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Nursing 271 > Med-Surg: Chapter 21: Coordinating Care for Patients with Multidrug-Resistant Organism Infectious Disorders > Flashcards

Med-Surg: Chapter 21: Coordinating Care for Patients with Multidrug-Resistant Organism Infectious Disorders Flashcards

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1
Q

What is needed for a pathogen to cause a disease?

A
  • a susceptible host

- mode of transmission

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2
Q

Routes of Transmission

A
  • contact
  • airborne
  • vehicle
  • vector
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3
Q

Who is a susceptible host?

A

has a weakened immune system or has had a breakdown in the body’s defense mechanism

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4
Q

Contact Transmission

A

when a person or object comes in contact with a pathogen

  • direct: person to person
  • in-direct: microorganisms spread from a source to a susceptible host by passive transfer from an inanimate object or fomite, an object or substance capable of carrying an infectious organism
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5
Q

Airborne Transmission

A

pathogens are carried through the air

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6
Q

Vehicle Transmission

A

indirect mode of transmission

-a disease carrying agent touches a person’s body or is ingested

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7
Q

Vector Transmission

A

indirect mode of transmission

-when a vector, an organism that transmits a pathogen, bites or infects a person

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8
Q

Nosocomial Infections

A

infections that are acquired in the hospital and were ot present on admission

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9
Q

What is a common cause to nosocomial infections?

A

Multidrug-resistant (MDR) Organisms

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10
Q

Examples of Multidrug-resistant (MDR) Organisms that cause nosocomial infections

A
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Vancomycin-resistant Enterococci (VRE)
  • Clostridioides difficile (C. diff)
  • Acinetobacter baumannii
  • Carbapenem-resistant Enterobacteriaceae (CRE)
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11
Q

Colonized

A

the host carries the bacteria without active infection

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12
Q

Best Treatment of MDR organism

A

prevention- hand washing

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13
Q

Clostridioides and Handwashing

A
  • alcohol-based hand sanitizers do not kill C. diff but just displace spores
  • must use soap and water
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14
Q

Patients in healthcare setting who are either colonized or infected with MDR organisms are placed on?

A

Contact isolation precautions

-placed in private rooms when available or placed in a room with other patients colonized or infected with same organism

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15
Q

Contact Isolation Precautions

A

reduce patient-to-patient spread of the organism within the hospital

  • wearing gowns and gloves on entry to room
  • removing gown and gloves prior to exiting
  • perform hand hygiene before exiting
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16
Q

Isolation Precautions

A
  • must be used for patients with MRSA, VRE, C. diff, Acinetobacter, and CRE
  • hand hygiene must be performed before healthcare workers put on isolation gowns and gloves
  • isolation gowns must be secured at the neck and waist to effectively prevent bacteria transmission
  • isolation gowns and glove must be removed before leaving the room
  • hand hygiene performed before leaving the room
17
Q

Discontinue criteria of contact isolation for patients with MRSA

A
  • may occur when clearance of the organism has been documented with 3 or more surveillance tests
  • retesting patients to document clearance is one 3 to 4 months after the last positive test result
18
Q

Antibiotic Treatments for MRSA

A
  • Vancomycin
  • Linezolid
  • Clindamycin (for CAMRSA)
  • Sulfamethoxazole/Trimethoprim (Bactrim) (for CAMRSA)
19
Q

Antibiotic Treatment for VRE

A

Quinupristin-dalfopristin

20
Q

Antibiotic Treatment for C. diff

A
  • Metronidazole
  • Vancomycin
  • Probiotics
21
Q

Antibiotic Treatment for Acinetobacter

A
  • Ampicillin-sulbactam
  • Tobramycin
  • Doxycycline
22
Q

Antibiotic Treatment for CRE

A

Ceftazidime-avibactam

23
Q

Clinical Manifestations seen with MDR organism infections are consistent with typical signs of infection:

