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• Hot Topics

○ Julie Mann, NP
○ N145
• Case Study
○ Gian Carlo is a 16 year old active male with
no pmh. His mom brings him to the NP
walk-in clinic with c/o left leg pain and a
sore that isn’t healing.
○ As his nurse what will you do when you
evaluate his sore?
• Apply gloves, appearance (red, pustule,
ulceration, what does it look like,
important characteristics), weeping, ○ Methicillin-Resistant Staphylococcus Aureus
odor (certain pathogens emit certain ○ resistant to broad spectrum antibiotics
odors), depth (measure with ruler if ○ staph normally/naturally found on the skin
appropriate), size (diameter, clear ○ Enters the body through a cut or wound
plastic measuring ruler), • How’d they get resistant?
• Get a wound culture (sterile swab, ○ unnecessary antibiotic use
swab in, stick in culture test tube, label, ○ antibiotics in the food and water
and send to lab) ○ germ mutation
○ What might you ask him about his • Makes it harder to treat today. Super
complaint? germs...
• What happened, how did you get the
sore?
• How long has it been there?
• MRSA

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○ starts with red bumps like spider bite or
pimple
○ quickly turn into deep painful abscesses
○ require surgical drainage
○ can get into vasculature and become a
• MRSA systemic infection
○ health care associated MRSA • Risk factors
• Can be systemic right away (introduced ○ HA-MRSA
via catheter, surgical, invasive tools). • elderly
○ community associated MRSA • compromised immune system
• Start with skin and soft tissue  (DM, immune supressant therapy,
infections, can lead to systemic HIV)
infection and pneumonia • recent hospitalization
○ can be fatal • Living in long-term care facility
• MRSA Skin Infection • invasive devices
• recent antibiotics use
○ CA-MRSA
• Young Age
• Participating in contact sports

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 Share has had 4-5 liquid BM’s for the past 3 days.
equipment/towels/razors/personal He has a low grade fever.
products. ○ As his nurse you go into his room to
• immunosupressed evaluate him...what might you ask? assess?
• institutionalized populations (prison) • Gloves, abd pain GI assessment, still
• association with health care workers taking stool softener? Skin (clammy,
• Treatment MRSA flushed, diaphoretic, cool), look at size,
○ Contact precautions auscultate, palpate.
○ What would you do with this information?
• Nurse can declare, talk to the charge
nurse • Mild abd pain, some distention.
• Sign on door • Let the MD know.
• Enter room with equipment (disposable • Expecting to hear, let's get a stool
gown, gloves whenever touching sample.
ANYTHING, not airborn - no mask) • Risk for infection - Low grade fever,
• DO NOT walk out of room wearing the DM, dialysis, surgery (on antibiotics,
equipment. Gown off first in room, normal flora killed off), been in hospital
gloves off, leave the room. for awhile, characteristic odor.
• DO NOT reuse supply. • C-Diff
• Good washing of hands. Skin is our best ○ a spore-forming gram positive bacterial
protection (keep strong, use lotion) agent that causes diarrhea and other more
serious intestinal conditions like colitis
• Extra credit: Leave shoes in the hallway
when you get home. • Spore-forming, able to live on surfaces
very well. Bed, tables, charts.
• Get own room unless someone else has
○ bacteria produces toxins that are
same strain of MRSA.
destructive to the mucosal lining of the
• Tell people, "It is for the protection of
colon.
the visitor and the protection of the ○ new drug resistant strain (floroquinolones &
patient)
Flagyl)
• Case Study
• releases more toxins (3 instead of 2)
○ Mr. Masters is 72 year old man with a pmh
then garden variety C-diff. More
significant for DM and CKD on dialysis who
damage.
15 days s/p prostatectomy. You review his
chart at the start of your shift and note he
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○ diagnosis is made through a stool culture • Symptoms
(or special test which is expensive) ○ watery diarrhea (get a commode!)
○ Found in the communities now. • > 3 BM’s a day for > 2 days
• Clostridium Difficile ○ fever
○ bacteria is found in the feces ○ loss of appetite
○ Can enter through skin/mouth. ○ nausea
○ transmission through contact on surfaces ○ abdominal pain/tenderness
OR through overgrowth of C-diff in the ○ Can use yogurt, acidophilus,
colon. (Normal flora killed off, all the
neighbors are gone, C-Diff has a block
party)
○ Must maintain contact precautions
• Who’s at risk?

• Complications
○ prolonged antibiotic therapies ○ pseudomembranous colitis (Pic below)
○ elderly • Overgrowth of inner lining from
○ GI surgery/manipulation (moving out of way inflammation.
for another surgery) ○ toxic megacolon (pic below)
○ long hospital stays • Distention of lower colon. Toxins
○ serious underlying illness leaking back into blood supply.
○ immunocompromised patients ○ perforation of the colon
○ Nurses - our immune system is strong, so • Lining is destroyed. Painful, high fever,
we are fine, but if we get sick and immune very ill very fast.
system is strained we can get ourselves ○ Sepsis from perf or toxic megacolon.
into trouble.
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○ death (rarely) Particularly with new strain
(rate of infection increasing 15fold every
year).

