Midterm #1 - Week 1 Flashcards
Infection Control and Older Adults
Pathogen
Pathogens are microorganisms that cause diseases
communicable disease
communicable means to be infectious or contagious, for example infection like the flu
immunocompromised
has an impaired immune system/weak immune system
normal flora
the normal microorganisms that live on surface and deep layers of skin, in the saliva, oral mucosa, and in the gastrointestinal and genitourinary tracts
health-care acquired/associated infection (HAI)
infections that are acquired in the healthcare system that the patient did not have when they were admitted. Patients in hospitals are more at risk due to them having higher acuity of illness and frequently undergoing aggressive treatments which compromise immunity
susceptibility
an individuals degree of resistance to a pathogen
asepsis
the process for keeping away disease producing microorganisms
medical asepsis
procedures used to prevent and limit the spread of microorganisms
routine or universal practices PPE
routine practices are the first tier of isolation guidelines that contains practices designed to care for all patients in any setting, regardless of their infectiousness. They apply when a healthcare worker is or potentially can be exposed to blood; all body fluids, (secretions, and excretions except sweat); nonintact skins; or mucus membranes
Older Persons - different groups and ages and what is geriatrics?
Older adults are defined as 65 and older
the young-old (approximately 65–74)
the middle-old (ages 75–84)
he old-old (over age 85)
Geriatrics – medical specialty focusing on the elderly
What is primary and secondary aging?
Primary aging is aging well (being able to perform ADL’s and a good quality of life)
Secondary aging is when they have commodities as they age
Life quality and expectancy of older persons?
Most elderly are functionally independent 71% ish
92% of older adults live in their homes
o in Canada is 81.3
o over 80 = wealth, diet, education, health-care (reasons they live longer)
o under 60 = HIV/AIDS, public health, medical care, diet (reasons they live shorter)
Reasons for Greying in Canada
Increased life expectancy: medical advancements, better treatment for chronic disease
Aging baby boomers (born between 1946 – 1964)
Physiological Aging Changes
- Integumentary - Loss of skin elasticity with fat loss in extremities; pigmentation changes; glandular atrophy (oil, moisture, sweat glands); thinning hair, with hair turning grey-white (facial hair: decreased in men, increased in women); slower nail growth; atrophy of epidermal arterioles
- Respiratory: Decreased cough reflex; decreased cilia; increased anterior–posterior chest diameter; increased chest wall rigidity; fewer alveoli, increased airway resistance; increased risk of respiratory infections
- Cardiovascular: Thickening of blood vessel walls, narrowing of vessel lumen, loss of vessel elasticity, lower cardiac output, decreased number of heart muscle fibers, decreased elasticity and calcification of heart valves, decreased baroreceptor sensitivity, decreased efficiency of venous valves, increased pulmonary vascular tension, increased systolic blood pressure, decreased peripheral circulation
- Gastrointestinal: Periodontal disease; decrease in saliva, gastric secretions, and pancreatic enzymes; smooth-muscle changes with decreased peristalsis and small intestinal motility; gastric atrophy; decreased production of intrinsic factor; increased stomach pH; loss of smooth muscle in the stomach; hemorrhoids; rectal prolapse; impaired rectal sensation
- Musculoskeletal: Decreased muscle mass and strength, decalcification of bones, degenerative joint changes, dehydration of intervertebral disks, fat tissue increases, with loss of muscular-skeletal integrity postural kyphosis may occur
- Neurological: Degeneration of nerve cells, decrease in neurotransmitters, decrease in rate of conduction of impulses
- Sensory - Eyes: Decrease in accommodation to near/far vision (presbyopia), difficulty adjusting to changes from light to dark, yellowing of the lens, altered colour perception, increased sensitivity to glare, smaller pupils
Changes with Aging (lifestyle)
- Retirement (income)
- Social isolation
- Elder abuse
- Sexuality
- Housing and environment
- Death
- Sense of usefulness
- Body appearance and function
What is health or healthy (for older persons and what are ADL’s
being able to perform ADLs and have a good quality of life
o Only 23% of older adults define their own health as poor
o What is quality of life? : WHO says it is an individuals perception of their postion in life and context of culture and the value system in which they live and in relation to their goals expectation, standards, and concerns.
