Materiały źródłowe

• #1 Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/necrotizing-fasciitis.html

  Necrotizing fasciitis is a rapidly progressive infection that destroys deep soft tissues. […] Primary treatment is early and aggressive surgical exploration and debridement of necrotic tissue. […] The wound should be left open and re-inspected 24 hours later to ensure adequacy of the initial debridement. […] Antibiotic therapy is based upon Gram stain findings. Once group A strep is confirmed to be the etiology, recommended treatment is high-dose penicillin and clindamycin (interferes with toxin production). […] Amputations are a common complication of necrotizing fasciitis. […] As the disease progresses, patients may quickly progress to sepsis, shock, organ failure, and death. […] In the most recent 5 years, the mortality rate of streptococcal necrotizing fasciitis has been around 13 to 18%. It increases with age of the person affected and the presence of streptococcal toxic shock syndrome.

• #2 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections that cause muscle fascia and subcutaneous tissue necrosis. […] This activity reviews the evaluation, treatment, and prognosis of necrotizing fasciitis and highlights the role of an interprofessional team in evaluating and improving care for patients with this condition. […] The nurse is often the first to recognize that the patient is critically ill or in pain. Nurses should be knowledgeable about necrotizing fasciitis and consult the surgeon as soon as possible. […] The patient should be kept NPO, hydrated, and immediately covered with broad-spectrum antibiotics. […] These patients are best managed in the intensive care unit until signs of toxicity diminish. […] A wound care nurse is mandatory as most patients have large open wounds that require daily dressings for weeks or months. […] Only through a systemic approach with close collaboration can the mortality of this condition be lowered.

• #3

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Timely care improves outcomes […] Despite advances in understanding, diagnosis, and treatment, NF still causes significant morbidity and mortality. Its microbiological profile remains complex and its classification may evolve as our understanding of NSTI increases. Vague and nonspecific presentations can make diagnosis difficult. Clinical judgment and a high index of suspicion for NF will ultimately expedite recognition. Timely diagnosis and supportive therapies, including antimicrobials and timely referral to surgery, are crucial to improve patient outcomes.

• #4

  https://journals.lww.com/nursingcriticalcare/fulltext/2019/01000/necrotizing_fasciitis__infection_identification.2.aspx

  Necrotizing fasciitis is a life-threatening infection that can affect anyone. Early identification and intervention implementation are key to managing the infection’s progression. An effective plan of care includes immediate assessment, antibiotic stewardship, and surgical intervention. […] An effective plan of care may include antibiotic therapy and surgical debridement. […] Patients presenting with suspected NF should be triaged for an immediate assessment with the surgical team. Initial care consists of blood work, oxygen therapy, and fluid resuscitation. Blood cultures are drawn and the patient may be placed on broad-spectrum empiric antibiotic therapy until results of the sensitivity are identified. […] Fournier gangrene requires immediate debridement of the affected tissue, antibiotic therapy, and an intensive care setting to monitor a patient’s hemodynamic functions.

• #5 Necrotizing Fasciitis Treatment & Management: Approach Considerations, Surgical Debridement, Antimicrobial Therapy

  https://emedicine.medscape.com/article/2051157-treatment

  Once the diagnosis of necrotizing fasciitis is confirmed, initiate treatment without delay. […] Because necrotizing fasciitis is a surgical emergency, the patient should be admitted immediately to a surgical intensive care unit in a setting such as a regional burn center or trauma center, where the surgical staff is skilled in performing extensive debridement and reconstructive surgery. […] A regimen of surgical debridement is continued until tissue necrosis ceases and the growth of fresh, viable tissue is observed. […] Prompt surgery ensures a higher likelihood of survival. […] Antibiotic therapy is a key consideration. […] Surgery is the primary treatment for necrotizing fasciitis. […] Surgeons must be consulted early in the care of these patients, as early and aggressive surgical debridement of necrotic tissue can be life-saving.

• #6

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Nursing considerations […] Given the subtlety in presentation and lack of confirmatory physical findings, timely diagnosis of NF may be difficult. It is crucial for nurses to maintain a high index of suspicion for NF, especially in patients who are at high risk. In particular, nurses should assess for localized erythema, warmth, tenderness disproportionate to the affected area, skin sclerosis, and signs of sepsis and septic shock including fever and hemodynamic instability. […] Nurses who suspect NF should promptly notify a provider and prepare for additional workup and management. This may include further imaging and lab studies. […] Nurses should also be prepared to initiate treatment for NF in a timely manner. Interventions include administration of I.V. antimicrobials and fluids and correction of metabolic derangements. For some patients, transfer to the ICU may be indicated for frequent assessments and invasive hemodynamic monitoring.

• #7

  https://journals.lww.com/nursingcriticalcare/fulltext/2019/01000/necrotizing_fasciitis__infection_identification.2.aspx

  When considering the care needs of a patient presenting with NF, critical care nurses may need to focus on early detection, pain management, nutrition, and emotional support. […] Nursing care is essential to support the patient and family, as further care may involve multiple surgeries/procedures and perhaps lifestyle adjustments. […] Perform a detailed skin assessment to detect distinct features associated with NF, such as pain, bullae, inflammation, and erythema. […] Educate high-risk patients (patients with comorbidities of diabetes mellitus and liver disease) on the importance of seeking medical care for any injury. […] Notify the physician of any patient who presents with intensely severe pain disproportionate to visual presentation and tenderness at the wound site and its surrounding tissue for a surgical opinion.

• #8 Necrotizing Fasciitis: Pathophysiology and Treatment – Page 6

  https://www.medscape.com/viewarticle/443523_6

  Nursing interventions involve recognizing those patients at risk, reporting these suspicions to the health care provider, monitoring patient vital signs and laboratory values, providing frequent dressing changes, wound assessment and documentation, and medication administration. […] Medication administration involves antibiotics and pain medications. […] Although the patient’s complaints of pain may seem disproportionate to the appearance of the affected area, the nurse must remain vigilant and recognize this severe pain as a pathologic process in NF. […] Nutritional requirements ranging from two to three times normal amounts with adequate hydration are critical to provide sufficient calories and protein for wound healing. […] Dressing changes may be excruciating for patients with NF, requiring pre-medication and sedation prior to these activities. […] Topical antimicrobials are also utilized in wound care.

• #9 Necrotizing fasciitis—why you should unlearn what you think you know

  https://www.aofoundation.org/trauma/about-aotrauma/blog/2023_05-blog-mcfayden-necrotizing-fasciitis

  We knew that if we were going to save this woman’s life, we would have to act quickly, and that we would have to start with the place where her problems had started. […] We chose to do a guillotine amputation without closing the skin, because the skin and fascial debridement was bigger than the muscle. […] I now realize that with cases like this one, there is a critical point early on that we cannot afford to miss. […] If we recognize early on what we are looking at, then extreme outcomes like this one can be averted, and in many cases probably with just antibiotic therapy. […] The first telltale sign is intense pain. […] If a patient reports having been in contact recently with some kind of group A strep type infection, then you should become even more alert. […] If you feel you are out of your depth, call a friend.

• #10

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Nursing considerations […] Given the subtlety in presentation and lack of confirmatory physical findings, timely diagnosis of NF may be difficult. It is crucial for nurses to maintain a high index of suspicion for NF, especially in patients who are at high risk. In particular, nurses should assess for localized erythema, warmth, tenderness disproportionate to the affected area, skin sclerosis, and signs of sepsis and septic shock including fever and hemodynamic instability. […] Nurses who suspect NF should promptly notify a provider and prepare for additional workup and management. This may include further imaging and lab studies. […] Nurses should also be prepared to initiate treatment for NF in a timely manner. Interventions include administration of I.V. antimicrobials and fluids and correction of metabolic derangements. For some patients, transfer to the ICU may be indicated for frequent assessments and invasive hemodynamic monitoring.

• #11

  https://journals.lww.com/nursingcriticalcare/fulltext/2019/01000/necrotizing_fasciitis__infection_identification.2.aspx

  When considering the care needs of a patient presenting with NF, critical care nurses may need to focus on early detection, pain management, nutrition, and emotional support. […] Nursing care is essential to support the patient and family, as further care may involve multiple surgeries/procedures and perhaps lifestyle adjustments. […] Perform a detailed skin assessment to detect distinct features associated with NF, such as pain, bullae, inflammation, and erythema. […] Educate high-risk patients (patients with comorbidities of diabetes mellitus and liver disease) on the importance of seeking medical care for any injury. […] Notify the physician of any patient who presents with intensely severe pain disproportionate to visual presentation and tenderness at the wound site and its surrounding tissue for a surgical opinion.

• #12

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Nursing considerations […] Given the subtlety in presentation and lack of confirmatory physical findings, timely diagnosis of NF may be difficult. It is crucial for nurses to maintain a high index of suspicion for NF, especially in patients who are at high risk. In particular, nurses should assess for localized erythema, warmth, tenderness disproportionate to the affected area, skin sclerosis, and signs of sepsis and septic shock including fever and hemodynamic instability. […] Nurses who suspect NF should promptly notify a provider and prepare for additional workup and management. This may include further imaging and lab studies. […] Nurses should also be prepared to initiate treatment for NF in a timely manner. Interventions include administration of I.V. antimicrobials and fluids and correction of metabolic derangements. For some patients, transfer to the ICU may be indicated for frequent assessments and invasive hemodynamic monitoring.

• #13 Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/necrotizing-fasciitis.html

  Necrotizing fasciitis is a rapidly progressive infection that destroys deep soft tissues. […] Primary treatment is early and aggressive surgical exploration and debridement of necrotic tissue. […] The wound should be left open and re-inspected 24 hours later to ensure adequacy of the initial debridement. […] Antibiotic therapy is based upon Gram stain findings. Once group A strep is confirmed to be the etiology, recommended treatment is high-dose penicillin and clindamycin (interferes with toxin production). […] Amputations are a common complication of necrotizing fasciitis. […] As the disease progresses, patients may quickly progress to sepsis, shock, organ failure, and death. […] In the most recent 5 years, the mortality rate of streptococcal necrotizing fasciitis has been around 13 to 18%. It increases with age of the person affected and the presence of streptococcal toxic shock syndrome.

• #14

  https://journals.lww.com/nursingcriticalcare/fulltext/2019/01000/necrotizing_fasciitis__infection_identification.2.aspx

  When considering the care needs of a patient presenting with NF, critical care nurses may need to focus on early detection, pain management, nutrition, and emotional support. […] Nursing care is essential to support the patient and family, as further care may involve multiple surgeries/procedures and perhaps lifestyle adjustments. […] Perform a detailed skin assessment to detect distinct features associated with NF, such as pain, bullae, inflammation, and erythema. […] Educate high-risk patients (patients with comorbidities of diabetes mellitus and liver disease) on the importance of seeking medical care for any injury. […] Notify the physician of any patient who presents with intensely severe pain disproportionate to visual presentation and tenderness at the wound site and its surrounding tissue for a surgical opinion.

• #15

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Nursing considerations […] Given the subtlety in presentation and lack of confirmatory physical findings, timely diagnosis of NF may be difficult. It is crucial for nurses to maintain a high index of suspicion for NF, especially in patients who are at high risk. In particular, nurses should assess for localized erythema, warmth, tenderness disproportionate to the affected area, skin sclerosis, and signs of sepsis and septic shock including fever and hemodynamic instability. […] Nurses who suspect NF should promptly notify a provider and prepare for additional workup and management. This may include further imaging and lab studies. […] Nurses should also be prepared to initiate treatment for NF in a timely manner. Interventions include administration of I.V. antimicrobials and fluids and correction of metabolic derangements. For some patients, transfer to the ICU may be indicated for frequent assessments and invasive hemodynamic monitoring.

• #16 Head and neck necrotising fasciitis: an Australian rural experience – You – Australian Journal of Otolaryngology

  https://www.theajo.com/article/view/4767/html

  Necrotising fasciitis (NF) is a rare but life-threatening soft tissue infection. In the head and neck (HN) region, it is associated with up to 70% mortality rates. […] The gold standard of NF treatment is early diagnosis and aggressive surgical debridement. […] Prompt diagnosis and referral to relevant surgical specialties is crucial, especially in the HN region, where NF can result in acute airway obstruction. […] In rural and regional areas, NF diagnosis and treatment is further complicated by limited resources for adequate investigations, operative treatments, and timely transfer to a centre for definitive management. […] HN NF is a life-threatening infection that is difficult to diagnose and manage, especially in rural Australian settings. High clinical suspicion and early diagnosis is required to overcome the logistical and geographical barriers.

• #17 Necrotising fasciitis and septic shock: a case report of a patient receiving an immunomodulatory agent for multiple sclerosis – Wounds International

  https://woundsinternational.com/journal-articles/necrotising-fasciitis-and-septic-shock-a-case-report-of-a-patient-receiving-an-immunomodulatory-agent-for-multiple-sclerosis-2/

  Necrotising fasciitis (NF) is a soft tissue infection commonly caused by group A streptococcus (GAS) and is characterised by rapid progression and high mortality. […] That means that early diagnosis is the most crucial step when dealing with this lethal condition, along with the formation of a multidisciplinary team that will be responsible for the patient during the whole treatment period. […] According to the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), the patient had a score of 9, indicating that she was at high risk for developing NF. All of the clinical and imaging findings were consistent with this diagnosis. […] Postoperatively, surgical and mechanical wound debridements were performed in the operating room under general anaesthesia every 45 days, while in between, daily dressing changes were performed at the bedside.