A
  • fever
  • tachycardia
  • tachypnea
  • hypovolemia
24
Q

Prominent manifestation of C. diff

A

diarrhea

25
Q

Prominent Manifestation of MRSA

A

wound infections can be red, warm, with purulent drainage

26
Q

Nursing Assessments

A
  • Vital Signs
  • Oxygen Saturation
  • Pain
  • Skin turgor and mucus membranes
  • Urine output
  • Wound or surgical sites
  • Bowel movement frequency and consistency
  • Skin integrity
  • Laboratory Tests (WBC count, Serum creatinine, Electrolyte and albumin levels)
27
Q

Assessments: Vital Signs

A
  • increased body temperature is an immune response to an infection
  • a persons body temperature rises to try to kill the bacteria or virus causing the infection
  • increased heart rate due to fever and metabolic rate increases or hypovolemia
  • tachypnea secondary to pneumonia from infection with MDR organism; secondary to fever, which increases metabolic rate, which then increases work of breathing
  • low blood pressure (hypotension) may indication vasodilation due to systemic infection and hypovolemia
  • hypovolemia secondary to fluid loss from C. diff diarrhea
28
Q

Assessment: Oxygen Saturation

A

decreased oxygen saturation can = pneumonia caused by MDR organism

29
Q

Assessment: Pain

A

fifth vital sign

  • monitor for increased pain
  • increased pain = sign of infection caused by MDR organism
  • pain may result from fever
30
Q

Assessment: Skin Turgor and Mucous Membranes

A

-decreased skin turgor and dry mucous membranes can result from dehydration secondary to a C. diff infection

31
Q

Assessment: Urine Output

A
  • decreased urine output = dehydration; can occur secondary to C. diff diarrhea or may indicate presence of a systemic infection with MDR organism
  • can be an adverse side effect of antibiotics
32
Q

Assessment: Wound or Surgical Sites

A

-an infected wound may be red, swollen, painful, warm to touch, and have purulent drainage

33
Q

Assessment: Bowel Movement Frequency and Consistency

A
  • increased bowel movement frequency can result in dehydration
  • in C. diff infection, the bacteria proliferate and cause the release of toxins, resulting in an inflammatory response in the colon, which causes fluid to be secreted into the colon, resulting in diarrhea
34
Q

Assessment: Skin Integrity

A

-monitor skin integrity to assess for skin breakdown or incontinence-associated dermatitis (IAD) secondary to C. diff diarrhea

35
Q

Assessment: Lab Tests: WBC count

A
  • increased WBC count part of immune response

- large increase in WBCs occurs in C. diff infections

36
Q

Assessment: Lab Values: Serum Creatinine

A
  • increased when dehydrated

- increased when has an adverse reaction to antibiotic treatment, signaling decreased renal function

37
Q

Assessment: Lab Values: Electrolyte and Albumin Levels

A

-may be decreased or increased secondary to dehydration from C. diff infection or any MDR organism infection

38
Q

Nursing Actions

A
  • Hand hygiene
  • Place patient on contact-isolation precautions
  • Administer medications (antibiotics, fever reducers, pain medication)
  • Administer IV fluids or encourage to drink fluids
  • Administer supplemental oxygen (increase O2 sat secondary to MDR pneumonia)
  • Administer chest physiotherapy (to mobilize secretions in patients with MDR pneumonia and increase O2 sat)
  • Encourage early mobilization (decrease risk of atelectasis secondary to MDR pneumonia and promote overall health)
  • Stop administration of causative antimicrobial agent with a C. diff infection (to stop/decrease C. diff-associated diarrhea)
  • Perform wound care as ordered
  • Cleanse perineum and apply moisture barriers
  • Use fecal diversion or containment systems in the stool-incontinent patient (to prevent skin breakdown and increase comfort in C. diff patients)
  • Encourage family visits and use of telephone and TV
39
Q

Teaching

A
  • Contact-isolation precautions
  • Hand-washing
  • Take antibiotics as prescribed; finish the course of antibiotics to prevent the reoccurrence of MDR infections
  • Clinical manifestations of infection
  • Sun protection; some antibiotics create sun sensitivities; wear sunscreen, avoid prolonged sun exposure, and appropriate covering clothing

Nursing 271 (208 decks)

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