Midterm module 2 infection, inflammation (Pneumonia, UTI, Cdiff, Arthritis) Flashcards
What is the normal range of WBC
4-10.5 x 10^9 /L
what does elevated WBC indicate
the inflammatory response & possible infection
what is the lifespan of a WBC `
13-20 days
how do we get rid of WBC
destroyed by lymphatic system - excreted in feces
What is the normal range for neutrophils
2-6 x 10^9 /L
what does elevated neutrophils mean
bacterial or pyrogenic infection
what does elevated basophils mean
parasitic infections & sme allergic disorders
what does elevated lymphocytes mean
viral infection
what does elevated monocyte mean
chronic infections (phagocytosis)
What is rheumatoid factor for
to diagnosis rheumatoid arthritis - likely diagnosis of RA
What is C reactive protein
-non specific indicator of inflammation
when would C reactive protein be elevated
- A serious bacterial infection like sepsis
- Pelvic inflammatory disease
- inflammatory bowel disease
- some forms of arthritis
what is procalcitonin for
to detect or rule out bacterial sepsis
when is procalcitonin elevated
High levels indicated high probability of bacterial sepsis.
what does culture mean
the propagation of microorganisms in a growth medium.
What is sensitivity
Sensitivity analysis is a test that determines the sensitive of a bacterial to an antibiotic & resistance
What is the normal value for Sodium
135-145 mmol/L
what are signs of hyponatremia
Weakness, confusion, ataxia, stupor & coma
what are the causes of hyponatremia
Diarrhea, vomiting, Ng tube, Diuretics, Chronic renal insufficiency
what are the signs of hypernatremia
Thirst, agitation, mania, convulsions, dry mucous membranes
what are the causes of hypernatremia
increased Na+ intake, excessive free body H20 Loss, cushing syndrome
What is the normal value for potassium
3.5-5.0 mmol / L
what are the signs of hypokalemia
decrease in contractility of smooth muscle, skeletal & cardiac muscles. Weakness, paralysis, hyporeflexia, ileus, cardiac dysrhythmias, shirts, flat T waves
what are the causes of hypokalemia
GI losses, diarrhea, vomiting, diuretics, burns
what are the signs of hyperkalemia
Irritatbility, n/v, diarrhea, intestinal colic
what are the causes of hyperkalemia
excessive dietary intake, ARF/CRF (acute renal failure/ chronic renal failure), infection
what drugs would you give for inflammation
NSAID (Ibuprofen & ASA)
what drugs would you give for antipyretic
acetaminophen, ASA, Ibuprofen
what drugs would you give for for infection (antiviral)
Acyclovir
what drugs would you give for infection (bacterial)
Cefazolin or vancomycin
what drugs would you give for infection (protozoal)
Metronidazole
what is the worst thing that could happen with antibiotics?
allergic
what is the connection between penicillin & cephalosporins
10% of patients allergic to penicillins will also be allergic to cephalosporins
most common side effects of antibiotic therapy
- Nausea
- Vomiting
- Diarrhea
- Nephrotoxicity
- Hepatic toxicty
What are the lifespan considerations for antibiotics
Pediatric: Dosages are weight based
Elderly: lower doses because worse kidney & liver function
Pregnancy: potential harm
what are the main antipyretics
Acetaminophen
asa
ibuprofen
What is the most common antipyretic
Acetaminophen
Why use ibuprofen instead of tylenol
tylenol is very hard on the liver
What are the risk factors to inflammation
- psychological stress
- physical injury
- exposure to irritants
- infection
what are the risk factors of arthritis
Sex, age, family history, smoking, environmental exposures, obesity
what are signs & symptoms of arthritis
Pain & joint swelling & limited movement & stiffness & weakness & fatigue
What are some non-pharmacological pain management options for arthritis
- Maintain & improve functional status
- increase & improve functional status
- increase patients knowledge of disease process
- promote self-management by patient compliance with the therapeutic regimen
What are the risk factors for UTI
- Inability to empty the bladder completely
- obstructed urinary flow
- decreased natural host defences
- catheterization or cystoscopy
- Inflammation or abrasion of the urethral mucosa
- diabetes related to increased urinary glucose so increased food for bacteria
what are the signs & symptoms of UTI
- 50% will have no symptoms
- pain & burning during urination
- Frequency
- Urgency
- Nocturia
- Incontinence
- Suprapubic or pelvic pain
- Hematuria or back pain
- fever
- older adult: fatigue & cognitive changes
What are pharmacological treatment for UTI’s
- Treat the infection (administer antibiotics as prescribed)
- Pain management (Antipyretic, anti-spasmodic agents, analgesic, heat to perineum)
what are the non-pharmacological therapy options
- Increased fluids PO or IV
- Frequent urination (helps to flush bacteria from urinary tract
- Avoid irritants (coffee, tea, spices, Cola, Alcohol)
- Promote patient knowledge
- Monitor & manage potential complications
what are the risk factors for C-Diff
Antibiotic therapy
- Surgery of the GI tract
- Diseases of the colon such as inflammatory bowel disease or colorectal cancer
- A weakened immune system
- use of chemotherapy drug
What are the signs & symptoms of C-Diff
Watery diarrhea, up to 15 times a day severe abdominal pain loss of appetite fever blood or pus in the stool weight loss
What are the pharmacological therapy option for C-Diff
- Antibiotic: Vancomycin, Metronidazole
- Fecal transplants
- Probiotics, Anti-medics
what are the non-pharmacological therapy option for C-Diff
Fluids PO and or IV Isolation precautions maintain nutrition promote patient knowledge monitor & manage potential complications
What are the risk factors of pneumonia
- Conditions that produce mucus or obstruct/interfere with normal drainage
- smoking
- prolonged immobility with shallow breathing
- depressed cough reflex
- advanced age ( depressed cough reflex, glottic reflexes, & nutritional depletion)
What are the signs & symptoms of pneumonia
- Vary with the type of pneumonia
- fever (shaking & chills)
- Chest pain
- tachypenia
- tachycardia
- sputum (green, yellow or other)
- orthopenia
- many more…
what is the pharmocological therapy of pneumonia
Admin the appropriate antibiotics & O2 if needed
non-pharmacological therapy for pneumonia
- Improving airway potency (remove secretions)
- Rest & conserve energy balance with mobilixation
- deep breathing & coughing
- promote fluid intake
- maintain nutrition
- promote patient knowledge
- monitor & manage potential complications
What are the steps to the sepsis screener
- Must be adult patient (16+)
1) Does the patient have 2 or more systemic inflammatory response syndrome criteria - Temperature greater then 38C or less then 36
- Heart rate greater than 90b/min
- Altered mental status (GCS less than 15)
- Respiratory rate greater than 20 per minute
2) Do they have any of the following risk factors? - looks unwell, age greater than 65, recent surgery, immunocompromised so AIDS chemotherapy, neutropenia, transplant, steroids, or chronic illness)
Steps of what you need to do if sepsis is occurring
1) Initiate initial management of adult patients with suspected sepsis clinical order set
2) If systolic BP is less than 90 or MAP less than 65
- contact physician
- administer normal saline IV bolus & repeat 2x to maintain MAP at 65 mmhm or greater
3) contact physician within 15 minutes of patient check in for ongoing investigation & fluid resuscitation strategy
4) Obtain lactate & cultures prior to administering antibiotics
- if lactate is greater than 4 mmol/L contact physician & repeat the lactate in 2 hours
5) Administer appropriate antibiotics within 60 minutes of check in for patients with
- Map less than 65 mm/Hg despite 2 laters or patients with lactate greater than 4mmol/L
