WEEK 5 Flashcards
chain of infection
sequence of factors needed for an infection to occur. It includes the following links:
presence of an infectious agent, an available reservoir, a portal of exit from the reservoir, a mode of transmission from the reservoir to a host, and a portal of entry to enter a susceptible host.
A break in any of the links of this chain can prevent the development of an infection.
Chain of Infection: Infectious Agent
something that contains a bacterium, fungus, virus, parasite, or prion
example of infectious agent
An individual’s resident flora—that is, the bacteria that live on or in a client and help protect the body from infection—can become an infectious agent when moved to a different location of the body; for example, flora from the gastrointestinal tract can move elsewhere in the body and create infection there.
How must infectious agents be destroyed?
disinfecting, sterilizing, and cleaning or through antimicrobial treatment (antibiotics, antifungals)
Chain of Infection: Resevoir
habitat of the infectious agent—where it lives, grows, reproduces, and replicates itself.
can be an animate or inanimate object (animals and humans, or soil, water, food, medical equipment, door handle, feces, etc)
How to break chain of infection with resevoirs?
nurses should use proper hand hygiene when caring for clients, clients should receive preoperative skin preparation prior to surgery, and the clinical or surgical environment should be cleansed properly by following the facility’s protocols to prevent infection.
Chain of Infection: Portal of Exit
the route by which an infectious pathogen can leave the reservoir
can be any body orifice—for example, ears, nose, or mouth—or can even be the skin. Any of these sites can provide a place for the infectious agent to replicate or for the toxin to act. and bodily fluids too.
How to break chain of infection with portal of exit?
careful containment of body fluids through usage of drains or dressings can be implemented, and methods can be used to decrease body secretions.
Chain of Infection: Mode of Transmission
How bacteria, viruses, fungi, parasites, and prions move from place to place. These are contact, droplet, and airborne.
What are the modes of transmission?
contact, droplet, airborne, vehicle, and vector-borne transmission.
How to break chain of infection with modes of transmission?
Hand hygiene and use of proper barrier devices can help break the chain of infection by eliminating various modes of transmission.
Chain of Infection: Portal of Entry
Any body orifice–for example, ears, nose, mouth, or skin–that provides a place for an infectious agent to replicate or for a toxin to act.
Can the portal of entry and portal of exit be the same?
yes, such as influenza. it both enters and exits the respiratory tract
Chain of Infection: Susceptible Host
required for the infectious agent to take hold and become a reservoir for infection.
How to decrease host susceptibility?
Immunizations, proper nutrition, dietary supplements, proper hygiene, and control of blood sugar
virulent
term to describe how efficient an infectious agent is at making people ill
What are the three main modes of transmission?
contact-transmitted by contact with an object or person
droplet-transmitted through droplets such as sneezing, coughing, and singing
airborne-transmitted through the air
contact transmission-direct and indirect
direct-Occurs when micro-organisms are directly moved from an infected person to another person, rather than through a contaminated object or person.
example of direct-a client’s blood coming in contact with an open abrasion on a nurse’s skin
indirect-that is, from an infected person to another person via a contaminated object or person.
example-staph infections in the hospital. drainage from a client’s wound might get on the bed rail or a bedside table, which others then touch
EXAM QUESTION!
airborne transmission
occurs when small particulates found in the air move into the airspace of another person and carry infectious agents.
examples: tuberculosis, rubeola (measles), and varicella (chickenpox).
how to treat client will illness that is airborne
For this reason, clients who have an infection that can be transmitted through the airborne route require placement in a private room with negative air pressure.
droplet transmission
occurs when infectious droplets from a client travel through the air and come in contact with the mucosa of a host (i.e., nurse, other client, health care worker).
examples: influenza virus and Bordetella pertussis
what medical procedures can release droplets into the air?
cardiopulmonary resuscitation (CPR), endotracheal intubation, and chest physiotherapy can release droplets into the air.
what are the three specific types of body defenses to fight off pathogens?
physical and chemical barriers, nonspecific immunity, and specific immunity
These defenses involve external and internal body structures, such as skin and white blood cells.
physical and chemical barriers
The skin is the body’s largest organ and is the primary physical defense mechanism. The skin performs three major functions:
Reduce loss of water
Protect against abrasion and micro-organisms
Provide a permeable barrier against the environment
intact skin the most important components in fighting infection
nonspecific immunity
maintained by neutrophils and macrophages—both are types of white blood cells—and their work as phagocytes.