• #18

  https://link.springer.com/article/10.1007/s00256-013-1813-2

  Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection and a medical and surgical emergency, with increasing incidence in the last few years. […] Many adjuncts such as laboratory findings, bedside tests e.g., the finger test or biopsy and imaging tests have been described as being helpful in the early recognition of the disease. […] Imaging is very useful to confirm the diagnosis, but also to assess the extent of the disorder, the potential surgical planning, and the detection of underlying etiologies. […] The main finding is thickening of the deep fasciae due to fluid accumulation and reactive hyperemia, best seen on magnetic resonance imaging. […] Necrotizing fasciitis: classification, diagnosis, and management.

• #19 Necrotizing fasciitis – EMCrit Project

  https://emcrit.org/ibcc/necfas/

  Necrotizing fasciitis is a life- and limb-threatening emergency. […] Patients in septic shock should receive an aggressive sepsis resuscitation. […] Surgical consultation must be obtained early for any patient with definite or suspected necrotizing fasciitis. […] Early debridement is generally felt to be essential, particularly in polymicrobial necrotizing fasciitis. […] The only way to exclude necrotizing fasciitis is surgical exploration of the fascia.

• #20 Necrotising fasciitis • LITFL • CCC

  https://litfl.com/necrotising-fasciitis/

  Necrotising fasciitis is a severe bacterial soft tissue infection marked by edema and necrosis of subcutaneous tissues with involvement of adjacent fascia and by painful red swollen skin over affected areas […] Investigations should not be performed if they delay definite surgical intervention in a suspected case of necrotizing fasciitis […] Specific therapy includes extensive urgent surgical debridement (the mainstay!) […] Seek and treat underlying cause and complications (e.g. diabetes mellitus) […] Supportive care and monitoring […] Consults include General surgeon, ENT (if needs grommets for hyperbaric chamber), Infectious diseases […] urgent transfer to operating theatre […] often need ICU admission post-operatively, may need further surgeries and often treated with hyperbaric oxygen.

• #21 Necrotising Fasciitis – RCEMLearning

  https://www.rcemlearning.co.uk/reference/necrotising-fasciitis/

  Necrotising fasciitis is a rare but life threatening bacterial soft tissue infection. A high index of clinical suspicion, prompt administration of broad-spectrum antibiotics and emergency surgery to debride affected tissues, are key to improving survival. Mortality is directly proportional to delay in diagnosis and treatment. Necrotising fasciitis is rare but associated with significant morbidity and mortality. It represents a time critical pathology where patient outcome is directly influenced by time to diagnosis and treatment. A high index of suspicion is required to make the diagnosis at the earliest opportunity. Necrotising fasciitis is a life and limb threatening surgical emergency and, if suspected, merits immediate senior surgical input. Broad spectrum IV antibiotics should also be administered immediately in accordance with local consultant microbiologist advice. The mainstay of treatment for necrotising fasciitis however remains early and aggressive surgical debridement of necrotic tissue until healthy, viable (bleeding) tissue is reached. Early and extensive debridement is the mainstay of management timing and adequacy of debridement have been shown repeatedly to be the main determinant of patients outcomes. Patients should be cared for in intensive care, using a multispecialty and multidisciplinary approach.

• #22

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Nursing considerations […] Given the subtlety in presentation and lack of confirmatory physical findings, timely diagnosis of NF may be difficult. It is crucial for nurses to maintain a high index of suspicion for NF, especially in patients who are at high risk. In particular, nurses should assess for localized erythema, warmth, tenderness disproportionate to the affected area, skin sclerosis, and signs of sepsis and septic shock including fever and hemodynamic instability. […] Nurses who suspect NF should promptly notify a provider and prepare for additional workup and management. This may include further imaging and lab studies. […] Nurses should also be prepared to initiate treatment for NF in a timely manner. Interventions include administration of I.V. antimicrobials and fluids and correction of metabolic derangements. For some patients, transfer to the ICU may be indicated for frequent assessments and invasive hemodynamic monitoring.

• #23

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Given the risk for septic shock, the nurse must frequently monitor vital signs and other the physical assessment findings for signs of decompensation. The nurse must immediately notify the provider and/or call the rapid response team of signs and symptoms of impending shock and be prepared to administer I.V. fluids, both crystalloids and colloids, and possibly vasoactive agents such as I.V. norepinephrine, as prescribed. Given the severe pain often associated with NF, nursing care includes frequent pain assessments and appropriate pain management interventions. […] Pre-op care should include medication reconciliation and the patient’s informed consent. Intraoperatively, nurses must be prepared to assist with the collection of deep tissue culture specimens according to institutional protocol.

• #24 Necrotizing Fasciitis Treatment & Management: Approach Considerations, Surgical Debridement, Antimicrobial Therapy

  https://emedicine.medscape.com/article/2051157-treatment

  Once the diagnosis of necrotizing fasciitis is confirmed, initiate treatment without delay. […] Because necrotizing fasciitis is a surgical emergency, the patient should be admitted immediately to a surgical intensive care unit in a setting such as a regional burn center or trauma center, where the surgical staff is skilled in performing extensive debridement and reconstructive surgery. […] A regimen of surgical debridement is continued until tissue necrosis ceases and the growth of fresh, viable tissue is observed. […] Prompt surgery ensures a higher likelihood of survival. […] Antibiotic therapy is a key consideration. […] Surgery is the primary treatment for necrotizing fasciitis. […] Surgeons must be consulted early in the care of these patients, as early and aggressive surgical debridement of necrotic tissue can be life-saving.

• #25 Necrotising Fasciitis – RCEMLearning

  https://www.rcemlearning.co.uk/reference/necrotising-fasciitis/

  Necrotising fasciitis is a rare but life threatening bacterial soft tissue infection. A high index of clinical suspicion, prompt administration of broad-spectrum antibiotics and emergency surgery to debride affected tissues, are key to improving survival. Mortality is directly proportional to delay in diagnosis and treatment. Necrotising fasciitis is rare but associated with significant morbidity and mortality. It represents a time critical pathology where patient outcome is directly influenced by time to diagnosis and treatment. A high index of suspicion is required to make the diagnosis at the earliest opportunity. Necrotising fasciitis is a life and limb threatening surgical emergency and, if suspected, merits immediate senior surgical input. Broad spectrum IV antibiotics should also be administered immediately in accordance with local consultant microbiologist advice. The mainstay of treatment for necrotising fasciitis however remains early and aggressive surgical debridement of necrotic tissue until healthy, viable (bleeding) tissue is reached. Early and extensive debridement is the mainstay of management timing and adequacy of debridement have been shown repeatedly to be the main determinant of patients outcomes. Patients should be cared for in intensive care, using a multispecialty and multidisciplinary approach.

• #26

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Given the risk for septic shock, the nurse must frequently monitor vital signs and other the physical assessment findings for signs of decompensation. The nurse must immediately notify the provider and/or call the rapid response team of signs and symptoms of impending shock and be prepared to administer I.V. fluids, both crystalloids and colloids, and possibly vasoactive agents such as I.V. norepinephrine, as prescribed. Given the severe pain often associated with NF, nursing care includes frequent pain assessments and appropriate pain management interventions. […] Pre-op care should include medication reconciliation and the patient’s informed consent. Intraoperatively, nurses must be prepared to assist with the collection of deep tissue culture specimens according to institutional protocol.

• #27 Necrotizing fasciitis – EMCrit Project

  https://emcrit.org/ibcc/necfas/

  Necrotizing fasciitis is a life- and limb-threatening emergency. […] Patients in septic shock should receive an aggressive sepsis resuscitation. […] Surgical consultation must be obtained early for any patient with definite or suspected necrotizing fasciitis. […] Early debridement is generally felt to be essential, particularly in polymicrobial necrotizing fasciitis. […] The only way to exclude necrotizing fasciitis is surgical exploration of the fascia.

• #28 Necrotizing Fasciitis Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/necrotizing-fasciitis-nursing-diagnosis/

  Nursing interventions and care are essential for the patients recovery from necrotizing fasciitis. In the following section, you’ll learn about possible nursing interventions for a patient with this condition. […] Administer broad-spectrum intravenous antibiotics as ordered. Prompt antibiotic therapy is crucial in combating the infection. Ensure timely administration and monitor for any adverse reactions. […] Prepare and assist with surgical debridement as ordered. Surgical intervention is often necessary to remove necrotic tissue. Explain the procedure to the patient and provide emotional support. […] Perform meticulous wound care. Clean and dress the wound according to facility protocol or surgeons orders. Use a sterile technique to prevent further contamination. […] Manage pain effectively. Administer analgesics as prescribed and employ non-pharmacological pain management techniques. Adequate pain control is essential for patient comfort and healing.

• #29 Necrotising fasciitis • LITFL • CCC

  https://litfl.com/necrotising-fasciitis/

  Necrotising fasciitis is a severe bacterial soft tissue infection marked by edema and necrosis of subcutaneous tissues with involvement of adjacent fascia and by painful red swollen skin over affected areas […] Investigations should not be performed if they delay definite surgical intervention in a suspected case of necrotizing fasciitis […] Specific therapy includes extensive urgent surgical debridement (the mainstay!) […] Seek and treat underlying cause and complications (e.g. diabetes mellitus) […] Supportive care and monitoring […] Consults include General surgeon, ENT (if needs grommets for hyperbaric chamber), Infectious diseases […] urgent transfer to operating theatre […] often need ICU admission post-operatively, may need further surgeries and often treated with hyperbaric oxygen.

• #30 Necrotising Fasciitis: Causes, Symptoms, and Treatment

  https://patient.info/doctor/necrotising-fasciitis-pro

  Necrotising fasciitis (NF) or flesh-eating disease is an uncommon but life-threatening infection. It is defined as necrotising infection involving any layer of the deep soft tissue compartment (dermis, subcutaneous tissue, fascia or muscle). […] Important early clues are pain, tenderness and systemic illness out of proportion to the localised physical signs. […] A high index of suspicion is necessary and suspected cases should be referred immediately. Prompt surgical debridement is essential. […] The essential treatment is early and aggressive debridement of the involved tissue. Resuscitation, antibiotics and medical care are also important. […] Urgent surgical debridement is the key factor in treatment and improved survival of NF. Even a few hours’ delay increases mortality. […] Following initial debridement, the wound must be observed closely. Surgical debridement is repeated daily until the infection is controlled. […] Non-surgical measures include close monitoring and general supportive treatment in an intensive care setting with antimicrobial treatment. […] Nutritional support is required from day one, owing to the high protein and fluid loss from the wound.

• #31 Necrotising Fasciitis – RCEMLearning

  https://www.rcemlearning.co.uk/reference/necrotising-fasciitis/

  Necrotising fasciitis is a rare but life threatening bacterial soft tissue infection. A high index of clinical suspicion, prompt administration of broad-spectrum antibiotics and emergency surgery to debride affected tissues, are key to improving survival. Mortality is directly proportional to delay in diagnosis and treatment. Necrotising fasciitis is rare but associated with significant morbidity and mortality. It represents a time critical pathology where patient outcome is directly influenced by time to diagnosis and treatment. A high index of suspicion is required to make the diagnosis at the earliest opportunity. Necrotising fasciitis is a life and limb threatening surgical emergency and, if suspected, merits immediate senior surgical input. Broad spectrum IV antibiotics should also be administered immediately in accordance with local consultant microbiologist advice. The mainstay of treatment for necrotising fasciitis however remains early and aggressive surgical debridement of necrotic tissue until healthy, viable (bleeding) tissue is reached. Early and extensive debridement is the mainstay of management timing and adequacy of debridement have been shown repeatedly to be the main determinant of patients outcomes. Patients should be cared for in intensive care, using a multispecialty and multidisciplinary approach.

• #32 Multidisciplinary management of periocular necrotising fasciitis: a series of 11 patients | Eye

  https://www.nature.com/articles/eye2011241

  The key to successful management of necrotising fasciitis is early diagnosis and intervention. […] It is vital for the patient to understand the seriousness of the condition, the implications if urgent surgical debridement is not undertaken, and the consequences and sequelae of the surgical debridement itself. […] A multidisciplinary approach for the comprehensive care of these patients is mandatory. While managing these patients, intensive care facilities should be made available and long-term follow-up and management of complications must be discussed and planned with the patient.

• #33

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Given the risk for septic shock, the nurse must frequently monitor vital signs and other the physical assessment findings for signs of decompensation. The nurse must immediately notify the provider and/or call the rapid response team of signs and symptoms of impending shock and be prepared to administer I.V. fluids, both crystalloids and colloids, and possibly vasoactive agents such as I.V. norepinephrine, as prescribed. Given the severe pain often associated with NF, nursing care includes frequent pain assessments and appropriate pain management interventions. […] Pre-op care should include medication reconciliation and the patient’s informed consent. Intraoperatively, nurses must be prepared to assist with the collection of deep tissue culture specimens according to institutional protocol.

• #34

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Nurses who care for patients in the post-op setting will have to carefully monitor them for surgical wound integrity, bleeding, and electrolyte imbalances. Nurses must be diligent about administering prescribed antimicrobials as scheduled to maintain serum drug levels. […] In the post-op setting, nursing care also includes hemodynamic monitoring, pain management, and nutritional support. Due to the large surgical wounds and increased metabolic demand experienced by patients with NF, the expected caloric requirement may be twice that of a typical patient in order to replace protein and fluid loss. The nurse should anticipate that multiple surgical procedures will be performed as definitive NF treatment. […] Along with standard precautions, nurses caring for patients with invasive GAS infection with soft tissue involvement should initiate droplet and contact precautions. Droplet and contact precautions may be discontinued after 24 hours of antimicrobial therapy.

