MRSANursing Care Plans Diagnosis and Interventions
MRSA NCLEX Review and Nursing Care Plans
Methicillin-resistant Staphylococcus aureus MRSA is a type of infection caused by S. aureus bacteria and is known to show resistance to many antibiotic therapies that can usually treat ordinary staph infections.
Many MRSA cases involve people who have previously been admitted to the hospital, dialysis centers, or nursing homes. However, some MRSA cases are community-acquired in crowded places.
MRSA is mainly diagnosed with an MRSA swab test that determines whether the person is positive or negative to it. The treatment for MRSA is focused on the elimination of the pathogen while the infected person is isolated in the healthcare facility.
Signs and Symptoms of MRSA
- Swollen and painful red bumps on the skin- can contain pus or serous fluids
- Warm and/or inflamed skin
- Fever (may or may not be present)
Some patients who are MRSA positive may not present with any signs or symptoms.
Causes and Risk Factors of MRSA
MRSA emerged from many years of utilizing antibiotic unnecessarily, particularly when they were prescribed for viral infections such as flu and colds while they actually should not have been treated with such antibiotic therapy.
Bacteria evolve fast and develop resistance against the antibiotics. The risk factors of getting infected with MRSA include hospitalization, undergoing a surgical procedure or any invasive medical treatment, playing contact sports such as wrestling, use of intravenous drugs, and living in crowded places or long-term healthcare facility.
Complications of MRSA
Staphylococcus aureus bacteria can burrow deep into the skin, reaching an infection the bones, joints, lungs, heart valves, and the bloodstream.
Bronchiectasis, or the dilatation of the lung airways, can be a serious complication of MRSA infection. Antibiotic resistance makes the treatment for patient with MRSA and its complications difficult, as this enables the pathogen to spread to other parts of the body.
Diagnosis of MRSA
MRSA infection is diagnosed by collecting a nasal and groin swabs and sending the to the lab to grow for up to 48 hours, in a dish that contains nutrients that encourage the growth of the staph bacteria.
Treatment of MRSA
- Decolonization. If MRSA is found on the skin, the patient is given an antibacterial wash every day for a period of 5 days. There is an antibacterial cream called mupirocin (Bactroban) that will be applied in the nostrils 3 times a day for a period of 5 days. He/she is then re-swabbed to check if the MRSA bacteria have been eradicated.
- Isolation. The patient should be isolated in a room while receiving medical treatment in a hospital facility. The clothes, towels, and beddings need to be changed every day, and should be placed in a separate laundry bag and washed at a high temperature.
- Antibiotic therapy. Tetracycline or clindamycin can be used as antibiotic therapy for MRSA infections. It is important to note that rifampicin and fusidic acid should be used in combination and not as single treatments when treating MRSA, as using one of these on its own can result to an increased rate of antibiotic resistance. Glycopeptides like vancomycin can be used for severe MRSA infections of the skin and soft tissues.
- Incision and drainage. The infected wound or lesion may contain pus that can be needle-aspirated or drained from the skin or soft tissue.
Prevention of MRSA
- Proper hand hygiene and single use PPEs such as gloves and apron are needed to prevent the spread of hospital-acquired MRSA.
- Contact precaution can help reduce the risk of spreading MRSA from the infected or colonized patient to other patients and staff in the ward or unit.
- Open wounds should be covered by dry, sterile bandage or dressing to reduce the risk of infection.
Nursing Diagnosis for MRSA
MRSA Nursing Care Plan 1
Nursing Diagnosis: Infection related to MRSA as evidenced by positive MRSA bacterial swab culture result, temperature of 38.5 degrees Celsius, and increased white blood cell count
Desired Outcome: The patient will be able to avoid the development of an infection.
