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n232 > module 2: inflammation and infection > Flashcards

module 2: inflammation and infection Flashcards

1
Q

what is arthritis

A

inflammation of a joint

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2
Q

rheumatic diseases primarily affect?

A

skeletal muscles, bones, cartilage, ligaments, tendons, joints

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3
Q

onset of rheumatic diseases?

A

may be acute or insidious

-course may have periods of remission and exacerbation

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4
Q

treatment for rheumatic diseases can be ____ or _____?

A

simple, localized relief OR

complex, directed toward relief of systemic effects

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5
Q

the basic system to classify rheumatic diseases?

A

monoarticular (affecting one joint) or
polyarticular (affecting multiple joints)
-can also be classified by inflammation or no inflammation

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6
Q

all rheumatic diseases involve

A

some degree of inflammation and degeneration

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7
Q

what is inflammation in the joint called?

A

synovitis

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8
Q

primary process of rheumatic diseases?

A

-inflammation caused by the immune response

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9
Q

secondary process of rheumatic diseases?

A

-degeneration resulting from the effect of pannus (proliferation of newly formed synovial tissue infiltrated with inflammation cells)

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10
Q

in degenerative rheumatic diseases, inflammation occurs as a…

A

secondary response

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11
Q

Inflammation and rheumatic diseases?

A

phagocytosis produces chemicals such as leukotrienes and prostaglandins which contribute to inflammation process by attacking WBC

  • leukotrienes and prostaglandins produce enzymes such as collagenase that break down collagen, vital part of a normal joint
  • causes edema, proliferation of synovial membrane, pannus formation, destruction of cartilage, erosion of bone
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12
Q

Degeneration and rheumatic diseases?

A
  • degeneration of articular cartilage poorly understood, known to be metabolically active, thus more accurately known as degradation
  • could be genetic or hormonal
  • degradation causes stiffening of bone tissue
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13
Q

Clinical Manifestations of rheumatic diseases?

A
  • most common reason to seek medical attention= pain

- other symptoms= joint swelling, limited movements, stiffness, weakness, fatigue

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14
Q

Assessment for rheumatic diseases

A

physical and functional assessment

  • gait, posture, general musculoskeletal size and structure
  • gross deformities and abnormalities
  • symmetry, contour, size
  • functional assessment of what the patient can or can not do
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15
Q

laboratory studies for rheumatic diseases

A

-creatinine, hematocrit, RBC and WBC count, antinuclear antibody, complement levels, CRP, Rheumatoid factor

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16
Q

diagnostics for rheumatic diseases

A
  • x rays
  • ct scan
  • mri
  • arhtrography
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17
Q

Geriatrics and rheumatic diseases?

A
  • often associated with aging
  • many think immobility and stiffness is coming of aging and dont seek help
  • diagnosis and treatment can improve QOL
  • osteoarthritis= leading cause of disability and pain in older
  • therapy= analgesic agents, postural assistance, modifications of lifestyle
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18
Q

pharmacologic therapy for rheumatic diseases?

A
  • manage symptoms, control inflammation
  • salicylates
  • NSAIDS
  • DMARDS
  • non opioid meds
  • low dose antidepressants may be prescribed for sleep and pain management
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19
Q

non-pharmacologic therapy for rheumatic diseases?

A
  • heat, tub, bath, showers, heat packs
  • paraffin baths
  • exercises after heat has been applied
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20
Q

what is rheumatoid arthritis?

A

autoimmune disease of unknown origin

  • primarily in synovial joint
  • phagocytosis produces enzyme in joint, breaks down collagen, pannus formation
  • destroys cartilage and erodes movement, leads to loss of joint movement
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21
Q

clinical manifestations of rheumatoid arthritis?

A
  • joint pain, swelling, warmth, erythema, lack of function
  • begins in small joints of hands, wrists, feet
  • onset usually acute
  • symptoms usually bilateral and symmetric
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22
Q

assessment and diagnosis of rheumatoid arthritis?

A
  • inflammation of joint, palpation, and labs
  • bilateral symmetric stiffness, tenderness, swelling (extra articular changes- weight loss, sensory changes, lymph node enlargement)
  • ESR elevated, RBC and C4 count decreased
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23
Q

medical management of rheumatoid arthritis?

A
  • early and aggressive treatment
  • education, balance, exercise, salicylates, NSAIDS
  • window opportunity for symptom control and disease management in first 2 years
  • treatment with DMARDs should begin within 3 months of disease onset
  • additional analgesia may be prescribed for periods of extreme pain
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24
Q

types of RA?

