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 was diagnosed with Diabetes type 2 two years ago and when homeless lives off left overs found in bins from fast food shops. Mr. Jones has been a heavy smoker for over 10 years. He has previously been admitted to hospital for depression and a suicide attempt. His blood tests returned positive for Hepatitis C. Blood glucose levels are within normal range at 7.8mmol/L and chest x ray returned clear. His BMI is 30.2 kg/m2, weight is 98kg 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: “Nursing: 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. Short answer questions: Each question must have no less than 150 words and be referenced. Read each question carefully and ensure you answer each part. Answer the following questions in relation to the information provided in the above case study: 1. Mr. Jones has MRSA within his wound: a) Define MRSA and discuss its microbiology and what type of bacteria it is? (150 WORDS, reference) b) Explain why MRSA is antibiotic resistant? Discuss this in terms of its genetic structure and ability to mutate.(150 WORDS, Reference) c) Discuss the major complications of MRSA and their impact on other body systems.(150 WORDS, reference) 2. . In regard to infection control and wound care answer the following questions: a) the chain of infection – discuss each step in the chain eg. Reservoir/ host, portal of entry/exit, transmission and link each step back to Mr. Jones. For example, identify what Mr. Jones’ portal of entry might be?. (150 WORDS) b) standard/additional precautions – put each one under a heading and identify the differences between them. Explain how you would apply them in your care of Mr. Jones (150 WORDS) c) Provide an education session to the client on wound care and how to prevent infection.(150 WORDS) 3. Compare and contrast the differences between a primary, secondary and tertiary intention wound. (150 WORDS) 4. There are three overlapping phases in wound healing known as the inflammatory, proliferative and maturation phases. Explain in detail each of these physiological processes and how long each stage takes. (150 WORDS) 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 – Define each letter and explain what is involved in each stage of this wound assessment method. (150 WORDS) 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. What dressing type would you select for Mr. Jones? (Check the journal article in “supplementary resources” on Healing by Secondary Intention as it discusses this scenario). (150 WORDS) 7. Choose one (1) contemporary (recent) wound management strategy for a client with a wound. Discuss this strategy, when it was introduced and give both the advantages and disadvantages of the chosen therapy. Your answer should demonstrate why it is a contemporary (current/recent) therapy and be supported by evidence-based research. (150 WORDS) 8. What impact will the following issues have on Mr. Jones wound healing and his activities of daily living? b) poor nutrition c) smoking d) substance abuse e) diabetes Put each of the above issues under a heading and discuss each in detail. Support each issue with research and a clear rationale (reason) for why it will affect his healing. In this question I am looking for your ability to problem solve and critically think. 9. Develop a nursing plan of care for Mr. Jones. Your care plan must follow a nursing problem solving approach for example SOAPIE (see table below). Give one nursing intervention for each problem stated below ie. A total of 6 nursing interventions that you would put into place to assist Mr. Jones with the following problems. Support each intervention with a rationale/reason and a reference PROBLEMS: • the location of his wound • activities of daily living • reduced mobility • Pain • Referral needs – which other health team members both within and outside the hospital environment would be involved in the care of Mr. Jones. • Education and understanding of infection control principles IMPORTANT: Please set this out in table format. Below is an example to assist you. Problem Intervention Rationale Evaluation Bowel elimination and prevention of constipation Encourage lots of fluids Provide nutritious diet high in fibre Encourage mobility as this helps with bowel movements Review medications that may cause constipation Implement stool softener if required Educate Mr Jones on the importance of relationship of fluid intake, diet and exercise Constipation can lead to complications of the bowel, pain and reduce the patients quality of life (Toner & Claros, 2012) Note: the rationale/reason is referenced. Expected Outcome: Client will have regular and comfortable bowel movements within two days. Client will demonstrate knowledge of the relationship between diet, fluid intake, exercise and regular bowel movements within two days. 1. Location of Wound 2. Activities of Daily Living 3. Reduced Mobility 4. Pain 5. Referral Needs 6. Education 10. Identify 3 professional organisations or education resources associated with wound management. Give the addresses, web addresses and/or phone numbers for each resource. Instructions: Read the following case study scenario and submit your responses to the questions below. Submit your responses in short answer format. A minimum of 150 words is required for each response. Use APA referencing to acknowledge your sources of information: Avoid the use of ‘unreferenced online google’ sites. A reference should come from a site that has an approved nursing/medical author, references and a reference list.