Medical Surgical Nursing Ch.8

659 views
608 views

Published on

Published in: Education, Health & Medicine
0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
659
On SlideShare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
27
Comments
0
Likes
7
Embeds 0
No embeds

No notes for slide

Medical Surgical Nursing Ch.8

  1. 1. Chapter 8 <ul><li>Nursing Care of Patients with Infections </li></ul>
  2. 2. Infectious Process <ul><li>Chain of Infection Required </li></ul><ul><li>Six Links in the Chain </li></ul><ul><li>Treatment Breaks the Chain </li></ul>
  3. 3. Chain of Infection
  4. 4. Link 1: Reservoir <ul><li>Environmental Home for I nfectious Agents </li></ul><ul><li>Animate: People, Insects, Animals, Plants </li></ul><ul><li>Inanimate: Water, Soil, Medical Devices </li></ul>
  5. 5. Link 2: Causative Agents <ul><li>Bacteria </li></ul><ul><li>Virus </li></ul><ul><li>Fungi </li></ul><ul><li>Protozoa </li></ul><ul><li>Helminth </li></ul><ul><li>Prion </li></ul>
  6. 6. Key Terms <ul><li>Normal Flora : Microbes Occurring Naturally in a Body Part </li></ul><ul><li>Pathogens : Disease-causing Microbe </li></ul>
  7. 7. Link 3: Mode of Transmission <ul><li>Direct Contact </li></ul><ul><li>Indirect Contact </li></ul><ul><li>Airborne </li></ul>
  8. 8. Direct Contact <ul><li>Direct Contact </li></ul><ul><ul><li>Touching </li></ul></ul><ul><ul><li>Biting </li></ul></ul><ul><ul><li>Kissing </li></ul></ul><ul><ul><li>Sexual Contact </li></ul></ul><ul><ul><li>Droplet Spray </li></ul></ul>
  9. 9. Direct Contact (cont’d) <ul><li>Prevention </li></ul><ul><ul><li>Hand Hygiene </li></ul></ul><ul><ul><li>Aseptic Technique </li></ul></ul><ul><ul><li>Personal Protective Equipment (Gloves, Surgical Masks, Goggles, Gowns, Shoe Covers) </li></ul></ul>
  10. 10. Personal Protective Equipment
  11. 11. Indirect Contact <ul><li>Vehicle-borne Transmission by Contact with Contaminated Object </li></ul><ul><ul><li>Prevention </li></ul></ul><ul><ul><ul><li>Hand Hygiene, Excellent Cleaning </li></ul></ul></ul><ul><ul><ul><li>Stethoscope Cleaning </li></ul></ul></ul><ul><ul><ul><li>Clean Water/Food </li></ul></ul></ul>
  12. 12. Indirect Contact (cont’d) <ul><li>Vector-borne Transmission by Living Source Other Than Humans </li></ul><ul><ul><li>Prevention </li></ul></ul><ul><ul><ul><li>Insect Repellants </li></ul></ul></ul><ul><ul><ul><li>Rodent Control </li></ul></ul></ul>
  13. 13. Airborne <ul><li>Transmission by Particles Floating in Air </li></ul><ul><li>Inhaled or Deposited on Mucous Membranes </li></ul><ul><li>Prevention </li></ul><ul><ul><li>High-efficiency Particulate Air (HEPA) Respirators </li></ul></ul>
  14. 14. Link 4: Portal of Entry <ul><li>Entry into Susceptible Host </li></ul>
  15. 15. Portals <ul><li>Respiratory Tract </li></ul><ul><li>Skin </li></ul><ul><li>Mucous Membranes </li></ul><ul><li>Gastrointestinal Tract </li></ul><ul><li>Genitourinary Tract </li></ul><ul><li>Placenta </li></ul>
  16. 16. Link 5: Susceptible Host <ul><li>From Defense Breakdown </li></ul>
  17. 17. Increased Risk <ul><li>Very Young or Old Age </li></ul><ul><li>Malnourishment </li></ul><ul><li>Immuno-compromised </li></ul><ul><li>Chronic Disease </li></ul><ul><li>Stress </li></ul><ul><li>Invasive Procedures </li></ul>
  18. 18. Link 6: Exit Portal <ul><li>Route Infectious Agent Uses to Leave </li></ul><ul><li>Host Who Has Become Reservoir for </li></ul><ul><li>Infection </li></ul>
  19. 19. Body’s Defense Mechanisms <ul><li>Skin and Mucous Membranes </li></ul><ul><li>Cilia </li></ul><ul><li>Gastric Juices </li></ul><ul><li>Immunoglobulins </li></ul><ul><li>Leukocytes and Macrophages </li></ul><ul><li>Lysozymes </li></ul>
