NUR-665- Dermatology Case Study Assignment-v.1-16
Subjective History
Beth is a 23 y/o female law student who comes to your practice with the complaint of abdominal pain. She states that she has a “pimple” on her abdomen that is very tender. It started approximately 1 week ago and she thought it was an insect bite. Since it hasn’t gotten better, she decided to come and see you. It has increased in size and is becoming more painful.
Allergies: Azithromycin
Sulfa
Medical Hx: 1) Asthma
2) Iron deficiency anemia
Surgical Hx: 1) Appendectomy, age 4
2) Tonsillectomy, age 11
Medications: 1) Loestrin 1/20
Proventil MDI 90mcg PRN
FeSO4 325mg QD
Objective Exam
VS: 122/70 mm Hg, HR 88, RR 16, T 99.4° F
Ht: 5’8” Wt: 130 lbs. Pulse Ox: 98% on room air
Skin: Area on abdomen that is erythematous, indurated and tender with 3 cm lesion in suprapubic area. The center is boggy without discharge and has what appears to be a puncture wound.
Lungs: CTA B/L without rhonchi or wheezing
CV: S1S2, RRR, Gr III/VI SEM, no rubs or gallops
GI: Abdomen soft, tenderness as noted under skin, ND, BS + x4Q, LKS without masses or tenderness
Assessment
Cellulitis -‐ unknown cause
Plan
Culture obtained and sent for C&S
Keflex 500mg BID x 10 days
Warm compresses to area BID minimally
If any changes, i.e., fever, streaking from site, return to office immediately or to closest ED
CASE STUDY QUESTIONS
Please refer to the 2011 (or most recent) clinical practice guidelines for the treatment of MRSA by the Infectious Diseases Society of America (Liu, et al).
NOTE: Each answer must be provided with a rationale using a peer- reviewed journal article or appropriate website reference
The patient is diagnosed with Methicillin-Resistant Staphylococcus aureus (MRSA) after the culture returned. According to the guidelines, what is the primary treatment for her simple cutaneous MRSA abscess? Provide the step-by-step process you would use.
The patient returns in 3 days after her initial treatment in #1 above. The wound site appears to have increased in size with erythema, induration and discharge.
What are the recommended guidelines for treatment if MRSA infections worsen during or after initial management?
What is the recommended management for recurrent MRSA infections?
What education do you need to provide the patient, their family and/or caregivers?
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