A Pathophysiology of Fournier’s Gangrene secondary to Infected Grade 4 Sacral

Decubitus Ulcer, Ischiorectal Abscess.

Predisposing Factors: Precipitating Factors:

>Age: 61y/o >Sedentary Lifestyle:
>Gender: M always lying down and
sitting down
>Diet: High in Cholesterol
>Open Wound

Insulin Resistance

Exhaustion of Beta Cells

Decrease secretion of Insulin

Breakdown of fat
Absorption of glucose by the cell

Fatty Acids and Glycerol

Cell Starvation
Fat content in the Blood
Stimulation of hunger mechanism
via hypothalamus Hyperlipidemia

Hunger Formation of Fatty

content on the walls of
the blood vessel
Polyphagia
Atherosclerosis
Hyperglycemia

Humulin R (Insulin) Rosuvastatin

NovoMix (Insulin Aspart) Diabetes Mellitus Type 2
(Rosuvin)

Nerve Demyelinization Capillary basement membrane thickening

Diffuse glomerularsclerosis
Diabetes Mellitus Neuropathy D5NR
Lactated Ringer's Polyuria and Albuminuria

Portal of entry of microorganisms Solution

Fluid and Electrolyte
into the area (perineum) Sterofundin
Plain NSS Low Sodium and Potassium

A Potassium Cholride (Kaligen)

Sodium Chloride (NaCl)
 A Pathophysiology of Fournier’s Gangrene secondary to Infected Grade 4 Sacral
Decubitus Ulcer, Ischiorectal Abscess.
A Mupirocin
Ciprofloxacin
Portal of entry of microorganisms Piperacillin-Tazobactam
into the area (perineum) Meropenem
Azithromycin
Favourable environment
CBC:
Monocyte: 3.10% Low
Compromised immunity
Lymphocytes:
5.0%Low
Infection
Fever Paracetamol

External pressure that exceeds

capillary pressure
Stage 1: Intact skin with areas of
persistent redness in lightly
Pressure interrupts blood flow pigmented skin or persistent red,
blue, or purple hues in darker
pigmented skin
Capillary flow is essentially
obstructed
Stage 2: Partial thickness loss of
ABG: skin involving the epidermis or
Respiratory Oxygen deprivation with an
accumulation of metabolic end dermis, or both. It presents
and Metabolic clinically as an abrasion, blister, or
alkalosis products
shallow crater

Irreversible tissue damage Stage 3: Full thickness skin loss

with damage and necrosis of the
Small underlying subcutaneous tissue that
superficial skin Extensive underlying tissue may extend down to but not through
lesion damage underlying fascia. It manifests as a
deep crater with or without
Tissue Necrosis undermining of adjacent tissue

Decubitus Ulcer Stage 4: Full thickness skin loss

with extensive damage and necrosis
of the underlying subcutaneous
Non-healing Ulcer tissues that may extend to involve
muscle, bone, or other structures.
Sacral Decubitus Ulcer Grade 4
Impaired pain sensation

Colonostomy
A Pathophysiology of Fournier’s Gangrene secondary to Infected Grade 4 Sacral
Decubitus Ulcer, Ischiorectal Abscess.

Bacteria gain access to solid

tissues (by means of small wound
on the skin)

Toxins released by bacteria

multiply

Redness, pain,
Trigger acute inflammation at site swelling and
heat
CBC:
WBC: 21.76 WBC collect at site
x10E9/L high
1. Acute Pain r/t
Sacral Ulcer
Phagocytosis 2. Impaired
CBC: Physical
Neutrophils: Mobility r/t
91.60% high Pus is formed Pain

Ischiorectal Abscess
Toradol
Arcoxia
Non-healing Ulcers Tramadol
TDL plus
Polymicrobial nature

Creates a synergy of enzyme Numbness

production

Promotes rapid multiplication

Microorganism produce enzymes

production

Coagulation of nutrient vessels

A Pathophysiology of Fournier’s Gangrene secondary to Infected Grade 4 Sacral
Decubitus Ulcer, Ischiorectal Abscess.

Thrombosis of nutrient vessels

Reduces local blood supply

Tissue oxygen tension falls

Tissue Hypoxia Blood culture:

-Gram positive (+)
cocci in chain:
Growth of facultative anaerobes Occasional
and microaerophilic
-Gram positive (+)
cocci in pairs:
Microaerophilic organisms produce Occasional
enzymes

Fluconazole
Digestion of fascial barriers
Moxifloxacin

Fueling rapid extension of infection

Obliterative Endarteritis develops

Ensuing cutaneous and

Incomplete Debridement
subcutaneous vascular necrosis

Localized Ischemia Acute Blood loss

Hypovolemic shock
Bacterial Proliferation

Hypotension: 70/30 mmHg

Infection of superficial perineal
fascia (colles fascia)
Debridement

Spread to perineal fascia

1. Impaired skin integrity
r/t Debridement
Fournier’s Gangrene secondary to sacral ulcer
2. Readiness for
enhanced self care
management related to
infection control
A Pathophysiology of Fournier’s Gangrene secondary to Infected Grade 4 Sacral
Decubitus Ulcer, Ischiorectal Abscess.
LEGEND:

PREDISPOSING FACTORS DISEASE PROCESS

NURSING DIAGNOSES SIGNS/ SYMPTOMS

DIAGNOSTIC RESULTS MEDICATIONS

PRECIPITATING FACTORS SURGICAL MANAGEMENT

DISEASE INTRAVENOUS SOLUTION