• 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
equipment/towels/razors/personal
products.
• immunosupressed
• institutionalized populations (prison)
• association with health care workers
• Treatment MRSA
○ Contact precautions
• Nurse can declare, talk to the charge
nurse
• Sign on door
• Enter room with equipment (disposable
gown, gloves whenever touching
ANYTHING, not airborn - no mask)
• DO NOT walk out of room wearing the
equipment. Gown off first in room,
gloves off, leave the room.
• DO NOT reuse supply.
• Good washing of hands. Skin is our best
protection (keep strong, use lotion)
• Extra credit: Leave shoes in the hallway
when you get home.
• Get own room unless someone else has
same strain of MRSA.
• Tell people, "It is for the protection of
the visitor and the protection of the
patient)
• Case Study
○ Mr. Masters is 72 year old man with a pmh
significant for DM and CKD on dialysis who
15 days s/p prostatectomy. You review his
chart at the start of your shift and note he
has had 4-5 liquid BM’s for the past 3 days.
He has a low grade fever.
○ As his nurse you go into his room to
evaluate him...what might you ask? assess?
• Gloves, abd pain GI assessment, still
taking stool softener? Skin (clammy,
flushed, diaphoretic, cool), look at size,
auscultate, palpate.
○ What would you do with this information?
• Mild abd pain, some distention.
• Let the MD know.
• Expecting to hear, let's get a stool
sample.
• Risk for infection - Low grade fever,
DM, dialysis, surgery (on antibiotics,
normal flora killed off), been in hospital
for awhile, characteristic odor.
• C-Diff
○ a spore-forming gram positive bacterial
agent that causes diarrhea and other more
serious intestinal conditions like colitis
• Spore-forming, able to live on surfaces
very well. Bed, tables, charts.
○ bacteria produces toxins that are
destructive to the mucosal lining of the
colon.
○ new drug resistant strain (floroquinolones &
Flagyl)
• releases more toxins (3 instead of 2)
then garden variety C-diff. More
damage.
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 ○ diagnosis is made through a stool culture
(or special test which is expensive)
○ Found in the communities now.
• Clostridium Difficile
○ bacteria is found in the feces
○ Can enter through skin/mouth.
○ transmission through contact on surfaces
OR through overgrowth of C-diff in the
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
○ elderly
○ GI surgery/manipulation (moving out of way
for another surgery)
○ long hospital stays
○ serious underlying illness
○ immunocompromised patients
○ Nurses - our immune system is strong, so
we are fine, but if we get sick and immune
system is strained we can get ourselves
into trouble.
• Symptoms
○ watery diarrhea (get a commode!)
• > 3 BM’s a day for > 2 days
○ fever
○ loss of appetite
○ nausea
○ abdominal pain/tenderness
○ Can use yogurt, acidophilus,
○ pseudomembranous colitis (Pic below)
• Overgrowth of inner lining from
inflammation.
○ toxic megacolon (pic below)
• Distention of lower colon. Toxins
leaking back into blood supply.
○ perforation of the colon
• Lining is destroyed. Painful, high fever,
very ill very fast.
○ Sepsis from perf or toxic megacolon.
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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)
○ spread by infected mosquitoes that feed on
birds that are infected.
○ Small likelihood - can be spread in blood
transfusions (1 case), organ transplants,
breastfeeding, and in pregnancy (across
placenta)
• 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,
stomach, and back.
○ Serious Symptoms in few people (one in
150 people) Need medical care.
• high fever, HA, neck stiffness (risk for
meningitis), stupor, disorientation,
coma, tremors, convulsions, muscle
weakness, vision loss, numbness and
paralysis (lasts several weeks)
neurological effects may be permanent.
○ most serious complication is fatal
encephalitis (inflammation of the brain)
causes the neurological symptoms.
○ Prevent spread through education (beware
foreclosed house pools)
• Get rid of dead birds (contact vector
control)
• See pic below
• Case Study
○ Mr. Jones is a 36 year old previously healthy
male who develops a fever, runny nose,
and cough. He presents to his urgent care.
○ What immediate nursing concerns do you
have for Mr. Jones?
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 • Usually not as concerned, but increased
risk of infection d/t pandemic
conditions.
• H1N1 virus.
• Get him separated from others, protect
ourselves as well.
○ What steps need to be taken?
• Droplets precautions (cough, sneeze)
 Mask, goggles, gown, gloves, shoe
protection, pressure negative room
(vent circulation, lack of beds).
• Prevent cough, prevent getting on
surfaces.
• Masks - special type, fit tested.
• Influenza
○ Transmission through droplet nuclei
○ incubation period is 1 to 4 days
○ infectious one day before symptoms and
for 5 days after
• B4 knowledge of sickness, can be
transmitted.
○ children and immunocompromised have
longer intervals (incubation, infectious
period)
○ causes 3 types of infections
• uncomplicated upper respiratory
infection
i. Runny nose
• viral pneumonia
• respiratory infection followed by
bacterial infection (Small percentage,
secondary)
• Pathogenesis
○ starts as upper respiratory tract infection
• virus kills mucus secreting, ciliated and
epithelial cells leading to extracellular
fluid escape and “runny nose”
○ spreads to lower respiratory tract
• virus causes severe shedding of
bronchial and alveolar cells.
• promotes bacterial adhesion to the
epithelial cells
• can eventually grow into a pneumonia
(PNA) viral or bacterial
• Symptoms
○ abrupt onset of fever and chills -->
○ malaise
○ muscle aching
○ HA
○ profuse watery nasal discharge
○ nonproductive cough
○ sore throat
• Complications
○ sinusitis
○ otitis media (middle ear infection, internal)
• Dizziness, balance issues, can develop
after flu alleviates.
○ bronchitis
○ bacterial pneumonia
○ Productive cough indicates PNA
• H1N1 Virus
○ a novel influenza A virus
• some relation to a swine based flu
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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