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Internal Med > Infectious Disease 1 > Flashcards

Infectious Disease 1 Flashcards

1
Q

PT implications for studying infectious disease

A
  • infections must be treated effectively to allow full recovery and allow the patient to progress in rehab
  • allow them to fully engage in PT
  • side effects may impair fxn and limit performance
  • prevent infection and control transmission
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2
Q

Signs and Symptoms of infectious disease

A

Box 8.1?
fever, chills, malaise (earliest symptoms) sweating, nausea and vomiting, lymph node swelling

increasing number of leukocytes or a change in the types of leukocytes

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3
Q

WBC response to infectious disease

A

leukocytosis (increase due to infection or inflammation)

leukopenia (decrease due to bone marrow disease, radiation, chemo or meds, inc risk of patients being infected)

Neutropenia

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4
Q

Neutropenia

A

neutrophils are most abundant WBC

a reduction of them increases the risk of nosocomial infections (healthcare-associated infections, HAI)

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5
Q

Normal WBC count levels

A

Normal - 5000-10000

> 10000 leukocytosis

< 4000 leukopenia

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6
Q

Normal body temp (how does it differ for older adults?)

A

96.8-99.5 (avg of 98.6)
lower values for older adults

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7
Q

What controls body temp?

A

Hypothalamus is temperature-regulating center

Pyrogens - protein substances and toxins cause the set point of the hypothalamic thermostat to rise

This activates the hypothalamus to conserve heat and increase heat production

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8
Q

Is fever always due to infectious disease?

A

No, it may accompany inflammation, neoplastic, and immunologically mediated diseases

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9
Q

Infectious causes of fever (Box 8.2)

A

UTI, Respiratory infection, catheter-relates infection, surgical wound infection, infected pressure wounds, (also colitis, peritonitis, meningitis)

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10
Q

Noninfectious causes of fever (Box 8.2)

A

injured or abnormal cells incite production of pyrogens

drug reaction
pulmonary emboli
neoplasm
tissue necrosis (stroke, MI)
autoimmune diseases

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11
Q

Intermittent fever

A

temperature returns to normal at least once every 24 hours

sepsis, abscesses, infective endocarditis

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12
Q

Remittent fever

A

temperature fluctuates but does not return to normal

viral upper respiratory infections

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13
Q

sustained or continuous fever

A

temperature remains above normal with minimal variation

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14
Q

recurring or relapsing fever

A

episodic fevers lasting 1 to 3 days with 1 or more days of normal temperatures between episodes

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15
Q

What occurs to some people who have serious infections?

A

Do not initially develop a fever but develop tachypneic, become confused, or develop hypOtension

most common in older adults or those with HAI

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16
Q

Other signs and symptoms of infectious disease

A

abscess (pus collection that if ruptured or drained into other tissues can cause spread of infection)

rash with fever - caused by any microbe that penetrates stratum corneum, skin lesions

red streaks - develop in direction of regional lymph nodes (acute lymphangitis), bacteria may enter blood stream, often swelling of lymph nodes

inflamed lymph nodes - in acute infection, nodes are tender, asymmmetric and enlarged, and overlaying skin may be red and warm

joint effusion - accumulation of excess fluid in a joint, associated with infectious arthritis

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17
Q

Why are older adults more susceptible to infectious diseases

A
  • increases susceptibility due to immunoescnece and comorbidities
  • increased morbidity and mortality, especially in frail and debilitated older adult
  • decrease in number of naive T cells and increase in memory T cells
  • slower to response and require a stronger stimulus
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18
Q

What specific part of the immune system is impacted most by aging?

A

As thymus ages, decrease number of naive T cells released, = decreased diversity and proliferation rate = difficulty responding to antigens especially viruses and ability to stimulate B cells to make antibodies

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19
Q

What factors outside the immune system can cause increased susceptibility for older adults?

A
  • atrophic skin more easily damaged
  • decreased cough and gag reflex make it harder to control secretions
  • decreased bronchiolar elasticity and mucociliary activity (doesn’t clear mucus that’s catching pathogens)
  • denture associated infections
  • more likely to have implanted device
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20
Q

Why do we have to be extra careful when working with older adults?

A

Symptoms of infection is often VAGUE, BLUNTED OR ATYPICAL

More serious infections may occur yet with little or no fever because of an impaired thermoregulatory system or masking effects of drugs

^ Lower threshold of temperature for infection should be used (99 or 100)

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21
Q

Incubation period

A

the period between the pathogen entering the host and the appearance of clinical symptoms

disease symptoms herald the end of the incubation period

22
Q

Subclinical infection

A

no apparent symptoms are evident other than an identifiable immune response of the host (ex; increase in antibodies)

23
Q

Infectious disease

A

clinically apparent infection in which the host-parasite interaction causes obvious injury and is accompanied by one or more clinical symptoms

24
Q

latent infection

A

occurs after a microorganism has replicated but remains dormant or inactive in the host, sometimes for years

25
Q

period of communicability

A

time period when an organism can be shed (when disease can be contagious)

may be towards the end of the incubation period meaning the person can be asymptomatic and still transmit the disease!

