Case Study Scenario:
John Jones, age 32, is admitted to your ward after post-surgical lancing of a cutaneous abscess located on his perineum. The abscess was caused by MRSA bacteria. The abscess required excision and drainage to remove pus and debris.
Mr. Jones is under police guard as he has been on remand at the nearby Correctional Centre for the past 2 days awaiting trial related to holding an illegal drug. Mr. Jones has a history of IV heroin use and homelessness. He states that he last used heroin "about 4 days ago". Mr. Jones's medical history reveals that he has previously been admitted to hospital for depression and a suicide attempt. His blood tests returned positive for Hepatitis C. Insulin levels are within the normal range and chest x ray returned clear. His BMI is 20kg/m2, weight is 65kg and height 180cm.
You read the surgeon's post-operative instructions:
Wound cavity to be dressed daily with Betadine-soaked gauze packing
Mr. Jones is visited by the wound management nurse who documented the following in his notes:
Wound to heal by secondary intention
Wound cavity measures 12mm long x 11mm wide and 10mm deep, extending to the subcutaneous tissue layer
Wound bed consists of 100% granulation tissue; is malodorous and is oozing large amounts of haemoserous exudate.
Based on this assessment, the wound management nurse disagreed with the surgeon's post-operative wound management strategy.
Answer the following questions in relation to the information provided in this case study:
1. a) Define MRSA?
b) Why is it antibiotic resistant?
c) Discuss the complications this organism may have on wound healing and other body systems.
2. What special infection control considerations would you implement for Mr Jones? In your answer include the following -
a) the chain of infection - include reservoir/ host, portal of entry/exit, transmission and discuss how these occurred in Mr. Jones' case.
b) standard/additional precautions
c) education required for Mr. Jones and the police guard.
3. What is a secondary intention wound? Include in your answer a description of primary and tertiary intention wounds.
4. There are three overlapping phases in wound healing known as the inflammatory, proliferative and maturation phases. Explain each of these physiological processes.
5. Wound Bed Preparation uses four principles in the acronym T.I.M.E which provides a systematic approach to the management of wounds. Discuss what is meant by:
a. Wound bed preparation
b. T.I.M.E
6. Why do you think the wound management nurse disagrees with betadine-soaked gauze packing as a dressing choice for Mr Jones's cavity wound? Support your answer with evidence-based research. (Check the journal article in "additional resources" on Healing By Secondary Intention).
7. Discuss one (1) contemporary wound management strategy for any wound patient. Support your answer with evidence-based research. This could be a new dressing, vac systems, maggot or honey therapy or ANY new wound strategy. Give both the advantages and disadvantages of your chosen therapy.
8. What impact will Mr Jones's previous circumstances have on wound healing? Consider lifestyle factors such as nutrition, IV drug use, potential/current co-morbidities such as hepatitis, BMI, depression, heroin use etc.
9. What nursing interventions could you put into place to assist Mr. Jones with the location of his wound, mobility and elimination. Support each nursing intervention with a rationale and reference. Minimum of 5 nursing interventions