Living Conditions for Homeless People
Hello John,
This is an interesting post. It is true that the living conditions of homeless people expose them to increased contact with insects and hence increase their risk of insect bites. The best approach to ensure that one provides the best first aid treatment to the patient is to diagnose correctly to determine whether the presented case is an insect bite or a sting. Insect bites differ from stings. In most cases, most insect bites do not have serious outcomes and heal within a short time. On the other hand, stings involving an injection of poison into the victim’s system may have varied reactions, from minor instances of irritation to serious outcomes such as anaphylaxis and bacterial infections and diseases (Guillet et al., 2022). Regardless of a bite or a sting, the risk of infection remains high, and first aid should be provided appropriately.
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References
Guillet, C., Martin, O. Y., Meincke, C., Joerg, L., & Schmid-Grendelmeier, P. (2022). Part I: Insect stings and bites—Beyond the realm of bee and wasp allergies: A survey of the literature and our own cases. Allergo Journal International, 31(6), 183–193. https://doi.org/10.1007/S40629-022-00199-5/FIGURES/9
Responding to Marilyn
Hello Marilyn,
This is a great post; I agree with you. Homeless people have higher morbidity, mortality, and rates of hospitalization than housed people. In fact, homelessness is a risk factor contributing to health disparities (Bowen et al., 2019). Homeless people are exposed to various risk factors for poor health outcomes. They are more exposed to acts of violence and safety as well as prone to stress and negative mental outcomes. In addition, they have the most limited access to healthcare and other factors of good health, including access to nutritional or even enough food. The health problem cannot be solved solely by providing care to this population in need. Long-term and permanent solutions can be achieved by educating the population on the availability of health services for the homeless. Most importantly, the federal and state governments will need to invest more in affordable homes for the homeless and people from low-income backgrounds.
References
Bowen, E., Savino, R., & Irish, A. (2019). Homelessness and Health Disparities: A Health Equity Lens. Homelessness Prevention and Intervention in Social Work, 57–83. https://doi.org/10.1007/978-3-030-03727-7_3
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Question 
1. John
Homelessness is a risk factor for spider bites as spiders have different habitats, and disturbing their natural habitat may trigger bites. Spiders inject venom, and the severity of the symptoms depends on the type of spider and your body’s sensitivity. The 52-year-old female was vulnerable to spider bites for sleeping in the park. The chief complaint is a large lump on the shoulder, and after examination, it is ruled in as furuncle, a boil that starts as purplish or reddish tender bumps. The patient presents additional small open lesions, which are more blisters (skin lesions filled with clear fluid).
Living Conditions for Homeless People
Based on the chief complaint, the client could have been bitten by a spider because it presents similar symptoms. For example, redness, pain, and swelling begin after the bite, resulting in furuncle and small open lesions. In addition, the spiders have symptoms similar to the client’s, such as the bite growing into an open sore and furuncle.
Treatment
According to the history of patient information, the diagnosis reveals the patient suffered from a recluse bite, and it takes time to heal, unlike other bites, and thus requires first-aid treatment (Mayo Clinic, 2021). After identifying the potential spider and underlying symptoms, treatment interventions are initiated. The first-line treatment involves first-aid. Cleaning the wound with water, mild soap, and an antibiotic ointment will help prevent infection. To reduce pain and swelling, using a clean cloth damped in ice for 15 minutes every hour will be effective (CDC, 2021). Apply Clindamycin 1% gel to the affected site once a day (Satter et al., 2022). Cephalexin 500 mg orally every 6 hours for 7 days as empiric antibiotic therapy for superficial and deep folliculitis (Satter et al., 2022). Tylenol 650mg every 6 hours orally as needed for pain.
2. Marilyn
Homeless individuals have higher morbidity, mortality, and hospitalization rates due to extreme poverty, congested living conditions in shelters, and harsh living environments (Adly et al., 2021). This creates barriers to adherence to medical advice and recommendations. Necessities such as food and shelter compete with the need for medication, a lack of social support, and discrimination and stigmatization in healthcare make the homeless population weary of routine care (Adly et al., 2021). Research has shown that the homeless suffer from dermatological issues at higher rates than those with homes and shelter, primarily due to the lack of access to regular hygiene (Adly et al., 2021). The homeless population suffers from parasitic infections, methicillin-resistant Staphylococcus aureus (MRSA) infections, Group A Streptococcus (GAS) infections, fungal infections, and trauma-relating skin problems (Adly et al., 2021).
Addressing shelter, hygiene, nutrition, and psychosocial needs are among the issues this patient needs help with along with the treatment for her skin condition. In the Portland metro area, more homeless than shelters are available; getting this patient into a hospital might also be very difficult due to the shortage of available beds. I would connect her with the Oregon Health Plan (OHP) and social services and see what help is available. The Oregon Health Plan does have emergency funds for individuals that allow them to stay in a hotel for a limited time. This could help her with the hygiene component needed to clear her skin and give her time to find accommodations and help. Patients can visit an OHP hospital or provider through Presumptive Medical Eligibility (Oregon.gov, 2022).
Superficial folliculitis can be managed through good hand washing and cleansing with soap and water; since availability is lacking for most homeless individuals, progression to deeper, more severe infections is a problem. Deep or refractory furuncles or lesions with a suspected infectious etiology should be treated empirically with oral antibiotics (Satter, 2020). Antibiotics that cover gram-positive organisms and coverage should include S aureus since it is the most common pathogen, and considering the organism may be penicillin-resistant, dicloxacillin or cephalosporin is the initial choice of therapy. Methicillin-resistant microorganisms are becoming more common, and treatment may require clindamycin, trimethoprim-sulfamethoxazole, minocycline, or linezolid (Satter, 2020).
The use of warm compresses for treating deep folliculitis is best approached with warm compresses, followed by incision and drainage once a conical pustular head develops (Satter, 2020). Finding the bacterial reservoir is essential for recurrent and recalcitrant folliculitis and administering oral antibiotics. Mupirocin ointment in the nasal vestibule twice daily for five days may eliminate the S aureus carrier state (Satter, 2020). The patient will need help ensuring her antibiotics are covered and she can pick them up immediately. She must return to the clinic in a week; the antibiotic treatment would take 7 to 10 days. She will also need supplies for cleaning and dressing the wound and teach-back instructions on care.