Exam 2 Review Flashcards
infection
the invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response1
acute infection
infection resolving in a few days or weeks
chronic infection
infection lasting longer than 12 weeks and in some cases is incurable
localized infection
infection limited to a specific body area
disseminated infection
a spread of infection from an initial site to other areas of the body
systemic infection
an infection that affects the body as a whole or has spread throughout the body
epidemic
situation in which there are more cases of an infectious disease than is normal for the population or geographic areas
pandemic
worldwide epidemic of a disease
how do bacteria cause cellular injury
- by releasing toxins (either endotoxins or exotoxins)
- diseases caused by bacterial invasion depend on the type of bacterial pathogen and the area of the body primarily invaded
how do viruses cause injury
- may immediately cause injury disease or remain relatively dormant for years
- cause cellular injury by blocking its genetically prescribed protein synthesis process
- diseases develop as a result of interference of normal cellular functioning of the host, with destruction of the virus by the immune system also requiring death of the host cell
how do fungal infections cause injury
- in a healthy individual, fungi do not cause disease and are contained in the body’s natural flora
- athlete’s foot and ringworm may develop in the individual with a competent immune system
- in the immunocompromised individual, fungi can result in infections that result in death
how do protozoa/parasites cause injury
- generally infect people with compromised immune responses
- typically found in dead material in water and soil
- spread by the fecal-oral route by ingesting contaminated food or water
- disease may develop in a healthy individual when spores invade organs and stimulate an immune response
secondary infection
an infection that develops that begins as one type and after an additional pathogen is introduced, a secondary infection occurs
example of secondary infection
- fungal infections may develop when treatment for a bacterial infection decimates the body’s natural flora
- bacterial infections may arise while a debilitated body is treated for viral infection
healthcare acquired infection example
- MRSA
- C. diff
- VRE
healthcare acquired infection
- infection acquired during a hospital stay
community acquired infection
infections acquired in the community
ex.
- sporting areas
- areas where children gather for sporting and other events
- restaurants
- food stores and other shopping facilities
- movie theaters
- other group activity locales
multidrug resistant organisms (MDROs)
Chain of Infection
- 6 components:
- pathogen
- susceptible host
- reservoir
- portal of exit (from the reservoir)
- mode of transmission
- portal of entry (to the susceptible host)
reservoir
- anywhere the pathogen may live and multiply, either in the body or on objects within the environment contaminated with the organism
- ex:
- door handles
- stagnant water
- healthcare equipment
portal of exit
- way out
- the germ that needs to find a way out of the infected person so it can spread
- urine
- feces
- saliva
- blood
- skin
- GI tract
portal of entry
- the germ needs to find a way into another person
- this can be through the eyes and mouth, hands, open wounds, and any tubes put into the body such as a catheter or feeding tube
- broken skin
- intimate sexual contact
- mouth
- respiratory tract
- gastrointestinal tract
- contaminated food or water
means of transmission
- once the germ is out it can spread from one person to another by hands or an equipment such as a commode, in the air by coughing or contact with body fluids and blood
- direct contact
- ingestion
- airborne
susceptible host
- a person who is at risk of infection because they are unable to fight the infection
- could be residents, staff or visitors
- elderly people can have decreased immune systems and catch infections easier
- infections also spread quickly in care homes due to many residents living closely together
- immunosuppression
- diabetes
- surgery
- burns
- elderly
infectious agents
- the microorganisms (germ or bug) that can cause harmful infections and make you ill
- common infections in care homes are respiratory such as colds and flu and stomach bugs like norovirus and C. diff
- bacteria
- fungi
- viruses
- protozoa
ways to prevent infection through infectious agent
rapid accurate identification of organisms
ways to break the chain of infection: reservoir
- employee health
- environmental sanitation
- disinfection/sanitization
ways to break the chain of infection: portal of exit
- hand hygiene
- control of excretions and secretions
- trash and waste disposal
ways to break the chain of infection: means of transmission
- hand hygiene
- sterilization
- standard precautions
- airflow control
- food handling
- isolation
ways to break chain of infection: portal of entry
- aseptic technique
- catheter care
- wound care
ways to break the chain of infection: susceptible host
- treatment of underlying diseases
- recognition of high-risk patients
how does infection affect infants and young children
- may have a diminished response to an invading pathogen resulting in increased susceptibility to infection
how does infection affect older adults
- older adults with a diminished immune response may have a muted inflammatory response to infection
- may present with symptoms of dizziness, confusion, anorexia, and fatigue
- the presence of comorbidities (diabetes, cancer, kidney disease) may alter the body’s response to infection
pathogen invasion
- bacteria release endotoxins or exotoxins, which damage the cells of the host and initiate an inflammatory response
- B lymphocytes are activated, resulting in the production of antibodies and memory cells
- T lymphocytes are activated, resulting in apoptosis
- complement system is activated to enhance the overall immune response
consequences of infection
- unresponsive or untreated infection
- compensation
- multisystem organ failure
What laboratory tests can help us diagnose infection?
