Immunity, Infection, Antibiotics

Question 1

What are parts of the immune system?

Answer 1

Self-tolerance, human leukocyte antigens (HLA’s), leukocytes (WBCs)

Question 2

The body’s specific protective response to a foreign agent or organism.

Answer 2

Immunity

Not automatic, different types.

Question 3

Clostriduim tetani bacteria. Toxin. Occurs if not previously immunized or incomplete series. Manifestations?

Answer 3

Inability to open jaw, lockjaw, trismus, difficulty swallowing, headache, fever

Question 4

What composes an adult tetanus immunization?

Answer 4

Primary is three IM injections. the second is 4-8 wks after the first, and the third is 6-12 months after the second. Hypersensitivity provokes a severe response if the booster is given more frequently than every ten years.

Question 5

What composes an adult influenza vaccine?

Answer 5

One IM injection every year. Best time is mid-Oct to mid-Nov through April. Avoid if allergy to eggs or egg products.

Question 6

Who should get the flu vaccine?

Answer 6

All adults age 50 or older, children and teens age 6 months-18 years. Residents of LTC, nursing homes, chronic-care places. Anyone with chronic diseases. Healthcare personnel.

Question 7

What composes the adult pneumonia vaccine?

Answer 7

Single injection at age 65. Not given annually, every five years instead. Can be given with the flu vaccine. For people with chronic illnesses too, immunosuppressant illnesses.

Question 8

What vaccine reduces the risk of shingles? What composes it?

Answer 8

Herpes zoster vaccine, Zostavax. Single injection at 60 years of age or older. Given one time.

Question 9

Natural immunity, innate response initiated by injury (mechanical, microbial, thermal).

Answer 9

Inflammation. Does not always indicate infection. Complex reaction to death-injury of cells/tissues. Defense mechanism.

Question 10

Sequence of inflammatory response, five cardinal manifestations?

Answer 10

Heat, redness, swelling, pain, loss of function

Calor, rubor, tumor, dolor, functio laesa

Question 11

Follows the invasion of cells and/or tissues by living organisms. Can initiate the inflammatory process. Three types?

Answer 11

Infection. Bacteria, viruses, fungi.

Localized, systemic, colonization

Question 12

S/s of localized infections?

Answer 12

Pain, tenderness, warmth, swelling, pruritus, drainage

Question 13

Later s/s of infections, more systemic?

Answer 13

Chills, tachycardia, hypotension, change in mental status, shock, convulsions

Question 14

What should be done when an infection is suspected? Certain site vs no certain site?

Answer 14

A culture is done. If a certain site is suspected, the culture comes from there. If no certain site, then all lines and sites should be cultured. Obtain cultures before antibiotics are started.

Question 15

Provide protection after the substance enters the body.

Answer 15

Neutrophils.

Question 16

What is the progression of SIRS?

Answer 16

Systemic inflammatory response syndrome (SIRS)
Sepsis
Severe sepsis
Septic shock and multiple organ dysfunction syndrome (MODS)

Question 17

SIRS screening requires the presence of two or more of what to be positive?

Answer 17

Temp greater than 100.4 F or less than 96.8 F.
HR greater than 90 bpm.
Respiration greater than 20/min or O2 less than 32.
WBC greater than 12,000 cells/mm3 or less than 4,000 cells/mm3, and/or greater than 10% bands

Question 18

Most common infectious cause of limbs swelling, skin barrier compromise. Inflammation. Higher incidence in communal living environments.

Answer 18

Cellulitis. Spread by rubbing or scratching the infected area. Secondary infection of open wound. If the infection isn’t responsive to antibiotics, then it may infect the blood leading to sepsis and death.

Question 19

S/s of cellulitis? Distribution?

Answer 19

S/s: Localized inflammation, redness, warmth, edema, tenderness, pain. May have blisters, fever. Lymphadenopathy.
Distribution: lower legs, areas of persistent edema, areas of skin trauma

Question 20

Most antibiotics work by?

Answer 20

Inhibiting cell wall formation, blocking protein synthesis, disrupting cell membranes, interfering with nucleic acid synthesis, preventing synthesis of folic acid.

Question 21

What factors can affect antibiotic therapy?

Answer 21

Microbial resistance to antibiotic, identifying bacteria causing the infection, site of infection, other drugs the pt is taking, pt’s clinical status

Question 22

What is looked at to decide which antibiotic to use?

Answer 22

Identify the organism. Broad spectrum antibiotics until culture and sensitivity results are available. Site of infection. Pt’s clinical status: assess history of antibiotic hypersensitivity, renal and hepatic function are important

Question 23

What are some side effects of antibiotics?

