So, let's take the obligatory gross picture.
See what you see there?
Now, we've talked about signs of infection.
Take a look at that picture,
and I'd like you to write in the
margin of your notes,
what are the signs of infection
that you see in this picture?
Now, I see some redness.
I obviously can't touch this person, and if
I did, I would definitely have gloves on,
but I would expect that this
patient would be warm
to the touch because I see redness,
I see swollen,
I see what I think is pus, you
can tell from this picture,
and then I see drainage coming.
So those would all be things that
I would document in my notes.
I would look at that wound and I would
document in my nursing notes that I see
redness, swelling. I would
document the diameter
or the size of the wound, the
color of the drainage,
and if the patient reports
any pain at that site.
Because it's really important that
I document accurately,
so the nurses that follow after me
can tell if the wound is getting
better or worse.
The health care provider should read
my notes too and they'll know
how the wound is progressing based
on the treatment that we have.
So, we base the treatment on severity
and location of the infection.
So my notes as a nurse are very important
that I clearly document where
it is, on the extremity.
Give as much information about the location,
and the look of the wound
and the drainage, etc.,
to help everyone on the team
be on the same page
so we can monitor the progress
of that wound.
Now, healthcare MRSA is really
usually -- we talked about
already more complicated
skin and soft tissue.
So these patients are going
to get things like
IV vancomycin, linezolid, daptomycin,
all those other drugs
that you see listed there.
But don't think that, "Oh, they got MRSA?
We'll just give them this medication."
It's not that easy to treat.
Yes, these drugs will eventually
but sometimes they have to be on this
antibiotic for a long period of time.
Now, you know what happens when
somebody is on an antibiotic
for a long period of time for one superbug,
it puts them at an increased risk
to pick up other superbugs.
So sometimes, we try to fix 1 problem
and we make multiple other problems
for our patients and for ourselves.
So keep that in mind, we have
the 2 different types,
healthcare associated and
Healthcare associated is usually
going to be more complex.
It's going to be a more involved --
which makes sense to you?
If we're going to be healthcare
associated and we
picked it up in the hospital that --
sorry, that population
is more challenged and vulnerable,
and we're going to hit it
with some big drugs.
Now, let's talk about community acquired.
I told you this is a little milder.
They're milder infections of
the skin and soft tissue,
can still be kind of painful.
But even a community acquired one
can progress to a more severe infection,
like necrotizing fasciitis or severe sepsis.
So, while it starts out more simple,
if it gets out of control,
depends on who's infected by it.
What's their status? Are they healthy?
How's their immune system?
Are they taking corticosteroids?
Ah, pause for just a minute.
What if I have a kid out in the community,
and we've got them on some
high doses of steroids
because of some inflammatory process.
They come in contact with
somebody with MRSA.
Is this child more at risk
or less at risk than the average child
who's not on glucocorticoids?
Pause for a minute and
just think that through.
Now, I don't want you to just say "yes" or "no,"
you have to explain why.
Okay, that child is definitely
more at risk. Why?
Because corticosteroids suppress
the immune system.
We're giving those drug to the child
because we want to suppress inflammation,
which is a really important part
of your immune system.
So, their immune system is
depending on how high the dose
and how long they're on it and
the route that we're giving.
But as a general rule, if I have 2 kids,
one who's on glucocorticoids or
corticosteroids, same thing,
or one who's not, the child that's on
the inflammatory-suppressing drugs,
like glucocorticoids or corticoids,
they're the child who's most at risk
to pick up something like this.
So, community acquired MRSA
is generally milder than
but this can also lead to
So, necro, we're talking death.
So, tissue death. Itis means inflammation,
fascia, we're talking about the skin.
So we're talking about an
inflammation in your skin.
You notice I'm pointing to my leg
as if that's going to help you.
horrible, terrible inflammation that
leads to death of tissue
and/or severe sepsis.
And when you have necrotizing fasciitis,
you're at risk for losing that
tissue or that limb,
depending on the location of the infection.
Now, the community acquired
is spread by contact,
so even healthy athletes can contract this,
kids who are young, strong, and healthy.
In fact, I even read about a case
where there were some
kids on a football team that had
a MRSA, community acquired,
and they could track the spread of MRSA
with the teams that this team played,
then kids on the team they played
against developed MRSA,
and then every other team
that came in contact
with these teams developed MRSA.
It's a very interesting study,
unless you're one of the kids
or a family member,
or one of those teams that are infected.
So keep in mind, even healthy
people can contract this.
So, if there's a small abscess that develops --
with any infection, if there's an
abscess, that's just like,
a giant pool of pus.
So, when we say abscess, that's what it is.
And so, a lot of times, in order
to really help with the
distribution of the antibiotic to
the point that's a problem,
we need to cut that, incise it, and
then drain it out.
Now, you don't want to go after that at home.
You want to do that in a medical setting.
So if it's an abscess or a small
abscess, we're going to cut it,
incise it, make an incision in it, and then
allow that pus to drain out.
And that will allow better access
to the antibiotic.
So, for the more serious infections
in the community,
these are the medications that we use.
Now, look at those at the screen.
How many medications do you see there?
What I'd like you to do is star
the medications that you've
already watched the videos for.
That way, you'll kind of trigger
your brain to think about
what you've already studied and what
you remember about those drugs.
For those drugs that you've
watched the videos for,
just jot yourself some quick notes about
what you remember about those medications.
Now, if there's a medication on there
you haven't watched a video for,
I want you to underline those medications.
Write yourself a quick note in the margin
that you want to follow up
and make sure you watch the videos that
contain those types of antibiotics.
So you know what that means you get
to do? You get to look up
what family or category do these
antibiotics belong to,
so you know the proper video to watch.
Now, that's not just because we're
trying to be mean,
but I know if you spend a little bit
of time looking that up,
it'll reinforce the concept to you
of which family or category
those drugs belong to.
That is the key to being successful
Learning drugs by family or category
and then knowing which drugs
in that category. Okay?
Cool. So, it's not a punishment. I
really mean it to help you,
because the more you use
repetition with your brain,
the more you're going to remember it.