Nursing care of patient with Septicemia from Deep neck infection: Case study

Abstract

Deep neck infection is parapharyngeal intraspace and muscle around neck inflammation. Including abscess type and non. Septicemia and hypoxia due to respiratory obstruction were serious illness of patient. In king narai hospital was found rare case but seriously. Motality was risk. Nursing care was very important in order to reduce risk of complication.

          A 71 years old male with swelling occurred throughout throat, both chin, cann^,t open mouth and fever 3 days were presented on september 3^rd, 2021 in King narai hospital. He experienced with untreat chronic dental caries and control Diabetic malletus. Deep neck infection was diagnosis. CT neck show Fluid collection left parapharyngeal space with extend to right masticator space. Septicemia and hypoxia due to respiratory obstruction were occure; stupor, SOS score = 4, abnormal vital signs, fever, trachycardia, O₂ Saturation = 92%. Intubation with ventilator, fluid resuscitation, septic workup, intraveneous antibiotic and retained Foley^, s cath were done in Emergency room. Then transferred to ICU surgery for operation preperation. Incisional & drainage and Tracheostomy tube were done. (50 min operation) 24-48 hours post operation peroid. Septicemia was still. Patient was stupor and SOS score = 4-5. Nursing care consist of intraveneous fluid resuscitation, Levophed administration, urine out put monitor every 1 hour. Acute renal failure was not found. Hypoxia was showed. Volume respirator care, vital signs and O₂ Saturation monitoring, VAP bundle protocal, aspirate pneumonia prevention, Tracheostomy tube care standarization were perform. Then hypoxia was improve. Phlebitis from extravasation was risk. Levophed administration, injection site observation were done. Phlebitis was not occure. Intraoral cavity infection from Klebsella Pneumonae was nursing diagnosis. Wound care, oral hygene, intraveneous antibiotic were done. After stable condition, weaning protocol was performed in weaning peroid then weaning was suscessed. Patient and family mental support was important nursing care in Intensive care unit. Patient was transferred to EENT department after improved condition. After follow up in EENT department; decreased chin swelling, normal vital signs. Encorage patient and family for Tracheostomy tube care, oral hygene care and continuum home care were performed. Patient can discharge on September 13^th, 2021, Length of stay were 10 days.