• #35 Necrotizing fasciitis – Wikipedia

  https://en.wikipedia.org/wiki/Necrotizing_fasciitis

  Necrotizing fasciitis is treated with surgery to remove the infected tissue, and antibiotics. It is considered a surgical emergency. Delays in surgery are associated with a much higher risk of death. […] Aggressive wound debridement should be performed as soon as the diagnosis is made. The affected area may need to be debrided several times, usually once every 12-36 hours. Large sections of tissue and muscle may need to be removed to prevent the infection from spreading. Amputation may be needed if the infection is too severe. […] After the wound debridement, adequate dressings should be applied to promote wound healing. Wounds are generally packed with wet-to-dry dressings and left open to heal. In certain cases, vacuum-sealing drainage may help the wound heal, especially in Fournier gangrene.

• #36 Necrotizing Fasciitis (Flesh-Eating Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23103-necrotizing-fasciitis

  Necrotizing fasciitis is a severe rapidly spreading bacterial infection that can cause death. […] Quick intervention is needed to control necrotizing fasciitis. You’ll require exploratory surgery to confirm the diagnosis of necrotizing fasciitis. Surgery is also required to remove dead tissue. It may take multiple surgeries to control the infection and remove all of the dead tissue. It takes an average of three surgeries to make sure all of the infection is gone. Your provider will also likely prescribe antibiotics and intravenous (IV) fluids. After surgery, you may need skin grafts or plastic surgery to help the wounds close completely. […] If you have this condition, your best outcome will come from receiving an accurate diagnosis and quick treatment with antibiotics combined with surgery to remove the dead tissue. […] If you’ve been diagnosed with and treated for necrotizing fasciitis, and you aren’t getting better, contact your healthcare provider. Keep any follow-up appointments that your provider may schedule. If you’re taking antibiotics, make sure you take them as instructed.

• #37

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Nurses who care for patients in the post-op setting will have to carefully monitor them for surgical wound integrity, bleeding, and electrolyte imbalances. Nurses must be diligent about administering prescribed antimicrobials as scheduled to maintain serum drug levels. […] In the post-op setting, nursing care also includes hemodynamic monitoring, pain management, and nutritional support. Due to the large surgical wounds and increased metabolic demand experienced by patients with NF, the expected caloric requirement may be twice that of a typical patient in order to replace protein and fluid loss. The nurse should anticipate that multiple surgical procedures will be performed as definitive NF treatment. […] Along with standard precautions, nurses caring for patients with invasive GAS infection with soft tissue involvement should initiate droplet and contact precautions. Droplet and contact precautions may be discontinued after 24 hours of antimicrobial therapy.

• #38 Necrotizing Fasciitis Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/necrotizing-fasciitis-nursing-diagnosis/

  Nursing interventions and care are essential for the patients recovery from necrotizing fasciitis. In the following section, you’ll learn about possible nursing interventions for a patient with this condition. […] Administer broad-spectrum intravenous antibiotics as ordered. Prompt antibiotic therapy is crucial in combating the infection. Ensure timely administration and monitor for any adverse reactions. […] Prepare and assist with surgical debridement as ordered. Surgical intervention is often necessary to remove necrotic tissue. Explain the procedure to the patient and provide emotional support. […] Perform meticulous wound care. Clean and dress the wound according to facility protocol or surgeons orders. Use a sterile technique to prevent further contamination. […] Manage pain effectively. Administer analgesics as prescribed and employ non-pharmacological pain management techniques. Adequate pain control is essential for patient comfort and healing.

• #39 Necrotizing Fasciitis Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/necrotizing-fasciitis-nursing-diagnosis/

  Nursing interventions and care are essential for the patients recovery from necrotizing fasciitis. In the following section, you’ll learn about possible nursing interventions for a patient with this condition. […] Administer broad-spectrum intravenous antibiotics as ordered. Prompt antibiotic therapy is crucial in combating the infection. Ensure timely administration and monitor for any adverse reactions. […] Prepare and assist with surgical debridement as ordered. Surgical intervention is often necessary to remove necrotic tissue. Explain the procedure to the patient and provide emotional support. […] Perform meticulous wound care. Clean and dress the wound according to facility protocol or surgeons orders. Use a sterile technique to prevent further contamination. […] Manage pain effectively. Administer analgesics as prescribed and employ non-pharmacological pain management techniques. Adequate pain control is essential for patient comfort and healing.

• #40

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Nurses who care for patients in the post-op setting will have to carefully monitor them for surgical wound integrity, bleeding, and electrolyte imbalances. Nurses must be diligent about administering prescribed antimicrobials as scheduled to maintain serum drug levels. […] In the post-op setting, nursing care also includes hemodynamic monitoring, pain management, and nutritional support. Due to the large surgical wounds and increased metabolic demand experienced by patients with NF, the expected caloric requirement may be twice that of a typical patient in order to replace protein and fluid loss. The nurse should anticipate that multiple surgical procedures will be performed as definitive NF treatment. […] Along with standard precautions, nurses caring for patients with invasive GAS infection with soft tissue involvement should initiate droplet and contact precautions. Droplet and contact precautions may be discontinued after 24 hours of antimicrobial therapy.

• #41 Necrotising fasciitis and septic shock: a case report of a patient receiving an immunomodulatory agent for multiple sclerosis – Wounds International

  https://woundsinternational.com/journal-articles/necrotising-fasciitis-and-septic-shock-a-case-report-of-a-patient-receiving-an-immunomodulatory-agent-for-multiple-sclerosis-2/

  Another factor that contributed to the positive outcome was the timely decision to perform a second look surgical intervention without any signs of deterioration, 48 hours after the first operation. […] NPWT provides several benefits to the wound; it keeps it clean by constantly draining and removing infected fluids, which reduces the size of the bacterial load. […] Even though surgical debridement and antibiotic agents are considered the main therapy of NF, Hyperbaric oxygen therapy (HBOT) and intravenous immunoglobulin (IVIG) therapy have been proposed as adjunct therapies. […] In addition to the individual steps, the authors believe that their teams personal involvement with this patients care, involving the early involvement of a large multidisciplinary team harmonically collaborating for her care, was the major factor contributing to her recovery. […] A multidisciplinary, early and aggressive approach is fundamental for the survival of the patient.

• #42

• #43

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Nurses who care for patients in the post-op setting will have to carefully monitor them for surgical wound integrity, bleeding, and electrolyte imbalances. Nurses must be diligent about administering prescribed antimicrobials as scheduled to maintain serum drug levels. […] In the post-op setting, nursing care also includes hemodynamic monitoring, pain management, and nutritional support. Due to the large surgical wounds and increased metabolic demand experienced by patients with NF, the expected caloric requirement may be twice that of a typical patient in order to replace protein and fluid loss. The nurse should anticipate that multiple surgical procedures will be performed as definitive NF treatment. […] Along with standard precautions, nurses caring for patients with invasive GAS infection with soft tissue involvement should initiate droplet and contact precautions. Droplet and contact precautions may be discontinued after 24 hours of antimicrobial therapy.

• #44 Necrotizing Fasciitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25623

  The earlier the surgery is undertaken, the better the outcome. […] The surgery requires extensive, wide debridement of all necrotic tissues. […] Daily dressing changes are mandatory. […] The patient’s recovery is faster as long as the necrotic tissue is removed. […] The nurse is often the first to recognize that the patient is critically ill or in pain. […] Nurses should be knowledgeable about necrotizing fasciitis and consult the surgeon as soon as possible. […] The patient should be kept NPO, hydrated, and immediately covered with broad-spectrum antibiotics. […] These patients are best managed in the intensive care unit until signs of toxicity diminish. […] A wound care nurse is mandatory as most patients have large open wounds that require daily dressings for weeks or months. […] Only through a systemic approach with close collaboration can the mortality of this condition be lowered.

• #45 Necrotizing Fasciitis: Pathophysiology and Treatment – Page 6

  https://www.medscape.com/viewarticle/443523_6

  Nursing interventions involve recognizing those patients at risk, reporting these suspicions to the health care provider, monitoring patient vital signs and laboratory values, providing frequent dressing changes, wound assessment and documentation, and medication administration. […] Medication administration involves antibiotics and pain medications. […] Although the patient’s complaints of pain may seem disproportionate to the appearance of the affected area, the nurse must remain vigilant and recognize this severe pain as a pathologic process in NF. […] Nutritional requirements ranging from two to three times normal amounts with adequate hydration are critical to provide sufficient calories and protein for wound healing. […] Dressing changes may be excruciating for patients with NF, requiring pre-medication and sedation prior to these activities. […] Topical antimicrobials are also utilized in wound care.

• #46 Necrotizing Fasciitis Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/necrotizing-fasciitis-nursing-diagnosis/

  Nursing interventions and care are essential for the patients recovery from necrotizing fasciitis. In the following section, you’ll learn about possible nursing interventions for a patient with this condition. […] Administer broad-spectrum intravenous antibiotics as ordered. Prompt antibiotic therapy is crucial in combating the infection. Ensure timely administration and monitor for any adverse reactions. […] Prepare and assist with surgical debridement as ordered. Surgical intervention is often necessary to remove necrotic tissue. Explain the procedure to the patient and provide emotional support. […] Perform meticulous wound care. Clean and dress the wound according to facility protocol or surgeons orders. Use a sterile technique to prevent further contamination. […] Manage pain effectively. Administer analgesics as prescribed and employ non-pharmacological pain management techniques. Adequate pain control is essential for patient comfort and healing.

• #47 Necrotizing Fasciitis: Pathophysiology and Treatment – Page 6

  https://www.medscape.com/viewarticle/443523_6

  Nursing interventions involve recognizing those patients at risk, reporting these suspicions to the health care provider, monitoring patient vital signs and laboratory values, providing frequent dressing changes, wound assessment and documentation, and medication administration. […] Medication administration involves antibiotics and pain medications. […] Although the patient’s complaints of pain may seem disproportionate to the appearance of the affected area, the nurse must remain vigilant and recognize this severe pain as a pathologic process in NF. […] Nutritional requirements ranging from two to three times normal amounts with adequate hydration are critical to provide sufficient calories and protein for wound healing. […] Dressing changes may be excruciating for patients with NF, requiring pre-medication and sedation prior to these activities. […] Topical antimicrobials are also utilized in wound care.

• #48 Necrotizing Fasciitis Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/necrotizing-fasciitis-nursing-diagnosis/

  Nursing interventions and care are essential for the patients recovery from necrotizing fasciitis. In the following section, you’ll learn about possible nursing interventions for a patient with this condition. […] Administer broad-spectrum intravenous antibiotics as ordered. Prompt antibiotic therapy is crucial in combating the infection. Ensure timely administration and monitor for any adverse reactions. […] Prepare and assist with surgical debridement as ordered. Surgical intervention is often necessary to remove necrotic tissue. Explain the procedure to the patient and provide emotional support. […] Perform meticulous wound care. Clean and dress the wound according to facility protocol or surgeons orders. Use a sterile technique to prevent further contamination. […] Manage pain effectively. Administer analgesics as prescribed and employ non-pharmacological pain management techniques. Adequate pain control is essential for patient comfort and healing.

• #49

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Given the risk for septic shock, the nurse must frequently monitor vital signs and other the physical assessment findings for signs of decompensation. The nurse must immediately notify the provider and/or call the rapid response team of signs and symptoms of impending shock and be prepared to administer I.V. fluids, both crystalloids and colloids, and possibly vasoactive agents such as I.V. norepinephrine, as prescribed. Given the severe pain often associated with NF, nursing care includes frequent pain assessments and appropriate pain management interventions. […] Pre-op care should include medication reconciliation and the patient’s informed consent. Intraoperatively, nurses must be prepared to assist with the collection of deep tissue culture specimens according to institutional protocol.

• #50 Case report: Necrotising fasciitis after removing the intrauterine device :: Cambridge Media Journals

  https://journals.cambridgemedia.com.au/wpr/volume-26-number-4/case-report-necrotising-fasciitis-after-removing-intrauterine-device

  Necrotising fasciitis can be successfully treated with early diagnosis, adequate debridement, and appropriate antibiotic therapy. […] A multidisciplinary approach is necessary for the comprehensive care of these patients. […] The care for a patient with NF is multidimensional and multidisciplinary, requiring nursing interventions. […] The basis of the treatment is an early diagnosis, broad-spectrum antibiotic therapy, debridement reaching intact tissues with no necrotic tissue left behind, regulating liquid-electrolyte balance, adequate oxygenation of the infected area and sufficient nutritional support and analgesia supply. […] The usual infection control precautions such as hand hygiene are important. […] The patient should be in a private room and under contact isolation. […] The timing of surgery is extremely important and is predicated on prompt diagnosis, and VAC application; it is a non-invasive method with controlled and localised negative pressure on the wound to accelerate healing in acute and chronic wounds.