  20. 20. Body’s Defense Mechanisms (cont’d) <ul><li>Interferon </li></ul><ul><li>Inflammatory Response </li></ul>
  21. 21. Inflammatory Response <ul><li>Vascular Response </li></ul><ul><li>Inflammatory Exudate </li></ul><ul><li>Phagocytosis and Purulent Exudate </li></ul>
  22. 22. Immune System <ul><li>Body’s Final Defense Against Infection </li></ul><ul><li>Immune Cells and Lymphoid Tissue </li></ul>
  23. 23. Infectious Disease <ul><li>Results When Immune System Protection Fails </li></ul>
  24. 24. Localized Infection <ul><li>Microbes in One Area </li></ul><ul><li>Pain, Redness, Swelling, Site Warmth </li></ul>
  25. 25. Generalized Infection <ul><li>Systemic Involvement </li></ul><ul><li>Signs and Symptoms </li></ul><ul><ul><li>Headache, Muscle Aches, Fever, Anorexia </li></ul></ul><ul><li>Sepsis </li></ul><ul><ul><li>Infection That Has Spread to Bloodstream </li></ul></ul>
  26. 26. Laboratory Assessment <ul><li>Gram’s Staining </li></ul><ul><li>Culture and Sensitivity </li></ul><ul><li>Antibody Test </li></ul><ul><li>CBC with D ifferential </li></ul><ul><li>Erythrocyte Sedimentation Rate </li></ul>
  27. 27. Immunity <ul><li>Ability of Body to Protect Itself from Disease </li></ul>
  28. 28. Immunity (cont’d) <ul><li>Natural Immunity </li></ul><ul><li>Innate Immunity </li></ul><ul><li>Acquired Immunity </li></ul>
  29. 29. Example of Infectious Disease <ul><li>Mononucleosis </li></ul>
  30. 30. Mononucleosis <ul><li>Epstein-Barr Virus </li></ul><ul><li>Contagious (“Kissing Disease”) </li></ul><ul><li>Extreme Fatigue, Anorexia, Chills </li></ul><ul><li>Red Sore Throat, Headache, High Fever, Tonsils with a White Coating </li></ul><ul><li>Supportive Care </li></ul>
  31. 31. Community Infection Control <ul><li>World Health Organization </li></ul><ul><li>Centers for Disease Control and Prevention </li></ul><ul><li>Local Health Departments </li></ul><ul><li>Home Health Nurse </li></ul>
  32. 32. Infection Control in Health-Care Agencies <ul><li>Community-acquired Infection </li></ul><ul><li>Nosocomial Infection </li></ul><ul><li>Hand Hygiene </li></ul>
  33. 33. Nosocomial Infections <ul><li>Infection from Stay in Health-care Agency </li></ul><ul><li>Risk Factors </li></ul><ul><ul><li>Host’s Condition </li></ul></ul><ul><ul><li>Multiple Antibiotic Therapy </li></ul></ul><ul><ul><li>High-risk Units </li></ul></ul>
  34. 34. Nosocomial Infections (cont’d) <ul><li>Common Pathogens </li></ul><ul><ul><li>Escherichia coli (E. coli) </li></ul></ul><ul><ul><li>Staphylococcus aureus </li></ul></ul><ul><ul><li>Pseudomonas aeruginosa </li></ul></ul>
  35. 35. Hand Hygiene <ul><li>Before and After </li></ul><ul><ul><li>Patient Contact </li></ul></ul><ul><ul><li>Glove Use </li></ul></ul>
  36. 36. Hand Hygiene (cont’d) <ul><li>Wet Hands, Soap, Lather 15 Seconds </li></ul><ul><li>Interlace Fingers </li></ul><ul><li>Clean Nails Against Palms </li></ul><ul><li>Rinse with Fingertips Downward </li></ul><ul><li>Dry with Paper Towels </li></ul><ul><li>Turn off Faucet with Towel </li></ul>
  37. 37. Asepsis <ul><li>Freedom from Organisms </li></ul><ul><li>Medical Asepsis </li></ul><ul><ul><li>Clean Technique </li></ul></ul><ul><li>Surgical Asepsis </li></ul><ul><ul><li>Sterile Technique </li></ul></ul>
  38. 38. Infection Prevention <ul><li>Standard Precautions </li></ul><ul><ul><li>Assume All Patients Infectious </li></ul></ul><ul><ul><li>Blood, Body Fluids, Body Substances </li></ul></ul><ul><ul><li>Hand Hygiene, Gloves, Gowns, Masks, Goggles, Face Shields </li></ul></ul>
  39. 39. Infection Prevention (cont’d) <ul><li>Transmission-based Precautions </li></ul><ul><ul><li>Specific Communicable Diseases </li></ul></ul><ul><ul><li>Used with S tandard Precautions </li></ul></ul>
