Week3 Flashcards
This is classified by shape and oxygen need, and constitutes about 38% of human pathogens.
Bacteria
Fungi can be one of two forms…
- True pathogen
Causes infections in healthy people
(Histoplasmosis; Coccidioidomycosis) - Opportunistic pathogens
Causes infection in immunocompromised persons
(Aspergillosis; Candidiasis; Cryptococcosis)
Virus is a subcellular organism made up of?
Only RNA or DNA covered with proteins
Infection agent composed entirely of protein material
Prions
Characterized by a long latent interval in a host that when reactivated causes a rapidly progressive deteriorating state
Prions
Indirect contact transmission
Contact w/ contaminated surface or object, food, blood, or water
Travel through the air
The “Big Five” infectious diseases according to WHO
Have the greatest impact in terms of mortality and DALY (disability-adjusted life year)
- Pneumonia
- Diarrhea
- HIV/AIDS
- TB
- Malaria
Sepsis
Life-threatening complication of infection occurring when immune reaction to infection triggers inflammatory responses throughout the body
Inflammation can trigger cascade that damages multiple organ systems leading to failure
Especially dangerous in older adults and immunocompromised
3 stages of sepsis
Sepsis->
Severe sepsis->
Septic shock
Sepsis: must exhibit at least 2 of following symptoms in addition to ___?
- Body temp >101 F or < 96.8 F
- HR > 90
- RR > 20 breaths/min
And a confirmed infection
Severe sepsis: exhibits at least 1 of the following s/s, indicating possible organ failure
- Significant decrease in urine output
- Abrupt mental status change
- Decrease in platelet count
- Difficulty breathing
- Abnormal heart pumping function
- Abdominal pain
Septic shock: exhibits ?
All s/s of severe sepsis:
- Significant decrease in urine output
- Abrupt mental status change
- Decrease in platelet count
- Difficulty breathing
- Abnormal heart pumping function
- Abdominal pain
PLUS extreme hypotension that does not respond adequately to fluid resuscitation
Sepsis risk factors
- Advanced age or very young age
- Immunocompromised
- Hospitalization, particularly ICU
- Presence of wounds- esp burns
- Presence of invasive devices (IV, caterers..)
- Antibiotic resistant bacteria
Sepsis complications
Impaired organ function
Blood clots
Death
WHO states ____ burden is greater than HIV/AIDS, TB and malaria combined
HAI: healthcare-associated Infections
Common sites for HAI
Urinary tract
Surgical wounds
Joints
Lower respiratory tract
Risk factors for HAI
- Extremes of age
- Immunodeficiency
- Immunosuppressed
- Misuse of antibiotics
- Invasive diagnostic and therapeutic procedures
- Agitation
- Surgery
- Burns
- Length of hospitalization
S/S infectious disease
- Fever
- Chills
- Malaise/Body aches
- Fatigue
- Coughing
- Diarrhea
- Palpable lymph nodes
most palpable lymph node sites
- Sub mandibular
- Axilla
- Supra clavicular
- Groin
Use light touch
S/S infectious disease
Age-Specific: Older adults
May be subtle and atypical
- Mental status change
- Subnormal body temp (or normal temp)
- Bradycardia/Tachycardia
- Fatigue (or increased fatigue)
- Lethargy/weakness
- Decreased appetite
- Increased incidence of falls in short period of time
S/S infectious disease
Age-Specific: Young children
- Irritability
- Inconsolability
- Generalized symptoms seeming let not related
- Lethargy/excessive sleepiness
- Decreased appetite
- Subnormal body temp
S/S infectious disease
Body system- integumentary
Purulent Drainage
Skin rash, red streaks (cellulitis?)
Bleeding from gums or into joints
Joint effusion or erythema
S/S infectious disease
Body system- CV
Petechial lesions
Tachycardia
Hypotension
Increase or decrease in HR
S/S infectious disease
Body system- CNS
Altered LOC, confusion, seizures HA Photophobia Memory loss Stiff neck, myalgia
With presentation of these symptoms, particularly with fever, HA, neck stiffness, and AMS- use screening tests:
Kernig sign
Brudzinski sign
Kernig sign
Supine
- Knee flexed to 90*
- Hip flexed to 90*
- Extension of the knee is painful or limited in extension
Screening for CNS infectious disease (like meningitis)
Brudzinski sign
Supine
1. Passive flexion of neck
Elicits hip and knee flexion
Screening for CNS infectious disease (like meningitis)
S/S of infectious disease
Body system- GI
Nausea
Vomiting
Diarrhea
May produce referred pain patterns: Lumbosacral Lower abdomen Mid-thoracic R shoulder
S/S of infectious disease
Body system- genitourinary
Dysuria or flank pain
Hematuria
Oliguria
Urgency, frequency
May produce referred pain patterns: L shoulder Low back region Unilateral subcostal or lower abdominal Suprapubic
New onset of fever in the inpatient environment- implication?
Without investigation for causative agent would preclude PT evaluation until cleared by physician
Screening question about fever..
How long have you had fever, and how high had it been?
102* (above or below this is the cutoff temp for determining causes)
Absolute exercise contraindications (aerobic)
- Unstable angina
- Uncontrolled cardiac dysrhythmias causing symptoms of hemodynamic compromise
- Uncontrolled symptomatic heart failure
- Acute or suspected major CV event
- Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands
Infectious disease
To proceed or not proceed?
