Chapter 8: nursing care of patients w/ infections Flashcards
Infection process
- chain of infection required
- six links in the chain
- treatment breaks the chain
infective (causative) agents
- bacteria
- virus
- fungi
- protozoa
- Helminth
- Prion
microbiota
microbes occurring naturally in a body part
pathogen
disease causing microbe
reservoir
environmental ome for infectious agents
- animate: people, insects, animals, plants
- inanimate: water, soil, medical devices
portal of exit
path by which infectious agent leaves its reservoir
mode of transmission
direct
indirect
direct mode of transmission: direct contact
touching
kissing
sexal contact
direct mode of transmission: droplet spread
sneezing
coughing
talking
disease examples for direct transmission
scabies
infectious mononucleosis
STIs
pertussis
influenza
prevention of direct contact
hand hygiene
aseptic technique
PPE: gloves, surgical masks, goggles, gowns, shoe covers
indirect transmission
vehicle born transmission by contact w/ contaminated object
indirect vehicle examples
toys, bedding, dressings, surgical instruments
biological: blood, organs
water/food
disease examples of indirect transmission
- influenza, norovirus, hepatitis
prevention of indirect transmission
- hand hygiene, stethoscope cleaning
- cleaning per protocols
- clean water/food
Indirect vector
born transmission by living source other than humans
- vectors: fleas, mice, mosquitos, rats, ticks
- disease examples: lyme disease, malaria, plague, zika
- prevention: insect repellents, rodent control
airborne transmission
- dust or droplet nuclei carry pathogen through air
- small particles in air for long time and large distance inhaled/deposited on host mucous membranes
- disease examples: measles, chickenpox, tb
- prevention: high effeciency particulate air (HEPA) respirators
- must have your own fit tested HEPA respirator
portal of entry
- entry into susceptible host
- portals: respiratory tract, skin, mucoumembranes, gastrointestinal tract, genitourinary tract, placenta
susceptible host
- occurs from defense breakdown
- increased risk: burns, chronic disease, immunocompromised, invasive procedures, malnourishment, stress, young or old age
body’s defense mechanisms
- skin and mucous membranes
- cilia
- gastric acid
- immunoglobulins
- leukocytes and macrophages
- lysozymes
- interferon
- inflammatory response
inflammatory response
- vascular response
- inflammatory exudate
- phagocytosis and purulent exudate
immune system
- body’s final defense against infection
- immune cells and lymphoid tissue
infection
results when immune system protection fails
localized infection
- microbes in one area
- pain, redness, swelling, site warmth
sepsis
- dysregulated host response to infection
- can be life threatening
- organ damage
- can lead to septic shock: decreased bp
laboratory assessment
- gram staining
- culture and sensitivity (C&S)
- antibody test
- complete blood count w/ differential
- erythrocyte sedimentation rate (ESR)
immunity
- natural immunity: species specific
innate immunity
hereditary
acquired immunity
exposure
vaccination
immunoglobulin injection
infectious mononucleosis
- epstein barr virus usual cause
- contagious
- symptomatic in teens, young adults
- extreme fatigue, anorexia, chills, red sore throat, headache, high fever, tonsils w/ white coating
- supportive care
ebola virus disease
- direct contact transmission
- use hand hygiene, specialized PPE
- symptoms appear in 2-21 days
- fever, headache, diarrhea, vomiting, abdominal pain, muscle pain, unexplained bruising/bleeding
- supportive care only
- complications: joint and vision problems
zika virus disease
- transmitted by infected aedes specis mosquitos
- use hand hygiene, contact precautions
- symptoms: fever, headache, rash, muscle/joint pain, conjunctivitis
- supportive care: acetaminophen, fluids, rest
- complications: Guillain-Barre syndrome, birth defects
community infection control
- world health organization
- centers for disease control and prevention
- local health depts
- home health nurses
infection control in health care agencies
- community acquired infection
- healthcare associated infections
health care associated infections
- infection from care in healthcare agency
risk factors for healthcare associated infections
- host’s condition
- multiple antibiotic therapy
- high risk units
common pathogens of health care associated infections