|MRSA Nursing Interventions||Rationales|
|Assess vital signs and monitor the signs of infection.||To establish baseline observations and check the progress of the infection as the patient receives medical treatment.|
|Administer the prescribed antibiotic for MRSA. The antibiotic choice is based on the result of the swab culture and sensitivity test.||To treat the underlying infection. Tetracycline or clindamycin can be used as antibiotic therapy for MRSA infections. Glycopeptides like vancomycin can be used for severe MRSA infections of the skin and soft tissues.|
|Place the patient in contact isolation. Explain to the patient the reason behind the need to isolate until the MRSA culture returns a negative result. Teach the patient to perform proper hand hygiene.||To reduce the risk of spreading the MRSA infection.|
|Perform MRSA decolonization as prescribed.||To eliminate the MRSA on the skin, the patient is given an antibacterial wash every day for a period of 5 days. There is an antibacterial cream called mupirocin (Bactroban) that will be applied in the nostrils 3 times a day for a period of 5 days.|
|Obtain a new swab sample for MRSA culture once the antibiotic therapy has been completed.||To confirm that the infection has been completely treated, or if there is a need to continue the same antibiotic therapy or shift to a different treatment.|
MRSA Nursing Care Plan 2
Nursing Diagnosis: Hyperthermia related to MRSA infection as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.
Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.
|MRSA Nursing Interventions||Rationales|
|Assess the patient’s vital signs at least every hour. Increase the intervals between vital signs taking as the patient’s vital signs become stable.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. Paracetamol) administered.|
|Remove excessive clothing, blankets and linens. Adjust the room temperature.||To regulate the temperature of the environment and make it more comfortable for the patient.|
|Administer the prescribed antibiotic and anti-pyretic medications.||Use the antibiotic to treat bacterial infection, which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.|
|Offer a tepid sponge bath.||To facilitate the body in cooling down and to provide comfort.|
|Elevate the head of the bed.||Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.|
MRSA Nursing Care Plan 3
Risk for Impaired Skin Integrity
Nursing Diagnosis: Risk for Impaired Skin Integrity related to swelling and redness of the skin secondary to MRSA infection
Desired Outcome: The patient will be able to maintain his skin intact and free from breakage or further damage.
|MRSA Nursing Interventions||Rationale|
|Evaluate the general health of the patient’s skin. Take note of areas oftentimes overlooked, such as the bony prominences (e.g., sacrum, elbow, etc.), back of the head, etc. Before implementing any intervention, it is critical to establish a baseline.||Before implementing any intervention, it is critical to establish a baseline. Although normal skin is unique to every individual, certain hallmarks indicate it is healthy. If it is healthy, it should have good turgor, feel dry and relatively warm to the touch, have no signs of skin breakdown (e.g., cuts, bruises, etc.), and have a capillary refill time of fewer than 6 seconds. The skin located on bony prominences is usually stretched out and thinner than the rest of the body. Because of this, they are more susceptible to damage and skin breakdown.|
|Use appropriate measuring tools for pressure injury risks, such as the Braden scale.||Validated tools such as the Braden scale are beneficial and necessary for an accurate and efficient assessment of pressure injury risk. In the case of using the Braden scale, it involves six domains of assessment, namely: sensory, perception, moisture, activity, nutrition, and friction or shear.|
|Follow evaluation guidelines for the patient’s skin regularly, especially when there are changes to his condition.||Compliance with skin reassessment will prevent any beginning or current skin breakdown from worsening. As the risk factors increase, so will the incidence rate and chance of skin breakdown.|
|Ensure that the patient receives adequate hydration and nutrition according to their bodily needs. A range of 2000–3000 kcal/day and 2 L/day fluid intake is ideal if not contraindicated.||Adequate nutrition and hydration will help to maintain the desired skin health. Healthy skin serves as a protective barrier against opportunistic infections.|
|Provide or assist in cleaning the skin carefully but thoroughly, two times a day or as necessary. Pay attention to the bony prominences when cleaning the patient’s body. Refrain from using hot water and talcum powder.||Efficient skin hygiene techniques will keep the skin from being compromised, leaving it more resistant to injury. Giving attention to bony prominences while cleaning is essential to prevent skin breakdown in these thin areas. Hot water may leave the skin dehydrated and prone to damage. Talc usage may precipitate lung damage.|
|Cover open wounds with gauze, a hydrocolloid dressing, or any other barriers or dressings.||Wound dressings such as hydrocolloids, gauze, etc. act as physical barriers to open wounds. They protect the damaged tissues from a further injury that may delay healing.|
|Educate the patient, family, and caregivers about healthy skin, including risk factors and manifestations of compromised skin.||Involving the patient, family, or caregivers in the therapeutic management process ensures that planned interventions are carried out and followed through for continuity of care.|
|Highlight the importance of maintaining mobility and ambulation, more so in the affected area if on the limbs, etc.||Ambulation and mobility will stimulate better blood flow to the affected body part. Increased blood flow carries with it essential components such as oxygen, leukocytes, clotting factors, etc. that will hasten recovery. It also accelerates the removal of dead cells, byproducts, etc. to allow more space for the regeneration of damaged tissues.|
|Suggest a referral to a dedicated healthcare provider for extensive wounds.||Staff who specialize in wound care are experts in managing wounds and skin breakdowns, especially complicated ones. They are more knowledgeable and skilled in wound management and can assist with care interventions. They are also useful resources in developing treatment plans for faster recovery.|
MRSA Nursing Care Plan 4
Nursing Diagnosis: Deficient Knowledge related to the complexity of information secondary to MRSA infection
Desired Outcome: The patient will be able to identify barriers to learning and execute coping techniques to comply with the therapeutic management of the condition.
