Communicable Diseases Flashcards
Who is at high risk for communicable diseases?
- Immunocompromised individuals
- Hospitalized Clients
- Extremes of Age
What communicable diseases can be aquired by travel?
SARS, lyme disease
What is the Primary NUR Dx for communicable disease?
Knowledge Deficient
What are the secondary NUR Dx for communicable disease?
- Fluid Volume Deficit
- Acute Pain
- Risk for Infection
- Imparied breathing pattern
Primary Prevention TNI
- Activities that decrease opportunity for illness
Examples:
- Teaching
- Good hand washing
- Cough etiquette
- Standard precaution technique
- Cook meat, fish, poultry to proper temp
- Vaccinate according to CDC guidelines
- Medications - Take correctly to minimize the likelihood of disease resistant organisms
Secondary TNIs for Communicable Disease
Early diagnosis and treatment
Example:
Screening - recognize disease and prevent spread
Tertiary Prevention
Restoration to optimum function
Examples:
- Isolation: to limit new individuals coming into contact with the infection
- Transmission based precautions
- Immune system enhancement
- Provide comfort
HIV Infection Transmission
Transmissible Body Fluid + Point of entry into blood stream = exposure
What are the modes of transmission for HIV?
- Sexual
- Blood and blood products
- Perinatal transmission
What is pretest counseling?
Pretest counseling is an appointment made prior to be tested for HIV. It establishes rapport, assesses risk factors, and teaches prevention, terminology, and other important factors.
When can false negative HIV tests occur?
During the window period
If the results of an HIV test are negative, what does this mean?
- Results are reported as negative
- Assess recent risks and encourage re-testing in 3 weeks, 6 weeks, 3 months
If an EIA test comes back positive, what should be done?
- Repeat the EIA test
- Results have to be confirmed with a Western Bloth or Immunofluorescence
What post-test counseling is important?
- Provide information in writing
- Provide resources
- Teaching
What teaching is helpful for post-test counseling?
- Effective Treatment
- Enhancing Immune System
- Preventing New Infections
- Testing Sexual Partners
What are common reactions to positive HIV test?
- Anixety
- Panic
- Fear
- Depression
- Denial
- Hopelessness
- Anger
- Guilt
- Reactions may extend to family, friends, caregivers
Stage of HIV Progression
Acute Retroviral Syndrome
Early Chronic Infection
Intermediate Chronic Infection
Late Chronic Infections (AIDS)
Goals of treatment for HIV Infected Clients
- Keep viral load as low as possible for as long as possible
- Maintain or restore a functioning immune system
- Improve quality of life
- Reduce incidence of HIV related opportunistic diseases
Prevention of communicable Disease
- Immunization
- Control of the spread of disease
Nursing Dx for child/family with communicable disease
- Risk for Infection
- Acute Pain
- Diversional Activity Deficit
Nursing goals for child/family with communicable disease
- Not spread the infection to others
- Not experience complications
- Have minimal discomfort
- Receive adequate emotional support (both child and family)
Bacterial Food Poisoning Agents & Prevention Strategies
Cook meat thoroughly - 160 degrees for beef and poultry; 140 for fish
Drug Resistant Organisms Agents & Prevention Strategies
- Wash hands
- Wear gloves
- Isolate in private room
- Wear gown if soiling likely
C. Diff Agents & Prevention Strategies
- Wash hands
- Wear gloves
- Isolate in private room
- Wear gown if soiling likely
CA-MRSA Agents & Prevention Strategies
- Practice good hygiene
- Keep cuts clean and covered
Rabies Agents & Prevention Strategies
- Common carriers: raccoons, skunks, foxes, coyotes, bats
- Avoid wild animals
- Vaccination for pets
Group A. Streptococci Agents & Prevention Strategies
- Good handwashing
- Stay home for 24 hours after beginning antibiotics
Hantavirus Agents & Prevention Strategies
- Maintain a clean house
- Clean out seasonal cabins using gloves and a mask
- Clear away brush around house to prevent rodent nesting
- Do not vacuum or broom to rid of rodent waste - wet mop with bleach sol/n
Legionnarie’s Disease Agents & Prevention Strategies
- Transmitted by breathed mist from contaminated sources
- Proper maintenance of water systems
Lyme Disease Agents & Prevention Strategies
- Avoid common tick habitats
- Wear protective clothing
- Reduce tick abundance
- To remove tick: use tweezers, cleanse with antispetic
- Transmission unlikely before 26 hours of tick attachment
How long must a tick stay attached to transmit lyme disease?
