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HCA and CA MRSA (Nursing)

by Rhonda Lawes

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    00:01 So, let's take the obligatory gross picture. See what you see there? Now, we've talked about signs of infection.

    00:08 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.

    00:24 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.

    00:41 So those would all be things that I would document in my notes.

    00:44 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.

    00:59 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.

    01:08 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.

    01:14 So, we base the treatment on severity and location of the infection.

    01:18 So my notes as a nurse are very important that I clearly document where it is, on the extremity.

    01:25 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.

    01:37 Now, healthcare MRSA is really usually -- we talked about already more complicated skin and soft tissue.

    01:43 So these patients are going to get things like IV vancomycin, linezolid, daptomycin, all those other drugs that you see listed there.

    01:51 But don't think that, "Oh, they got MRSA? We'll just give them this medication." It's not that easy to treat.

    01:58 Yes, these drugs will eventually be effective, but sometimes they have to be on this antibiotic for a long period of time.

    02:05 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.

    02:16 So sometimes, we try to fix 1 problem and we make multiple other problems for our patients and for ourselves.

    02:22 So keep that in mind, we have the 2 different types, healthcare associated and community associated.

    02:28 Healthcare associated is usually going to be more complex.

    02:31 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.

    02:47 Now, let's talk about community acquired. I told you this is a little milder.

    02:51 They're milder infections of the skin and soft tissue, can still be kind of painful.

    02:55 But even a community acquired one can progress to a more severe infection, like necrotizing fasciitis or severe sepsis.

    03:05 So, while it starts out more simple, if it gets out of control, depends on who's infected by it.

    03:12 What's their status? Are they healthy? How's their immune system? Are they taking corticosteroids? Ah, pause for just a minute.

    03:22 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.

    03:31 They come in contact with somebody with MRSA.

    03:34 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.

    03:44 Now, I don't want you to just say "yes" or "no," you have to explain why.

    03:54 Okay, that child is definitely more at risk. Why? Because corticosteroids suppress the immune system.

    04:02 We're giving those drug to the child because we want to suppress inflammation, which is a really important part of your immune system.

    04:10 So, their immune system is somewhat compromised, depending on how high the dose and how long they're on it and the route that we're giving.

    04:18 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.

    04:36 So, community acquired MRSA is generally milder than healthcare associated, but this can also lead to necrotizing fasciitis.

    04:47 So, necro, we're talking death.

    04:50 So, tissue death. Itis means inflammation, fascia, we're talking about the skin.

    04:55 So we're talking about an inflammation in your skin.

    04:58 You notice I'm pointing to my leg as if that's going to help you.

    05:00 Necrotizing fasciitis; horrible, terrible inflammation that leads to death of tissue and/or severe sepsis.

    05:11 And when you have necrotizing fasciitis, you're at risk for losing that tissue or that limb, depending on the location of the infection.

    05:21 Now, the community acquired is spread by contact, so even healthy athletes can contract this, kids who are young, strong, and healthy.

    05:28 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.

    05:50 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.

    05:56 So keep in mind, even healthy people can contract this.

    06:00 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.

    06:08 So, when we say abscess, that's what it is.

    06:12 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.

    06:22 Now, you don't want to go after that at home.

    06:24 You want to do that in a medical setting.

    06:27 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.

    06:35 And that will allow better access to the antibiotic.

    06:38 So, for the more serious infections in the community, these are the medications that we use. Now, look at those at the screen.

    06:45 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.

    06:54 That way, you'll kind of trigger your brain to think about what you've already studied and what you remember about those drugs.

    07:05 For those drugs that you've watched the videos for, just jot yourself some quick notes about what you remember about those medications.

    07:17 Now, if there's a medication on there you haven't watched a video for, I want you to underline those medications.

    07:28 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.

    07:37 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.

    07:46 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.

    07:57 That is the key to being successful in pharmacology.

    08:01 Learning drugs by family or category and then knowing which drugs are representative 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.


    About the Lecture

    The lecture HCA and CA MRSA (Nursing) by Rhonda Lawes is from the course Anti-Infective Drugs in Nursing. It contains the following chapters:

    • HCA MRSA
    • CA MRSA

    Included Quiz Questions

    1. Redness
    2. Swelling
    3. Drainage of pus
    4. Fever
    5. Cool skin
    1. A client on a high dose of corticosteroids
    2. A client on aspirin therapy
    3. A client who smokes habitually
    4. A pregnant client
    1. Glucocorticoids
    2. Cephalosporins
    3. Macrolides
    4. Fluoroquinolones
    1. Skin-to-skin contact
    2. Coughing
    3. Sneezing
    4. Inhalation

    Author of lecture HCA and CA MRSA (Nursing)

     Rhonda Lawes

    Rhonda Lawes


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