. Classifying the wound helps a health provider to know the extent of the injury. For this case, I cleaned the wound area with warm water and soap. I gently pressed on the wound to trigger a small amount of bleeding as I did that. This is important as it helps flush out germs. I then applied an antibacterial lotion and covered the wound with a sterile bandage. The next step was prescribing some drugs to the patient. The patient informed me that she was not allergic to any drugs and was not using any drugs. I administered a rabies vaccine because the dog that had bitten her showed signs of rabies, considering how the patient described the dog. I advised the patient to come for an additional injection of rabies immune globulin, which is required as part of the treatment. I did not administer a tetanus injection because the patient had received one two years ago. I prescribed antibiotics to fight any bacteria that could have entered the body and prevent infection. I prescribed amoxicillin because it is considered the first-line prophylactic treatment for animal bites (Evans, Hannoodee, & Wittler, 2019).
I prescribed Amoxicillin/clavulanate 875/125 mg by mouth every 12 hours for seven days. I also prescribed Ibuprofen which I advised the patient to take when she experiences any form of pain. I educated the patient on the importance of staying away from unknown dogs. That helps protect oneself from dog bites and their complications (Jakeman et al., 2020). I also educated the patient on how she will be cleaning the wound while at home. I informed the patient that she should come back to the clinic for a follow-up checkup after one week to ensure that the wound is healing properly, and in case of any severe symptoms, she should come back to the clinic immediately.
According to Malaekah et al. (2021), proper wound care is crucial because it helps prevent infection and other complications. It is also vital as it helps speed up the healing process with less scarring. Wounds that are poorly taken care of can lead to the development of a chronic wound which can be expensive to treat (Malaekah et al., 2021). Prescribing the appropriate antibiotic helps prevent the development of unexisting complications, which can be caused by medication errors such as prescribing the wrong antibiotic to a patient.
Evans, J., Hannoodee, M., & Wittler, M. (2019). Amoxicillin Clavulanate.
Jakeman, M., Oxley, J. A., Owczarczak-Garstecka, S. C., & Westgarth, C. (2020). Pet dog bites in children: management and prevention. BMJ paediatrics open, 4(1).
Malaekah, H. M., Alotaibi, A. E., Alsebail, R. A., Alelawi, G. T., Alsarrani, R. H., & Banjar, W. M. (2021). Wound care knowledge and perception of the Saudi general population in Riyadh Region. Advances in Wound Care, 10(6), 293-300.