• #51 Necrotising fasciitis and septic shock: a case report of a patient receiving an immunomodulatory agent for multiple sclerosis – Wounds International

  https://woundsinternational.com/journal-articles/necrotising-fasciitis-and-septic-shock-a-case-report-of-a-patient-receiving-an-immunomodulatory-agent-for-multiple-sclerosis-2/

  In addition, nutritional assessment and support, as well as daily physical therapy and kinesiotherapy, were provided in order to prevent further complications related with reduced mobility and sepsis. […] Despite the indications of improvement, it was decided to make early contact with the plastics department in order to accelerate recovery and rehabilitation. […] In addition, a tissue viability nurse (TVN) specialist was recommended in order to standardise the most appropriate method of NPWT application in such a difficult anatomical area. […] The aim of surgical intervention is to remove all necrotic tissues along the muscle-fascial layers of the affected area until we reach healthy boundaries and achieve hemostasis. […] Delays in the surgical debridement may be fatal, as the infection expands fast and it is crucial for the recovery of the patient to keep as many healthy tissues as possible.

• #52 Necrotizing Fasciitis Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/necrotizing-fasciitis-nursing-diagnosis/

  Monitor and maintain fluid and electrolyte balance. Administer IV fluids as ordered and monitor intake and output. Necrotizing fasciitis can lead to significant fluid losses and electrolyte imbalances. […] Implement infection control measures. To prevent the spread of infection, wear proper personal protective equipment (PPE) and follow isolation precautions as needed. […] Provide nutritional support. Collaborate with a dietitian to ensure adequate caloric and protein intake. If oral intake is insufficient, consider enteral or parenteral nutrition. […] Prevent pressure injuries. Implement regular repositioning and use pressure-relieving devices to prevent further skin breakdown.

• #53 Necrotizing Fasciitis: Pathophysiology and Treatment – Page 6

  https://www.medscape.com/viewarticle/443523_6

  Nursing interventions involve recognizing those patients at risk, reporting these suspicions to the health care provider, monitoring patient vital signs and laboratory values, providing frequent dressing changes, wound assessment and documentation, and medication administration. […] Medication administration involves antibiotics and pain medications. […] Although the patient’s complaints of pain may seem disproportionate to the appearance of the affected area, the nurse must remain vigilant and recognize this severe pain as a pathologic process in NF. […] Nutritional requirements ranging from two to three times normal amounts with adequate hydration are critical to provide sufficient calories and protein for wound healing. […] Dressing changes may be excruciating for patients with NF, requiring pre-medication and sedation prior to these activities. […] Topical antimicrobials are also utilized in wound care.

• #54

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Nurses who care for patients in the post-op setting will have to carefully monitor them for surgical wound integrity, bleeding, and electrolyte imbalances. Nurses must be diligent about administering prescribed antimicrobials as scheduled to maintain serum drug levels. […] In the post-op setting, nursing care also includes hemodynamic monitoring, pain management, and nutritional support. Due to the large surgical wounds and increased metabolic demand experienced by patients with NF, the expected caloric requirement may be twice that of a typical patient in order to replace protein and fluid loss. The nurse should anticipate that multiple surgical procedures will be performed as definitive NF treatment. […] Along with standard precautions, nurses caring for patients with invasive GAS infection with soft tissue involvement should initiate droplet and contact precautions. Droplet and contact precautions may be discontinued after 24 hours of antimicrobial therapy.

• #55 Necrotizing Fasciitis Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/necrotizing-fasciitis-nursing-diagnosis/

  Monitor and maintain fluid and electrolyte balance. Administer IV fluids as ordered and monitor intake and output. Necrotizing fasciitis can lead to significant fluid losses and electrolyte imbalances. […] Implement infection control measures. To prevent the spread of infection, wear proper personal protective equipment (PPE) and follow isolation precautions as needed. […] Provide nutritional support. Collaborate with a dietitian to ensure adequate caloric and protein intake. If oral intake is insufficient, consider enteral or parenteral nutrition. […] Prevent pressure injuries. Implement regular repositioning and use pressure-relieving devices to prevent further skin breakdown.

• #56 Necrotising Fasciitis: Causes, Symptoms, and Treatment

  https://patient.info/doctor/necrotising-fasciitis-pro

  Necrotising fasciitis (NF) or flesh-eating disease is an uncommon but life-threatening infection. It is defined as necrotising infection involving any layer of the deep soft tissue compartment (dermis, subcutaneous tissue, fascia or muscle). […] Important early clues are pain, tenderness and systemic illness out of proportion to the localised physical signs. […] A high index of suspicion is necessary and suspected cases should be referred immediately. Prompt surgical debridement is essential. […] The essential treatment is early and aggressive debridement of the involved tissue. Resuscitation, antibiotics and medical care are also important. […] Urgent surgical debridement is the key factor in treatment and improved survival of NF. Even a few hours’ delay increases mortality. […] Following initial debridement, the wound must be observed closely. Surgical debridement is repeated daily until the infection is controlled. […] Non-surgical measures include close monitoring and general supportive treatment in an intensive care setting with antimicrobial treatment. […] Nutritional support is required from day one, owing to the high protein and fluid loss from the wound.

• #57

  https://journals.lww.com/nursingcriticalcare/fulltext/2019/01000/necrotizing_fasciitis__infection_identification.2.aspx

  Ensure appropriate nutrition support for the patient because his or her healing needs are increased after a surgical incision, drainage, and debridement. […] Develop a pain management plan of care during the patient’s hospitalization and postprocedure process. […] Provide extensive emotional support to the patient and family.

• #58 The Diagnosis And Management Of Necrotising Fasciitis : Virtual Library

  https://resources.wfsahq.org/atotw/the-diagnosis-and-management-of-necrotising-fasciitis-anaesthesia-tutorial-of-the-week-298/

  NF is a surgical emergency and warrants immediate surgical referral. Evidence has shown that when treatment is based on just antimicrobial therapy and support, mortality approaches 100%. Surgery is a vital means of source control. […] Antibiotics are a vital adjunct to source control and may prevent the progression of septic shock when used early. […] Patients with NF frequently develop septic shock and multi-organ failure. Other common complications include disseminated-intra-vascular coagulation, adult respiratory distress syndrome, acidosis and hypothermia. […] The role of IVIG and HBO in the treatment of NF remains unclear due to the lack of randomized controlled trials. However if available, these therapies should be considered when surgical debridement, antibiotics and general supportive measures have proved unsuccessful.

• #59

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Given the risk for septic shock, the nurse must frequently monitor vital signs and other the physical assessment findings for signs of decompensation. The nurse must immediately notify the provider and/or call the rapid response team of signs and symptoms of impending shock and be prepared to administer I.V. fluids, both crystalloids and colloids, and possibly vasoactive agents such as I.V. norepinephrine, as prescribed. Given the severe pain often associated with NF, nursing care includes frequent pain assessments and appropriate pain management interventions. […] Pre-op care should include medication reconciliation and the patient’s informed consent. Intraoperatively, nurses must be prepared to assist with the collection of deep tissue culture specimens according to institutional protocol.

• #60 Necrotizing Soft Tissue Infection/ Necrotizing Fasciitis: Symptoms & Causes | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/burn-center/conditions-treatment/necrotizing-soft-tissue

  Patients may require multiple procedures or medications to manage the infection. These may include the following: Having an IV to keep hydrated, Taking antibiotics to control infection, Breathing through a temporary tube to maintain the patients airway, Taking medications for blood pressure, Replacing electrolytes (potassium, sodium, phosphorus, and the like), Managing glucose or blood sugar. […] Comfort is a top priority for our patients. The treatment team will give you pain medications as you need them.

• #61 Necrotizing Fasciitis Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/necrotizing-fasciitis-nursing-diagnosis/

  Monitor and maintain fluid and electrolyte balance. Administer IV fluids as ordered and monitor intake and output. Necrotizing fasciitis can lead to significant fluid losses and electrolyte imbalances. […] Implement infection control measures. To prevent the spread of infection, wear proper personal protective equipment (PPE) and follow isolation precautions as needed. […] Provide nutritional support. Collaborate with a dietitian to ensure adequate caloric and protein intake. If oral intake is insufficient, consider enteral or parenteral nutrition. […] Prevent pressure injuries. Implement regular repositioning and use pressure-relieving devices to prevent further skin breakdown.

• #62 Necrotizing Soft Tissue Infection/ Necrotizing Fasciitis: Symptoms & Causes | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/burn-center/conditions-treatment/necrotizing-soft-tissue

  Patients may require multiple procedures or medications to manage the infection. These may include the following: Having an IV to keep hydrated, Taking antibiotics to control infection, Breathing through a temporary tube to maintain the patients airway, Taking medications for blood pressure, Replacing electrolytes (potassium, sodium, phosphorus, and the like), Managing glucose or blood sugar. […] Comfort is a top priority for our patients. The treatment team will give you pain medications as you need them.

• #63

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Given the risk for septic shock, the nurse must frequently monitor vital signs and other the physical assessment findings for signs of decompensation. The nurse must immediately notify the provider and/or call the rapid response team of signs and symptoms of impending shock and be prepared to administer I.V. fluids, both crystalloids and colloids, and possibly vasoactive agents such as I.V. norepinephrine, as prescribed. Given the severe pain often associated with NF, nursing care includes frequent pain assessments and appropriate pain management interventions. […] Pre-op care should include medication reconciliation and the patient’s informed consent. Intraoperatively, nurses must be prepared to assist with the collection of deep tissue culture specimens according to institutional protocol.

• #64

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Given the risk for septic shock, the nurse must frequently monitor vital signs and other the physical assessment findings for signs of decompensation. The nurse must immediately notify the provider and/or call the rapid response team of signs and symptoms of impending shock and be prepared to administer I.V. fluids, both crystalloids and colloids, and possibly vasoactive agents such as I.V. norepinephrine, as prescribed. Given the severe pain often associated with NF, nursing care includes frequent pain assessments and appropriate pain management interventions. […] Pre-op care should include medication reconciliation and the patient’s informed consent. Intraoperatively, nurses must be prepared to assist with the collection of deep tissue culture specimens according to institutional protocol.

• #65 Necrotizing Fasciitis Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/necrotizing-fasciitis-nursing-diagnosis/

  Monitor and maintain fluid and electrolyte balance. Administer IV fluids as ordered and monitor intake and output. Necrotizing fasciitis can lead to significant fluid losses and electrolyte imbalances. […] Implement infection control measures. To prevent the spread of infection, wear proper personal protective equipment (PPE) and follow isolation precautions as needed. […] Provide nutritional support. Collaborate with a dietitian to ensure adequate caloric and protein intake. If oral intake is insufficient, consider enteral or parenteral nutrition. […] Prevent pressure injuries. Implement regular repositioning and use pressure-relieving devices to prevent further skin breakdown.

• #66 Necrotising fasciitis and septic shock: a case report of a patient receiving an immunomodulatory agent for multiple sclerosis – Wounds International

  https://woundsinternational.com/journal-articles/necrotising-fasciitis-and-septic-shock-a-case-report-of-a-patient-receiving-an-immunomodulatory-agent-for-multiple-sclerosis-2/

  In addition, nutritional assessment and support, as well as daily physical therapy and kinesiotherapy, were provided in order to prevent further complications related with reduced mobility and sepsis. […] Despite the indications of improvement, it was decided to make early contact with the plastics department in order to accelerate recovery and rehabilitation. […] In addition, a tissue viability nurse (TVN) specialist was recommended in order to standardise the most appropriate method of NPWT application in such a difficult anatomical area. […] The aim of surgical intervention is to remove all necrotic tissues along the muscle-fascial layers of the affected area until we reach healthy boundaries and achieve hemostasis. […] Delays in the surgical debridement may be fatal, as the infection expands fast and it is crucial for the recovery of the patient to keep as many healthy tissues as possible.

• #67 Necrotizing Fasciitis – Straight A Nursing

  https://straightanursingstudent.com/necrotizing-fasciitis/

  Before I started working as a nurse in a medical ICU, I thought necrotizing fasciitis was one of those really scary conditions that hardly ever happened and that I would probably never see. […] The priority intervention with necrotizing fasciitis is surgical debridement of the wound. The surgeon must cut away all of the dead, damaged and infected tissue and thoroughly wash out the wound to ensure no microorganisms remain. […] Emphasize personal hygiene and handwashing as a first-line defense against infection. The bacteria can spread from the current wound to another individual or part of the body, so excellent hand hygiene and PPE are crucial!

• #68

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Nurses who care for patients in the post-op setting will have to carefully monitor them for surgical wound integrity, bleeding, and electrolyte imbalances. Nurses must be diligent about administering prescribed antimicrobials as scheduled to maintain serum drug levels. […] In the post-op setting, nursing care also includes hemodynamic monitoring, pain management, and nutritional support. Due to the large surgical wounds and increased metabolic demand experienced by patients with NF, the expected caloric requirement may be twice that of a typical patient in order to replace protein and fluid loss. The nurse should anticipate that multiple surgical procedures will be performed as definitive NF treatment. […] Along with standard precautions, nurses caring for patients with invasive GAS infection with soft tissue involvement should initiate droplet and contact precautions. Droplet and contact precautions may be discontinued after 24 hours of antimicrobial therapy.

• #69 Necrotizing Fasciitis: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.necrotizing-fasciitis-care-instructions.zc1619

  Call your doctor now or seek immediate medical care if: […] You have worse symptoms of infection, such as: […] Increased pain, swelling, warmth, or redness. […] Red streaks leading from the area. […] Pus draining from the area. […] A fever. […] Watch closely for changes in your health, and be sure to contact your doctor if: […] You do not get better as expected.

