Week 7: Infection Flashcards
Which of the following factors make infection difficult to recognize in the elderly population?
1) Asymptomatic bacteriuria is common in the elderly
2) The febrile response that signals infections may be blunted or absent in the older person
3) Medications commonly taken may reduce the normal fever response
4) Only about 60% of older adults with serious infection develop leukocytosis
5) Older person with infection may present with hypothermia
All the above
What are predisposing factors of infection? (9)
1) Immunosenescence
2) Malnutrition (ex: protein-energy malnutrition)
3) Comorbidities: DM, COPD, CHF, renal failure
4) Polypharmacy: steroids, NSAIDs, hypoglycemics, diuretics, antidepressants, antibiotics, anti arthritic agents, anticonvulsants (neutropenia and lymphocytopenia)
5) Social and environment factors (ex: crowding or residing in a long-term care facility; poor understanding/acceptance of prevention; depression; stress, isolation)
6) Frailty/impaired cognition (ex: physical changes such as dry mucous membranes and reduced gag reflex).
7) Reduced cough reflex can predispose to aspiration pneumonia
8) Urinary or fecal incontinence can predispose to urinary tract and perineal dermatologic infections
9) Immobility can predispose to pressure injuries.
Which of the following should the nurse include when providing teaching to the elderly at a community health center? Select all that apply.
1) Obtain the influenza vaccine yearly if no contraindication
2) All individuals over 65 should receive Pneu-P-23 vaccination and a booster 5 years after the initial vaccination.
3) HIV and STD prevention measures
4) Healthy diet
All of the above.
What is the prevalence of infection?
It’s the primary cause of death in 1/3 of those 65+
It causes the majority of hospitalizations in pts 65+
They cause 30% of deaths in those 65+
Risk of death in 65+ compared w/ younger pts
- UTI (5-10x)
- Pneumonia (3x)
Older pts w/ bacteremia are less likely than younger pts to have systemic signs such as fever, chills, or diaphoresis. Why is that?
The decline in basal temp and the blunted response to inflammatory stimuli makes it less likely that a frail older adult will have a body temp commonly recognized as a fever
True or false: infectious diseases frequently present w/ atypical features in older adults.
True
True or false: less than 20% of older people with bacteria exhibits a fever response.
True
1) Persistent elevation of body temp of at least 1.1°C over baseline values,
2) Oral temps of 37.2°C or greater on repeated measures, or
3) Rectal temps of 37.5°C or greater on repeated measures.
True or false: hypothermia associated with systemic infection is an ominous sign in the elderly.
True
When should you suspect an infection in LTCF residents? (2)
1) Decline in functional status, defined as new or increasing confusion, incontinence, falling, deteriorating mobility, reduced food intake, or failure to cooperate with staff.
2) Underlying illness (ex: CHF or diabetes) may be exacerbated by infection.
What are the signs and symptoms of sepsis? (6)
1) Sweaty skin
2) Disorientation
3) Shivering
4) High HR
5) Extreme pain
6) SOB
True or false: wounds are a billion-dollar worldwide issue.
True
$28 billion/year in the US (primary wound diagnosis)
$31.7 billion/year (secondary diagnosis)
High impact antibiotic use:
- 16.4% of antibiotic prescriptions attributed to wound care
- They are trying to decrease the use of antibiotics to curb the spread of multi-drug resistant organisms/pathogens
Impact on healthcare system:
- UK: 25-50% of acute hospital beds occupied by pts w/ wounds
- Ireland: up to 66% of community nurses devoted to wound care
What is the prevalence of pressure injuries across health care settings?
- Annual prevalence of wounds is estimated to grow at a rate of 9% (acute) and 12% (chronic)
- 15% acute care
- 15% home care
- 12% LTC
- 31% complex
- 72% exhibited more than one skin lesion in LTC
- 28% of PIs in LTC developed 1 week post-hospitalisation
What is biofilm? What occurs as a result of formation?
Biofilm: a thin, slimy film of bacteria that adheres to a surface (ex: plaque.
- Formation -> it’s the process whereby microorganisms irreversibly attach to and grow on a surface and produce extracellular polymers that facilitate attachment and matrix formation, resulting in an alteration in the phenotype of the organisms with respect to growth rate and gene transcription.
Biofilm can also spread to other environments and produce an inflammatory response (may explain why chronic wounds become chronic)
Discuss the formation process of biofilm.
Biofilm formation can be divided into five stages: Initial reversible attachment (1), irreversible attachment (2-3), maturation (4) and dispersion (5)
1) Individual planktonic bacteria attach to the wound surface
2) The bacteria colonise the wound surface and form a colony (biofilm)
- Microbial detachment and reattachment
3) The biofilm increases in size and triggers subclinical signs of infection in the host
- Microbial detachment and reattachment
4) The biofilm has matured
- Microbial detachment and reattachment
Check slide 13
Describe what a wound site with biofilm may look like.
- Inflamed
- Slough
- Exudate (level)
- Deterioration of tissues
