Features of nursing care and treatment of patients with Fournier gangrene

Abstract

Introduction. Fournier’s gangrene - belongs to necrotizing fasciitis, localized on the genitals and perineum. The pathology has a complex pathogenesis, which is based on thrombosis of the vessels of the superficial and deep fascia of the body with localization in the lower abdomen and genitals. The pathogens are aerobic-anaerobic flora, where anaerobes are predominant. Subsequently, purulent inflammation of necrotic tissues in the lower abdomen develops with damage to visceral organs (bladder, testicles, colon).

The aim of the study – to analyze the main links in the pathogenesis of Fournier’s gangrene and, accordingly, the participation of both a nurse and a doctor in the process of treatment and care for these patients.

The main part. Having analyzed the literature sources, we summarized the main links in the pathogenesis of this disease. It has been shown that the initial thrombosis of the superficial and deep fascia vessels of the lower abdomen and perineum caused by anaerobes leads to purulent inflammation of this area in Fournier’s gangrene. The latter causes a syndrome of systemic inflammatory process with a «cytokine cascade». Therefore, the clinical manifestations of the disease develop from redness and swelling of the perineal and genital tissue, to necrosis, endotoxicosis up to a septic state. This pathology combines local manifestations - necrosis and purulent inflammation, and general manifestations - endotoxicosis, septic shock and the occurrence of secondary septic metastases. Therefore, the condition of such patients is mostly severe. This requires treatment of these patients in the intensive care unit with the use of powerful antibiotic therapy and intensive infusion therapy. At the same time, surgical intervention is urgently needed, consisting of tissue dissection, excision of necrosis and drainage using the «picket fence» drainage technique in the wound. In addition, there is a second stage in the treatment of these patients - restoration of the integrity of the skin of the genitals and perineum. Such patients require constant attention, both from the medical and nursing staff at an early stage - in the intensive care unit, and from the dressing nurse throughout the entire period of treatment.

Conclusions. In the treatment of patients with Fournier gangrene, the role of both the doctor and the nurse is important. High mortality requires the search for new methods of drug treatment and methods of surgical intervention. This disease is accompanied by severe endotoxicosis, up to septic shock. Careful care by the dressing nurse ensures rapid wound healing and prevents perspiration through the wound and dehydration of the body.