EXAM QUESTION!
specific immunity
refers to the work of antibodies (also called immunoglobulins) and lymphocytes. Antibodies bind to infectious agents and activate the white blood cells and complement to destroy the infectious agent.
inflammatory response
Natural defense of the body when injured, when foreign substances are present or when infectious agents attack.
basic steps of inflammation
Recognition of harmful stimuli by pattern receptors (located on the surface of cells)
Activation of the inflammatory pathway
Release of inflammatory markers
Recruitment of inflammatory cells
inflammatory response triggers: infectious triggers
Viruses
Bacteria
Other micro-organisms
inflammatory response triggers: noninfectious triggers
Physical: burns, frostbite, injury, foreign bodies, trauma, radiation
Chemical: glucose, fatty acids, toxins, alcohol, irritants (e.g., fluoride, nickel)
Biological: damaged cells
Psychological: excitement
example of inflammation as a solitary response?
a client might get struck in the face while playing baseball. The face swells and then resolves, so that this is a solitary event.
when would inflammation repeat itself?
a client who has asthma develops bronchial swelling, and its resolution occurs chronically.
gastroesophageal reflux disease (GERD) causes acid to regurgitate into the esophagus. This acid causes erosion, followed by inflammation to heal the erosion. This cycle happens repeatedly, leaving the client with GERD in a constant state of inflammation.
manifestations of inflammation
heat
redness
swelling
pain
loss of function
place the findings in the order in which the occur during the inflammatory process
Bacteria invade an open wound (the pattern receptors on the surface cells recognize the bacteria as harmful stimuli) 2. Histamine, Kinins, and Prostaglandins (the inflammatory mediators are released) 3. Plasma from the blood enters the site (blood flow is increased to the site causing erythema and heat. Plasma from the blood causes swelling and pain at the site) 4. Phagocytosis occurs (the increased blood flow brings in more WBCs to the site and they begin to wall off the infection and destroy the harmful stimuli and the affected cells – bacteria) 5. Pus develops (the containment of the destroyed pathogen and the affected cells as well as the WBCs)
stages of infection
incubation
prodromal
acute illness
period of decline
period of convalescence
local vs systematic infections
local-are confined to one area of the body. These infections can be treated with topical antibiotics and oral antibiotics.
systematic-start as local infections and then move into the bloodstream, from which they infect the entire body. Intravenous antibiotics and careful monitoring are both needed to treat systemic infections.
types of antiseptic agents
Alcohols
Chlorhexidine
Chlorine
Chloroxylenol (parachlorometaxylenol [PCMX])
HexachloropheneIodine/iodophors
Quaternary ammonium compounds
Triclosan
how short should you keep your nails
less than 0.25 inches
standard precautions
Infection prevention practices and these apply to all clients, whether or not they are known to have an infectious agent.
contact precautions
Precautions used when a client has an infectious agent that can be transmitted by direct or indirect contact with body secretions; requires a minimum of gown and gloves prior to client interactions.
PPE Removal: Contact Precautions
Always remove PPE inside the client’s room if the client is prescribed contact precautions to avoid contaminating surfaces outside the client’s room.
droplet precautions
Don a mask when entering the room or coming into close contact with a client.
airborne precautions
Used when a client has an infectious agent that can be transmitted through the air should don an N95 mask or a high-level respirator when entering the room of a client.
protective isolation
Clients who become immunocompromised after having an allogenic hematopoietic stem cell transplant (HSCT) need a special protective isolation environment during the first 100 days after the transplant, and possibly longer if they experience complications.
Define medical asepsis
(clean technique) a term used to define the elimination of and absence of disease-causing microorganisms
What are the four major HAIs (Healthcare Associated Infections)
central line-associated bloodstream infections (CLABSIs)
Catheter-associated urinary tract infection (CAUTIs)
surgical site infections (SSIs)
ventilator-assisted pneumonias (VAPs)
What makes a patient more susceptible host?
compromised immune systems
cancer patient
etc
EXAM QUESTION
STAGES OF INFECTION
incubation-enters host & multiplies
prodromal-begins to have symptoms
acute illness-symptoms increase and become worse
decline-get better, and symptoms lessen
convalescence-return to “normal” health
EXAM QUESTION!
True or False: everyone who had major surgery or broken bone with have a little fever in first 24 hours
true
How are localized infections treated?
antibiotics and oral antibiotics
How are systematic infections start?
start as local and then spread to bloodstream and can lead to sepsis
What are the three essential components of handwashing?
water
soap
friciton
How to: Hand Hygiene
place hands under warm water
add soap
rub hands together for 15 seconds, vigorously to remove transient flora and up to 2 minutes if hands are visibly soiled
rinse hands, everything pointed downward
dry hands
use paper towel to turn off faucet
What does a nurse use to break the chain of infection and thus stop the spread of infection?
