Nursing Diagnoses for MRSA

If you're a nurse, or nursing student, you may want to look at nursing diagnoses as part of a care plan for a patient. A nursing diagnosis is defined by NANDA International, Inc. (a nursing diagnosis association that has expanded globally) as a way to "define the knowledge of professional nursing". It is used to guide care and standardize language and the work of nurses across the world. 

A MRSA infection may present in many different forms. It could be a small red bump, a boil, cellulitis (infection of a deeper layer of skin), an abscess, or even sepsis (a bloodstream infection). Therefor, nursing care depends on what degree of a MRSA infection you're treating. Below are some examples of possible nursing diagnoses for the various degrees of a MRSA infection, or even for educating patients on prevention from getting a MRSA infection.  

Sample Nursing Diagnoses

1.) Impaired skin integrity related to skin infection 

2.) Risk for shock related to infection 

3.) Acute pain related to infection 

4.) Impaired tissue integrity related to insufficient knowledge about protecting tissue integrity

5.) Risk for imbalanced body temperature related to infection 

6.) Readiness for enhanced health management related to expressed desire to enhance management of risk factors 

7.) Ineffective protection related to noncompliance with treatment regimen

Let's take a deeper look into one of these diagnoses- Risk for shock related to infection- and go into more detail. The table below asks the question in the left hand column and answers it for this diagnosis in the right hand column.  

Actual or potential	Potential
Related to	Infection
Plan	Assess for signs and symptoms of septic shock; if signs and symptoms occur maintain IV therapy, administer antibiotics if ordered, maintain oxygen therapy, etc.
Outcome	Desired- the patient will not develop septic shock
Nursing intervention	Assess vitals, skin, pulses. Administer medications as prescribed. Properly dress skin infection to help contain the infection.

This is just a sample of some parts of a plan and interventions. For more extensive information on this nursing diagnosis, or the others, take a look at this website Elsevier Health

Resources: 

EHS: Nursing Diagnosis Care Plans, 4/e - Care Plan Index. (n.d.). Retrieved May 20, 2015, from http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/cpindex.html  

About Our Name. (n.d.). Retrieved May 20, 2015, from http://www.nanda.org/nanda-international-about-our-name.html  

Nursing care for MRSA

If you are a nurse and reading this blog, there are three major areas of care involved with MRSA. They are: patient education, prevention of spread, and assistance in treatment. 

Patient education

Patient education ties directly into preventing transmission of MRSA from one person to another. The biggest part of preventing MRSA from spreading is hand hygiene. Educating patients on proper technique for hand washing along with covering their infected site with a dry and clean bandage are essential. Individuals might also be encouraged to discontinue participation in activities that involve close contact (sports, sharing clothing, etc) until healing has occurred. Additionally, educating patients on what signs and symptoms to look out for helps in early identification, treatment and less time for MRSA to potentially spread. 

Preventing the spread of MRSA

Additionally, nurses can help prevent the spread of MRSA through engaging in proper hand hygiene themselves. This is especially crucial in hospital settings where nurses are prime real estate for carrying MRSA from one room to another. Nurses and other medical staff may also wear gloves, gowns and face masks while in a room of someone with MRSA. 

Assistance in treatment of MRSA

Nurses may assist in administering antibiotics, assessing sites for infection and/or changing wound dressings as needed. 

Here's a video that can be used to educate yourself, or others on great hand hygiene: 

If you're a nurse and extensive information on your role involvement with MRSA, check out this manual: 

http://www.health.gov.nl.ca/health/publichealth/cdc/infectioncontrol/mrsa_manual_for_nurses_other_healthcare_workers.pdf

Resources: 

(n.d.). Retrieved May 15, 2015, from http://www.health.gov.nl.ca/health/publichealth/cdc/infectioncontrol/mrsa_manual_for_nurses_other_healthcare_workers.pdf

NurseTogether.com. (n.d.). Retrieved May 15, 2015, from http://www.nursetogether.com/nurse-role-methicillin-resist-staph-aureus   

