review Flashcards
4 things for handwashing**:
4 things for handwashing**:
1. before initial patient contact
2. Before an aseptic procedure
3. After body fluid exposure risk (after procedure)
4. After patient/patient environment contact
- remember PPE, get risk of gloves after one task, wear barriers
Hepatitis B Virus Diagnostic Testing:**
Hepatitis B Virus Diagnostic Testing:**
Serology testing for HBV antigens and HBV antibodies
Diagnostic test uses antigens (from virus) and antibody production (from host response)
Treat all patients if they have:
Bloodborne pathogens
Infectious/drug resistant organisms
Chain of Transmission:
Infectious agents: what’s spreading
Reservoirs: where is it found?
Susceptible hosts: who is susceptible?
Portal of exit: how does it go from person to person?
Portal of entry: how did it get into/on the person?
Modes of transmission: how was it transmitted?
Routes of Transmission:
Routes of Transmission:
Respiratory: airborne, droplet
Parenteral (anywhere other than mouth): needle-stick injuries, abrasions
Vaccine induced immune response
- 1st/Primary Response: IgM develops relatively quickly, then IgG much later, takes 7-14 das to mount a response
- 2nd/Secondary/Anamnestic (Memory) Response: (Post vaccine, actual exposure): HUGE and FAST IgG response, smaller IgM; takes 1-2 days after exposure and lasts sort-of forever may need a booster
live attenuated vaccine
live organism that is significantly weakened
VZV, MMR
inactivated vaccine
killed, completely dead
not as immunogenic
HAV, Influenza
polysaccharide vaccines
needs frequent boosters
streptococcus, neisseria, pneumococcus
toxoid vaccines
strong immune response bc toxins are naturally immunogenic
tetanus, diphtheria
subunit vaccines
uses small portions of pathogen put together and presented as an antigen to us
bordetella pertussis, prevnar
Recombinant Vector Vaccines (DNA Vectors)
- DNA viral vector with DNA spliced into it
- viral DNA that produces viral proteins and put into a vector
- vector enters body; shit loads of viral proteins are made
- sueper good target practice but also super experimental
HBV, malaria
how do vaccines work
- antigen or foreign protein of a pathogen is presented to host
- host mounts an antibody/t-cell/both response to protein components of pathogen
- viral proteins aren’t great at eliciting strong IR, need proteins carried on adjuvants which potently initiate immune response
passive immunization
temp protection, given there’s no time to develop antibodies through active immunity
Hepatitis
general term, clinical presentation “inflammation of liver”
we focus on the viruses
5 types: ABCDE; ABC is focused, D is Africa/Middle East, E is sea
Hep A Presentation
telltale is jaundice
can be completely asympt, can cause disease, fever, nausea, debilitating vomiting
Hep A diagnosis
- ALT liver enzyme means you should get a Hep test
- Detecting HAV IgM in serum = early antibodies, acute infection
- Detecting HAV IgG in serum = later antibodies
Hep A prevention
no vaccine
Hep B transmission
sexually
parenteral (iv)
perinatal
hep c pathogenesis
acute phase
chronic
cirrhosis
liver transplant
HBsAg
surface antigen (ur infected)
HBsAB
surface antibody (immune)
HBcAB (IgM)
core antibody early
were infected more recently, still an acute infection, started developing an immune response
HBcAB (IgG)
core antibody later
infected a while ago; could be in past or chronic stage
HBeAg
Envelope Antigen
Virus actively replicating and you are infectious
HBeAB
Envelope antibody
body is stopping virus from replicating
prevention of HBV
vax
antivirals
liver transplant - for liver failure
bacteremia
presence of bacteria in bloodstream
primary bacteremia
ONLY in blood
secondary bacteremia
blood AND other sites
transient bacteremia
- bacteria enters blood but immune sys can handle it
- no symp
- not clinically signif
intermittent bacteremia