A
  • moderate erosive RA (therapy, immunosuppressant)
  • persistent erosive RA (reconstructive therapy, corticosteroids)
  • advanced unremitting RA (immunosuppresents, foods high in vitamins, protein, iron)
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25
Q

urinary tract infection- what causes it?

A

pathologic microorganisms (normal urinary tract is sterile above urethra)

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26
Q

lower UTIs include? (3)

A 
bacterial cystitis (inflm of urinary bladder)
bacterial prostatitis (inflm of prostate gland)
bacterial urethritis (inflm of urethra)
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27
Q

upper UTIs include? (3)

A

pyelonephritis (inflm of renal pelvis)
interstitial nephritis (inflm of kidney)
renal abcesses

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28
Q

complicated UTIs?

A

nosocomial and related to catheterization

29
Q

uncomplicated UTIs?

A

community-acquired infection

30
Q

patho of UTIs?

A

bacteria must gain access to bladder, attach, and colonize the epithelium of the urinary tract

  • most UTIs involve fecal matter coming in contact with urethra and bladder
  • bladder can clear itself from bacteria by increasing normal shedding of bladder epithelial cells
31
Q

obstruction to free flowing urine is a problem known as?

A

ureterovesical reflux- backward flow of urine from urethra into the bladder

32
Q

with coughing sneezing or straining the bladder pressure rises which may?

A

force urine from the bladder into the urethra, when pressure returns to normal, urine flows back into bladder

33
Q

what is bacteriuria?

A

more than 10 to the power of 5 colonies of bacteria per mL of urine
-men can be defined as 10 to power of 4 colonies/mL

34
Q

routes of infection of UTIs?

A
  • up the urethra
  • through bloodstream
  • fistula from intestine
  • transurethral (bacteria from fecal matter)
  • shorter urethra in women= higher incidence of UTIs
  • sex forces bacteria into bladder
35
Q

clinical manifestations of UTIs

A

-can have no symptoms
lower UTI signs: pain, burning urination, frequency, urgency, nocturia, incontinence
-can be hematuria and back pain
-pyelonephritis: fever, chills, lower back or flank pain, nausea or vomiting, malaise,

36
Q

Geriatric considerations and UTIs

A
  • bacteriuria increases with age and disability
  • structural abnormalities , decreased bladder tone, neurogenic bladder secondary to stroke, etc increase risk of UTI
  • absence of estrogen following menopause women are susceptible to colonization and increased adherence
  • UTIs become more common in men at around 50 years, prostatic secretions decreases that protect
  • most common presenting symptom: fatigue, change in cognitive functioning
37
Q

assessment and diagnosis for UTIs

A

colony counts- UTI is diagnosed by bacteria in urine
cellular studies- microscopic hematuria (greater than 4 RBC per high power field), pyuria= greater than 4 WBC per high power field

38
Q

testing methods for UTIs

A

dipstick for WBC
nitrate testing
STI testing
CT, ultrasound

39
Q

acute pharm therapy for UTIs?

A
  • ideal treatment is antibacterial agent

- in complicated UTI, cephalosporin or ampicillin

40
Q

long term pharm therapy for UTIs?

A
  • infections that reoccur within 2 weeks after therapy is called relapse
  • suggest bacteria may be in upper tract or initial treatment was not enough
  • options include an antimicorbial agent after sex, cranberry juice
41
Q

what is c-diff?

A
  • spore forming bacterium associated with HAIs (most frequent cause of HAIs in canada)
  • antibiotics disrupt intestinal flore and allow antibiotic resistant spores to proliferate within intestine
  • usually transmitted within health care facilities from person to person through fecal oral route
  • can create profound sepsis, can be fatal
  • involves antibiotic vancomycin, however once drug is stopped recurrence may occur
42
Q

what is the causative organism in chain of infection?

A

microbe that causes infection

43
Q

what is the reservoir in chain of infection?

A

person, plant, animal, substance, or location that provides nourishment for microbes

44
Q

what is the mode of exit from the chain of infection?

A

mode of exit from reservoir, infected host must shed organisms to another or environment
-can exit from resp tract, GI blood

45
Q

what is the route of transmission from chain of infection?

A

necessary to connect the infectious source with its new host

-sexual contact, skin to skin, injection, air

46
Q

person who carries or transmits an organism but does not have signs or symptoms?