• #70 Necrotizing Fasciitis (Flesh-Eating Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23103-necrotizing-fasciitis

  Necrotizing fasciitis is a severe rapidly spreading bacterial infection that can cause death. […] Quick intervention is needed to control necrotizing fasciitis. You’ll require exploratory surgery to confirm the diagnosis of necrotizing fasciitis. Surgery is also required to remove dead tissue. It may take multiple surgeries to control the infection and remove all of the dead tissue. It takes an average of three surgeries to make sure all of the infection is gone. Your provider will also likely prescribe antibiotics and intravenous (IV) fluids. After surgery, you may need skin grafts or plastic surgery to help the wounds close completely. […] If you have this condition, your best outcome will come from receiving an accurate diagnosis and quick treatment with antibiotics combined with surgery to remove the dead tissue. […] If you’ve been diagnosed with and treated for necrotizing fasciitis, and you aren’t getting better, contact your healthcare provider. Keep any follow-up appointments that your provider may schedule. If you’re taking antibiotics, make sure you take them as instructed.

• #71

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Patient education and support […] The nurse should assess the patient’s understanding of NF and provide additional teaching as necessary. Additional elements of patient teaching include pain management, antimicrobial therapy, surgical procedures, and wound care. As the patient prepares for discharge from acute care, the nurse must provide patient education regarding home medications, follow-up care, and signs and symptoms of normal healing versus those suggesting possible complications. […] The patient should also receive targeted rehabilitation from the physiatry team to increase functional status. Given the severity of the condition, the nurse should prepare the patient and family for a prolonged hospital stay. If partial or full amputation was required to treat NF, the patient may experience significant disfigurement and associated psychological distress. In addition, patients who survive to hospital discharge are at increased risk for morbidity and mortality due to functional decline and impaired wound integrity. Nurses must provide patients and their families emotional support services, including social work and counseling if possible.

• #72 Necrotising fasciitis and septic shock: a case report of a patient receiving an immunomodulatory agent for multiple sclerosis – Wounds International

  https://woundsinternational.com/journal-articles/necrotising-fasciitis-and-septic-shock-a-case-report-of-a-patient-receiving-an-immunomodulatory-agent-for-multiple-sclerosis-2/

  In addition, nutritional assessment and support, as well as daily physical therapy and kinesiotherapy, were provided in order to prevent further complications related with reduced mobility and sepsis. […] Despite the indications of improvement, it was decided to make early contact with the plastics department in order to accelerate recovery and rehabilitation. […] In addition, a tissue viability nurse (TVN) specialist was recommended in order to standardise the most appropriate method of NPWT application in such a difficult anatomical area. […] The aim of surgical intervention is to remove all necrotic tissues along the muscle-fascial layers of the affected area until we reach healthy boundaries and achieve hemostasis. […] Delays in the surgical debridement may be fatal, as the infection expands fast and it is crucial for the recovery of the patient to keep as many healthy tissues as possible.

• #73 Atypical Wounds – Necrotizing Fasciitis | AccessMedicine Network

  https://www.accessmedicinenetwork.com/posts/57884-atypical-wounds-necrotizing-fasciitis

  Necrotizing fasciitis is a fast-moving infection along a fascial plane that requires timely diagnosis, immediate surgical debridement of infected tissue, meticulous wound care, and rehabilitation services in order for the patient to survive and regain function. […] Medical management includes appropriate antibiotics, aggressive and immediate surgical debridement of all infected subcutaneous and dermal tissue (the saying is that the patient goes straight from the ER to the OR), and medical stabilization as needed. Adjunctive hyperbaric oxygen therapy may be beneficial in promoting healing after all infected tissue is removed. […] Wound management depends on the extent of surgical debridement, as well as the amount and quality of the residual soft tissue. If there is concern about continued infection, antimicrobial dressings are used, for example, Nano crystalline silver, half or quarter strength Dakin solution (unless there is granulation tissue), or acetic acid washes for pseudomonas. Once the wounds are more than 70% clean, negative pressure wound therapy is useful to facilitate wound contraction and angiogenesis in preparation for skin grafts or flaps. Pain management during wound care is essential, as well as nutritional supplements for adequate caloric and protein intake. If the wounds are extensive, physical and occupational therapies are needed to optimize strength, range of motion, and function. […] In summary, the most important aspects of treating NF are timely diagnosis of the infection, immediate surgical debridement, meticulous wound care, and rehabilitation during and after wound healing.

• #74 Atypical Wounds – Necrotizing Fasciitis | AccessMedicine Network

  https://www.accessmedicinenetwork.com/posts/57884-atypical-wounds-necrotizing-fasciitis

  Necrotizing fasciitis is a fast-moving infection along a fascial plane that requires timely diagnosis, immediate surgical debridement of infected tissue, meticulous wound care, and rehabilitation services in order for the patient to survive and regain function. […] Medical management includes appropriate antibiotics, aggressive and immediate surgical debridement of all infected subcutaneous and dermal tissue (the saying is that the patient goes straight from the ER to the OR), and medical stabilization as needed. Adjunctive hyperbaric oxygen therapy may be beneficial in promoting healing after all infected tissue is removed. […] Wound management depends on the extent of surgical debridement, as well as the amount and quality of the residual soft tissue. If there is concern about continued infection, antimicrobial dressings are used, for example, Nano crystalline silver, half or quarter strength Dakin solution (unless there is granulation tissue), or acetic acid washes for pseudomonas. Once the wounds are more than 70% clean, negative pressure wound therapy is useful to facilitate wound contraction and angiogenesis in preparation for skin grafts or flaps. Pain management during wound care is essential, as well as nutritional supplements for adequate caloric and protein intake. If the wounds are extensive, physical and occupational therapies are needed to optimize strength, range of motion, and function. […] In summary, the most important aspects of treating NF are timely diagnosis of the infection, immediate surgical debridement, meticulous wound care, and rehabilitation during and after wound healing.

• #75

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Patient education and support […] The nurse should assess the patient’s understanding of NF and provide additional teaching as necessary. Additional elements of patient teaching include pain management, antimicrobial therapy, surgical procedures, and wound care. As the patient prepares for discharge from acute care, the nurse must provide patient education regarding home medications, follow-up care, and signs and symptoms of normal healing versus those suggesting possible complications. […] The patient should also receive targeted rehabilitation from the physiatry team to increase functional status. Given the severity of the condition, the nurse should prepare the patient and family for a prolonged hospital stay. If partial or full amputation was required to treat NF, the patient may experience significant disfigurement and associated psychological distress. In addition, patients who survive to hospital discharge are at increased risk for morbidity and mortality due to functional decline and impaired wound integrity. Nurses must provide patients and their families emotional support services, including social work and counseling if possible.

• #76 Necrotising fasciitis and septic shock: a case report of a patient receiving an immunomodulatory agent for multiple sclerosis – Wounds International

  https://woundsinternational.com/journal-articles/necrotising-fasciitis-and-septic-shock-a-case-report-of-a-patient-receiving-an-immunomodulatory-agent-for-multiple-sclerosis-2/

  In addition, nutritional assessment and support, as well as daily physical therapy and kinesiotherapy, were provided in order to prevent further complications related with reduced mobility and sepsis. […] Despite the indications of improvement, it was decided to make early contact with the plastics department in order to accelerate recovery and rehabilitation. […] In addition, a tissue viability nurse (TVN) specialist was recommended in order to standardise the most appropriate method of NPWT application in such a difficult anatomical area. […] The aim of surgical intervention is to remove all necrotic tissues along the muscle-fascial layers of the affected area until we reach healthy boundaries and achieve hemostasis. […] Delays in the surgical debridement may be fatal, as the infection expands fast and it is crucial for the recovery of the patient to keep as many healthy tissues as possible.

• #77

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Patient education and support […] The nurse should assess the patient’s understanding of NF and provide additional teaching as necessary. Additional elements of patient teaching include pain management, antimicrobial therapy, surgical procedures, and wound care. As the patient prepares for discharge from acute care, the nurse must provide patient education regarding home medications, follow-up care, and signs and symptoms of normal healing versus those suggesting possible complications. […] The patient should also receive targeted rehabilitation from the physiatry team to increase functional status. Given the severity of the condition, the nurse should prepare the patient and family for a prolonged hospital stay. If partial or full amputation was required to treat NF, the patient may experience significant disfigurement and associated psychological distress. In addition, patients who survive to hospital discharge are at increased risk for morbidity and mortality due to functional decline and impaired wound integrity. Nurses must provide patients and their families emotional support services, including social work and counseling if possible.

• #78

  https://journals.lww.com/nursingcriticalcare/fulltext/2019/01000/necrotizing_fasciitis__infection_identification.2.aspx

  Ensure appropriate nutrition support for the patient because his or her healing needs are increased after a surgical incision, drainage, and debridement. […] Develop a pain management plan of care during the patient’s hospitalization and postprocedure process. […] Provide extensive emotional support to the patient and family.

• #79

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Patient education and support […] The nurse should assess the patient’s understanding of NF and provide additional teaching as necessary. Additional elements of patient teaching include pain management, antimicrobial therapy, surgical procedures, and wound care. As the patient prepares for discharge from acute care, the nurse must provide patient education regarding home medications, follow-up care, and signs and symptoms of normal healing versus those suggesting possible complications. […] The patient should also receive targeted rehabilitation from the physiatry team to increase functional status. Given the severity of the condition, the nurse should prepare the patient and family for a prolonged hospital stay. If partial or full amputation was required to treat NF, the patient may experience significant disfigurement and associated psychological distress. In addition, patients who survive to hospital discharge are at increased risk for morbidity and mortality due to functional decline and impaired wound integrity. Nurses must provide patients and their families emotional support services, including social work and counseling if possible.

• #80

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Patient education and support […] The nurse should assess the patient’s understanding of NF and provide additional teaching as necessary. Additional elements of patient teaching include pain management, antimicrobial therapy, surgical procedures, and wound care. As the patient prepares for discharge from acute care, the nurse must provide patient education regarding home medications, follow-up care, and signs and symptoms of normal healing versus those suggesting possible complications. […] The patient should also receive targeted rehabilitation from the physiatry team to increase functional status. Given the severity of the condition, the nurse should prepare the patient and family for a prolonged hospital stay. If partial or full amputation was required to treat NF, the patient may experience significant disfigurement and associated psychological distress. In addition, patients who survive to hospital discharge are at increased risk for morbidity and mortality due to functional decline and impaired wound integrity. Nurses must provide patients and their families emotional support services, including social work and counseling if possible.

• #81

  https://journals.lww.com/nursingcriticalcare/fulltext/2019/01000/necrotizing_fasciitis__infection_identification.2.aspx

  Ensure appropriate nutrition support for the patient because his or her healing needs are increased after a surgical incision, drainage, and debridement. […] Develop a pain management plan of care during the patient’s hospitalization and postprocedure process. […] Provide extensive emotional support to the patient and family.

• #82

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Patient education and support […] The nurse should assess the patient’s understanding of NF and provide additional teaching as necessary. Additional elements of patient teaching include pain management, antimicrobial therapy, surgical procedures, and wound care. As the patient prepares for discharge from acute care, the nurse must provide patient education regarding home medications, follow-up care, and signs and symptoms of normal healing versus those suggesting possible complications. […] The patient should also receive targeted rehabilitation from the physiatry team to increase functional status. Given the severity of the condition, the nurse should prepare the patient and family for a prolonged hospital stay. If partial or full amputation was required to treat NF, the patient may experience significant disfigurement and associated psychological distress. In addition, patients who survive to hospital discharge are at increased risk for morbidity and mortality due to functional decline and impaired wound integrity. Nurses must provide patients and their families emotional support services, including social work and counseling if possible.

• #83

  https://journals.lww.com/nursingcriticalcare/fulltext/2019/01000/necrotizing_fasciitis__infection_identification.2.aspx

  When considering the care needs of a patient presenting with NF, critical care nurses may need to focus on early detection, pain management, nutrition, and emotional support. […] Nursing care is essential to support the patient and family, as further care may involve multiple surgeries/procedures and perhaps lifestyle adjustments. […] Perform a detailed skin assessment to detect distinct features associated with NF, such as pain, bullae, inflammation, and erythema. […] Educate high-risk patients (patients with comorbidities of diabetes mellitus and liver disease) on the importance of seeking medical care for any injury. […] Notify the physician of any patient who presents with intensely severe pain disproportionate to visual presentation and tenderness at the wound site and its surrounding tissue for a surgical opinion.

• #84

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Patient education and support […] The nurse should assess the patient’s understanding of NF and provide additional teaching as necessary. Additional elements of patient teaching include pain management, antimicrobial therapy, surgical procedures, and wound care. As the patient prepares for discharge from acute care, the nurse must provide patient education regarding home medications, follow-up care, and signs and symptoms of normal healing versus those suggesting possible complications. […] The patient should also receive targeted rehabilitation from the physiatry team to increase functional status. Given the severity of the condition, the nurse should prepare the patient and family for a prolonged hospital stay. If partial or full amputation was required to treat NF, the patient may experience significant disfigurement and associated psychological distress. In addition, patients who survive to hospital discharge are at increased risk for morbidity and mortality due to functional decline and impaired wound integrity. Nurses must provide patients and their families emotional support services, including social work and counseling if possible.

