the first step in the process of formulating any plan of care whether written or not is to make an assessment of the patient. assuming this is a real patient that you are doing a care plan on, then you want to assemble the information from your patient history and physical assessment. you are looking for those things that are abnormal; things that are problems. put them on a separate piece of paper in a list or on separate little pieces of paper that you will be able to move around. if this is a case study, then you need to hit the books and find the signs and symptoms of mrsa keeping in mind the things you would be doing if a real patient existed to determine that this condition existed. case studies are a little more intensive since you won't know the source of the infection and may need to also assume sites of infection as well. if this is a real patient, does the patient have an open wound somewhere, a uti, pneumonia, something where the mrsa is initially lurking? did the infection go septic? you also want to take a look at the side effects of some of the medications and/or treatments that are used to treat mrsa. there are some big time antibiotics that are used, usually over a long period of time, and have a number of complications. sometimes mrsa patients have picc lines inserted for iv therapy to treat the mrsa.
- this is what a search of medline plus got me. you should explore these links. there will be information for both patients and caregivers among these links.
- information on mrsa
- antibiotic resistance - also includes two links to patient education handouts that you can download and print. it will give you some ideas on what you need to include in your patient teaching.
- staphylococcal infections
- staphylococcal infections
the second step in the care planning process is to take a look at all your assessment data, blood work results, and culture and sensitivity results if you have them. you want to group data together into groups that are going to logically form the backbone of a nursing diagnosis. if you have a care plan handbook that lists the 172 nanda diagnoses and describes each of their defining characteristics (signs and symptoms) and related factors (cause of the signs and symptoms) this process will be easier for you. it is the grouping of signs and symptoms that will determine which nursing diagnosis(es) you will use.
about a nursing diagnosis: risk for infection is out since it is an anticipated condition. your patient already had mrsa, so don't make the mistake of using this diagnosis. some possibilities for mrsa are:
- ineffective protection r/t compromised immune system
- hyperthermia r/t illness (mrsa), increased metabolic rate, infection
- impaired tissue integrity r/t wound, presence of infection [assuming there is an open infected wound present]
- imbalanced nutrition, less than body requirements r/t infection, hyperthermia
- impaired urinary elmination: frequency r/t urinary tract infection [assuming uti is the source of the mrsa]
- acute pain:dysuria r/t process of inflammation in the bladder
- activity intolerance r/t imbalance between oxygen supply and demand [if infection is in the lungs]
- impaired gas exchange r/t decreased functioning lung tissue [if infection is in the lung]
your nursing interventions are based on the abnormal signs and symptoms and the problems you identified back in your first step, assessment. you take each of those signs and symptoms and complications that you grouped under each diagnosis and develop your nursing interventions along with rationales for doing them if your instructors are requiring that of you. if you don't have a care plan book(s) to help you with this, then use the index of your nursing textbook(s) to find the independent nursing actions you can take for each of these problems the patient is experiencing. your interventions will include independent nursing actions, patient teaching and, if allowed by your instructors, those things you will do by doctor's orders. your task is to prioritize them into a nice list under the nursing diagnosis. with your patient teaching you will want to emphasize not only how to prevent spread of the infection to others, but also preparation for any tests and treatments that may be required. one feature that is unique about the treatment of mrsa is the length of time of the treatments. also, the body doesn't completely obliterate the bacteria, so the patient needs teaching regarding the difference between being symptomatic and asymptomatic.
your goals/outcomes are based on solving the signs, symptoms and other problems you've identified and that fit with each nursing diagnosis.