module 2: inflammation and infection Flashcards
what is arthritis
inflammation of a joint
rheumatic diseases primarily affect?
skeletal muscles, bones, cartilage, ligaments, tendons, joints
onset of rheumatic diseases?
may be acute or insidious
-course may have periods of remission and exacerbation
treatment for rheumatic diseases can be ____ or _____?
simple, localized relief OR
complex, directed toward relief of systemic effects
the basic system to classify rheumatic diseases?
monoarticular (affecting one joint) or
polyarticular (affecting multiple joints)
-can also be classified by inflammation or no inflammation
all rheumatic diseases involve
some degree of inflammation and degeneration
what is inflammation in the joint called?
synovitis
primary process of rheumatic diseases?
-inflammation caused by the immune response
secondary process of rheumatic diseases?
-degeneration resulting from the effect of pannus (proliferation of newly formed synovial tissue infiltrated with inflammation cells)
in degenerative rheumatic diseases, inflammation occurs as a…
secondary response
Inflammation and rheumatic diseases?
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
Degeneration and rheumatic diseases?
- 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
Clinical Manifestations of rheumatic diseases?
- most common reason to seek medical attention= pain
- other symptoms= joint swelling, limited movements, stiffness, weakness, fatigue
Assessment for rheumatic diseases
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
laboratory studies for rheumatic diseases
-creatinine, hematocrit, RBC and WBC count, antinuclear antibody, complement levels, CRP, Rheumatoid factor
diagnostics for rheumatic diseases
- x rays
- ct scan
- mri
- arhtrography
Geriatrics and rheumatic diseases?
- 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
pharmacologic therapy for rheumatic diseases?
- manage symptoms, control inflammation
- salicylates
- NSAIDS
- DMARDS
- non opioid meds
- low dose antidepressants may be prescribed for sleep and pain management
non-pharmacologic therapy for rheumatic diseases?
- heat, tub, bath, showers, heat packs
- paraffin baths
- exercises after heat has been applied
what is rheumatoid arthritis?
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
clinical manifestations of rheumatoid arthritis?
- joint pain, swelling, warmth, erythema, lack of function
- begins in small joints of hands, wrists, feet
- onset usually acute
- symptoms usually bilateral and symmetric
assessment and diagnosis of rheumatoid arthritis?
- 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
medical management of rheumatoid arthritis?
- 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
types of RA?
- moderate erosive RA (therapy, immunosuppressant)
- persistent erosive RA (reconstructive therapy, corticosteroids)
- advanced unremitting RA (immunosuppresents, foods high in vitamins, protein, iron)
urinary tract infection- what causes it?
pathologic microorganisms (normal urinary tract is sterile above urethra)
lower UTIs include? (3)
bacterial cystitis (inflm of urinary bladder) bacterial prostatitis (inflm of prostate gland) bacterial urethritis (inflm of urethra)
upper UTIs include? (3)
pyelonephritis (inflm of renal pelvis)
interstitial nephritis (inflm of kidney)
renal abcesses
complicated UTIs?
nosocomial and related to catheterization
uncomplicated UTIs?
community-acquired infection
patho of UTIs?
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
obstruction to free flowing urine is a problem known as?
ureterovesical reflux- backward flow of urine from urethra into the bladder
with coughing sneezing or straining the bladder pressure rises which may?
force urine from the bladder into the urethra, when pressure returns to normal, urine flows back into bladder
what is bacteriuria?
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
routes of infection of UTIs?
- 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
clinical manifestations of UTIs
-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,
Geriatric considerations and UTIs
- 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
assessment and diagnosis for UTIs
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
testing methods for UTIs
dipstick for WBC
nitrate testing
STI testing
CT, ultrasound
acute pharm therapy for UTIs?
- ideal treatment is antibacterial agent
- in complicated UTI, cephalosporin or ampicillin
long term pharm therapy for UTIs?
- 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
what is c-diff?
- 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
what is the causative organism in chain of infection?
microbe that causes infection
what is the reservoir in chain of infection?
person, plant, animal, substance, or location that provides nourishment for microbes
what is the mode of exit from the chain of infection?
mode of exit from reservoir, infected host must shed organisms to another or environment
-can exit from resp tract, GI blood
what is the route of transmission from chain of infection?
necessary to connect the infectious source with its new host
-sexual contact, skin to skin, injection, air
person who carries or transmits an organism but does not have signs or symptoms?
carrier
portal of entry from chain infection?
entry route into the host
susceptible host from chain of infection?
host must be susceptible, previous infection may render host immune to further infection, person who is immunosuppressed has a much greater chance of infection
what is colonization?
used to describe microorganisms present without host interference or interaction
-microbiology test results often reflect colonization rather than infection
what is infectious disease?
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
what is pneumonia?
inflammation of the lung and parenchyma caused by microorganisms
-leading cause of death from infection
pneumonitis?
more general term, describes inflammation in lung tissue that may predispose a pt and place at risk
CAP vs HAP pneumonia?
CAP- commonly acquired
HAP- hospital acquired
CAP pneumonia
- 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
HAP pneumonia
- 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
when does HAP pneumonia occur
- host defenses impaired
- inoculum or organisms reaches pt lower resp tract and overwhelms the host defenses
- highly virulent organism is present
patho of pneumonia?
- 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
risk factors for pneumonia
- common in HF, diabetes, alcoholism, COPD, AIDS
prevention: staff education, infection surveillance, prevention of transmission of microbes, modifying host risk for infection
clinical manifestations of pneumonia?
- 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
assessment/diagnosis for pneumonia?
- physical exam
- x ray
- blood culture
- sputum examination
- bronchoscopy often used in pt with acute severe infection
- sputum can be collected by nasotracheal suctioning
medical management for pneumonia?
- 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
geriatric considerations for pneumonia?
- 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
possible complications of pneumonia?
- shock and resp failure
- atelactasis and plural effusion
- superinfection
what is atelectasis?
obstruction of bronchus by accumulated secretions
pleural effusions are associated with?
bacterial pneumonia
three stages of para-pneumonic pleural effusions?
- complicated
- uncomplicated
- thoracic empyema
what is done when atelectasis or pleural effusion occurs?
chest tube to drain
-antibiotics
why does superinfection occur?
may occur with admin of very large doses of antibiotics
what is colonization?
- difference between acute infection and being colonized
- colonization= never fully kill off bacteria
- common in COPD, UTI, quadriplegics