• #85 Necrotizing Fasciitis: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.necrotizing-fasciitis-care-instructions.zc1619

  Necrotizing fasciitis is a rare infection that kills skin, fat, and muscles. It is also called „flesh-eating” bacteria. It usually affects the legs and arms. It can cause scarring and can lead to amputation and death. […] This condition is treated in a hospital. Treatment includes antibiotics and supportive care. Surgery is usually needed to remove dead or infected tissue, stop the spread of infection, and repair damage. Sometimes people are placed in a chamber with high levels of oxygen. This is called a hyperbaric chamber. It helps the tissue heal. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

• #86 Necrotizing Fasciitis: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.necrotizing-fasciitis-care-instructions.zc1619

  Call your doctor now or seek immediate medical care if: […] You have worse symptoms of infection, such as: […] Increased pain, swelling, warmth, or redness. […] Red streaks leading from the area. […] Pus draining from the area. […] A fever. […] Watch closely for changes in your health, and be sure to contact your doctor if: […] You do not get better as expected.

• #87 Centre for Health Protection – Necrotising Fasciitis

  https://www.chp.gov.hk/en/healthtopics/content/24/48372.html

  NF is a severe illness that require hospitalisation, and some patients require intensive care. […] Prompt treatment with appropriate antibiotics is necessary to kill the bacteria. […] In order to stop the infection from spreading, surgery, e.g. removal of the dead tissues or amputation of the limb, may be required. […] To prevent the infection, members of the public should maintain good personal hygiene and practise good wound care; wear protective gloves when handling raw shellfish or other seafood. […] Clean wounds immediately and cover properly with waterproof adhesive dressings until healed. […] Prompt first-aid care of even minor, non-infected wounds. […] Perform hand hygiene before and after touching wounds. […] Consult doctor promptly if symptoms of infection develop, such as increasing redness, swelling and pain on the skin.

• #88

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc1619

  Necrotizing fasciitis is a rare infection that kills skin, fat, and muscles. It is also called „flesh-eating” bacteria. It usually affects the legs and arms. It can cause scarring and can lead to amputation and death. […] This condition is treated in a hospital. Treatment includes antibiotics and supportive care. Surgery is usually needed to remove dead or infected tissue, stop the spread of infection, and repair damage. Sometimes people are placed in a chamber with high levels of oxygen. This is called a hyperbaric chamber. It helps the tissue heal. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

• #89 Necrotizing Fasciitis: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.necrotizing-fasciitis-care-instructions.zc1619

  Call your doctor now or seek immediate medical care if: […] You have worse symptoms of infection, such as: […] Increased pain, swelling, warmth, or redness. […] Red streaks leading from the area. […] Pus draining from the area. […] A fever. […] Watch closely for changes in your health, and be sure to contact your doctor if: […] You do not get better as expected.

• #90

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Patient education and support […] The nurse should assess the patient’s understanding of NF and provide additional teaching as necessary. Additional elements of patient teaching include pain management, antimicrobial therapy, surgical procedures, and wound care. As the patient prepares for discharge from acute care, the nurse must provide patient education regarding home medications, follow-up care, and signs and symptoms of normal healing versus those suggesting possible complications. […] The patient should also receive targeted rehabilitation from the physiatry team to increase functional status. Given the severity of the condition, the nurse should prepare the patient and family for a prolonged hospital stay. If partial or full amputation was required to treat NF, the patient may experience significant disfigurement and associated psychological distress. In addition, patients who survive to hospital discharge are at increased risk for morbidity and mortality due to functional decline and impaired wound integrity. Nurses must provide patients and their families emotional support services, including social work and counseling if possible.

• #91 Necrotizing Fasciitis: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.necrotizing-fasciitis-care-instructions.zc1619

  Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. […] If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics. […] Most people who get this condition are in good health before they get infected. You can lower your risk of infection by giving proper care to skin wounds. […] Keep all wounds clean. This includes cuts, burns, sores, and bites. […] If you strain a muscle or sprain a joint and get a fever, chills, and severe pain, seek medical care right away. These may be signs of deep soft tissue infection. […] If you have severe pain and swelling and a fever, do not treat these with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. These medicines may keep you from seeing a doctor quickly when you really need to.

• #92 Necrotizing Fasciitis: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.necrotizing-fasciitis-care-instructions.zc1619

  Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. […] If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics. […] Most people who get this condition are in good health before they get infected. You can lower your risk of infection by giving proper care to skin wounds. […] Keep all wounds clean. This includes cuts, burns, sores, and bites. […] If you strain a muscle or sprain a joint and get a fever, chills, and severe pain, seek medical care right away. These may be signs of deep soft tissue infection. […] If you have severe pain and swelling and a fever, do not treat these with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. These medicines may keep you from seeing a doctor quickly when you really need to.

• #93 Necrotizing Fasciitis: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.necrotizing-fasciitis-care-instructions.zc1619

  Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. […] If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics. […] Most people who get this condition are in good health before they get infected. You can lower your risk of infection by giving proper care to skin wounds. […] Keep all wounds clean. This includes cuts, burns, sores, and bites. […] If you strain a muscle or sprain a joint and get a fever, chills, and severe pain, seek medical care right away. These may be signs of deep soft tissue infection. […] If you have severe pain and swelling and a fever, do not treat these with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. These medicines may keep you from seeing a doctor quickly when you really need to.

• #94

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Patient education and support […] The nurse should assess the patient’s understanding of NF and provide additional teaching as necessary. Additional elements of patient teaching include pain management, antimicrobial therapy, surgical procedures, and wound care. As the patient prepares for discharge from acute care, the nurse must provide patient education regarding home medications, follow-up care, and signs and symptoms of normal healing versus those suggesting possible complications. […] The patient should also receive targeted rehabilitation from the physiatry team to increase functional status. Given the severity of the condition, the nurse should prepare the patient and family for a prolonged hospital stay. If partial or full amputation was required to treat NF, the patient may experience significant disfigurement and associated psychological distress. In addition, patients who survive to hospital discharge are at increased risk for morbidity and mortality due to functional decline and impaired wound integrity. Nurses must provide patients and their families emotional support services, including social work and counseling if possible.

• #95

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Patient education and support […] The nurse should assess the patient’s understanding of NF and provide additional teaching as necessary. Additional elements of patient teaching include pain management, antimicrobial therapy, surgical procedures, and wound care. As the patient prepares for discharge from acute care, the nurse must provide patient education regarding home medications, follow-up care, and signs and symptoms of normal healing versus those suggesting possible complications. […] The patient should also receive targeted rehabilitation from the physiatry team to increase functional status. Given the severity of the condition, the nurse should prepare the patient and family for a prolonged hospital stay. If partial or full amputation was required to treat NF, the patient may experience significant disfigurement and associated psychological distress. In addition, patients who survive to hospital discharge are at increased risk for morbidity and mortality due to functional decline and impaired wound integrity. Nurses must provide patients and their families emotional support services, including social work and counseling if possible.

• #96

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc1619

  Necrotizing fasciitis is a rare infection that kills skin, fat, and muscles. It is also called „flesh-eating” bacteria. It usually affects the legs and arms. It can cause scarring and can lead to amputation and death. […] This condition is treated in a hospital. Treatment includes antibiotics and supportive care. Surgery is usually needed to remove dead or infected tissue, stop the spread of infection, and repair damage. Sometimes people are placed in a chamber with high levels of oxygen. This is called a hyperbaric chamber. It helps the tissue heal. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

• #97 What is necrotising fasciitis aka 'flesh-eating disease’? | Queensland Health

  https://www.health.qld.gov.au/newsroom/features/what-is-necrotising-fasciitis-aka-flesh-eating-disease

  Necrotising fasciitis is a rare and very serious infection. It can spread rapidly in the body and lead to sepsis, shock, organ failure and death. […] Quick and accurate diagnosis of necrotising fasciitis and rapid antibiotic treatment and surgery are critical in stopping this infection before it causes severe damage or death. […] Early diagnosis and treatment of necrotising fasciitis is key. Its a very serious illness that requires hospital care, often in intensive care. […] Good wound care is the best way to prevent bacterial skin infections, including necrotising fasciitis. You can look after most minor wounds yourself, keeping them clean and preventing infection.

• #98

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc1619

  Take your medicine exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine. […] If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics. […] Most people who get this condition are in good health before they get infected. You can lower your risk of infection by giving proper care to skin wounds. […] Keep all wounds clean. This includes cuts, burns, sores, and bites. […] If you strain a muscle or sprain a joint and get a fever, chills, and severe pain, seek medical care right away. These may be signs of deep soft tissue infection. […] If you have severe pain and swelling and a fever, do not treat these with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. These medicines may keep you from seeing a doctor quickly when you really need to.

• #99 Centre for Health Protection – Necrotising Fasciitis

  https://www.chp.gov.hk/en/healthtopics/content/24/48372.html

  NF is a severe illness that require hospitalisation, and some patients require intensive care. […] Prompt treatment with appropriate antibiotics is necessary to kill the bacteria. […] In order to stop the infection from spreading, surgery, e.g. removal of the dead tissues or amputation of the limb, may be required. […] To prevent the infection, members of the public should maintain good personal hygiene and practise good wound care; wear protective gloves when handling raw shellfish or other seafood. […] Clean wounds immediately and cover properly with waterproof adhesive dressings until healed. […] Prompt first-aid care of even minor, non-infected wounds. […] Perform hand hygiene before and after touching wounds. […] Consult doctor promptly if symptoms of infection develop, such as increasing redness, swelling and pain on the skin.

• #100 Centre for Health Protection – Necrotising Fasciitis

  https://www.chp.gov.hk/en/healthtopics/content/24/48372.html

  NF is a severe illness that require hospitalisation, and some patients require intensive care. […] Prompt treatment with appropriate antibiotics is necessary to kill the bacteria. […] In order to stop the infection from spreading, surgery, e.g. removal of the dead tissues or amputation of the limb, may be required. […] To prevent the infection, members of the public should maintain good personal hygiene and practise good wound care; wear protective gloves when handling raw shellfish or other seafood. […] Clean wounds immediately and cover properly with waterproof adhesive dressings until healed. […] Prompt first-aid care of even minor, non-infected wounds. […] Perform hand hygiene before and after touching wounds. […] Consult doctor promptly if symptoms of infection develop, such as increasing redness, swelling and pain on the skin.

• #101 Centre for Health Protection – Necrotising Fasciitis

  https://www.chp.gov.hk/en/healthtopics/content/24/48372.html

  NF is a severe illness that require hospitalisation, and some patients require intensive care. […] Prompt treatment with appropriate antibiotics is necessary to kill the bacteria. […] In order to stop the infection from spreading, surgery, e.g. removal of the dead tissues or amputation of the limb, may be required. […] To prevent the infection, members of the public should maintain good personal hygiene and practise good wound care; wear protective gloves when handling raw shellfish or other seafood. […] Clean wounds immediately and cover properly with waterproof adhesive dressings until healed. […] Prompt first-aid care of even minor, non-infected wounds. […] Perform hand hygiene before and after touching wounds. […] Consult doctor promptly if symptoms of infection develop, such as increasing redness, swelling and pain on the skin.

• #102

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc1619

  Take your medicine exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine. […] If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics. […] Most people who get this condition are in good health before they get infected. You can lower your risk of infection by giving proper care to skin wounds. […] Keep all wounds clean. This includes cuts, burns, sores, and bites. […] If you strain a muscle or sprain a joint and get a fever, chills, and severe pain, seek medical care right away. These may be signs of deep soft tissue infection. […] If you have severe pain and swelling and a fever, do not treat these with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. These medicines may keep you from seeing a doctor quickly when you really need to.

• #103

  https://journals.lww.com/nursingcriticalcare/fulltext/2019/01000/necrotizing_fasciitis__infection_identification.2.aspx

  When considering the care needs of a patient presenting with NF, critical care nurses may need to focus on early detection, pain management, nutrition, and emotional support. […] Nursing care is essential to support the patient and family, as further care may involve multiple surgeries/procedures and perhaps lifestyle adjustments. […] Perform a detailed skin assessment to detect distinct features associated with NF, such as pain, bullae, inflammation, and erythema. […] Educate high-risk patients (patients with comorbidities of diabetes mellitus and liver disease) on the importance of seeking medical care for any injury. […] Notify the physician of any patient who presents with intensely severe pain disproportionate to visual presentation and tenderness at the wound site and its surrounding tissue for a surgical opinion.

• #104 Necrotizing Fasciitis – Straight A Nursing

  https://straightanursingstudent.com/necrotizing-fasciitis/

  Before I started working as a nurse in a medical ICU, I thought necrotizing fasciitis was one of those really scary conditions that hardly ever happened and that I would probably never see. […] The priority intervention with necrotizing fasciitis is surgical debridement of the wound. The surgeon must cut away all of the dead, damaged and infected tissue and thoroughly wash out the wound to ensure no microorganisms remain. […] Emphasize personal hygiene and handwashing as a first-line defense against infection. The bacteria can spread from the current wound to another individual or part of the body, so excellent hand hygiene and PPE are crucial!

• #105

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc1619

  Take your medicine exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine. […] If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics. […] Most people who get this condition are in good health before they get infected. You can lower your risk of infection by giving proper care to skin wounds. […] Keep all wounds clean. This includes cuts, burns, sores, and bites. […] If you strain a muscle or sprain a joint and get a fever, chills, and severe pain, seek medical care right away. These may be signs of deep soft tissue infection. […] If you have severe pain and swelling and a fever, do not treat these with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. These medicines may keep you from seeing a doctor quickly when you really need to.

• #106

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc1619

  Take your medicine exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine. […] If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics. […] Most people who get this condition are in good health before they get infected. You can lower your risk of infection by giving proper care to skin wounds. […] Keep all wounds clean. This includes cuts, burns, sores, and bites. […] If you strain a muscle or sprain a joint and get a fever, chills, and severe pain, seek medical care right away. These may be signs of deep soft tissue infection. […] If you have severe pain and swelling and a fever, do not treat these with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. These medicines may keep you from seeing a doctor quickly when you really need to.