Use “neck check” rule:
Symptoms confined to above neck - participate as able
If systemic symptoms present- refrain from exercise until symptoms resolve
Special case- infectious mono : warrants further referral due to danger of spenomegaly and risk of splenic rupture with higher level of activity
Acute osteomyelitis
Clinical presentation
Pain/tenderness in infected area
Described as “deep and constant”
Causes antalgic gait when in LE
Inflammation, redness and warmth
Fever, chills, excessive sweating
Nausea and malaise
Swelling of legs, ankles, and feet when LE
Possible presence of suppurations, pus/purulence
Rapid dx followed by tx is imperative!
Vertebral osteomyelitis
Clinical presentation
Localized LBP and tenderness
Paravertebral muscle spasm unresponsive to conservative tx
Radicular pain and extremity weakness in case of more advanced disease process causing spinal cord or nerve root compression
Chronic osteomyelitis
Clinical presentation
Pain for months to years
Intermittent bone pain/tenderness
Not as painful as acute osteomyelitis
May be result of partially successful tx of acute osteomyelitis
Prosthetic joint infection
Clinical presentation
Persistent joint pain after total joint arthroplasty may be only symptom
3 categories dependent on onset of symptoms:
1. Early: < 3 months post-surgery
Acute symptoms; Sinus tract w/ purulent drainage
2. Delayed: 3-24 months post-surgery
Often lack systemic symptoms; Joint pain and/or prosthetic joint loosening
3. Late: > 24 month post-surgery
Often blood-born infection “seeding” prosthetic; Joint pain w/ unexplained onset of increasing MSK symptoms
Osteomyelitis
Patient population at risk
Systemic involvement that impairs immune surveillance, metabolism, and local vascularity
Malnutrition; Renal/Hepatic failure; Cheonic hypoxia; Immunocompromised/suppressed; Extremes of age; impaired circulation
Deep pressure ulcers
IV drug users
S/P open fx and implanted orthotics
Osteomyelitis
Diagnostic test
Lab work X-ray CT/MRI Bone scan Bone biopsy
Osteomyelitis
PT involvement in process
Screening role
Prevention
Substance abuse effects by system- CV
Cardiomyopathy
CV disease (incl MI, CVA, PVD)
Arrhythmia (esp. amphetamines and cocaine)
Endocarditis or heart valve infection (needle drugs)
HTN
Substance abuse effects by system- pulmonary
Respiratory depression Impaired cough and gag reflex Aspiration Lung infections Pulmonary edema Nasal passageway infection Interstitial lung disease
Substance abuse effects by system- GI
Gastritis Esophageal cancer Decreased gastric and intestinal motility Malabsorption Cancers of GI tract Ischemic colitis Constipation -> bowel obstruction
Substance abuse effects by system- pancreatic
Pancreatitis- Chronic and acute
Pancreatic cancer
Substance abuse effects by system- gallbladder
Gallstones
Substance abuse effects by system- hepatic
Alcoholic effects: Fatty liver Alcoholic hepatitis Cirrhosis Hepatic encephalopathy
DILI: Drug induced liver injury
Substance abuse effects by system- Renal
Hyponatremia
Hypovolemia
“Beer potomania syndrome”
Renal tubular dysfunction
Acute renal failure
Substance abuse effects by system- neurological effects
Cognitive
Behavioral/Psychological
Disorders of movement
Peripheral nervous system
Mixed effects
Other effects
Neurological effects of substance abuse
Mechanism due to?
Direct influence on CNS and PNS
Withdrawal effects
Changes in structure
Indirect effects on other organs (ie liver) than interferes w/ CNS/PNS function
Nutritional deficiencies
Toxic accumulation of byproducts normally eliminated through other organ systems
Trauma caused during intoxication
Addiction is a disorder of altered cognition.
4 key points ?
- Alters normal brain structure and function in areas of essential cognitive functions
- Cognitive shifts promote continued use through maladaptive learning and hinders acquisition of adaptive behaviors that support abstinence
- Particularly disruptive when abuse during brain development (prenatal; adolescence, those with mental disorders)
- Individuals w/ mental disorders and ADHD particularly susceptible to abuse
Korsakoff’s syndrome
Thiamine deficiency
Associated w/ long-term alcohol use
Progression from untreated Wernicke syndrome
Amnestic syndrome characterized by impaired recent memory and relatively intact intellectual function
Substance abuse- stroke
Alcoholics:
Cerebral atrophy increases susceptibility to subdural hematomas and coagulation disorders which increase risk of ischemic CVA
Illicit drug use main cause of CVA < 35 y/o
Substance abuse- cerebellar degeneration
Associated with chronic alcohol use
Broad-based unstable gait, incoordination, upper limbs rarely involved
Substance abuse- tremor
Seen in withdrawal syndromes
Postural tremor w/ alcohol
Present when sustaining position against gravity seen in Late Stage dependence or early withdrawal
Myoclonus with opioids
Substance abuse- PNS (chronic alcohol abuse)
- Peripheral neuropathy:
Symmetrical, bilateral mixed sensory and motor types- usually LE
May be asymptomatic or present w/ pain, numbness, burning, hyperaesthesia
May have muscle weakness, diminished tendon reflexes
Assoc w/ thiamine deficiency (usu damage permanent even w/ supplementation) - Autonomic neuropathy:
Impairs control of BP, HR, sweating, bowel/bladder, digestion
Wernicke’s encephalopathy
AKA: Wernicke-Korsakoff
Thiamine deficiency
Bleeding in brainstem and hypothalamus
Presentation:
Progressive external ophthalmoplegia, Horizontal nystagmus, Bilateral rectus palsy,
Ataxia, Confusion, Disorientation
Can progress to complete paralysis if untreated to Korsakoff’s
Reversible if treated early (thiamine)