|MRSA Nursing Interventions||Rationale|
|Measure the patient’s readiness to acquire new knowledge. Consider the learning styles of the patient and how he processes new information.||Measuring the different factors in learning, such as interest, emotional state, and mental fortitude, is crucial before any new knowledge is introduced. Knowing the learning style of the patient would promote the best technique for putting forth complex information, simplifying explanations, and hastening to understand for better care management compliance.|
|Evaluate the patient’s limitations, including cultural factors, health literacy, etc.||Certain aspects such as developmental level, educational attainment, age, and language can affect learning. Cultural limitations can be hindrances to learning and the application of interventions. The health knowledge bank of the patient can also determine his competency in processing health-related concerns (e.g., medication, nature of the disease, etc.).|
|Secure a calm and quiet environment conducive to learning.||A calm and quiet environment ensures that any unnecessary distractions are removed. Distractions while learning complex knowledge inhibit understanding and will increase the patient’s learning curve.|
|Work with the patient in formulating the treatment plan. Maintain constant two-way communication throughout the process.||Including the patient in the process facilitates patient compliance through consideration of his preferences. Letting the patient take an active role in health management will ensure adherence, promote ownership of interventions, and ensure accountability when it comes to his health.|
|Employ different methods and learning tools when teaching the patient.||Multiple learning modalities work in two ways: first, they encourage various forms of learning to thoroughly saturate the patient with desired knowledge; second, they encourage the opportunity to discover which of the techniques is the most to least effective, allowing for adjustments as needed for the best possible result.|
|Remember to cluster information accordingly, especially when introducing new knowledge or complex ideas.||All learners have a learning curve. Each person will respond differently to new or complex information. The healthcare provider should limit giving excess information without validating comprehension of previously taught ideas. Too much information can confuse the learner.|
|Determine learning priorities with the patient.||Establishing priorities together with the patient ensures that learning is focused on the most urgent and needed areas. This is to prevent information overload and to deal with any issue systematically and efficiently.|
|Involve significant others and caregivers when teaching the patient, especially during critical care interventions.||Involving the patient’s significant others in the teaching process will result in co-responsibility for the taught interventions. Assuring the participation of the significant other will ensure adherence to the healthcare plan.|
|Offer positive reinforcement for adequately learned behaviors.||Positive reinforcement can serve as motivation. Highly motivated learners absorb and process information much better, therefore allowing for better recall of action and demonstration of a learned skill.|
|Ensure that supportive resources are available during teaching sessions.||Additional sources of information can support the continuous learning of the patient. Access to websites, support groups, etc. will be beneficial as the patient learns the intricacies of his diagnosis and its management.|
|Foster open communication by allowing clarification of concerns and raising inquiries.||Encouraging questions promotes a safe space for open communication without being judged or feeling embarrassed. This provides an opportunity to clarify vague concepts, therefore promoting confidence for the patient to engage more.|
MRSA Nursing Care Plan 5
Nursing Diagnosis: Impaired Social Interaction related to preventive isolation secondary to MRSA infection
Desired Outcome: The patient will be able to take advantage of accessible resources within the parameters of his capacity to perform activities and health interventions within the confines of safety and infection standards.