• There are other resistant


○ VRE and more.
• Case Study
○ Ms. Molly is a 42 year old woman with no
significant pmh who presents with fever
and HA. Upon examination you note she
has swollen anterior and posterior cervical
lymph nodes.
○ What questions do you have for her?
○ What is going on with her?
○ Ms. Molly is diagnosed with West Nile Virus.
Her symptoms do not get worse and after
several weeks they disappear completely.
○ What is the nurses role with this patient?
• Educate her.
• West Nile Virus
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○ a single strand RNA virus (genus flavivirus) paralysis (lasts several weeks)
○ spread by infected mosquitoes that feed on neurological effects may be permanent.
birds that are infected. ○ most serious complication is fatal
○ Small likelihood - can be spread in blood encephalitis (inflammation of the brain)
transfusions (1 case), organ transplants, causes the neurological symptoms.
breastfeeding, and in pregnancy (across ○ Prevent spread through education (beware
placenta) foreclosed house pools)
• Get rid of dead birds (contact vector
control)
• See pic below

• Symptoms
○ Asymptomatic in some people (about 80%
of people) immune system takes care of it.
○ Milder symptoms in some people (up to
20%)
• fever, HA, body aches, n/v, swollen
lymph glands, skin rash on chest, • Case Study
stomach, and back. ○ Mr. Jones is a 36 year old previously healthy
○ Serious Symptoms in few people (one in male who develops a fever, runny nose,
150 people) Need medical care. and cough. He presents to his urgent care.
• high fever, HA, neck stiffness (risk for ○ What immediate nursing concerns do you
meningitis), stupor, disorientation, have for Mr. Jones?
coma, tremors, convulsions, muscle
weakness, vision loss, numbness and
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• Usually not as concerned, but increased • Pathogenesis
risk of infection d/t pandemic ○ starts as upper respiratory tract infection
conditions. • virus kills mucus secreting, ciliated and
• H1N1 virus. epithelial cells leading to extracellular
• Get him separated from others, protect fluid escape and “runny nose”
ourselves as well. ○ spreads to lower respiratory tract
○ What steps need to be taken? • virus causes severe shedding of
• Droplets precautions (cough, sneeze) bronchial and alveolar cells.
 Mask, goggles, gown, gloves, shoe • promotes bacterial adhesion to the
protection, pressure negative room epithelial cells
(vent circulation, lack of beds). • can eventually grow into a pneumonia
• Prevent cough, prevent getting on (PNA) viral or bacterial
surfaces. • Symptoms
• Masks - special type, fit tested. ○ abrupt onset of fever and chills -->
• Influenza ○ malaise
○ Transmission through droplet nuclei ○ muscle aching
○ incubation period is 1 to 4 days ○ HA
○ infectious one day before symptoms and ○ profuse watery nasal discharge
for 5 days after ○ nonproductive cough
• B4 knowledge of sickness, can be ○ sore throat
transmitted. • Complications
○ children and immunocompromised have ○ sinusitis
longer intervals (incubation, infectious ○ otitis media (middle ear infection, internal)
period) • Dizziness, balance issues, can develop
○ causes 3 types of infections after flu alleviates.
• uncomplicated upper respiratory ○ bronchitis
infection ○ bacterial pneumonia
i. Runny nose ○ Productive cough indicates PNA
• viral pneumonia • H1N1 Virus
• respiratory infection followed by ○ a novel influenza A virus
bacterial infection (Small percentage, • some relation to a swine based flu
secondary)
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○ spread by droplet ○ Mr. Jones tests positive for H1N1 virus and
○ Pandemic (this is the concern) is hospitalized due to his high fever and
○ Immunization (egg medium) some altered respiratory status.
• Not very successful lately, worried ○ What concerns do you have before you get
about supply. report?
• Highly suggested that MEPN students ○ What preparations need to be made?
(healthcare providers) get a flu shot. ○ How does the nurse prevent transmission of
• Priority - Pregnant women. this virus to self, staff, and other patients?
• Symptoms
○ fever
○ cough
○ sore throat
○ body aches
○ chills
○ fatigue
○ Nausea (not in all pts, in more sever pts)
○ Vomiting (not in all pts, in more sever pts)
○ diarrhea(not in all pts, in more sever pts)
○ severe illness and death
• High Risk Groups
○ pregnant women
○ anyone with a chronic medical condition
• DM, heart disease, asthma, kidney
disease
• Still at risk groups
○ Younger previously healthy people are
getting sick
○ Small number of people have died.
○ Flu season starts in the Bay around
November to Mid-Spring.
• Case study