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Scenario J.D., age 45, noticed a red spot on his calf after a day of yard work. It did not bother him at first, and he thought it may have been a spider bite. The next morning, he noticed that the spot had grown to the size of a nickel, and it was hardened and very painful. His wife asked him to get it checked, but he said he could take care of it, and tried to pierce it with a pocketknife he had sterilizedwith a match in an attempt to drain it. Nothing came out when he tried this, so he put some antibacterial ointment over it and covered it with a bandage. Two days later, he realized that the wound was draining yellowish fluid, and the skin around the wound was red and tender. He decides to see his health care provider (HCP), who told J.D.that he had developed cellulitis around the wound,which was infected. 1.What is cellulitis? What contributed to the development of cellulitis in J.D.s situation? 2.The HCP obtains wound cultures. Which statements reflect the correct technique for obtaining an aerobic wound culture? Select all that apply. a. Swab the drainage that is present on the bandage. b. Collect from the edges of the wound near the skin. c.Label the specimen tube before sending it to the lab. d. Collect from an area of fresh drainage from within the wound. e. Remove old exudate from the wound before obtaining a specimen. 3. Explain the difference between an aerobic and an anaerobic wound culture. J.D. sent home with a prescription for doxycycline capsules. Two days later, the results from the culture are reported to the HCP. J.D. is asked to go to the hospital for treatment for a MRSA infection. Wound Culture and Sensitivity Report Staphylococcus aureus(MRSA), ≥100,000 colonies Amoxicillin,R,Ceftriaxone,R,Ciprofloxacin,R,Clindamycin,R,Doxycycline,R,Levofloxacin,R,Linezolid,S,Trimethoprim-sulfa,R,Vancomycin,R Anaerobic Culture,No growth after 2 days 4.What is “MRSA,” and what are the implications of this infection? 5.Explain the “R”and the “S” results on the culture report.Which drug will be chosen to treat J.D’s infection, based on the report? 6.Differentiate CA-MRSA and HA-MRSA. Which one does J.D.have? 7. What do you need to assess before beginning antibiotic therapy? 8. Which class of medications, if on J.D’s list of current medications, would be of concern if taken with linezolid? a.Aspirin b.Beta blockers c.Benzodiazepines d. Selective serotonin reuptake inhibitor Contact Precautions are implemented. In addition to intravenous linezolid antibiotic treatment, the HCP performs an incision and drainage procedure. Wound care is ordered every 12 hours with sterile normal saline wet-to-dry dressings. 9.Does J.D.also need to be on Standard Precautions? Explain your answer. 10. You are about to enter J.D.’s room to give the IV linezolid. Which measures are appropriate for Contact Precautions for wound MRSA? Select all that apply. a.Donning gloves b.Wearing a gown c.Wearing eye protection d.Wearing a mask to prevent inhalation of droplets. e. Handwashing before entering and upon leaving the patient’s room. 11.In addition to the antibiotic, J.D. receives methylprednisolone,10mg IV every 6 hours. What is the purpose of this drug? a. For antiinflammatory effects b. To make the antibiotic more effective c. As a second antibiotic to fight MRSA d.To reduce pain during routine wound care 12.What potential complications may occur if this wound is not treated properly? 13. Which nursing actions are appropriate to delegate to the UAP? Select all that apply. a. Taking vital signs b. Assessment of the wound c.Obtaining a wound culture d. Teaching about wound care e. Changing the sterile dressing f.Maintaining contact precautions 14.What will you assess during wound care? 15. What is the most important action you can do to promote comfort when it is time to do a dressing change? Case Continuation. After 7 days of IV antibiotic therapy, the wound shows signs of healing, and J.D’s is prescribed an oral antibiotic for the
SCIENCE
HEALTH SCIENCE
NURSING

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