Emergency Nursing & Triage Q 5

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You are assessing a patient who has sustained a cat bite to the left hand. The cat is up-to-date immunizations. The date of the patient’s last tetanus shot is unknown. Which of the following is the priority nursing diagnosis?

  

    A. Impaired Skin Integrity related to puncture wounds

    B. Ineffective Health Maintenance related to immunization status

    C. Risk for Infection related to organisms specific to cat bites

    D. Risk for Impaired Mobility related to potential tendon damage

    

    

Correct Answer: C. Risk for Infection related to organisms specific to cat bites.

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Cat’s mouths contain a virulent organism, Pasteurella multocida, that can lead to septic arthritis or bacteremia. Infections resulting from bites of all animal species are poly-microbial with aerobic and anaerobic bacteria; dogs and cats have an oral flora of Pasteurella, Staph, and Strep most commonly. In cat bites and scratches, Bartonella infections are an additional concern.

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Option A: The initial injury is the result of the physical trauma of teeth puncturing and/or tearing soft tissue, and in the case of some dog bites, blunt force breaking bones. Cat bites are narrow and deep as the animal rarely pulls or shakes its head, simply biting and holding. Because the cat bite wound is deep and narrow, it is much more likely to seal itself relatively quickly, providing an anaerobic environment for the inoculated bacteria as well as initially appearing less consequential and prolonging time to seeking medical care.

Option B: A tetanus shot can be given before discharge. The patient’s TDaP status should be updated if necessary. Patients should be encouraged to get an updated tetanus vaccination. The prognosis for most animal bites is excellent. However, it is essential to know that, on average, about 30 to 50 people die from dog bites each year.

Option D: There is also a risk for tendon damage due to deep puncture wounds. Cat bites deeper than superficial need thorough irrigation under local anesthesia and the wound left open. The patient should be discharged with a week’s course of amoxicillin-clavulanate and given strict wound care precautions.

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