(more common than continuous)
bacteria comes from EXTRAvascular source
(wound, UTI, GI perforation)
continuous bacteremia
bacteria consistently from INTRAvascular source
(biofilms from IV line, endocarditis)
bacteremia diagnosis
collect blood in culture bottles, DON’T refrigerate, send to lab ASAP
rapid cultures help ensure early antibiotic therapy and decrease hospital stay
Common causes of issues with blood cultures**
- inadequate skin preparation; clean top of bottle AND skin to prevent contaminants from skin
- improper volume of blood taken: collect 8-10 mL per bottle, collect 3-4 bottles (4 if >70 pounds or older than 15)
- not take from right sites: two sites; site #1 and #2 each 1 anaerobic and 1 aerobic bottle; if doing 3 bottles don’t do 2nd anaerobic bottle
- improper number of bottles
- improper timing; take before antibiotic initiation, 10-20 min btwn sites
- issues with pediatric patients; <35 lbs take ped’s bottles with 1-3 mL in each bottle
likely a blood culture contaminant if
coagulase neg staph, prop acne, gram +’ve bacilli in ONE bottle
possible pathogen for blood culture
same organism diff times >1 bottle and >1 set
- staph aureus, gram neg bacilli (e. coli), bacillus anthracis, c. diff
OR
multiple bottles of coagulase negative staph, prop acne, gram positive bacilli
epidemic impetigo
- epidermal eruptions of flacid pustules around mouth and nose (highly contagious lesions, rupture and form thick honey coloured crust)
- superficial, epidermis
- streptococcus pyogenes (group a strep), staphylococcus aureus
- treatment: Abx w/o culture if not healing/complicated take culture
Risk Factors: day care/school, breaks in skin
erysipelas
- infection of deeper skin layers
- may b source of bacteremia
- causes inflammation
- dermis
- streptococcus pyogenes (group a strep)
cellulitis
- deeper infection
- may cause bacteremia
- subcutaneous layers of skin
- staphylococcus aureus, streptococcus pyogenes, pseudomonas aeruginosa, gram neg bacilli
- follows local infection/trauma
furuncles
- infected sebaceous gland
- always treat staphylococcus aureus
- treatment: cloxacillin (unless MRSA)
decubitus ulcers
- bed sore colonized with mixed potential pathogens and non pathogens
- complete breakdown of the skin therefore deep layers
- often skin flora or GI flora organisms
- treatment: nursing care
types of surgical wounds
clean = no contamination
clean contaminated = clean would but in area w bacterial colonization
contaminated = wound is close to high prevalence of organisms
dirty/infected = wound in site with existing infection
bites
- know what kind of bite
- complications: cellulitis, abscess, deep tissue infection
fasciitis
- rapidly progressing cellulitis with EXTENSIVE NECROSIS of subcut tissue resulting in injection of inner fascia
- organisms: toxin producing agents; streptococcus pyogenes
- rapid clinical diagnosis with gram stain and culture for confirmation
dermatophyte infection
- fungal infection of hair, skin, or nails (ringworm, dandruff, athletes foot)
- caused by yeast or dermatophytic fungi or tinea/ringworm
- diagnosis: clinical, skin/nail scraping sent for calcofluor stain +/- fungal culture
- treatment: topical antifungals
scabies
- female microscopic mite that burrows into skin and lays eggs causing inflammatory reaction
- diagnosis: clinical; can see the tracks/migratory patterns of mites, immunological reaction to eggs causing inflammation, very easily spread bc patient shed mice
scabies
- female microscopic mite that burrows into skin and lays eggs causing inflammatory reaction
- diagnosis: clinical; can see the tracks/migratory patterns of mites, immunological reaction to eggs causing inflammation, very easily spread bc patient shed mice
lice
head lice
crabs
pubic lice
herpes simplex virus
- cold sores (HSV 1)
- genital (HSV 1 or 2)
- organism HSV type 1 and 2
- direct contact transmission; kissing, sex