36 hours
West Nile Virus Agents & Prevention Strategies
- Reduce standing water
- Reduce risk of mosquito bites
Hepatitis Agents & Prevention Strategies
- Use Infection control measure
- Vaccination against Hep A & B
Airborne pathogens Agents & Prevention Strategies
- Use standard precautions
- Airborne infection isolation room (AIIR) - private from with negative air pressure (6-12 ACH)
- Wear respiratory device when entering room
SARS Agents & Prevention Strategies
Contact precautions (gown, glove, mask)
Influenza Agents & Prevention Strategies
Vaccination
Avian Influenza Agents & Prevention Strategies
- Avoid contact with infected poultry
- Contact precautions (gown, glove, mask) when caring for avian flu client
- Eye protection, AIIR - private room with negative air pressure (6-12 ACH)
STDs Agents & Prevention Strategies
- Avoid exposure to infected body fluids
- Use condom and spermicide
- Reduce # of partners
What are the three types of Anthrax infections?
- Cutaneous
- Inhalation
- Gastrointestinal
95% of Anthrax infections are which type?
Cutaneous
Which type of anthrax infection has the highest mortality rate?
Inhalation
Treatment Anthrax
- Ciprofloxacin antibiotic of choice
- Post exposure prophylaxis
- Vaccine limited availability
Can botulism be spread from person to person?
no
How is botulism spread?
Through air or improperly canned foods
Is there a vaccine for botulism?
no
How do you inactivate the toxin that causes botulism?
Heating food and drink to 85C for at least 5 minutes
How is hemorrhagic fever spread?
direct person-to-person spread, spread by body fluids
Who carries hemorrhagic fever?
rodents and mosquitos
Can hemorrhagic fever be aerosolized?
yes!
Is there a treatment for hemorrhagic fever?
no known treatment
How is plague spread?
direct person to person spread
How is plague transmitted?
flea bites and ingestion of contaminated meat
How is plague treated?
Streptomycin or gentamicin
When was small pox eradicated by vaccine?
1980 (but is starting to come back!)
How is small pox spread?
direct person to person spread
Is small pox contagious?
HIGHLY contagious
How is small pox transmitted?
air droplets and contaminated materials
What is the cure for small pox?
no known cure
What would one do when exposed to small pox?
vaccinate those exposed
Is tularemia spread from person to person?
no
How is tularemia spread?
rabbits and ticks
What routes can tularemia get you by?
aerosol or intradermal routes
What can tularemia infect?
food, air, water
What are the three types of transmission based precautions?
Airborne, droplet, contact
Who are airborne precautions used for?
Clients known to have or suspected of having serious illnesses transmitted by airborne droplet nuclei smaller than 5 microns.
Examples of airborne precaution illnesses
Measles (rubeola), varicella,TB
Droplet precautions
Used for clients known or suspected to have serious illnesses transmitted by particle droplets larger than 5 microns
Examples of droplet precaution illnesses
Diphtheria, mycoplasma pneumonia, pertussis, mumps, rubella, strep. Pharyngitis, pneumonia, scarlet fever in infants and children and pneumonic plague
Contact precautions
Used for clients known or suspected to have serious illnesses easily transmitted by direct client contact with items in the client’s environment
Contact precaution example illnesses
GI, R, skin, or wound infections. Colonization with multidrug resistant bacteria, specific enteric infections such as c diff and enterohemorrhagic E. coli, shigella, and hep A, diapered or incontinent clients, R syncytial virus, parainfluenza, enteroviral infections in infants and young children and herpes simplex, impetigo, pediculosis, scabies
Incidence
Measures the occurence of new events in a population during a time period
Morbidity Rates
Used to measure disease and injury and present an objective picture of the health status of a community
Prevalence
Measures existing events in a population during a time period
NUR Diagnosis for child with communicable disease
- Risk for Infection r/t susceptible host and infectious agents
- Pain r/t skin lesions, malaise
- Impaired Social Interaction r/t isolation from peers
- Risk for Impaired Skin Integrity r/t scratching from pruritus
- Interrupted Family Processes r/t child with an acute illness
Patient outcomes for child with communicable disease
- Child will not spread the infection to others
- Child will not experience complications
- Child will have minimal discomfort
- Child and family will receive adequate emotional support
What to assess in a child with a possible communicable disease
- Recent exposure to a known case
- Prodromal symptoms or evidence of constiutional symptoms such as fever or rash
- Immunization history
- History of having the disease
Prodromal symptoms
symtoms that occur between early manifestations of the disease and its overt clinical syndrome
Primary Prevention Children
Immunization
Incubation E. Coli
3-4 Days, variable depending on strain
What does E. Coli produce?
Diarrhea, watery, lasting 1-2 days and then severe abdominal cramping and bloody diarrhea
How is E. Coli transmitted?
- Foodbourne pathogen
- Traveler’s Diarrhea
- Highest incidence in summer
- Cause of nursery spidemics
- Symptomatic Treatment
- Antibiotics may worsen course
- Avoid antimotility agents and opiods
Salmonella Pathology
Invasion of mucosa in the small and large intestine, edema of the lamina propria, focal acute inflammaation with disruption of the mucosa and microabscesses
What does salmonella cause?