- CBC with WBC differential
- culture and sensitivity
- ESR
- serological tests to detect specific antibodies or viruses
What does a culture and sensitivity test tell us?
it identifies the invading pathogen and determines the antimicrobial most likely to be effective in treatment
where are most culture and sensitivity tests drawn from?
- GU tract: urine culture
- respiratory tract: sputum culture
- oropharynx: throat culture
- blood
- wounds
- spinal fluid
What should always be done before starting IV antibiotics?
cultures!
primary prevention of infection
- infection control measures:
- hygiene
- standard precautions
- immunization
secondary prevention of infection
- opportunity to identify an infection for the purpose of early treatment and reduction of transmission
collaborative/tertiary prevention of infection
Goal:
- eradicate infection
- prevent secondary infections
- limit damage to the body
- Use of antimicrobials:
- antibiotics
- antivirals
- antifungal
- Nutrition
- Fluids
broad spectrum antibiotics
a wide variety of bacteria are sensitive
narrow spectrum antibiotics
only a few types of bacteria are sensitive
indications for prophylactic antibiotic use
- surgery
- sexually transmitted infection following exposure
- prosthetic heart valves prior to dental procedures
- recurring UTIs
principles in selecting an antibiotic
- identity of the causative organisms
- sensitivity of the infecting organism to an antimicrobial
- other factors: location of the infection, age, pregnancy status, allergies, and immune status
peaks and trough are monitored to…
to ensure effectiveness and prevent toxicity
what is a peak
- highest serum drug concentration
- drawn 30-60 minutes after medication administration
what is a trough
- lowest serum drug concentration
- drawn 30 minutes before next scheduled dose
key points to remember about ciprofloxacin
- teach clients to avoid sun exposure and wear protective clothing while outdoors
- report pain and swelling, and redness at the Achilles tendon to provider
- monitor for signs and symptoms of loose, frequent, foul smelling stool
key points about metronidazole
- teach clients it may cause a darkening of urine
- take medication with food to reduce adverse GI effects (nausea, vomiting, and dry mouth)
- instruct clients to call their provider if they experience headache, vertigo, and ataxia
- avoid alcohol when taking this medication
key points about penicillin
- educate clients to wear an allergy identification bracelet if allergic to this medication
- clients should take this medication with food to avoid GI upset
- monitor kidney function
- monitor client for 30 minutes after initial dose (IV or IM doses)
key points about erythromycin
- take the medication with food to lessen GI discomfort- nausea, vomiting, epigastric pain
- assess for cardiac rhythm abnormalities prior to administration
- educate client to report ringing in the ears, hearing loss, or vertigo
key points about vancomycin
- important to monitor peak and trough levels to avoid drug toxicity and nephrotoxicity
- monitor for signs of infusion reaction if the medication is infused too quickly
- assess IV site before, during, and after administration for signs of phlebitis
- report signs of tinnitus, vertigo, and hearing loss
key points about sulfamethoxazole
- monitor and report severe GI side effects
- may cause rare hypersensitivity reaction —> Stevens-Johnson Syndrome
- instruct clients to drink at least 1250 mL of fluid while taking this medication
- client should report new fatigue, pallor, easy bruising, and any new infection
key points about acyclovir
- used for treatment of viral infections like herpes simplex and herpes zoster
- prevents viral DNA replication
- can be given oral, topical, or IV
- ensure IV assessment before, during, and after administration
key points about cefazolin
- similar in structure to penicillins
- contraindicated if client has had an anaphylactic reaction to penicillin
- monitor for watery or bloody diarrhea
- assess IV site for signs of phlebitis
key points about tetracycline
- may cause tooth discoloration- especially in young
- can cause GI discomfort and taking with meals (non-diary) is indicated if this occurs
- contraindicated in pregnancy
- instruct clients to wear protective clothing and use sunscreen when outdoors
- monitor for signs of jaundice
key points about aztreonam
- monitor IV site for redness, swelling, and pain
- use caution in clients with a known allergy to penicillin and cephalosporins
- can be given via inhalation
key points about gentamicin
- can cause ototoxicity when trough levels are elevated above expected range
- monitor for signs of nephrotoxicity
- encourage fluid intake
key points about meropenem
- use caution in client with a known allergy to penicillin and cephalosporins
- can cause GI upset- important to infuse at recommended rate
- monitor for signs of phlebitis
class and prototype of penicillin
Class: penicillin
Prototype: amoxicillin
What is the prototype of cephalosporins
cephalexin
what is the prototype of monobactums
aztreonam
what is the prototype of vancomycin
- vancomycin
- vancocin (brand name)
what is the prototype of macrolides
erythromycin