  40. 40. Example: Vancomycin-Resistant Enterococci
  41. 41. Respiratory Tract Infection Prevention <ul><li>Risk Factors </li></ul><ul><ul><li>Invasive Tubes </li></ul></ul><ul><li>Prevention </li></ul><ul><ul><li>Oral Hygiene </li></ul></ul><ul><ul><li>Coughing and Deep Breathing </li></ul></ul><ul><ul><li>Ventilator-associated Pneumonia Bundles </li></ul></ul>
  42. 42. Genitourinary Tract Infection <ul><li>Risk Factors </li></ul><ul><ul><li>Urinary Catheters </li></ul></ul>
  43. 43. Genitourinary Tract Infection Prevention <ul><li>Appropriate Use of Urinary Catheters </li></ul><ul><li>Intermittent Catheterization </li></ul><ul><li>Strict Aseptic Technique </li></ul><ul><li>Secure Tubing to Leg </li></ul><ul><li>Closed System </li></ul><ul><li>Drainage Bag Below Bladder Level </li></ul>
  44. 44. Surgical Wound Infection Prevention <ul><li>Sterile Technique for Dressing Changes </li></ul><ul><li>Monitor Wound </li></ul>
  45. 45. Septicemia Prevention <ul><li>Sterile Technique for Catheters </li></ul><ul><li>Uncontaminated Solutions </li></ul><ul><li>Report Indications Promptly </li></ul>
  46. 46. Septicemia Indications <ul><li>Fever </li></ul><ul><li>Tachypnea </li></ul><ul><li>Tachycardia </li></ul><ul><li>Hypotension </li></ul><ul><li>Elevated White Blood Cell Count </li></ul>
  47. 47. Septicemia Treatment <ul><li>Blood Cultures </li></ul><ul><li>Antibiotics </li></ul><ul><li>IV Drotrecogin alfa (Xigris) </li></ul><ul><ul><li>Severe Sepsis </li></ul></ul>
  48. 48. Antibiotic-Resistant Infections <ul><li>Methicillin-resistant Staphylococcus aureus (MRSA) </li></ul><ul><ul><li>Difficult to Treat </li></ul></ul><ul><ul><li>High Mortality Rate </li></ul></ul><ul><ul><li>Treatment: Vancomycin Hydrochloride </li></ul></ul>
  49. 49. Antibiotic-Resistant Infections (cont’d) <ul><li>Vancomycin-resistant Enterococci (VRE) </li></ul><ul><ul><li>Difficult to Treat </li></ul></ul><ul><ul><li>Combination Antibiotic Therapy </li></ul></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><ul><li>Quinupristin/Dalfopristin (Synercid) </li></ul></ul></ul><ul><ul><ul><li>Linezolid (Zyvox) </li></ul></ul></ul>
  50. 50. Treatment of Infectious Diseases <ul><li>Type of Organism Guides Drug Selection </li></ul><ul><ul><li>Antibiotics: Bacterial Infections </li></ul></ul><ul><ul><li>Antivirals: Viral Infections </li></ul></ul><ul><ul><li>Antifungals: Fungal Infections </li></ul></ul>
  51. 51. Nursing Responsibilities <ul><li>Check Allergies </li></ul><ul><li>Monitor Side Effects </li></ul><ul><li>Signs of Superinfection </li></ul>
  52. 52. Patient Education <ul><li>Take All Medication </li></ul><ul><li>Report Side Effects </li></ul>
  53. 53. Nursing Diagnoses <ul><li>Risk for Infection </li></ul><ul><li>Acute Pain </li></ul><ul><li>Imbalanced Nutrition </li></ul><ul><li>Ineffective Protection </li></ul><ul><li>Deficient Knowledge </li></ul>
  54. 54. Respiratory Tract Infections <ul><li>Assessment </li></ul><ul><ul><li>Signs and Symptoms </li></ul></ul><ul><ul><li>Sputum Culture </li></ul></ul><ul><li>Nursing Diagnosis </li></ul><ul><ul><li>Risk for Infection </li></ul></ul>
  55. 55. Gastrointestinal Tract Infections <ul><li>Assessment </li></ul><ul><ul><li>Signs and Symptoms </li></ul></ul><ul><ul><li>Dehydration </li></ul></ul><ul><ul><li>Stool Culture </li></ul></ul><ul><li>Nursing Diagnosis </li></ul><ul><ul><li>Risk for Infection </li></ul></ul>
  56. 56. Genitourinary Tract Infections <ul><li>Assessment </li></ul><ul><ul><li>Signs and Symptoms </li></ul></ul><ul><ul><li>Urinalysis </li></ul></ul><ul><ul><li>Urine Culture </li></ul></ul><ul><li>Nursing Diagnosis </li></ul><ul><ul><li>Risk for Infection </li></ul></ul>

×