N/V/bloody D, colicky abdominal pain, fever, headache, infants adebrile and nontoxic, may result in life-threatening septicemia and meningitis
Salmonella transmission
incidence highest in warm months, foodborne outbreaks common, usually transmitted person to person by may transmit via undercooked meets or poultry, about half of cases cause by poultry and poultry products, in children is r/t pets, communicable as long as organisms are excreted, antibiotics not recommended in uncomplicated cases, antimotility agents also not recommended- prolong transit time and carrier state, incidence decreasing over past 10 years
C. Diff Pathology
produces two important toxins (A and B), toxin binds to the enterocyte surface receptor, resulting in altered permeability, protein synthesis, and direct cytotoxicity
What does C. Diff cause?
mild watery diarrhea lasting a few days, some prolonged diarrhea and illness, may cause pseudomembranous colitis, some individuals extremely ill with high fever, leukocytosis, hypoalbuminemia
How is C. Diff transmitted?
associated with alteration of normal intestinal flora by antibiotics, adults tend to have more severe symptoms than children, treatment with antibiotics in mildly to moderately symptomatic patients, for nonresponders, give vancomycin, resistant strains have developed, relapse common
What is the principal mode of HIV transmission to the pedatric population?
mother-to-child transmission and adolscent drug abuse and sexual acitivity
Where is HIV found?
blood, semen, vaginal secretions, breast milk
What is the dominant strain of HIV in the United States?
HIV-1
Horizontal transmission of HIV
occurs through intimate sexual contact of parenteral exposure to blood or body fluids containing visible blood
Perinatal (vertical) Transmission of HIV
occurs when an HIV infected pregnant woman passes the infection to her infant
What cells does HIV infect?
T Lymphocytes
What are common clinical manifestations of HIV infection in children?
- Lymphadenopathy
- Heptosplenomegaly
- Oral Candidiasis
- Chronic or recurrent diarrhea
- Failure to thrive
- Development Delay
- Parotitis
How is HIV diagnosed in children 18 months and older?
ELISA and Western Blot
Why might you get false positive HIV results in an infant with a mother who is HIV positive before 18 months of age?
presence of maternal antibodies doesn’t decrease until around 18 months of age.
What are the goals of therapy for HIV infection?
slowing the growth of the virus, preventing and treating opportunistic infections, and proving nutritional support and symptomatic treatment
Antiretroviral Drugs
work at various stages of the HIV life cycle to prevent reproduction of funcitonal new virus particles
What is the most common opportunistic infection of children infected with HIV?
pneumocystis carinii pneumonia (PCP)
When does PCP most freqently occur?
between 3 and 6 months of age
What is rabies?
an acute infection of the nervous system caused by a virus that is almost invariably fatal if left untreated
How is rabies transmitted?
Saliva of an infected mammal and is introduced through a bite or skin abrasion
What does rabies do once in the body?
After entry into a new host, the virus multiplies in a muscle cells and is spread through neural pathways without stimulating a protective host immune response.
General wound care of animal bites
lactated ringer solution under pressure via syringe and of washing the surrounding skin with mild soap
What can botulism cause?
loss of neurological function and respiratory failure
How long does it take for CNS symptoms to appear for botulism?
12-36 hours after ingestion of contaminated food and may or may not be preceded by acute digestive disturbance
Infant Botulism
Caused by ingestion of spores or vegitative cells of C. botulinum.
What toxins are responsible for infant botulism?
types A and B
What food should infants avoid in order to lower the risk of botulism?
honey
What is a pain symptom of botulism?
muscle impairment
Staphylococcus aureus is resistant to
methicillin
staphylococcus aureus preferred treatment
vancomycin (vancocin)
enterococcus faecalis is resistant to
vancomycin, streptomycin, gentamycin
enterococcus faecalis preferred treatment
penicillin G or ampicillin
Streptococcus pneumoniae is resistant to
penicillin G
Streptococcus pneumoniae preferred treatment
ceftriaxone, ceftaxime
kiebsiella pneumoniae is resistant to
third-generation cephalosporins
klebsiella pneumoniae preferred treatment
imipenem/cilastatin, meropenem
Disseminated Infection
spread to areas of the body beyound the initial site of infection
mycosis
any disease caused by a fungus
Emerging Infection
an infectious disease whose incidence has increased in the past 20 years or threatens to increase in the immediate future
Standard Precautions apply to
blood, all body fluids, secretions, excretions, nonintact skin, and mucous membranes
HIV epidemic in north america
- women
- people of color
- people who live in poverty
- adolescents
How is HIV transmitted?
- blood
- semen
- vaginal fluids
- breast milk
Retrovirus
RNA to DNA
What does E. Coli cause?
hemorrhagic collitis and kidney failure
Hep. A Transmission
fecal oral
Hep B transmission
sex, perinatal, percutaneous/permucosal exposure to blood or blood products
Hep C Transmission
percutaneous/mucosal exposure to blood or blood products, sex, perinatal contact
Hep D transmission
must have Hep B first, routes same as Hep B
Hep E transmission
fecal oral, outbreaks associated with contaminated water supply in developing countries