medical asepsis
surgical asepsis
standard precautions
types of pathogens
bacteria
viruses
fungi
prions
parasites
Pathogen: Bacteria
Staphylococcus aureus, Escherichia coli, Mycobacterium tuberculosis
Pathogens: Viruses
organisms that use the host’s genetic machinery to reproduce (HIV, hepatitis, herpes zoster, herpes simplex virus (HSV), SARS-CoV2-Covid 19)
Pathogens: Fungi
molds and yeasts (candida albicans, Aspergillus)
Pathogens: Prions
protein particles (new variant Creutzfeldt-Jakob diesease)
Pathogens: Parasites
protozoa (malaria, toxoplasmosis) and helminths (worms-flatworms and roundworms, flukes-Schistosomal)
Nonspecific innate-native immunity
restricts entry or immediately responds to a foreign organism (antigen) through the activation of phagocytic cells, complement, and inflammation.
this occurs with all mirco-organisms, regardless of previous exposure
nonspecific innate-passive
antibodies are produces by an external source
Specific adaptive immunity
Allows the body to make antibodies in response to a foreign organism (antigen). This reaction directs against identifiable micro-organisms
Specific adaptive immunity-active
Antibodies are produced in response to an antigen.
Requires time to react to antigens
Provides permanent immunity
Involves B- and T-lymphocytes
Produces specific antibodies against specific antigens
What are the most common risk factors of infection?
Inadequate hand hygiene (client and caregiver)
Individuals who have compromised health or defenses against infection (see other flashcard)
Caregivers using medical or surgical asepsis and do not use correct guidelines
Client who has poor hygiene, smoke, bad nutrition, high stress, high consumption of alcohol
Clients who live in a very crowded environment
Older adults clients
What are the most common risk factors of infection? - comprised health or defenses against infection
Those who are immunocompromised
Those who have had surgery
Those with indwelling devices (catheter, central-line, port)
A break in the skin (in which the skin is the body’s best protection against infection)
Those with poor oxygenation
Those with impaired circulation
Those with chronic or acute disease (diabetes mellitus, adrenal insufficiency, renal failure, hepatic failure, or chronic lung disease)
Portal of Exit: Respiratory tract
(Droplet, airborne)
TB, Staph, COVID
Portal of Exit: Gastrointestinal tract
Shigella, Salmonella enteritis, Salmonella typhi, hepatitis A
Portal of Exit: Genitourinary Tract
E-Coli, hepatitis A, HSV, HIV
Portal of Exit: skin/mucous membranes
NSV, varicella (chicken pox)
Portal of Exit: blood/body fluids
HIV, Hepatitis b, hepatitis C
What is the best way to prevent HAIs?
Frequent and effective hand hygiene
Where do HAIs often happen)
In the ICU
how is pertussis transmitted
droplet
how is influenza transmitted
droplet
what test can indicate generalized inflammation?
c-reactive protein
what type of precaution is N95 used
airborne
surgical asepsis: hand hygiene
apply chlorhexidine and ethanol to the hands
tuberculosis is transmitted how
airborne
what do you experience in prodromal stage
nonspecific symptoms: fever, chills, etc
a nurse is caring for a client who is having a seizure. what should nurse do
record the time and length of the seizure
what to identify before admin of med
full name and DOB
ISBARR-assessment component
lab results i.e.
when to fill out occurrence report i.e.
visitor falls in hallway
dentures are lost
client develops an unexpected reaction to a medication
what should water heater temp not exceed
120 degrees F
- Select ALL the patients that would be placed in droplet precautions:
B. A 36 year old patient with Pertussis.
C. A 25 year old patient with Scarlet Fever.
E. A 69 year old patient with Streptococcal Pharyngitis.
- A patient with Disseminated Herpes Zoster requires routine tracheostomy suction. Select the appropriate PPE you will wear:
B. N95 mask, face shield, gown, gloves
disseminated herpes zoster is both airborne AND contact
- A 6 year old female is diagnosed with Varicella. What type of isolation precautions will be initiated for this patient?
airborne and contact
- You’re patient is being transported to special procedures for a PICC line placement. The patient is in droplet precautions. What are your nursing actions to ensure proper transport of the patient?
A. Notify the receiving department and place a surgical mask on the patient.
- Select ALL the conditions that warrant airborne precautions:
C. Measles
D. Varicella
F. Tuberculosis
- A patient is diagnosed with Hepatitis A and is incontinent of stool. What type of precautions would be initiated?
contact
- You’rer providing care to a patient with C. Diff. After removing the appropriate PPE, you would perform hand hygiene by:
using soap and water
- Which of the following patients would be in contact precautions? Select-all-that-apply:
A. A 8 year old patient with lice.
D. A 75 year old patient with Disseminated Herpes Zoster.
- You’re providing an in-service on transmission-based precautions to a group of nursing students. Which statement made by a student warrants re-education about the topic?
B. “Patients with airborne diseases such as Meningitis require a special room with negative air pressure.”
- Your patient in droplet precautions has family visiting. A family member asks how far they should stand away from the patient while visiting. Your response is:
B. 3 feet or more
adverse effect of medications: morphine
urinary retention
adverse affects of medications: dexamethasone (Prednisone)
hyperglycemia