- escherichia coli
- staphylococcus aureus
- pseudomonas aeruginosa
asepsis
freedom from organisms
medical asepsis
clean technique
surgical asepsis
sterile technique
ultraviolet environmental disinfection
- UV light used to disinfect pt care areas and rooms after traditional cleaning
infection prevention: standard precautions
- assume all pts infectious
- blood, body fluids, bdy substances
- hand hygiene, gloves, gowns, masks, goggles, face shields
infection prevention: transmission based precautions
- specific infectious diseases
- used w/ standard precautions
precautions for vancomycin-resistant enterococci
- private room required
- gloves must be worn by all hospital personnel entering room
- wash hands on entering and leaving room
- gowns: required if contamination of clothing is likely
- decontaminate all equipment used in the room before removal from the room
risk factors for respiratory tract infections
invasive tubes
prevention of respiratory tract infections
- oral hygiene
- coughing and deep breathing
- ventilator asociated pneumonia bundles
risk factors for genitourinary tract infection
urinary catheters
prevention of genitourinary tract infections
- appropriate use of urinary catheters
- intermittent catheterization
- strict aseptic technique
- secure tubing as directed
- closed system
- drainage bag below bladder level
prevention of surgical wound infections
- sterile technique used for dressing changes
- monitor wound
antibiotic resistant infections: methicillin resistant staphylococcus aureus (MRSA)
- difficult to treat
- high mortality rate
- treatment: vancomycin hydrochloride
VRE
- direct/indirect transmission
- difficult to treat
- treatment: combination antibiotic therapy
- isolation when hospitalized
treatment of infections
- type of organism guides drug selection: antibiotics, antivirals, fungals
- monitor peak/trough levels
antibiotics
bacterial infections
antivirals
viral infections
antifungals
fungal infections
antibiotic associated diarrhea
- upset of balance of natural gut microbiota
- harmful bacteria increase
- toxins cause inflammation
- watery stools result
- may resolve when antibiotic stopped
clostridium difficile
- gram positive bacterium
- overgrowth w/ imbalance in normal gut microbiota
- often from antibiotic therapy
- serious cause of AAD
- psuedomembranous colitis, a life threatening condition, may result
- transmitted by the fecal oral route
- handwashing essential
- alcohol based rubs not effective
- antibiotic treatment stopped
- treatment: metronidazole or vancomycin
fecal microbiota transplantation
- treatment for c diff infection
- restores healthy gut bacteria
- rapid, dramatic results to restore health
- screened healthy donated feces
- transplanted via colonoscopy, sigmoidoscopy, nasogastric or nasoenteric tube, enema, esophagogastroduodenoscopy, or oral capsules
- stool substitutes under study: purified intestinal bacterial cultures, more acceptable to patients
nursing responsibilities for care of pts w/ infections
- check allergies
- monitor side effects
- check for signs of superinfection
- monitor peak/trough levels
patient education for infections
- take all medication as prescribed
- report side effects
respiratory tract infections
- data collection: signs and symptoms, sputum culture
- nursing diagnosis: risk for infection
implementation
- coughing and deep breathing
- oral care: toothbrush or suction-type toothbrush and fluoride toothpaste
- hydrate
- manage pain
- elevate head of bed 30 degrees or more for tube feeding
evaluation of respiratory tract infections
- oxygen saturation above 90%
- decreased dyspnea
- respirations not labored
- free of infection signs/symptoms
GI tract infections
- data collection: signs and symptoms, dehydration, stool culture
- nursing diagnosis: risk for infection
implementation for Gi tract infections
- hydrate
- follow standard precautions
- evaluation: free of infection and GI symptoms
Genitourinary tract infections
- data collection: signs and symptoms, urinalysis, urine culture
- nursing diagnosis: risk for infection
implementation of genitourinary tract infections
- avoid use of urinary catheters
- use sterile technique to insert urinary catheters
- avoid contamination when emptying urinary catheter bags
- report symptoms
evaluation of genitourinary tract infections
- normal urine output w/out symptoms