o Activities of daily living = ADL
Physiological Changes: Neurological - Misconceptions
- Cognitive impairment
- Disorientation
- Loss of language
- Inability to calculate
- Poor judgement
- Forgetfulness
- Not able to use computers
- Not able to learn
- Rigid
decrease in brain weigh and volume
decrease in white matter
ventricular system enlarges
brain generates fewer neurotransmitters
Physiological Changes: Integumentary and Musculoskeletal
- Osteoporosis is a higher risk for females
- Misconceptions: Disabled- functionally dependent & slow.
skin loses muscle
deep wrinkles
elastic fibres broken
collagen breaks down
lack of melanin produced in hair root
bones break more easily and do not repair
Physiological Changes: Respiratory and Cardiovascular
- Tubes are getting smaller (harder to breather and pump blood)
increased stiffness of chest wall
decreases muscles mass
reduced mucocillary clearance
decreased elastic fibres
increased cross linked collagen
enlarged alveolar ducts and alveoli
change in cardiac shape
pacemaker tissue, conducting pathway degeneration
Physiological Changes: Gastrointestinal & Genitourinary
- Kidney is smaller and less nephrons, so doesn’t function the same
Physiological Changes: Sensory
- Presbycusis age related hearing loss
- Tinnitus – ringing noises or other noises in one or both ears
- Macular degeneration- (retinal degeneration) – disease that blurs central vision
Physiological Changes: Reproductive and Endocrine
- Misconceptions: Not interested in sex or sexual activity. Unattractive
- Colder as they age
- Older adults are still sexually active
Physiological Change: Immune System
- Things slow down which increases risk of infection
Leading Health Challenges in Older Persons and leading cause of death?
- Chronic diseases: noncommunicable, persistent and generally slow in progression, cannot be cured
- Leading cause of death is Cancer and Heart Disease: 41.8% of deaths
What is ageism
- Discrimination based on the age of a person
- Our society values attractiveness energy youth = undervaluing older persons
How can the Nurses’ Attitudes impact ageism and caring for older persons?
- What you do as a nursing student and as a nurse – the language you use and your behaviour – can influence others
- Nurses must treat older persons as independent, dignified persons – not just older persons but all persons.
- Nurses need to recognize and address ageism
- By questioning prevailing negative attitudes and stereotypes
- By advocating for older persons; such as their independence
Nursing care and age specific approaches (things to be aware of)
- Physical and psychosocial changes of ageing
- Effects of disease and disability on function
- Decreased homeostasis
- Lack of standards for norms of health and wellness
- Altered response and manifestations of disease
- Be aware of atypical signs and symptoms
- Use appropriate wording
- Being more patient when asking questions and helping
- Do not make assumptions
- The transitions that may be difficult are moving out of home, having less autonomy, having a new environment
Normal Defences against infection
- Normal flora
- Body system defenses
- Inflammation:
o vascular and cellular responses
o Inflammatory exudate
o Tissue repair
(Damaged Cells + Histamine release)
What are the Risks for Infection – Susceptibility
- Age: very young & older persons
- Nutritional status
- Stress
- Disease processes
o Immune system
o Chronic disease - Medical therapy
o Meds that suppress the immune system
Stages of Infection
- Incubation: pathogen enters the body, no symptoms present
- Prodromal: first symptoms: mild or non-specific signs and symptoms are present transmission may occur
- Illness: specific signs and symptoms present
- Convalescence: acute symptoms disappear
What is a systemic and localized infection?
o Localized infection: an infection that is limited to a specific part of the body and has local symptoms
o Systemic infection: pathogen is distributed throughout the body
Signs and Symptoms: Local inflammation/infection - Cardinal signs of local infection
- Heat
- Redness
- Swelling
- Pain
- immobility
Older Adult: Signs and Symptoms and Infection (ATYPICAL)
- Mental status changes (delirium),
- Falls,
- Dehydration,
- Decreased appetite,
- Loss of function/ incontinence,
- Dizziness.