(2014, September 9). Retrieved May 15, 2015, from http://www.cdc.gov/mrsa/healthcare/clinicians/precautions.html  

Treatment for the untreatable

What scares us about MRSA? Mostly, it's the idea that we can't treat it because of its resistant nature toward certain antibiotics (the key word there being CERTAIN). Fortunately, there are still some antibiotics that do put up the fight against MRSA and win. Most importantly, if you suspect an infection you should consult a medical professional as they can do tests to figure out what antibiotic to use, how to drain the sore (if this is an option), or when you might need to see a specialist in infectious disease. There is no simple answer to what antibiotic, or treatment will work best as it depends on the location of infection, size and what strain of MRSA. 

Before moving along, let's first take a look at what an antibiotic is. In the simplest form, it is a medication that kills bacteria in your body that should not be there and are causing problems. However, the power of an antibiotic can be weakened with overuse and incomplete use. Here's a video that explains antibiotics and resistance that can develop: 

Currently, some antibiotics still work against MRSA, but resistance may occur in the future. If you're prescribed a course of oral antibiotics to take over (usually) 7-10 days, common ones include: Bactrim, clindamycin, minocycline, or doxycycline. Your provider may also drain the pus filled lesion. As previously mentioned in the blog, your provider may recommend an IV antibiotic (especially if you're already in a hospital) which you would need to receive in a hospital, or clinic setting. This would likely be given until there are signs of improvement. 

For a very detailed look at treatments, visit the CDC website on recommendations for medical professionals for both community MRSA and hospital MRSA: 

http://www.cdc.gov/mrsa/community/clinicians/

http://www.cdc.gov/mrsa/healthcare/clinicians/index.html

References: 

MRSA Research Center. (n.d.). Retrieved May 15, 2015, from http://mrsa-research-center.bsd.uchicago.edu/patients_families/faq.html

Patient information: Methicillin-resistant Staphylococcus aureus (MRSA) (Beyond the Basics). (n.d.). Retrieved May 15, 2015, from http://www.uptodate.com/contents/methicillin-resistant-staphylococcus-aureus-mrsa-beyond-the-basics 

(2013, September 10). Retrieved May 15, 2015, from http://www.cdc.gov/mrsa/community/clinicians/ 

(2013, September 11). Retrieved May 15, 2015, from http://www.cdc.gov/mrsa/healthcare/clinicians/index.html     

Signs and Symptoms of MRSA

Early identification of a MRSA infection is important, so treatment can start right away and potential spreading can be stopped. In order to identify MRSA, here are the top signs and symptoms of an infection that may appear on the skin as a bump, or in a general area, according to the CDC (Center for Disease Control and Prevention): 

• Redness 
• Painful 
• Swollen
• Warm to the touch
• Full of drainage, or pus 

These signs and symptoms represent the presentation in earlier stages of an infection. However, if the infection does spread the presentation might change and include more serious concerns. These might include: 

• Fever
• Chills
• Low blood pressure
• Joint pain
• Severe headaches
• Shortness of breath
• Rash

At a certain point, if the infection spreads enough, your body may go into septic shock, where the infection has spread throughout. Signs of this whole body infection, include: 

• Fever, or low body temperature
• Fast heart rate
• Fast breathing rate........along with previously mentioned signs and symptoms 

Here are some visuals of what an infection might look like: 

If you have signs of infection, consult your provider as soon as possible! 

For more detailed information on signs and symptoms of MRSA, take a look at this article: 

http://www.medicalnewstoday.com/articles/10634.php

And lastly, for some humor......

References: 

MRSA Symptoms, Causes, Treatment - What are the signs and symptoms of a MRSA infection? - MedicineNet. (n.d.). Retrieved May 15, 2015, from http://www.medicinenet.com/mrsa_infection/page4.htm#what_are_the_signs_and_symptoms_of_a_mrsa_infection 

  

(n.d.). Retrieved May 15, 2015, from http://www.medicalnewstoday.com/articles/10634.php

MRSA Research Center. (n.d.). Retrieved May 15, 2015, from http://mrsa-research-center.bsd.uchicago.edu/patients_families/resources.html