• #107

  https://journals.lww.com/nursingcriticalcare/fulltext/2019/01000/necrotizing_fasciitis__infection_identification.2.aspx

  When considering the care needs of a patient presenting with NF, critical care nurses may need to focus on early detection, pain management, nutrition, and emotional support. […] Nursing care is essential to support the patient and family, as further care may involve multiple surgeries/procedures and perhaps lifestyle adjustments. […] Perform a detailed skin assessment to detect distinct features associated with NF, such as pain, bullae, inflammation, and erythema. […] Educate high-risk patients (patients with comorbidities of diabetes mellitus and liver disease) on the importance of seeking medical care for any injury. […] Notify the physician of any patient who presents with intensely severe pain disproportionate to visual presentation and tenderness at the wound site and its surrounding tissue for a surgical opinion.

• #108 Centre for Health Protection – Necrotising Fasciitis

  https://www.chp.gov.hk/en/healthtopics/content/24/48372.html

  NF is a severe illness that require hospitalisation, and some patients require intensive care. […] Prompt treatment with appropriate antibiotics is necessary to kill the bacteria. […] In order to stop the infection from spreading, surgery, e.g. removal of the dead tissues or amputation of the limb, may be required. […] To prevent the infection, members of the public should maintain good personal hygiene and practise good wound care; wear protective gloves when handling raw shellfish or other seafood. […] Clean wounds immediately and cover properly with waterproof adhesive dressings until healed. […] Prompt first-aid care of even minor, non-infected wounds. […] Perform hand hygiene before and after touching wounds. […] Consult doctor promptly if symptoms of infection develop, such as increasing redness, swelling and pain on the skin.

• #109 Necrotizing Fasciitis (Flesh-Eating Disease) | HealthLink BC

  https://www.healthlinkbc.ca/healthlinkbc-files/necrotizing-fasciitis-flesh-eating-disease

  Necrotizing fasciitis is a very severe bacterial infection that spreads quickly through the tissue (flesh) surrounding the muscles. […] Antibiotics are an important part of the treatment for necrotizing fasciitis. However, antibiotics on their own are not usually enough. This is because necrotizing fasciitis cuts off the blood supply to body tissue, and the antibiotics must be carried by blood to the infected site to work. Surgery, combined with antibiotics, is the usual treatment. […] Since this severe form of streptococcal infection can progress so rapidly, the best approach is to get medical attention as soon as symptoms occur. Remember, an important clue to this disease is very severe pain at the site of a wound.

• #110 Multidisciplinary treatment of a patient with necrotizing fasciitis caused by Staphylococcus aureus: A case report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6854421/

  The advantages of different disciplines were combined to improve the therapeutic effect for this patient. They included physicians who offered early basic life support and organ function maintenance, surgeons who performed surgical interventions, bacteriological experts who provided culture and drug sensitivity results on time, dietitians who provided effective nutrition support, and anaesthesiologists who conducted the perioperative management of the patient. In addition, the radiology department provided imaging data for clinical diagnosis and treatment analysis. Interdisciplinary intensive care was a necessary condition for the successful treatment of this patient. […] Prompt diagnosis and early operative debridement with adequate antibiotics are vital. Interdisciplinary intensive care treatment is a guarantee for successful therapy.

• #111 Necrotizing Fasciitis Treatment & Management: Approach Considerations, Surgical Debridement, Antimicrobial Therapy

  https://emedicine.medscape.com/article/2051157-treatment

  The authors recommend wide, extensive debridement of all tissues that can be easily elevated off the fascia with gentle pressure. […] After the initial debridement, the wound must be carefully examined. […] Following each debridement of the necrotic tissue, daily antibiotic dressings are recommended. […] Once all of the affected tissues have been debrided, soft tissue reconstruction can be considered. […] Empiric antibiotics should be started immediately. […] Nutritional support is also an integral part of treatment for patients with necrotizing fasciitis. […] Successful use of intravenous immunoglobulin (IVIG) has been reported in the treatment of streptococcal toxic shock syndrome. […] Once other modalities, including surgical debridement and antibiotic administration, have been used, hyperbaric oxygen therapy (HBOT) may be considered, if available. […] A team approach is the best method of treating this complicated disorder.

• #112 Necrotizing Fasciitis Treatment & Management: Approach Considerations, Surgical Debridement, Antimicrobial Therapy

  https://emedicine.medscape.com/article/2051157-treatment

  Once the diagnosis of necrotizing fasciitis is confirmed, initiate treatment without delay. […] Because necrotizing fasciitis is a surgical emergency, the patient should be admitted immediately to a surgical intensive care unit in a setting such as a regional burn center or trauma center, where the surgical staff is skilled in performing extensive debridement and reconstructive surgery. […] A regimen of surgical debridement is continued until tissue necrosis ceases and the growth of fresh, viable tissue is observed. […] Prompt surgery ensures a higher likelihood of survival. […] Antibiotic therapy is a key consideration. […] Surgery is the primary treatment for necrotizing fasciitis. […] Surgeons must be consulted early in the care of these patients, as early and aggressive surgical debridement of necrotic tissue can be life-saving.

• #113 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Necrotising fasciitis is a very serious bacterial infection of the soft tissue and fascia. The bacteria multiply and release toxins and enzymes that result in thrombosis in the blood vessels. The result is the destruction of the soft tissues and fascia. […] Once the diagnosis of necrotising fasciitis is confirmed, treatment should be initiated without delay. The patient must be hospitalised and is often admitted to an intensive care unit. The causative organism(s) should be identified and treated with high dose intravenous antibiotics. The initial antibiotic choice includes penicillin, clindamycin, metronidazole, cephalosporins, carbapenems, vancomycin, and linezolid. After the culture is reported, the choice is adjusted. […] It is absolutely vital that an experienced surgeon urgently removes all necrotic tissue (debridement). Supplemental oxygen, fluids, and medicines may be needed to raise blood pressure. Hyperbaric oxygen and intravenous immunoglobulin may also be considered.

• #114 The Diagnosis And Management Of Necrotising Fasciitis : Virtual Library

  https://resources.wfsahq.org/atotw/the-diagnosis-and-management-of-necrotising-fasciitis-anaesthesia-tutorial-of-the-week-298/

  The term necrotising fasciitis (NF) refers to severe inflammation of the muscle sheath that leads to necrosis of the subcutaneous tissue and adjacent fascia. It is associated with a significant risk of mortality and long-term disability from limb and tissue loss. […] Early clinical suspicion, surgery and antibiotics are key to improving survival as rapid progression can occur leading to systemic toxicity, limb loss and death. […] Patients need integrated, interdisciplinary management involving surgeons, intensive care physicians and microbiologists. Close monitoring and physiological support in an intensive care unit is often essential. […] Treatment of NF consists of early and aggressive debridement of necrotic tissue, together with broad-spectrum antibiotics and haemodynamic support. Treatment should be delivered by a multidisciplinary team of intensivists, microbiologists and surgeons, preferably including a plastic surgeon.

• #115 Necrotizing Fasciitis: Pathophysiology and Treatment – Page 6

  https://www.medscape.com/viewarticle/443523_6

  Nursing interventions involve recognizing those patients at risk, reporting these suspicions to the health care provider, monitoring patient vital signs and laboratory values, providing frequent dressing changes, wound assessment and documentation, and medication administration. […] Medication administration involves antibiotics and pain medications. […] Although the patient’s complaints of pain may seem disproportionate to the appearance of the affected area, the nurse must remain vigilant and recognize this severe pain as a pathologic process in NF. […] Nutritional requirements ranging from two to three times normal amounts with adequate hydration are critical to provide sufficient calories and protein for wound healing. […] Dressing changes may be excruciating for patients with NF, requiring pre-medication and sedation prior to these activities. […] Topical antimicrobials are also utilized in wound care.

• #116 Necrotizing Fasciitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25623

  The earlier the surgery is undertaken, the better the outcome. […] The surgery requires extensive, wide debridement of all necrotic tissues. […] Daily dressing changes are mandatory. […] The patient’s recovery is faster as long as the necrotic tissue is removed. […] The nurse is often the first to recognize that the patient is critically ill or in pain. […] Nurses should be knowledgeable about necrotizing fasciitis and consult the surgeon as soon as possible. […] The patient should be kept NPO, hydrated, and immediately covered with broad-spectrum antibiotics. […] These patients are best managed in the intensive care unit until signs of toxicity diminish. […] A wound care nurse is mandatory as most patients have large open wounds that require daily dressings for weeks or months. […] Only through a systemic approach with close collaboration can the mortality of this condition be lowered.

• #117 Multidisciplinary treatment of a patient with necrotizing fasciitis caused by Staphylococcus aureus: A case report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6854421/

  The advantages of different disciplines were combined to improve the therapeutic effect for this patient. They included physicians who offered early basic life support and organ function maintenance, surgeons who performed surgical interventions, bacteriological experts who provided culture and drug sensitivity results on time, dietitians who provided effective nutrition support, and anaesthesiologists who conducted the perioperative management of the patient. In addition, the radiology department provided imaging data for clinical diagnosis and treatment analysis. Interdisciplinary intensive care was a necessary condition for the successful treatment of this patient. […] Prompt diagnosis and early operative debridement with adequate antibiotics are vital. Interdisciplinary intensive care treatment is a guarantee for successful therapy.

• #118 Necrotising fasciitis and septic shock: a case report of a patient receiving an immunomodulatory agent for multiple sclerosis – Wounds International

  https://woundsinternational.com/journal-articles/necrotising-fasciitis-and-septic-shock-a-case-report-of-a-patient-receiving-an-immunomodulatory-agent-for-multiple-sclerosis-2/

  In addition, nutritional assessment and support, as well as daily physical therapy and kinesiotherapy, were provided in order to prevent further complications related with reduced mobility and sepsis. […] Despite the indications of improvement, it was decided to make early contact with the plastics department in order to accelerate recovery and rehabilitation. […] In addition, a tissue viability nurse (TVN) specialist was recommended in order to standardise the most appropriate method of NPWT application in such a difficult anatomical area. […] The aim of surgical intervention is to remove all necrotic tissues along the muscle-fascial layers of the affected area until we reach healthy boundaries and achieve hemostasis. […] Delays in the surgical debridement may be fatal, as the infection expands fast and it is crucial for the recovery of the patient to keep as many healthy tissues as possible.

• #119

  https://journals.lww.com/nursingcriticalcare/fulltext/2019/01000/necrotizing_fasciitis__infection_identification.2.aspx

  Ensure appropriate nutrition support for the patient because his or her healing needs are increased after a surgical incision, drainage, and debridement. […] Develop a pain management plan of care during the patient’s hospitalization and postprocedure process. […] Provide extensive emotional support to the patient and family.

• #120

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Patient education and support […] The nurse should assess the patient’s understanding of NF and provide additional teaching as necessary. Additional elements of patient teaching include pain management, antimicrobial therapy, surgical procedures, and wound care. As the patient prepares for discharge from acute care, the nurse must provide patient education regarding home medications, follow-up care, and signs and symptoms of normal healing versus those suggesting possible complications. […] The patient should also receive targeted rehabilitation from the physiatry team to increase functional status. Given the severity of the condition, the nurse should prepare the patient and family for a prolonged hospital stay. If partial or full amputation was required to treat NF, the patient may experience significant disfigurement and associated psychological distress. In addition, patients who survive to hospital discharge are at increased risk for morbidity and mortality due to functional decline and impaired wound integrity. Nurses must provide patients and their families emotional support services, including social work and counseling if possible.

• #121 Multidisciplinary treatment of a patient with necrotizing fasciitis caused by Staphylococcus aureus: A case report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6854421/

  The advantages of different disciplines were combined to improve the therapeutic effect for this patient. They included physicians who offered early basic life support and organ function maintenance, surgeons who performed surgical interventions, bacteriological experts who provided culture and drug sensitivity results on time, dietitians who provided effective nutrition support, and anaesthesiologists who conducted the perioperative management of the patient. In addition, the radiology department provided imaging data for clinical diagnosis and treatment analysis. Interdisciplinary intensive care was a necessary condition for the successful treatment of this patient. […] Prompt diagnosis and early operative debridement with adequate antibiotics are vital. Interdisciplinary intensive care treatment is a guarantee for successful therapy.

• #122 Necrotising fasciitis and septic shock: a case report of a patient receiving an immunomodulatory agent for multiple sclerosis – Wounds International

  https://woundsinternational.com/journal-articles/necrotising-fasciitis-and-septic-shock-a-case-report-of-a-patient-receiving-an-immunomodulatory-agent-for-multiple-sclerosis-2/

  Another factor that contributed to the positive outcome was the timely decision to perform a second look surgical intervention without any signs of deterioration, 48 hours after the first operation. […] NPWT provides several benefits to the wound; it keeps it clean by constantly draining and removing infected fluids, which reduces the size of the bacterial load. […] Even though surgical debridement and antibiotic agents are considered the main therapy of NF, Hyperbaric oxygen therapy (HBOT) and intravenous immunoglobulin (IVIG) therapy have been proposed as adjunct therapies. […] In addition to the individual steps, the authors believe that their teams personal involvement with this patients care, involving the early involvement of a large multidisciplinary team harmonically collaborating for her care, was the major factor contributing to her recovery. […] A multidisciplinary, early and aggressive approach is fundamental for the survival of the patient.