|MRSA Nursing Interventions||Rationale|
|Assess the patient’s current psychosocial landscape, including their perception of their current diagnosis.||Knowing the patient’s current mood concerning his diagnosis will help the healthcare team establish a baseline from which to start applying necessary interventions. How the patient perceives his current health concerning his mental health makes it necessary that feelings of loneliness are addressed without compromising the safety and infection standards in place.|
|Identify manifestations of isolation due to condition-induced low self-esteem.||Patients who have MRSA infections are oftentimes placed on contact precautions to prevent transmission of the infection to other patients. Because of the restrictions, patients will feel isolated and eventually develop symptoms of low self-esteem and lowered self-worth.|
|Keep watch for odd behaviors, or vague signals.||Noting ambiguous cues could signal that the patient is in a state of crisis and is having difficulties adjusting. Unpredictable communication patterns, comprehension problems regarding humor or sarcasm, etc. are some barriers that would hinder sufficient socialization.|
|Discover the psychosocial problems of the patient, such as a lack of support systems, etc.||Patients who feel lonely oftentimes verbalize and discuss instances of strained relationships and other social issues.|
|The nurse should present himself freely as a nonjudgmental listener.||Freely offering oneself as someone whom the patient can openly discuss issues with will build trust and establish a therapeutic relationship. Establishing a therapeutic relationship can serve as a safe space where the patient can freely discuss his concerns without feeling isolated or judged.|
|Promote support groups if the patient permits.||Patients with chronic conditions or those with debilitating diseases would benefit from support groups, for they would serve as outlets and avenues for freely exchanging experiences with others undergoing the same diagnosis.|
|Make use of available technology such as cell phones, video calling applications, etc.||Patients on forced isolation precautions, such as those suffering from infectious diseases such as MRSA, are placed on these safety standards for long periods. Allowing the patient to use technology to keep up and interact with loved ones and peers lessens feelings of isolation.|
|Present another form of viewpoint on the patient’s condition.||The patient who is forced to isolate himself due to his illness may behave differently than other patients. Because of this, they may not be as readily aware of their actions and their consequences. Reflecting on these observations by using constructive criticism reorients them towards the desired behaviors, therefore eliciting self-introspection of actions.|
|If safe and practical, reduce the use of protective personal equipment (PPE) when speaking with the patient, if not contraindicated.||Doing these measures may give the patient more confidence and make them less doubtful of themselves. They are also less likely to react erratically due to the enforced medical isolation standards.|
|Help the patient and their significant others comprehend the need for isolation precautions.||Educating the patient and his or her family about the importance of precautions would ensure compliance with the interventions used. Because of this, the healthcare provider oftentimes offers explanations to get the patient and relative involved in the process.|
|Begin and act as an initiator for the patient’s current support system.||Significant others who are directly involved in their patient’s care elicit comfort and reduce feelings of isolation and rejection. Anxiety, apprehension, and a lack of awareness of the patient’s condition may hinder the patient from receiving the needed support while they are faced with illness.|
|Take time to converse with the patient while providing care. Make sure that the patient’s dignity is maintained and, if possible, uplifted.||Patients on isolation precautions may encounter or feel social stigma and bias because of the nature of their disease. It is vital that open communication is maintained and practiced, strengthening their mental fortitude and psychosocial welfare.|
|Collaborate with the patient in creating a plan for the next course of action, taking note of the following: Evaluate the available sources, promote healthy practices, and assist the patient with problem-solving strategies for short-term or long-term issues.||Involving patients in formulating strategies regarding their care management would stimulate their enthusiasm toward recovery. This will enable them to achieve a sense of purpose and control in their lives.|
|Motivate the patient to interact more with others, ensuring to give positive feedback.||Increasing the patient’s socialization opportunities will prompt their recovery from the resulting feelings of isolation while improving their relationships with others.|
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