- diagnosis: clinical, also possible genital viral culture
- treatment: antiviral drugs
varicella zoster virus
chicken pox or shingles
- respiratory spread to blood than to skin
- healthcare workers test for immunity, live vaccine
Conjunctivitis (pink eye)
- infection/inflammation of conjunctiva
- organisms: organisms in upper resp tract are most common
bacteria: strep pneumo
virus: adenovirus
neonates: chlamydia trachomatis
diagnosis: gram stain and culture
treatment: abx if bacterial, supportive care if viral, antivirals if HSV
otitis externa
infection of OUTER ear
typically caused by environment: swimmers ear, prolonged antibiotic use
diagnosis: only do culture and sensitivity if extensive/severe
treatment: dry the area, topical Abx after enviro is cleaned out/dried
otitis media
infection of INNER ear
blocked eustachian tubes therefore no draining of normal secretions and no pressure regulation
organisms: often pathogens of URTI; bacteria: streptococcus pneumoniae, haemophilus influenzae
viral: RSV, influenza
diagnosis: otoscope
treatment: Abx
pharyngitis
majority caused by viruses
viruses:
- epstein Barr
- adeno
- influenza
bacteria:
- streptococcus pyogenes = STREP THROAT
- chlamydia
diagnosis: throat swab
treatment: penicillin
complication: endocarditis
tracheobronchitis
croup, laryngitis, bronchitis
viruses: RSV, influenza, parainfluenza
bacteria: bordetella pertussis (whooping cough)
tracheobronchitis: influenza
fall and winter, in the tropics = yr round
virulence factors: paralyze cilia, antigenic drift and shift
diagnosis: NP swab or wash, virus culture, PCR
tracheobronchitis: parainfluenza
croup in children
bronchitis in older children/adults
clinical unless hospitalized
tracheobronchitis: RSV
- bronchiolitis (inflammation of bronchus)
fall and winter - diagnoses: NP swab or wash, rapid antigen detection, virus culture, PCR
complication: pneumonia
whooping cough
bordetella pertussis (gram neg) that infects resp epithelial cells
starts w mild URTI: cough
leads to uncontrollable coughing followed by a WHOOP and vomiting
PCR of NP swab
prevention: DTaP vaccine
pneumonia
inflammation and infection of lungs
acute onset, fever, SOB, productive cough
types: community acquired, ventilator associated, hospital acquired
community acquired pneumonia
streptococcus pneumoniae (most common), haemophilus influenzae (2nd most common)
diagnosis: blood culture, PCR
ventilator associated pneumonia
translocated from URT to LRT via tube
- pseudomonas aeruginosa, MRSA
diagnosis: blood cultures, suctioning
tuberculosis
mycobacterium tuberculosis
- transmission from airborne droplets from coughing, sneezing, speaking
- culture, TB test
infection control: neg pressure, private room
6-9 month treatment
cystitis
bladder infection
pyelonephritis
kidney infection
urethritis
urethra inflammation
how to UTI’s happen
- organisms from rectum/perineal region translocate to urethra
- normal flora typically protect against this (lactobacillus)
- if UTI untreated = urosepsis
asymptomatic bacteriuria
NOT AN INFECTION, colonization of bacteria
do we treat it? NO
if they have a catheter: change catheter and re-assess
uncomplicated UTI’s
healthy adults
non-preg
complicated UTI’s
structural or functional urinary tract abnormalities
preg women
catheters
diagnosis of UTI’s
urine dipstick *if positive and sympt present=UTI, if neg=further testing
urine culture and sensitivity - midstream
interpreting urine culture results
1 organism growing - that’s responsible
of colonies of organism 1> # of colonies of organism 2: organism 1 is causing UTI
3 diff bacteria” most likely contaminated
if bacteria not growing a lot (<10 colonies): prob not a UTI
treatment of UTI’s
high dose antibiotics x3 if UNCOMPLICATED
frequent urination
cranberry juice?
DON’T overhydrate
Types of vaginitis
bacterial - microscopy
candidiasis/yeast infection
trichomonas vaginitis
