Care of Patients with Infection Flashcards
Communicable infections
transmitted from person to person
Transmission of Infection requires three factors:
Reservoir of infectious agents
Susceptible host with portal of entry
Mode of transmission
A person with an active infection or asymptomatic carrier is a
reservoir
Toxins:
protein molecule released by bacteria to affect host cells at a distant site
Passive immunity:
short duration (days or months) and either natural by transplacental transfer from the mother or artificial by injection of antibodies
Active immunity:
lasts for years and is natural by infection or artificial by stimulation of the body’s immune defenses
What is the body’s best barrier of defenses against infection:
Skin
Routes of transmission:
Respiratory: influenza virus, myobacterium tuberculosis, and streptococcus pneumonia
GI tract: Shigella, Salmonella enteritidis, Salmonella typhi, hepatitis A virus
Genitourinary tract: UTIs
Intact skin or mucous membranes: Treponema pallidum
Bloodstream
Sometimes medical procedures create a break in cutaneous or mucocutaneous barriers as in
catheter acquired bacteremia (blood in the bloodstream) and surgical site infections (SSIs)
Microorganisms can gain direct access to the bloodstream when
invasive devices or tubes are used
Methods of transmission:
Contact: direct or indirect
Droplet
Airborne
Vector-borne (for example, insects/animals)
Environment (for example, contaminated food, water)
Portal of exit
Common defense mechanisms:
Body tissues
Phagocytosis
Inflammation
Immune systems
AMI:
produces antibodies directed against certain pathogens
CMI:
Resistance to other microorganisms is mediated by the action of specifically sensitized T-lymphocytes
Infection control includes:
Facility policies and procedures Surveillance and analysis Patient and staff education Community collaboration Product evaluation Bioengineering
Methods of infection control:
Hand hygiene Disinfection/sterilization Standard Precautions Transmission-Based Precautions Staff and patient placement and cohorting
RH/CE elements:
Respiratory hygiene/cough etiquette:
Patient, staff, and visitor education
Posted signs
Hand hygiene
Covering the nose and mouth with a tissue and prompt tissue disposal
Separation from the person with respiratory infection by more than 3 feet
Transmission based precautions:
Airborne: use negative airflow rooms
Droplet: may travel 3 ft Ex. influenza, mumps, meningitis, pertussis
Contact: patients with significant multidrug resistant organisms (MDRO) Ex. MRSA, VRE, RSV, lice
What has been a way to reduce spread of infection?
Patient placement
Cohorting:
the practice of grouping patients who are colonized or infected with the same pathogen
Biofilm:
glycocalyx
complex group of microorganism that functions within “slimy” gel coating on medical devices such as urinary catheters, orthopedic implants, and enternal feeding tubes
-extremely difficult to treat
MRSA:
Staphlococcus aureus is common bacteria found on the skin and perineum and in the nose of many people
does not respond to methicillin or other penicillin-based drug
Susceptible to vancomycin, linezolid, ceftaroline fosamil
How to avoid MRSA:
Frequent hand hygiene Avoiding close contact w/ people who have infectious wounds Avoiding large crowds Avoiding contaminated objects Using good oral hygiene
VRE:
Enterococci are bacteria live in the intestinal tract and are important for digestion
-move to another area and cause an infection
Ex. Surgery
CRE:
Carbapenem antibiotics given for abdominal interactions such as peritonitis, have been used extensively for the past 15 years
-Recommends chlorhexidine (2% dilution) bathing
Problems from inadequate antimicrobial therapy:
- Drug regimen noncompliance or non-adherence also contributes to resistant organism development
- Septic shock: insufficient cardiac output is compounded by hypovolemia = inadequate blood supply to organs
- Legal sanctions compelling a patient to complete treatment (for example, TB)
- Septicemia or bloodstream infection (BSI)
Clinical manifestations:
pain swelling heat redness pus Lymphadenopathy: enlarged lymph nodes Pharyngitis GI disturbance
Assessment patient history:
age, history of tobacco or alcohol use, current illness or disease, past and current drug use, and poor nutritional status
Psychosocial assessment:
Assess patient’s and family’s level of understanding about various diagnostic procedures and the time required to obtain test results
Lab assessment:
- Best procedure: obtaining a culture
- Sensitivity testing: occurs to determine effects of various drugs on that particular microorganism
- WBC count
- ESR
- Serologic testing: performed to identify pathogens by detecting antibodies to the organisms
Imaging assessment:
X-ray films
CT and MRI
Analysis: Priority NANDA-I nursing diagnosis and collaborative problems include:
- Hyperthermia related to immune response
2. Social isolation related to being placed on Transmission Based Precautions
Hyperthermia: Expected outcome
Patients with an infection are Expected to have a body temp w/in normal limits
Interventions of Hyperthermia:
Drug therapy: antibiotics, antiviral agents, antifungals, antipyretics
External cooling: blankets or ice bags or packs
Teach UAP to observe and report shivering during any form of external cooling
Antimicrobials act on susceptible pathogens by:
Inhibiting wall synthesis
Injuring the cytoplasmic membrane
Inhibiting biosynthesis
Inhibiting nucleic acid synthesis
Interventions of Social isolation:
education is priority
Home care management:
- Clean home environment is important especially to patients with superinfection
- Explain disease and making certain the patient understands what is causing their illness
Health Care resources: hand off information to the next facility such as
SBAR
Expected outcomes in general:
Has body temp and vital signs w/in normal range
Adheres to drug therapy regimen
Copes w/ feeling of social isolation
C-diff:
due to the use of fluoroquinolone antibiotics, such as ciprofloxacin (Cipro)
Pathogen (agent) –
Microorganism capable of producing disease
Pathogenicity –
Ability to cause disease
Virulence –
Degree of communicability
Normal flora –
Characteristic bacteria of a body location; often compete with other microorganisms to prevent infections
Surveillance –
Tracking and reporting of infections
Types of HAIs
- Endogenous infection – From patient flora
2. Exogenous infection – From outside the patient, often from tubes, implants, or health care workers’ hands
MRSA Spread by:
Indwelling urinary catheters
Vascular access devices
Endotracheal tubes
Emerging Infections and Global Bioterrorism:
Emerging infectious diseases Multidrug-resistant organisms (MDROs) Pandemic infections Contaminated food Clostridium difficile (C. difficile)