Health care – Associated Infection HAI
- An infection acquired in the hospital, received the illness in the hospital
4 systems associated with HAI
- Surgical and traumatic wounds
- Urinary tract - unnecessary catheters
- Respiratory tract - Lungs (respiratory system) (high on the list because people stay with the same group)
- bloodstream
What is ARO- MRSA, prophylaxis, endogenous, exogenous
o ARO- MRSA – antibiotic resistant organisms/methicillin-resistant Staphylococcus aureus (resistant to some antibiotics)
o Prophylaxis – an attempt to prevent disease
o Endogenous – having an internal cause or origin, result from injury or physical insult
o Exogenous – developing from external factors
Protecting the susceptible host (ways to protect patients)
- Routine practices: Apply to all HCW exposed or potentially exposed to:
o Blood
o Body fluids (not sweat)
o Non-intact skin
o Mucous membranes - Isolation precautions: Apply to specific circumstances.
Personal Protective Equipment
o Routine practices
o Gown and gloves: contact precautions
o Surgical mask/eye protection: droplet precautions
o N95 mask/eye protection: airborne precautions
o Full face protection: splash
to the face
C. DIff
o Diarrhea from bacteria
o HAI – due to abx
o Life – threatening
o Clostridioides difficile is a bacterium (germ) that causes diarrhea and colitis. Colitis is an inflammation of the colon
o symptoms: diarrhea, fever, stomach tenderness or pain, loss of appetite, nausea
C. diff germs spread from person to person in poop, but the bacteria are often found in the environment. Usually healthy people don’t get it but if they take antibiotics their gut biome will be weakened
Influenza
o Virus – (nose, throat, lungs)
o Mild to severe (can be deadly)
o Flu is a contagious respiratory illness caused by influenza viruses
o Flu can cause mild to severe illness
o People over 65 are among those at higher risk
Most experts believe that flu viruses spread mainly by tiny droplets made when people with flu cough, sneeze, or talk.
C. Diff and Influenza risks
- Both Contagious AKA- Communicable. With both- our older adults are at a higher risk- due to all the changes. Especially if they have co-morbidities. Asthma, CVS disease, Stoke, DM and CKD, Ca., HIV/AIDS
Health Promotion and Maintenance
- Focus on prevention
- Consider individual needs
- Promote independence
- Stabilize chronic conditions
o Oral hygiene
o Getting vaccinations
Establishing health maintenance programs and recommending preventive measures through them. Examples include community centres, houses of worship, schools, shopping malls, libraries, and hospital lobbies, can be used as setting to conduct screening tests and present information health topics.
Nurses can also recommend the following general preventive measures: - Regular exercise (150 minutes per week)
- Weight reduction if the older person is overweight
- Management of hypertension
- Smoking cessation
- Immunization for influenza, pneumococcal pneumonia, tetanus, and COVID-19
What is the chain of infection
For an infection to occur all the parts of the chain of infection must be present:
o Infectious agent (Microorganisms are usually single cell and can only be seen under a microscope, including bacteria, fungi, some algae, etc.)
o Reservoir (a place where a pathogen can survive but may or may not multiply)
o Portal of exit (the path where the pathogen leaves the reservoir)
o Mode of transmission (how the microorganism is transported, can be indirect)
o Portal of entry (where the pathogen enters the body, can be the same as the portal of exit)
o Susceptible Host (whether a person gets an infection depends on their susceptibility to an infectious agent,
Why are patients in health care settings more at risk for developing infections?
