Chapter 41: Animal and Human Bites Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A young adult has been bitten by a dog resulting in several puncture wounds near the thumb of one hand but can move all fingers and the bleeding has stopped. What understanding regarding dog bites should direct the care of this patient?

a. Infection is a likely outcome for a dog bite.

b. Dog bites generally result in serious injury.

c. Neurovascular and destructive soft tissue injuries can occur from such a bite.

d. Oral antibiotics are needed to address the increased risk for the development of osteomyelitis.

ANS: C a. Possible exposure to rabies virus b. Potential septic arthritis or osteomyelitis c. Sepsis from Capnocytophaga canimorsus infection

Dog bites account for most of the domestic animal bites that require medical care, yet dog bites have had the lowest incidence of wound infection (2% to 13%). Even though most dog bites are relatively minor, severe injuries can occur. These can include crush injuries, destructive soft tissue injuries, neurovascular injuries, orthopedic injuries, and death. Osteomyelitis is a risk for human bites.

2. A patient has sustained a human bite on the hand during a fist fight. Which is especially concerning with this type of bite injury?

NURSINGTB.COM d. Transmission of human immunodeficiency virus

ANS: B

Clenched-fist injury, or “fight bite,” has a high complication rate from the high penetrating force with the potential for osteomyelitis, tendinitis, and septic arthritis. Humans do not transmit rabies unless infected, which is highly unlikely. Humans do not transmit C. canimorsus. HIV transmission is potential, but the risk is extremely low.

Multiple Response

1. Which type of bite is generally closed by delayed primary closure? (Select all that apply.)

a. Bites to the face b. Bites to the hand c. Deep puncture wounds d. Dog bites on an arm e. Wounds 6 hours old or older

ANS: B, C, E

Cat and human bites, deep puncture wounds, clinically infected wounds, wounds more than 6 to 12 hours old, and bites to the hand should be left open and closed by delayed primary closure. A bite to the face is closed by primary closure. Dog bites do not require delayed or secondary closure.