A

carrier

47
Q

portal of entry from chain infection?

A

entry route into the host

48
Q

susceptible host from chain of infection?

A

host must be susceptible, previous infection may render host immune to further infection, person who is immunosuppressed has a much greater chance of infection

49
Q

what is colonization?

A

used to describe microorganisms present without host interference or interaction
-microbiology test results often reflect colonization rather than infection

50
Q

what is infectious disease?

A

when infected host displays a decline in wellness due to infection, when host interacts immunologically with an organism but remains symptom free- not infectious disease yet

51
Q

what is pneumonia?

A

inflammation of the lung and parenchyma caused by microorganisms
-leading cause of death from infection

52
Q

pneumonitis?

A

more general term, describes inflammation in lung tissue that may predispose a pt and place at risk

53
Q

CAP vs HAP pneumonia?

A

CAP- commonly acquired

HAP- hospital acquired

54
Q

CAP pneumonia

A
  • occurs in community or within 48 hours of hospitalization
  • pneumococcus is most common CAP in pt younger than 60
  • most common during spring and winter when upper resp infections most common
55
Q

HAP pneumonia

A
  • nosocomial
  • onset more than 48 hours after hospital admission
  • 2nd most common and lethal HAI
  • associated with endotracheal incubation and mechanical ventilation
  • factors can predispose PT
  • usual presentation is new pulmonary infiltrate combined with symptoms
  • destruction of lung structure, alveolar walls, consolidation, bacteremia
56
Q

when does HAP pneumonia occur

A
  • host defenses impaired
  • inoculum or organisms reaches pt lower resp tract and overwhelms the host defenses
  • highly virulent organism is present
57
Q

patho of pneumonia?

A
  • affects ventilation and diffusion
  • inflammation can occur in alveoli producing an exudate that interferes with diffusion of oxygen and C)2
  • WBCs migrate into alveoli and fill normally air-filled spaces
  • decrease in alveolar oxygen, branchospasm may occur
  • arterial hypoxemia
58
Q

risk factors for pneumonia

A
  • common in HF, diabetes, alcoholism, COPD, AIDS
    prevention: staff education, infection surveillance, prevention of transmission of microbes, modifying host risk for infection
59
Q

clinical manifestations of pneumonia?

A
  • shaking, chills, rapid fever
  • pleuritic chest pain
  • tachypnea (25-45bpm)
  • resp distress
  • pulse rapid and bounding
  • nasal congestion, sore throat, myalgia, rash
  • after a few days mucoid sputum
  • severe: cheeks flushed, lipis and nail beds demonstrate central cyanosis
  • orthopnea: SOB when reclining
  • poor appetite, diaphortic
  • crackles, consolidation, increased tactile fremitus
60
Q

assessment/diagnosis for pneumonia?

A
  • physical exam
  • x ray
  • blood culture
  • sputum examination
  • bronchoscopy often used in pt with acute severe infection
  • sputum can be collected by nasotracheal suctioning
61
Q

medical management for pneumonia?

A
  • lots of antibiotic options
  • mainly pharmacologic were listed
  • IV antibiotic or monoterapy
  • hydration is key bc of fluid loss due to tachypnea and fever
  • antipyretics
  • oxygen if hypoexmia develops
62
Q

geriatric considerations for pneumonia?

A
  • pulmonary infections in elder often difficult to treat, higher death rates
  • less likely to exhibit classic symptoms
  • general deterioration, weakness, abdominal symptoms, anorexia, confusion
  • dx may be missed as some symptoms seem like normal aging
  • treat with hydration, oxygen, deep breathing, early ambulations
63
Q

possible complications of pneumonia?

A
  • shock and resp failure
  • atelactasis and plural effusion
  • superinfection
64
Q

what is atelectasis?

A

obstruction of bronchus by accumulated secretions

65
Q

pleural effusions are associated with?

A

bacterial pneumonia

66
Q

three stages of para-pneumonic pleural effusions?

A
  • complicated
  • uncomplicated
  • thoracic empyema
67
Q

what is done when atelectasis or pleural effusion occurs?

A

chest tube to drain

-antibiotics

68
Q

why does superinfection occur?

A

may occur with admin of very large doses of antibiotics

69
Q

what is colonization?

A
  • difference between acute infection and being colonized
  • colonization= never fully kill off bacteria
  • common in COPD, UTI, quadriplegics

n232 (12 decks)

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