Answer 23

Direct toxicity, allergic reaction, super infection

Question 24

What do penicillins and cephalosporins do?

Answer 24

Bactericidal amor bacteriostatic actions. Elimination. Used for both gram positive and negative.

Question 25

Explain ampicillin (Omnipen)?

Answer 25

(PCN family). Broad spectrum. Leading cause of colitis with antibiotic use. May cause rash that is not an allergic reaction, oral contraceptives to be less effective.

Question 26

These are common and may occur at any time during therapy.

Answer 26

Allergic reactions. Pt's should be observed for at least 30 minutes at the beginning of new therapy. Always ask about allergies. Cross-sensitives.

Question 27

PCN allergic reactions?

Answer 27

Skin rash, urticaria, anaphylaxis, GI upset. Cannot be given with aminoglycosides, synergistic reaction

Question 28

Nausea, flushing, occurs mostly if vancomycin is given IV too rapidly.

Answer 28

Red Man Syndrome

Question 29

What can happen with NSAIDS?

Answer 29

Decreased pain and inflammation without the same risk of GI upset. Also impair renal function, can cause high BP. Can increase the risk of MI and strokes.

Question 30

Reasons for taking cephalosporins, broad spectrum

Answer 30

``` Respiratory infection Skin infection Pneumonia UTI Improves appetite and well-being ```

Question 31

Nursing implications and adverse reactions for broad spectrum cephalosporins

Answer 31

``` Culture and sensitivity Assess for PCN allergy Monitor for diarrhea, nausea, vomiting, rash Monitor for changes in bowel Adverse is Anaphylaxis Stevens-johnson syndrome ```

Question 32

Reasons for raking quinolone: cipro. Nursing implications, adverse reactions

Answer 32

Respiratory infection, UTI, anthrax Contraindicated in pt history, myasthenia gravis, C/S Monitor changes in bowel Adverse: Anaphylaxis, tendonitis, Stevens-johnson syndrome

Question 33

Reasons for taking the macrolides Zithromax and erythromycin (broad spectrum)

Answer 33

Whooping cough Diphtheria Chlamydial infection Acne (topical)

Question 34

Nursing implications and adverse for macrolides Zithromax and erythromycin

Answer 34

``` Monitor bowel function Monitor QT interval Adverse is Pseudomembranous colitis Angioedema Stevens-johnson syndrome Anaphylaxis ```

Question 35

Why take vancomycin? How to know it's working?

Answer 35

C. diff MRSA PCN allergy Working when improved appetite and decreased diarrhea

Question 36

Nursing implications and adverse for vancomycin

Answer 36

``` Monitor changes in bowel Monitor n/v Monitor renal functions Adverse is ototoxicity Nephrotoxicity Red man syndrome ```

Question 37

Why take broad spectrum tetracyclines? Adverse reactions?

Answer 37

``` Tetracycline-sensitive infection Acne Periodontal disease Adverse is Hepatotoxicity Nephrotoxicity Photosensitivity ```

Question 38

Nursing implications for tetracyclines

Answer 38

Take on an empty stomach Avoid giving to pregnant and breastfeeding women, and kids under the age of 5 Monitor for superinfection: CDAD, fungal Monitor renal functions

Question 39

Why take board spectrum aminoglycosides like gentamicin? Nursing implications?

Answer 39

Serious gram negative infections Implications are Monitor: inner ear functions Renal functions Serum drug level, the peak and trough

Question 40

How to know ahminoglycosides are working? Adverse?

Answer 40

WBCs decrease, no temp | Adverse are ototoxicity and nephrotoxicity

Question 41

Why take NSAIDS?

Answer 41

Decreased inflammation Analgesia Antipyretic Decreased platelet aggregation

Question 42

Nursing implications and adverse for NSAIDS?

Answer 42

``` Give with food Monitor pain level Monitor for bleeding Adverse: Reye’s syndrome GI bleeding Anaphylaxis ```

Question 43

Why take glucocorticoids like corticosteroids? Implications?

Answer 43

``` Decreased normal immune response Inflammation Implications are Assess system involved PO give with food Monitor for infection and blood sugar Taper off ```

Question 44

How to know glucocorticoids are working? Adverse?

Answer 44

``` Decreased inflammation Decreased rejection of organ transplant Suppression of s/s to an acceptable level Adverse:Osteoporosis Infection Hyperglycemia Peptic ulcer disease Adrenal insufficiency ```