- Patients in health care setting are more at risk for developing infections because they often have a lower resistance to infectious microorganisms and a higher exposure to number and types of diseases.
- They also sometimes go under invasive procedures where organs or body cavities has an incision or puncture.
- In acute care of ambulatory care facilities, patients can be exposed to pathogens which some of them can be resistant to antibiotics.
In what ways do human organs defend against infection?
- In the lungs cilia move to move a blanket of mucus that traps organisms and move them up to the pharynx so it can be removed
- At the cellular level inflammation occurs to deliver fluid, blood products, and nutrients to intestininal tissues in an area of injury. The pathogens are destroyed and the tissue is healed
What is the inflammatory response
- The inflammatory response can by triggered by physical agents, chemical agents, or microorganisms. There are 3 series of events:
- Vascular and cellular responses
o Acute inflammation occurs, blood vessels dilate to bring more blood with WBC’s to kill the microorganism
o The spot gets warmer - Inflammatory exudates
o Dead tissue gathers and the WBC’s form a exudates that can either be water or bloody or both. Eventually it is discarded through the lymphatic system - Tissue repair
o Damaged cells and tissues are replaced with new ones. The tissues and cell mature; however, the new tissues are usually not as strong as the ones they replaced so scarring occurs
Isolation precautions (4)
- Airborne: private room door closed, N95 mask, negative airflow,
- Droplet: private or cohort room door closed if bed less than 2m apart from door, mask worn 2m within patient
- Contact: private room or cohort door can be open, gloves, gown,
- Contact+: like contact but additional cleaning needed
chronic illness
a condition that last for 3 months or longer and gets worse with time
ageism
discrimination to people based on increasing age
quality of life
in older persons, resilience to adversity and a perception of physical and psychological wellness have been found to be connected to the older person’s perception of quality of life
functional status
the capacity and safe performance of ADLs in older persons
palliative care
– provides care to individuals who are dying
polypharmacy
the concurrent use of many medications
What are some common myths and stereotypes for older persons? (from textbook)
That they use up too many of the limited health resources, they are stereotyped as ill and disabled, they are forgetful, confused, rigid, bored, unfriendly, and unable to understand and learn, they are unattractive and worthless to society after they leave the work force, their beliefs are too old fashioned
Functional Changes in older adults
Change in functions is shown through a decline or change in an older person’s ability to perform any one or combination of ADLs (activities of daily living). It is a sign of the onset of an acute illness, pain, or worsening of a chronic condition.
Cognitive Changes in older adults
Forgetfulness is not a normal part of aging, as well as disorientation, loss of language, loss of ability to calculate, and poor judgement are not normal aging changes.
Psychosocial Changes in older adults
Roles and relationship in the family change for older adults as parents become grandparents, spouses become widows or widowers, and children become caregivers for their aging parents
Other changes are in groups, such as reinterment from work, moving from a familiar neighbourhood, and stepping back from social activities due to declining health
What are some physiological health concerns for the older adult?
- Health concerns in older adults are cancer and heart disease, which are the leading causes of death.
- Other concerns are respiratory disease, stroke, accidents or falls, diabetes, kidney disease, and liver disease.
- The most common chronic conditions in older adults are arthritis, high blood pressure, back problems, chronic heart problems, cataracts, and diabetes.
What is palliative care?
Palliative care is the care of improving overall quality of life for persons with life limiting illness and for their families
What is acute care?
For older adults acute care is focused on interventions during convalescence (the period from acute illness or surgery and are directed toward regaining or improving the prior level of independence in ADLs. The interventions in acute care setting should be continued and later modified as convalescence progresses
What is restorative care?
Restorative care is focused on activities to prevent, improve, reduce, or eliminate problems. They are two types of ongoing restorative care: continuing the convalescence from acute illness of surgery that began in the acute care setting and the other is addressing chronic conditions that affect day to day functioning