• #123 The Diagnosis And Management Of Necrotising Fasciitis : Virtual Library

  https://resources.wfsahq.org/atotw/the-diagnosis-and-management-of-necrotising-fasciitis-anaesthesia-tutorial-of-the-week-298/

  The term necrotising fasciitis (NF) refers to severe inflammation of the muscle sheath that leads to necrosis of the subcutaneous tissue and adjacent fascia. It is associated with a significant risk of mortality and long-term disability from limb and tissue loss. […] Early clinical suspicion, surgery and antibiotics are key to improving survival as rapid progression can occur leading to systemic toxicity, limb loss and death. […] Patients need integrated, interdisciplinary management involving surgeons, intensive care physicians and microbiologists. Close monitoring and physiological support in an intensive care unit is often essential. […] Treatment of NF consists of early and aggressive debridement of necrotic tissue, together with broad-spectrum antibiotics and haemodynamic support. Treatment should be delivered by a multidisciplinary team of intensivists, microbiologists and surgeons, preferably including a plastic surgeon.

• #124 Multidisciplinary treatment of a patient with necrotizing fasciitis caused by Staphylococcus aureus: A case report

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6854421/

  The advantages of different disciplines were combined to improve the therapeutic effect for this patient. They included physicians who offered early basic life support and organ function maintenance, surgeons who performed surgical interventions, bacteriological experts who provided culture and drug sensitivity results on time, dietitians who provided effective nutrition support, and anaesthesiologists who conducted the perioperative management of the patient. In addition, the radiology department provided imaging data for clinical diagnosis and treatment analysis. Interdisciplinary intensive care was a necessary condition for the successful treatment of this patient. […] Prompt diagnosis and early operative debridement with adequate antibiotics are vital. Interdisciplinary intensive care treatment is a guarantee for successful therapy.

• #125 Multidisciplinary management of periocular necrotising fasciitis: a series of 11 patients | Eye

  https://www.nature.com/articles/eye2011241

  The key to successful management of necrotising fasciitis is early diagnosis and intervention. […] It is vital for the patient to understand the seriousness of the condition, the implications if urgent surgical debridement is not undertaken, and the consequences and sequelae of the surgical debridement itself. […] A multidisciplinary approach for the comprehensive care of these patients is mandatory. While managing these patients, intensive care facilities should be made available and long-term follow-up and management of complications must be discussed and planned with the patient.

• #126

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc1619

  Necrotizing fasciitis is a rare infection that kills skin, fat, and muscles. It is also called „flesh-eating” bacteria. It usually affects the legs and arms. It can cause scarring and can lead to amputation and death. […] This condition is treated in a hospital. Treatment includes antibiotics and supportive care. Surgery is usually needed to remove dead or infected tissue, stop the spread of infection, and repair damage. Sometimes people are placed in a chamber with high levels of oxygen. This is called a hyperbaric chamber. It helps the tissue heal. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

• #127 Necrotising fasciitis and septic shock: a case report of a patient receiving an immunomodulatory agent for multiple sclerosis – Wounds International

  https://woundsinternational.com/journal-articles/necrotising-fasciitis-and-septic-shock-a-case-report-of-a-patient-receiving-an-immunomodulatory-agent-for-multiple-sclerosis-2/

  Another factor that contributed to the positive outcome was the timely decision to perform a second look surgical intervention without any signs of deterioration, 48 hours after the first operation. […] NPWT provides several benefits to the wound; it keeps it clean by constantly draining and removing infected fluids, which reduces the size of the bacterial load. […] Even though surgical debridement and antibiotic agents are considered the main therapy of NF, Hyperbaric oxygen therapy (HBOT) and intravenous immunoglobulin (IVIG) therapy have been proposed as adjunct therapies. […] In addition to the individual steps, the authors believe that their teams personal involvement with this patients care, involving the early involvement of a large multidisciplinary team harmonically collaborating for her care, was the major factor contributing to her recovery. […] A multidisciplinary, early and aggressive approach is fundamental for the survival of the patient.

• #128

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Timely care improves outcomes […] Despite advances in understanding, diagnosis, and treatment, NF still causes significant morbidity and mortality. Its microbiological profile remains complex and its classification may evolve as our understanding of NSTI increases. Vague and nonspecific presentations can make diagnosis difficult. Clinical judgment and a high index of suspicion for NF will ultimately expedite recognition. Timely diagnosis and supportive therapies, including antimicrobials and timely referral to surgery, are crucial to improve patient outcomes.

• #129 Necrotising Fasciitis – RCEMLearning

  https://www.rcemlearning.co.uk/reference/necrotising-fasciitis/

  Necrotising fasciitis is a rare but life threatening bacterial soft tissue infection. A high index of clinical suspicion, prompt administration of broad-spectrum antibiotics and emergency surgery to debride affected tissues, are key to improving survival. Mortality is directly proportional to delay in diagnosis and treatment. Necrotising fasciitis is rare but associated with significant morbidity and mortality. It represents a time critical pathology where patient outcome is directly influenced by time to diagnosis and treatment. A high index of suspicion is required to make the diagnosis at the earliest opportunity. Necrotising fasciitis is a life and limb threatening surgical emergency and, if suspected, merits immediate senior surgical input. Broad spectrum IV antibiotics should also be administered immediately in accordance with local consultant microbiologist advice. The mainstay of treatment for necrotising fasciitis however remains early and aggressive surgical debridement of necrotic tissue until healthy, viable (bleeding) tissue is reached. Early and extensive debridement is the mainstay of management timing and adequacy of debridement have been shown repeatedly to be the main determinant of patients outcomes. Patients should be cared for in intensive care, using a multispecialty and multidisciplinary approach.

• #130

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Given the risk for septic shock, the nurse must frequently monitor vital signs and other the physical assessment findings for signs of decompensation. The nurse must immediately notify the provider and/or call the rapid response team of signs and symptoms of impending shock and be prepared to administer I.V. fluids, both crystalloids and colloids, and possibly vasoactive agents such as I.V. norepinephrine, as prescribed. Given the severe pain often associated with NF, nursing care includes frequent pain assessments and appropriate pain management interventions. […] Pre-op care should include medication reconciliation and the patient’s informed consent. Intraoperatively, nurses must be prepared to assist with the collection of deep tissue culture specimens according to institutional protocol.

• #131 Necrotizing Fasciitis Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/necrotizing-fasciitis-nursing-diagnosis/

  Nursing interventions and care are essential for the patients recovery from necrotizing fasciitis. In the following section, you’ll learn about possible nursing interventions for a patient with this condition. […] Administer broad-spectrum intravenous antibiotics as ordered. Prompt antibiotic therapy is crucial in combating the infection. Ensure timely administration and monitor for any adverse reactions. […] Prepare and assist with surgical debridement as ordered. Surgical intervention is often necessary to remove necrotic tissue. Explain the procedure to the patient and provide emotional support. […] Perform meticulous wound care. Clean and dress the wound according to facility protocol or surgeons orders. Use a sterile technique to prevent further contamination. […] Manage pain effectively. Administer analgesics as prescribed and employ non-pharmacological pain management techniques. Adequate pain control is essential for patient comfort and healing.

• #132 Necrotizing Fasciitis: Pathophysiology and Treatment – Page 6

  https://www.medscape.com/viewarticle/443523_6

  Nursing interventions involve recognizing those patients at risk, reporting these suspicions to the health care provider, monitoring patient vital signs and laboratory values, providing frequent dressing changes, wound assessment and documentation, and medication administration. […] Medication administration involves antibiotics and pain medications. […] Although the patient’s complaints of pain may seem disproportionate to the appearance of the affected area, the nurse must remain vigilant and recognize this severe pain as a pathologic process in NF. […] Nutritional requirements ranging from two to three times normal amounts with adequate hydration are critical to provide sufficient calories and protein for wound healing. […] Dressing changes may be excruciating for patients with NF, requiring pre-medication and sedation prior to these activities. […] Topical antimicrobials are also utilized in wound care.

• #133 Necrotising Fasciitis: Causes, Symptoms, and Treatment

  https://patient.info/doctor/necrotising-fasciitis-pro

  Necrotising fasciitis (NF) or flesh-eating disease is an uncommon but life-threatening infection. It is defined as necrotising infection involving any layer of the deep soft tissue compartment (dermis, subcutaneous tissue, fascia or muscle). […] Important early clues are pain, tenderness and systemic illness out of proportion to the localised physical signs. […] A high index of suspicion is necessary and suspected cases should be referred immediately. Prompt surgical debridement is essential. […] The essential treatment is early and aggressive debridement of the involved tissue. Resuscitation, antibiotics and medical care are also important. […] Urgent surgical debridement is the key factor in treatment and improved survival of NF. Even a few hours’ delay increases mortality. […] Following initial debridement, the wound must be observed closely. Surgical debridement is repeated daily until the infection is controlled. […] Non-surgical measures include close monitoring and general supportive treatment in an intensive care setting with antimicrobial treatment. […] Nutritional support is required from day one, owing to the high protein and fluid loss from the wound.

• #134 Necrotising fasciitis and septic shock: a case report of a patient receiving an immunomodulatory agent for multiple sclerosis – Wounds International

  https://woundsinternational.com/journal-articles/necrotising-fasciitis-and-septic-shock-a-case-report-of-a-patient-receiving-an-immunomodulatory-agent-for-multiple-sclerosis-2/

  Another factor that contributed to the positive outcome was the timely decision to perform a second look surgical intervention without any signs of deterioration, 48 hours after the first operation. […] NPWT provides several benefits to the wound; it keeps it clean by constantly draining and removing infected fluids, which reduces the size of the bacterial load. […] Even though surgical debridement and antibiotic agents are considered the main therapy of NF, Hyperbaric oxygen therapy (HBOT) and intravenous immunoglobulin (IVIG) therapy have been proposed as adjunct therapies. […] In addition to the individual steps, the authors believe that their teams personal involvement with this patients care, involving the early involvement of a large multidisciplinary team harmonically collaborating for her care, was the major factor contributing to her recovery. […] A multidisciplinary, early and aggressive approach is fundamental for the survival of the patient.

• #135

  https://journals.lww.com/nursing/fulltext/2020/09000/necrotizing_fasciitis__a_comprehensive_review.11.aspx

  Patient education and support […] The nurse should assess the patient’s understanding of NF and provide additional teaching as necessary. Additional elements of patient teaching include pain management, antimicrobial therapy, surgical procedures, and wound care. As the patient prepares for discharge from acute care, the nurse must provide patient education regarding home medications, follow-up care, and signs and symptoms of normal healing versus those suggesting possible complications. […] The patient should also receive targeted rehabilitation from the physiatry team to increase functional status. Given the severity of the condition, the nurse should prepare the patient and family for a prolonged hospital stay. If partial or full amputation was required to treat NF, the patient may experience significant disfigurement and associated psychological distress. In addition, patients who survive to hospital discharge are at increased risk for morbidity and mortality due to functional decline and impaired wound integrity. Nurses must provide patients and their families emotional support services, including social work and counseling if possible.

• #136

  https://ecohumanism.co.uk/joe/ecohumanism/article/view/5544

  Background: Necrotizing fasciitis (NF) is a rapidly progressing soft tissue infection that causes extensive tissue destruction. […] Aim: This article provides an updated overview of NF, emphasizing diagnosis, management, and nursing interventions to improve patient outcomes. […] Nursing interventions, including patient monitoring and postoperative care, were also reviewed. […] Nursing interventions play a pivotal role in managing pain, ensuring nutritional support, and monitoring for complications. […] Comprehensive management requires multidisciplinary collaboration, with nurses playing a vital role in patient care and recovery.

• #137 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections that cause muscle fascia and subcutaneous tissue necrosis. […] This activity reviews the evaluation, treatment, and prognosis of necrotizing fasciitis and highlights the role of an interprofessional team in evaluating and improving care for patients with this condition. […] The nurse is often the first to recognize that the patient is critically ill or in pain. Nurses should be knowledgeable about necrotizing fasciitis and consult the surgeon as soon as possible. […] The patient should be kept NPO, hydrated, and immediately covered with broad-spectrum antibiotics. […] These patients are best managed in the intensive care unit until signs of toxicity diminish. […] A wound care nurse is mandatory as most patients have large open wounds that require daily dressings for weeks or months. […] Only through a systemic approach with close collaboration can the mortality of this condition be lowered.

• #138 Necrotizing Fasciitis: Treatment and Recovery – Nursing CE Central

  https://nursingcecentral.com/lessons/necrotizing-fasciitis-treatment-and-recovery/

  Necrotizing fasciitis is a soft tissue infection that causes necrosis to the muscle fascia and subcutaneous tissue. […] This course is designed to better inform nurses about this condition to apply this information into their daily practice. […] Management and treatment for necrotizing fasciitis should be started as quickly as possible as this infection progresses rapidly. Patients are commonly transferred into the intensive care unit if they are not already there. […] The main treatment for necrotizing fasciitis is prompt surgical intervention. Drainage of abscesses and debridement is necessary to remove all the necrotic tissue. […] Nurses should assess for erythema, edema, and warmth. Any changes to skin color or an increase in edema should be reported to the provider. […] In the recovery phase of the infection, nurses need to change surgical dressings, help their patients adequately manage pain, and monitor vital signs. […] Nurses also must educate their patients and family members in the recovery process. […] Necrotizing fasciitis requires a multidisciplinary care team for treatment and management.

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