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Child Health
문제

A 7-year-old child is brought to the emergency department with a rapidly spreading skin infection. The nurse is assessing for signs of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Which assessment finding would be MOST characteristic of CA-MRSA skin infection in this child?

해설
CA-MRSA skin infections are most characterized by large, painful, pus-filled lesions with erythema and induration. Other options describe different skin conditions.
같은 주제 다음 문제A 7-year-old child is brought to the emergency department with a rapidly spreading skin in…

심화 해설

Clinical Judgment The core of this question is applying the 'Recognize Cues' and 'Prioritize Hypotheses' stages of the Clinical Judgment Measurement Model (CJMM). In a CA-MRSA infection, the most dangerous aspect is not the localized infection but sepsis that has spread systemically. In option 3, the fever (102.8°F), altered mental status, and hypotension are classic signs of SIRS (Systemic Inflammatory Response Syndrome), strongly suggesting sepsis. This is a medical emergency requiring immediate life-sustaining interventions. The other options are merely signs of a localized infection. Memory Tip: To remember the danger signals of CA-MRSA, think "Systemic signs over Local signs." Systemic signs (fever, hypotension, altered mental status) always take priority over local signs (pain, redness, abscess). KR vs US In Korea, there may be a more cautious approach to fluid administration during the initial management of a sepsis patient, but in the US NGN/NCLEX, the standard when the triad of hypotension, high fever, and altered mental status appears is to immediately report and begin aggressive resuscitation, including fluid administration. A 'wait-and-see' approach is never correct.

임상 시나리오

Clinical Assessment of CA-MRSA Skin Infections

Community-associated MRSA typically presents as a purulent skin and soft tissue infection (SSTI). The classic presentation is an abscess or furuncle that the patient or caregiver often initially mistakes for a spider bite.

Key Assessment Findings
  • Primary Lesion: Large, painful, pus-filled nodule or mass.
  • Surrounding Tissue: Erythema, warmth, and induration extending from the central lesion.
  • Pain: Disproportionate tenderness due to intense inflammation and tissue pressure.
  • Location: Commonly occurs on areas prone to friction or minor trauma, such as the extremities, axillae, and buttocks.
Differential Diagnosis Considerations
  • Insect Bite Reaction: Often the initial misdiagnosis; however, insect bites lack the progressive enlargement and significant induration of an abscess.
  • Herpes Simplex/Varicella: Presents with grouped vesicles on an erythematous base, not a single large purulent nodule.
  • Molluscum Contagiosum: Small, dome-shaped, painless papules with central umbilication, lacking erythema and pus.
Nursing Actions
  • Infection Control: Immediately initiate contact precautions. Use gloves and gown for all patient contact. Ensure the wound is covered with a clean, dry dressing.
  • Wound Culture: Obtain a sample of purulent drainage, not a superficial swab, for culture and sensitivity testing to confirm MRSA and guide antibiotic therapy.
  • Incision and Drainage (I&D): Prepare the patient for this primary treatment. I&D alone may be curative for small abscesses without systemic symptoms.
  • Patient Education: Instruct the family on strict hand hygiene, avoiding sharing personal items (towels, razors), and laundering clothes and linens in hot water.
Warning Signs for Hospitalization

Evaluate for systemic involvement requiring inpatient management: fever >38.5°C, tachycardia, rapid lesion progression, inability to tolerate oral antibiotics, or failure of outpatient I&D.

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