MRSA Nursing Diagnoses

One way that nurses formulate their perspective on a disease or condition, and also plan out the way they're going to care for you and intervene therapeutically, is through the use of something called a nursing diagnosis.

A nursing diagnosis, as opposed to a medical diagnosis, looks at something physical or psychological that you may be at risk for, that is within the scope of nursing practice to care for. Consequently, it is a little difficult to find nursing diagnoses related to MRSA specifically, because these diagnoses will be based on the full picture of the patient, and MRSA can present in many different ways.

For example, if you have a wound that is infected with MRSA and refuses to heal, the nursing diagnosis might be:

Impaired skin integrity related to delayed wound healing associated with infection.
After writing this diagnosis, the nurse may create a plan for how to intervene with the situation. In this situation with a wound, their planned interventions may include:

1) Inspect skin in contact with wound drainage for pallor, redness, and breakdown
2) Notify appropriate health care provider (e.g. physician, wound care specialist) if tissue breakdown actually occurs

Their desired outcome may be absence of redness or irritation. They will then evaluate at the end of the shift to see if they accomplished their outcome, which should be measurable.

This particular nursing plan was pulled from this website, which is a very helpful source for nursing diagnoses: http://www1.us.elsevierhealth.com/SIMON/Ulrich/Constructor/diagnoses.cfm?did=427%7C428

Other nursing diagnoses related to MRSA may include (depending on the patient):

Risk for acute/chronic pain
Risk for infection (sepsis) related to release of bacteria into the blood associated with presence of infected necrotic areas
Readiness for enhanced learning
Risk for fluid volume deficit

Nurses learn these nursing diagnoses in school because it trains their mind to think about the whole picture of you as the patient, and not just your medical diagnosis.



Source:
http://www1.us.elsevierhealth.com/SIMON/Ulrich/Constructor/diagnoses.cfm?did=427%7C428
http://www1.us.elsevierhealth.com/SIMON/Ulrich/Constructor/diagnoses.cfm?did=355

Nursing Care for MRSA

This post will explore the type of care you should receive from a nurse if you are in the hospital (or a clinic) and you have a MRSA infection.

First of all, if you are in the hospital, your room will have a sign outside that says "Contact Precautions". This means that anyone who enters the room (including any visitors) will need to wear a gown and gloves. This is to protect against the spread of MRSA. That is one of the nurse's important tasks.

It is the nurse's responsibility to understand MRSA, and to understand how to properly wear PPE (personal protective equipment) and wash their hands to prevent the spread of infection. Manuals like this one provide nurse's with this information: http://www.health.gov.nl.ca/health/publichealth/cdc/infectioncontrol/mrsa_manual_for_nurses_other_healthcare_workers.pdf.

Another important task of the nurse is to educate you as the patient, so that you understand what MRSA is, how it is treated, and what you can do yourself to get better and to prevent the further spread of MRSA.

Websites like this one will help you learn more about MRSA: http://www.upmc.com/patients-visitors/education/infection-control/Pages/mrsa.aspx.

For example, do you know the difference between MRSA colonization and MRSA infection? MRSA colonization is when the MRSA bug is colonizing on your body (likely in the nares of your nose, or in your armpits for example), but you aren't feeling sick. This can be determined through a nasal swab that is tested in the lab.

A MRSA infection, however, is when the MRSA bug actually invades your tissues. You will start feeling sick (you might have a fever or inflammation), or you might have a wound that won't heal. This is when the infection will need to be treated with antibiotics.

Besides preventing the spread and providing you with information, the other nursing care will depend on what sort of infection that you have. If you have a wound, the nurse will help to clean and dress the wound. The nurse may also help administer the correct antibiotics ordered for your infection, and help to treat your fever or other symptoms.

Sources:
http://infectionpreventionuncc.weebly.com/transmission-based-isolation-precautions.html
http://www.health.gov.nl.ca/health/publichealth/cdc/infectioncontrol/mrsa_manual_for_nurses_other_healthcare_workers.pdf
http://www.upmc.com/patients-visitors/education/infection-control/Pages/mrsa.aspx

MRSA Treatment Recommendations

Clinicians, for example in an out-patient setting, will follow certain guidelines when treating a MRSA skin infection. They will have to follow certain criteria that will dictate the treatment.


If a patient has the signs of a MRSA skin infection, the clinician will first examine whether the skin wound is purulent. The signs of purulence include fluctuance (palpable fluid-filled cavity), yellow or white center, central point or "head', draining pus, and whether it's possible to aspirate pus with syringe or needle.

If the lesion is NOT purulent, the clinician will provide antimicrobial therapy with coverage for Streptococcus, maintain close follow up, and consider adding coverage for MRSA if patient doesn't respond to treatment.
If the lesion IS purulent, the clinician will drain the lesion and send the wound drainage for culture and susceptibility testing. They will educate the patient about wound care and hygiene, and discuss follow-up care with the patient. (For example, if you have a skin lesion it's very important to keep it covered with a dressing, to prevent spreading the infection to others.)

If there are systemic symptoms, severe local symptoms, immunosuppression, or failure to respond to incision and drainage, the physician will consider further antibiotic (oral or IV) treatment focused specifically on MRSA.
The side effects of these treatments depend on the type of antibiotic used. For example, Vancomycin can cause temporary or permanent hearing loss, and also can be toxic to the kidneys.


Interestingly, it was recently found that an Anglo-Saxon potion from 1000 years ago successfully treated the MRSA bug! You can view a video on this phenomenon here:

http://www.cnn.com/2015/03/31/health/anglo-saxon-potion-mrsa/

Source: 
http://www.cdc.gov/mrsa/pdf/Flowchart_pstr.pdf
http://www.livestrong.com/article/110099-drugs-used-treat-mrsa/
http://newsroom.ucla.edu/releases/new-guidelines-for-treating-skin-268853
http://www.cnn.com/2015/03/31/health/anglo-saxon-potion-mrsa/

Signs and Symptoms of MRSA

When trying to identify MRSA through signs and symptoms, one important clue is a wound that refuses to heal, or doesn't respond normally to antibiotics. Please view the video below for a summary:

This video explains how a wound that doesn't want to heal is a huge clue to the presence of a MRSA infection. If a wound is consistently infected (signs of infection include inflammation, irritation and discharge) this could be a sign that you're dealing with a resistant bacteria.

MRSA wounds may appear as a small red bump.

MRSA wounds are often mistaken as a spider bite.

Cellulitis could occur - this is an infection of the skin causing symptoms similar to a sunburn.

MRSA infection can also create an abscess (a lump that's filled with pus).

These are all signs of a skin infection. Signs of a more serious MRSA infection include:

- Bone pain
- Chest pain
- Chills
- Drainage of pus
- Fatigue
- Fever
- Headache
- Joint pain
- Malaise (feeling unwell)
- Muscle aches
- Rash
- Shortness of breath, and painful breathing

If you are experiencing any of these signs or symptoms, especially a wound that will not heal, I recommend seeing your health care provider and being tested for MRSA.


Sources:
https://www.youtube.com/watch?v=1gH8oGH-95E
http://www.webmd.com/skin-problems-and-treatments/ss/slideshow-closer-look-at-mrsa
http://www.healthcommunities.com/mrsa-infection/causes-symptoms.shtml