Infection Prevention Flashcards
5 non specific natural defenses with examples
- anatomic : skin
- mechanical : cilia
- chemical : acidity of secretions
- local tissue factors: inflammation
- WBC fxn: fever and phagocytosis
Neutrophil
Granulocyte
- phagocyte
- link in generating fever
Eosinophil
Granulocyte
-allergic rxn
Basophil
Granulocyte
- unknown fxn
- contain heparin and histamine in granules
T lymphocyte
Agranulocyte
- synthesis of immunoglobulins
- stimulate B lymphocyte
- 3 types: helper, killer, suppressor
B Lymphocyte
Agranulocyte
- synthesis of antibodies
- humoral immunity
- stimulated by T lymphocyte Helper T
- form memory cells
Monocytes
Agranulocyte
- “Macrophage”
- dispose of cellular debris
- increase in late stage infection/chronic infection
- increase in response to viral, bacterial, and parasitic infection
What is goal of inflammatory response?
contain microorganisms when there is injury
What are the 5 signs of LOCAL inflammation
- erythema
- warmth
- edema
- pain
- functional impairment
What are the 5 signs of SYSTEMIC inflammation
- fever
- leukocytosis
- malaise
- sepsis
- anorexia
What changes in routine vital signs with increase in inflammatory response?
Increase: heart rate, RR, temp
Temp change correlated to heart rate
1 degree celsius increase means heart rate increase 10 BPM
4 types of immunity
- cellular
- humoral
- active
- passive
Cellular immunity
t cell maintain a memory of an antigen for rapid response
Humoral Immunity
B lymphocyte remain in lymphoid tissue and respond if antigen comes back
Active immunity examples
- natural (get sick)
- vaccination
Passive immunity
- placenta to fetus
- breast milk to newborn
- direct transfusion (monoclonal anitbodies and covid)
Endotoxins are released by which antigen?
Bacteria
What does a compromised immune system mean?
Low WBC count- inability to fight off infection
What do endotoxins do?
Trigger inflammatory response into overdrive
5 things that compromise the host?
- impaired skin integrity
- impaired mechanical fxn
- inadequate nutrition
- prolonged stress
- medicine or medical problems
impaired skin integrity examples
- injury to skin
- surgical incision
- invasive device
impaired mechanical fx and infection prevention examples
- trach
- sedation
- smoking
Prolonged stress and infection prevention
-CORTISOL which leads to HYPERGLYCEMIA which leads to increase bacterial growth
medications that increase infection
chemo, steroids, improper use of antibiotics
4 stages of infection
- incubation
- prodromal
- acute
- convalescence
incubation
- pathogen enters
- initial symptoms
prodromal
-vague nonspecific sxs: nausea, fever, weakness, aches/pain
acute phase
- specific symptoms
- usually test here
- symptom resolution
- lab tests
convalescence phase
- antibodies formed
- body returns to normal
sepsis =
severe infection that reached blood stream
Endotoxin and sepsis
endotoxin leads to shock and makes it harder to profuse all of the organs
endotoxins → inflammatory response → shock → hypotension
early symptoms of sepsis =
systemic inflammatory response syndrome
hypothermia ( T < 36C) or hyperthermia (T >38C)
HR >90
RR >20 (tachypnea) or PaCO2 < 32 mmHg
WBCs >12,000 or WBCs <4,000 (cells per microliter)
need 2 or more to be called SIRS
systemic inflammatory response syndrome temp
T > 38 or < 36 C
systemic inflammatory response syndrome heart rate
HR >90 BPM
systemic inflammatory response syndrome RR
RR >20 OR PaCO2 <32mmHg
systemic inflammatory response syndrome WBC
WBC >12,000 or <4,000 units
How many need to qualify for systemic inflammatory response syndrome
2 or more
Location of pain indicates…..
location of infection
UTI - urine looks like…
cloudy, whitish, yellowish, purulent
Abscess =
pocket or purulent drainage
What sxs occur when small or large intestine is inflamed from pathogen?
- diarrhea
- increase peristalsis or hyperactive bowel sounds
What is leukocytosis
increase WBC count
Neutrophils are normally ____% of WBC
50
Higher # of Neutrophils =
body is fighting infection well
Shift to left =
more immature granulocytes (bands) to fight infection
- neutrophils are depleted
- chronic or severe infection
Absolute Neutrophil Count (ANC)
- reduced by chemo
- patients must take additional precautions if low: “neutropenic precautions”
Neutropenic precautions
- limit visitors
- pt wear mask out of room
- gentle oral care, no flossing
- no razors
- no rectal temp
- no stagnant water/flowers/potted plants
- avoid crowds
- hand hygeine
- visitor wear mask/gown/gloves
Erythrocyte sedimentation rate
- increased with infection
- impacted by other factors so not for diagnosis alone
Lactate
- sepsis indicator
- anerobic metabolism, decreased O2 to tissue
- lactate changes occur before hypotension sets in from shock
situations that call for obtaining cultures when an infection is suspected
- productive cough
- invasive line
- purulent drainage
- parasites
Peak level
- highest amount of drug
- shortly after drug administered
Trough level
- lowest level of drug
- right before dose is administered
Why do we get peak and trough levels for antibiotics?
-prevent oto and nephro toxicity
When is trough level drawn?
30 minutes before next dose
Shivering paradox
-anything cold makes someone shiver so giving cold drink when having a fever will only make them warmer
Common nursing diagnosis that almost anyone will have
risk for infection
