Module 2- Inflammation and Infection Flashcards
what diagnostics would you want for inflammation?
- CRP
- rheumatoid factor
- WBC count
- differential
what diagnostics would you want for infection?
- WBC count
- differential
- CRP
- procalcitonin
- identification of an organism
- gram stain (purple dye that appears in gram positive bacteria)
- C+S
lifespan for WBC’s
13-20 days
how are WBC’s destroyed and excreted?
destroyed by lymphatic system and excreted in feces
what is rheumatoid factor?
- TO DIAGNOSE RHEUMATOID ARTHRITIS (RA)
* POSITIVE RESULTS = LIKELY DIAGNOSIS OF RA
whats the normal range for basophils?
0.0-0.10 x10 9/L
basophils
parasitic infections and some allergic disorders
normal range for eosinophils
0.0-0.45 x10 9/L
eosinophils
allergic disorders and parasitic infections
what is the normal range for neutrophils?
2.00-6.00 x10 9/L
neutrophils
bacterial or pyogenic infections
normal range for lymphocytes?
1.00-4.00 x10 9/L
lymphocytes
viral infections
normal range for monocytes?
0.10-0.80 x10 9/L
monocytes
chronic infections (phagocytosis)
what is c-reactive protein?
non-specific indicator of inflammation
what could cause someone to have high levels of CRP?
- serious bacterial infection (sepsis)
- pelvic inflammatory disease (PID)
- inflammatory bowel disease
- some forms of arthritis
why is a procalcitonin test done?
detect or rule out bacterial sepsis
normal range for procalcitonin? what could a high level mean?
0.0-0.25 u/L. Its a protein and means high probability of bacterial sepsis
low levels of procalcitonin mean?
low risk of bacterial sepsis
when would you want a test for procalcitonin and CRP?
monitor for increases or decreases in CRP and PCT to determine response to therapy or progression of inflammatory/infectious
what is a culture?
growth of microorganisms in a growth medium. Any tissue or fluid can be evaluated
what is a sensitivity test?
determines sensitivity of bacteria to an antibiotic and evaluates resistance to antibiotics
what is hyponatremia?
low sodium concentration
symptoms of hyponatremia
weakness, confusion, ataxia, stupor, and coma
what could cause hyponatremia?
diarrhea, vomiting, NG tube O/P, diuretics, CRI (colour rendering index)
what is hypernatremia?
elevated sodium concentration
symptoms of hypernatremia
thirst, agitation, mania, convulsions, dry mucous membranes
what could cause hypernatremia?
increased Na intake (IV/PO), excessive free body water loss, cushing syndrome
what is hypokalemia?
lower than normal potassium levels (lower than 3.5mmol/L)
symptoms of hypokalemia
decrease contractility of smooth muscle, skeletal and cardiac muscles- weakness, paralysis, hyporeflexia, ileus, cardiac dysrhythmias, thirst, flat T waves
what could cause hypokalemia?
GI losses/disorders, diarrhea, vomiting, diuretics, burns
what is hyperkalemia?
higher than normal potassium levels (greater than 5.0mmol/L)
symptoms of hyperkalemia
irritability, N/V, diarrhea, intestinal colic
what could cause hyperkalemia?
excessive dietary intake, ARF/CRF, infection
what do you want to give with hyponatremia?
want to give sodium
what do you want to give with hypernatremia?
want to give free water
signs of localized infection
warmth, erythema at site
signs of systemic infection
inc. body temp, fatigue, malaise, low BP, high HR (cause body is compensating)
what is a sepsis screener?
2 or more inflammatory receptors
if patient is septic, will they look well/pink?
no!
what temp is considered febrile?
greater than 38.5 deg. cel
are older or younger people more susceptible to fever?
younger. older people don’t tend to show high fever (even if bacteria is present), they will show signs of confusion etc instead
what drugs are anti-inflammatories
NSAIDS- aspirin and ibuprofen
what drugs are antipyretics
acetaminophen, ibuprofen, ASA
what is the classification for infection
antimicrobials (anti-virals, anti-bacterials, anti-protozoals)
what drug is an antiviral?
Acyclovir
what drug is an antibacterial (antibiotics)?
cefazolin, vancomycin
what drug is very nephrotoxic?
vancomycin
what drug is an anti-protozoal?
metronidazole
what do you need to know about antibacterial drugs?
- know pre/post assessments
- is it a safe dose
- what organ is this going to affect (liver/kidney toxicity)
- antibiotics affect the GUT, GI upset
- assess to see if antibiotic is working or not (WBC count)
what is the worst thing that could happen with a drug?
allergic rxn, could lead to anaphylaxis, lead to death
common side effects with antibiotic therapy?
N+V, diarrhea, nephrotoxicity, hepatic toxicity
lifespan considerations regarding antibiotics?
pediatric: doses are weight based
elderly: lower dosages
pregnancy: potential harm for fetus/mother
diabetics: inc. risk for infection
what drugs could you give for fever
acetaminophen, ASA, ibuprofen
why is ASA not a good medication to treat fever?
- b/c it can thin blood (be careful for excess bleeding)
- reyes syndrome in kids (can cause swelling in live and brain)
what is infection?
- when body doesnt get rid of bacteria and will turn into infection (WBC’s will tell you)
- colonization (presence of bacteria on body surface w/o causing disease in person
most common anti-pyretic and why?
acetaminophen (tylenol) and because it comes in all forms
why would you choose ibuprofen over tylenol?
because it decreases fever and helps with inflammation
why is it bad to give ibuprofen if pt has renal impairment?
because ibuprofen blocks PG which may lead to decreased blood flow to the kidneys
list risk factors for inflammation
psychological stress, physical injury, exposure to irritants, infection
what are S+S of infection?
