From the Guidelines
The patient should receive a tetanus booster if it has been more than 5 years since their last tetanus toxoid-containing vaccine dose, as per the guidelines for wound management. I recommend a thorough examination of the injured finger, cleaning of the wound, and administration of a tetanus booster if the patient hasn't received one within the past 5 years 1. For pain management, I suggest acetaminophen 500-650mg every 6 hours or ibuprofen 400-600mg every 6-8 hours as needed. The finger should be cleaned with sterile saline solution, and any visible foreign material should be removed. A digital block with 1% lidocaine (without epinephrine) may be necessary if the examination is too painful. After cleaning, apply antibiotic ointment like bacitracin or mupirocin and cover with a sterile dressing. The patient should keep the wound clean and dry, changing the dressing daily until healing occurs. If there's concern about a retained nail fragment, an X-ray may be warranted to identify any foreign body. The severe pain on contact suggests possible subungual hematoma, nail bed injury, or retained foreign body, all of which require proper evaluation. If signs of infection develop (increasing redness, warmth, swelling, purulent drainage), the patient should return for possible oral antibiotics.
The guidelines for tetanus prophylaxis in routine wound management, as outlined in the 2018 study 1, provide a clear framework for determining the need for a tetanus booster. According to these guidelines, a booster is recommended for all other wounds (such as the patient's injured finger) if the patient has not received a tetanus toxoid-containing vaccine within the preceding 5 years. This recommendation is supported by the study, which notes that persons with unknown or uncertain previous tetanus vaccination histories should be considered to have had no previous tetanus toxoid-containing vaccine.
In terms of wound care, it is essential to prioritize cleaning and dressing the wound to prevent infection. The use of sterile saline solution and antibiotic ointment can help to reduce the risk of infection, and the patient should be instructed to keep the wound clean and dry. If signs of infection develop, the patient should return for possible oral antibiotics. The 2014 study 1 provides guidance on the diagnosis and management of skin and soft tissue infections, including the use of antibiotics in wound care.
Overall, the patient's injured finger requires thorough examination, cleaning, and dressing, as well as consideration of a tetanus booster if it has been more than 5 years since their last tetanus toxoid-containing vaccine dose. By following these guidelines and prioritizing wound care, we can help to prevent infection and promote healing.
From the Research
Patient Evaluation and Care
- The patient presents with a left third index finger injury, which occurred 3 days ago, and is concerned about the potential need for a tetanus shot 2.
- He reports severe pain when the injured area is touched, and requests that the wound be cleaned to ensure no residual piece of the nail is embedded.
Wound Assessment and Treatment
- A comprehensive assessment of the wound is crucial in planning and evaluating care, including collection of baseline history and physical examination, wound assessment, treatment plan, and documentation 3.
- The wound should be cleaned and debrided, and the patient should be assessed for the need for suturing or other treatments, depending on the mechanism of injury 4.
Infection Control and Prevention
- The patient's wound may be at risk for infection, and antimicrobial prophylaxis may be necessary to prevent infection, including tetanus 2.
- The patient's overall health and medical history should be taken into account when determining the need for antimicrobial prophylaxis.
Nursing Care and Patient Education
- Nurses play a critical role in providing preoperative care to patients, including physical and psychosocial care, and patient education 5.
- Nurses should also be knowledgeable about respiratory assessment and physical examination of the chest in adults, although this may not be directly relevant to the patient's current condition 6.