Lecture 2 - Signs, symptoms and Monitoring of Infection Flashcards

1
Q

What are bacterial infections caused by?

A

Bacteria

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2
Q

What are viral infections caused by?

A

Viruses

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3
Q

What are fungal infections caused by?

A

Fungus

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4
Q

What are antibacterial agents not effective against?

A

viral or fungal infections

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5
Q

What helps guide best treatment?

A

determining the most likely cause of the infection

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6
Q

What to consider for diagnosis?

A

actual or presumes
best guess of diagnosis
clinical judgement
cultures available

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7
Q

Source?

A

likely organism

bacterial, viral, fungal

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8
Q

Why do we need cultures?

A

To tailor therapy to suit the patient and the infection

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9
Q

Signs and symptoms of an infection?

A

redness/changes in skin colour

pain

heat

swelling

loss of function

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10
Q

Clinical assessment of a patient?

A

temperature

tachycardia

tachypnoea (breathing rate)

white cell count

hypotension

hyperglycaemia

swollen lymph nodes

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11
Q

What is a high/low temperature?

A

High = 38 degrees +

Low = 36 degrees or lower

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12
Q

Normal white cell count?

A

between 4 and 11

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13
Q

Tachypnoea?

A

breathing rate more than 20 breaths per minute

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14
Q

What are clinical signs related to specific infections?

A

increased sputum volume/increased sputum purulence

pus/exudates

rashes

cough

pain on urination

nasal congestion

sore throat

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15
Q

SIRS criteria?

A

temperature <36 or >38

Pulse > 90bpm

respiratory rate > 20 breaths per minute

white cell count <4 or >11

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16
Q

Sepsis ?

A

One SIRS criteria + documented infection

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17
Q

What is a documented infection?

A

a host response to the presence of microorganisms or tissue invasion by microorganisms

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18
Q

Signs of a documented infection?

A

cellulitis

purulent sputum

X ray changes in the lung

redness

swelling

heat

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19
Q

Patient factors to consider?

A

age

other conditions/illness

nutritional status

compromised immune system

medications

20
Q

Exogenous source of infection?

A

via host or from environment e.g. food, water, soil, coughing and sneezing

21
Q

Endogenous source of infection?

A

normal flora from another part of the body e.g. skin pathogens, gut pathogens

22
Q

What does the clinical diagnosis give?

A

‘best guess’

patients often treated for this as cultures can take days - weeks to come back from lab

23
Q

What is taken before treatment?

A

samples from the site of infection e.g. blood cultures

24
Q

Why must a sample be taken before treatment?

A

the bacterial level will lower after the patient has started treatment

25
What is done after sampling?
emperic/best guess treatment most times you can't wait for the outcome of cultures to start treatment
26
What happens when you get the culture and sensitivity results?
you can continue or modify the treatment
27
Blood cultures?
taken from different sites must be taken while the patient is pyrexial
28
Sputum samples?
must get a good sample
29
Urine sample?
needs to be a mid stream sample as urine is usually sterile so need a good sampe
30
Swabs?
wounds, eyes, nose, throat
31
Other samples?
pus bone samples surgical samples nail clippings
32
Bacteriological assessment?
agar plates stains e.g. gram stain and zeihl-neelsen confirmatory tests - oxidase/catalase selective media viral cultures PCR ELISA tests
33
What is sensitivity testing?
tests for sensitivity or resistance to a selection of potential treatments
34
What does sensitivity testing help?
guide the continuing therapy for treating the patient national and local sensitivity patterns guides the development of local formularies
35
What is the modified early warning system (MEWS)?
used in hospital to monitor the patient the patient is given a score depending on the assessment score of 4+ then the ward doctor is informed score of 0 means no infection
36
SEWS?
surgical early warning system modified for the surgical ward score or 4 or more means contact doctor for review score of 6 or more means urgent review needed
37
What are CRP and ESR?
c-reactive protein and erythrocyte sedimentation rate they are non-specific markers of inflammation
38
What can CRP be used for?
to monitor how well a patient is reacting to antibacterial therapy
39
What is CURB-65?
assessment of pneumonia, a predictor of the outcome
40
CURB-65 scores?
the risk of death at 30 days increases as the score increases 0 = 0.6% 1 = 2.7% 3 = 14% 4 or 5 = 27.8%
41
CURB-65 score of 0?
low risk of death and do not normally require hospitilisation
42
CURB-65 score of 1 or 2?
increased risk of death, particularly score of 2 | hospital referral and assessment should be considered
43
CURB-65 score of 3 or more?
high risk of death and require urgent hospital admission
44
What needs to be taken into account when deciding on home treatment?
the patients social circumstances and wishes
45
What are used for monitoring?
all diagnostic parameters
46
What does the frequency of monitoring depend on?
the severity of the infection
47
What does monitoring guide?
when to change route of therapy when to stop therapy when to change therapy