26
Q

What is larger, bacteria or virus?

A

bacteria

27
Q

What is the chain if transmission

A

KNOW TABLE 8.2 (slide 40)

transmission of a pathogen depends on:

pathogenic agent
a reservoir
portal of exit from the reservoir
mode of transmission
portal of entry into host
susceptible host

28
Q

How are pathogens different than parasites?

A

Pathogens create a disease response that hurts their host and eventually kill the pathogen

29
Q

What determines the likelihood of a pathogen producing disease and the type it produced?

A

the characteristics of the organism and the susceptibility of the host

30
Q

Pathogenicity

A

the ability of the organism to induce disease, depends on the organisms speed of reproduction in the host, the extent of damage to tissues, and strength of any toxin released by the pathogen

31
Q

Virulence

A

the potency in the pathogen in producing severe disease and is measured by the case fatality rate (the number of people who die of the disease divided by the number of people who have the disease

32
Q

opportunistic pathogens

A

don’t cause disease in those with intact immune systems but cause devastating disease in people with severe defects in host defense mechanisms

33
Q

Carriers of disease (reservior)

A

carrier maintains an environment that promotes growth, multiplication, and shedding of the parasite without exhibiting signs of disease (hepatits)

human and animal reservoirs can be asymptomatic or symptomatic carriers

34
Q

Examples of portal of exit

A

secretions and fluids
excretions (urine and feces)
open lesions
exudates (pus from open would or ulcer)

HIV has multiple portals of exit

35
Q

Transmission - direct contact vs indirect contact

A

indirect - inanimate and intermediate objects (fomite), any items that come into direct contact with the infected person

36
Q

Airborne vs Droplet transmission

A

Airborne - less than 5 um, can be suspended in the air for several hours

Droplet - larger than 5 um, do not remain suspended in air but fall out within 3 feet of the source travel only a short distance

37
Q

Airborne vs Droplet transmission DISEASE EXAMPLES

A

Airborne - tuberculosis, chicken pox, rubeola measles

Droplet - influenza

38
Q

Vehicle transmission

A

Occurs when infectious organisms are transmitted through a common source (contaminated food, water, and IV fluid) to many potential susceptible hosts

39
Q

Vector-borne transmission

A

insects and/or small animals that act as intermediaries between two or more hosts

40
Q

Portal of entry

A

may enter new host by ingestion (GI), inhalation (respiratory) or bites or injury if the skin

microbes commonly enter through contact with mucus membranes and less frequently, transplacentally

41
Q

Host susceptibility - what makes someone more susceptible

A

biologic and personal characteristics - age, sex, ethnicity and heredity

general health - nutrition, hormone, diseases, drug use, sexual practices

inadequate or absent hand hygiene

underlying medical disorders

immunosuppressive agents and corticosteroids

breaches of body integrity (nasal tubes, catheters, respiratory tubes, IV devices, chest tubes)

42
Q

Lines of defense

A

first-line - microbial antagonism of the normal flora of microorganisms

second - inflammation process

third (immune response)

43
Q

Control of transmission

A

goal is the break the chain of transmission at most cost effective points

education
isolation and barriers
comprehensive immunization
prophylactic antibiotic therapy
improved nutrition, living conditions and sanitation
avoid risk taking behavior - proper handling of disposal of secretions, excretions and exudates, isolation of infected clients

44
Q

CDC standard precautions for all patient care

A

assume any person may be contagious

all clients receiving therapy (and this in contact with health care workers) may be asymptomatic hosts during the period of communicability

45
Q

Infectious waste

A

blood and components

disposable sharps (used or unused)

urine, stool or emesis if contaminated with blood

vaginal secretions

semen

CSF

synovial fluid

pericardial fluid

amniotic fluid

46
Q

safe waste

A

cotton balls, band-aids

gloves, masks, PPE

nasal secretions

sputum

feces

urine

vomitus

tears

sweat

47
Q

What is HAI?

A

Health care-associated infection (previously nosocomial infections)

infections that develop in hospitalized person that were not present before admission

results in prolonged stay, more $ and increased morbidity and mortality

most caused by pneumonia, GI tract infection (C. diffiucle) and surgical site infection (SSIs)

48
Q

Causes of HAI

A

frequent use on invasive devices

increase use of immunosuppressants and antibiotics

more colonization and infection by multidrug-resistant organisms

greater debilitation and severity of illness of hospitalized clients who acquire these infections

lack of hand hygiene predisposes people

CENTRAL LINE-associated bloodstream infections (CLABSIs)

Catheter-associated urinary tract infections (CAUTIs)

Ventilatory-associated pneumonia (VAP)

Surgical site infection (SSIs)

49
Q

What is the best way to prevent HAI?

A

Hand hygiene, must be done routinely even when gloves are used

50
Q

When should you wash your hands (vs using sanitizer)?

A

when hands are visibly spoiled with blood or body fluid
before eating
after bathroom, proven or suspected exposure to Bacillus anthracis or Clostridioles diffcle

51
Q

Box 8.6

A

Probably don’t need but read over

52
Q

Most infectious diseases are confined to where?

A

specific organ systems

Internal Med (15 decks)

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