- inc WBC
- inflammation
- fever
- malaise
- dec. BP and inc. HR
- cloudy urine
- inc. RR, dec. O2
- neutrophils (CRP)
- cough
- sputum
- crackles
- pain with inspiration
risk factors for arthritis?
- sex
- age
- family history
- environmental exposures
- obesity
- smoking
S+S for arthritis?
- pain
- joint swelling
- limited movement
- stiffness
- weakness
- fatigue
- inc. fluid in joints
pharmacological therapy for arthritis
manage the symptoms, dec. inflammation, modify the disease
non pharmacological pain mgmt
- maintain and improve functional status
- inc. patients knowledge of disease process
- promote self management by patient compliance with the therapeutic regimen
risk factors for UTI
- inability to empty bladder completely
- obstructed urinary flow
- dec. natural host defences
- catheterization or cystoscopy
- inflm or abrasion of urethral mucosa
- diabetes d/t inc. urinary glucose (bacteria love sugar)
S+S of UTI
- 50% of patients have no symptoms (if colonized, wont show S+S until UTI is really bad)
- pain and burning during urination
- frequency, urgency, nocturia
- incontinence
- supra pubic/pelvic pain
- hematuria/back pain and fever
pharmacological therapy for UTI
- treat infection (administer antibiotics as prescribed)
- pain management (anti-spasmodic agents, analgesics, heat to perineum)
non pharmacological therapy for UTI
- inc. fluids PO and or IV, frequent urination (helps to flush bacteria)
- avoid irritants (coffee, tea, spices, cola, alcohol
- good hygiene, remove/replace foley (BID pericare)
- promote patient knowledge
- monitor and manage potential complications
risk factors for C-diff
- antibiotic therapy
- surgery of GI tract
- diseases of the colon (ex. inflammatory bowel disease, colorectal cancer)
- weakened immune system
- use of chemotherapy drug
S+S for C-diff
- watery diarrhea, up to 15x/day
- severe abdominal pain
- loss of appetite
- fever
- blood/pus in stool
- weight loss
pharmacological therapy for C-diff
- antibiotics: vancomycin, metronidazole
- fecal transplant
- probiotics (try to re-balance), antiemetics (for nausea and vomiting)
what diagnostics would you get for c-diff?
- C+S of stool
- electrolyte levels
- WBC (neutrophils)
non-pharmacological therapy for c-diff
- fluids PO and/or IV
- isolation precautions
- maintain nutrition
- promote pt knowledge
- monitor and manage potential complications
risk factors for pneumonia
- conditions that produce mucous or obstruct/interfere w/ normal drainage
- smoking
- prolonged immobility with shallow breathing
- dec. cough reflex
- advanced age (depressed cough reflex, glottic reflexes, and nutritional depletion
S+S of pneumonia
vary with type of pneumonia
- fever (shaking and chills)
- chest pain
- tachycardia
- tachypnea
- sputum (green or yellow)
- orthopnea
pharmacological therapy of pneumonia
-admin of appropriate antibiotics (vancomycin, cefazolin) and antipyretic as needed, O2 if required
non-pharmacological therapy of pneumonia
- improving airway patency (removing secretions)
- rest and conserve energy balance with mobilization
- deep breathing and coughing
- promote fluid intake
- maintain nutrition
- promote patient knowledge
- monitor and manage potential complications
main symptoms of infectious pneumonia
- high fever
- chills
- clamminess, blueness
- headaches
- loss of appetite
- mood swings
- low bp, high HR
- pain in joints, fatigue, aches
- nausea
- vomiting
- SOB
- cough with sputum
how to break the chain of infection
- hand hygiene
- don’t use anything from floor
- different cloth for bed bath/pericare
- dirty linens away from body
what are the major types of pneumonia?
- community-acquired pneumonia (CAP),
- hospital-acquired pneumonia (HAP),
- pneumonia in the immunocompromised host,
- aspiration pneumonia
community acquired pneumonia
occurs in community setting or within first 48hrs of hospitalization
s. pneumoniae (pneumococcus)
most common community acquired pneumonia (CAP) in people less than 60years old with no comorbidity and those greater than 60 with comorbidity
where does S. pneumoniae naturally reside?
upper resp tract
what CAP affects those with comorbid illnesses (COPD, alcoholism, diabetes etc)?
H. influenzae
hospital acquired pneumonia (aka nosocomial pneumonia)
occurs 48hrs after admission to hospital
most lethal nosocomial infection is?
Hospital-acquired pneumonia (nosocomial pneumonia)
pneumonia in the immunocompromised host
occurs with use of corticosteroids or other immunoexpressive agents, chemo, nutritional depletion,, AIDS, genetic immune disorders, long-term advanced life-support technology
diagnosis of pneumonia is made by?
- history of resp. tract infection
- physical exam
- chest xray studies
- blood culture
- sputum exam
what is a key treatment measure when community acquired pneumonia (CAP) is strongly suspected?
prompt admin (within 4-8hrs) of antibiotics in patients
mortality rate is greater in what age group?
greater in older pt’s, more difficult to treat
aspiration pneumonia
entry of endogenous or exogenous substances into lower airway
most common type of aspiration pneumonia
bacterial infection (normally resides in the upper airway)
patho of pneumonia
arises from normally present flora in patient whose resistance has been altered or it results from aspiration of flora present in oro-pharynx
define colonization
microorganisms present without host interference or interaction
define infection
host interaction with organism
define infectious disease
infected host displays a decline in wellness due to infection
