Understanding Infection


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Understanding Infection

  1. 1. Understanding Infection NUR 154 Spring 2010
  2. 2. The Chain of Infection
  3. 3. Key Terms <ul><li>Pathogen (agent) </li></ul><ul><li>Communicable </li></ul><ul><li>Pathogenicity </li></ul><ul><li>Virulence </li></ul><ul><li>Normal Flora </li></ul><ul><li>Colonization </li></ul><ul><li>Carrier </li></ul><ul><li>Reservoirs </li></ul><ul><li>Toxins </li></ul><ul><li>Exotoxins </li></ul><ul><li>Endotoxins </li></ul><ul><li>Susceptibility </li></ul><ul><li>Host </li></ul><ul><li>Incubation Period </li></ul>
  4. 4. <ul><li>Primary Infection </li></ul><ul><li>Secondary Infection </li></ul><ul><li>Focal Infection </li></ul><ul><li>Endemic </li></ul><ul><li>Panendemic </li></ul><ul><li>Epidemic </li></ul>Key Terms
  5. 5. Pathogens <ul><li>Organisms that can cause illness/disease </li></ul><ul><ul><li>Bacteria, viruses </li></ul></ul><ul><ul><li>Fungi; intracellular organisms </li></ul></ul><ul><ul><li>Multicellular animals </li></ul></ul><ul><li>Cause disease in two ways </li></ul><ul><ul><li>Divide rapidly to overcome body defenses </li></ul></ul><ul><ul><li>Disrupt normal cell function </li></ul></ul><ul><li>Secrete toxins </li></ul><ul><ul><li>Disrupt normal cell function </li></ul></ul>
  6. 6. Infectious Process <ul><li>Prodromal syndrome - preclinical or nondescript, nonspecific manifestations of a beginning infection. </li></ul><ul><li>As the infection progresses, symptoms become more specific or severe. </li></ul>
  7. 7. Factors That Influence Susceptibility <ul><li>Natural Immunity </li></ul><ul><li>Age </li></ul><ul><li>Normal Flora </li></ul><ul><li>Environmental </li></ul><ul><li>Hormonal Factors </li></ul><ul><li>Phagocytosis </li></ul><ul><li>Nutrition </li></ul><ul><li>Skin/MM Integrity </li></ul><ul><li>Medical Interventions </li></ul>
  8. 8. Portals of Entry Sites <ul><li>Respiratory tract </li></ul><ul><li>Gastrointestinal tract </li></ul><ul><li>Genitourinary tract </li></ul><ul><li>Skin/mucous membranes </li></ul><ul><li>Bloodstream </li></ul>
  9. 9. Mode of Transmission <ul><li>Contact transmission by direct, indirect contact or fecal-oral transmission. </li></ul><ul><li>Droplet transmission such as in influenza </li></ul><ul><li>Airborne transmission such as in tuberculosis </li></ul><ul><li>Vector-borne transmission involving insect or animal carriers, such as in Lyme disease </li></ul>
  10. 10. Physiologic Defenses Against Infection <ul><li>Body tissues </li></ul><ul><li>Phagocytosis </li></ul><ul><li>Inflammation </li></ul><ul><li>Specific defenses </li></ul><ul><ul><li>Antibody-mediated immune system </li></ul></ul><ul><ul><li>Cell-mediated immunity </li></ul></ul>
  11. 11. Infection Control in Inpatient Health Care Agencies <ul><li>Nosocomial or health care–associated infections are infections acquired in the inpatient health care setting which were not present or incubating at admission. </li></ul><ul><ul><li>Bacteremia NYS reportable event </li></ul></ul><ul><li>Endogenous infection is from a client’s flora. </li></ul><ul><li>Exogenous infection is from outside the client, often from the hands of health care workers. </li></ul>
  12. 12. Nosocomial Infections <ul><li>Infections that develop after the person has been admitted to the hospital. Occur in about 2 million of the 30 million patients admitted to a hospital each year </li></ul><ul><li>Common in very young, very old and persons w/chronic, debilitating diseases. </li></ul><ul><li>Two contributing factors: </li></ul><ul><ul><li>Concentration of virulent forms of different organisms w/in hospitals. </li></ul></ul><ul><ul><li>Presence of patients w/anatomic or physiologic defects in their immune defenses </li></ul></ul>
  13. 13. Methods of Infection Control <ul><li>Practice hand hygiene and proper hand washing. </li></ul><ul><li>No Artificial fingernails. </li></ul><ul><li>Gloves should be worn. </li></ul><ul><li>The CDC provides guidelines for disinfection and sterilization, outlining standard precautions for all modes of transmission. </li></ul>
  14. 14. What are the CDC hand hygiene guidelines?
  15. 15. Immunizations
  16. 16. Multiple Drug–Resistant Infections <ul><li>Multiple drug–resistant infections are no more transmissible than their drug-sensitive counterparts, S. aureus and Enterococcus organisms. </li></ul><ul><li>To control antimicrobial resistance in health care settings, see the CDC program. </li></ul>
  17. 17. Problems from Inadequate Antimicrobial Therapy <ul><li>Noncompliance or nonadherence </li></ul><ul><li>Legal sanctions that compel a client to complete treatment, such as in the instance of tuberculosis </li></ul><ul><li>Septicemia </li></ul><ul><li>Septic shock </li></ul>
  18. 18. Collaborative Management <ul><li>History </li></ul><ul><li>Physical assessment & clinical manifestations </li></ul><ul><li>Psychosocial assessment </li></ul><ul><li>Laboratory assessment including: </li></ul><ul><ul><li>Culture and antibiotic sensitivity testing </li></ul></ul><ul><ul><li>Complete blood count </li></ul></ul><ul><ul><li>Erythrocyte sedimentation rate </li></ul></ul><ul><ul><li>Serologic testing </li></ul></ul><ul><ul><li>Radiographic and other assessment </li></ul></ul>
  19. 19. Nursing Diagnosis <ul><li>Hyperthermia </li></ul><ul><li>Risk for Social Isolation </li></ul>
  20. 20. Nursing Interventions <ul><li>Prevent the spread of infections. GOOD HANDWASHING </li></ul><ul><li>Prevent complications. </li></ul><ul><li>Treat symptoms of infection </li></ul><ul><li>Monitor for secondary symptoms of infection </li></ul>
  21. 21. Hyperthermia Interventions <ul><li>Eliminate the underlying cause of hyperthermia and destroy the causative microorganism. </li></ul><ul><li>Manage fever by: </li></ul><ul><ul><li>Drug therapy: antimicrobial, antipyretic therapy </li></ul></ul><ul><ul><li>External cooling, fluid administration </li></ul></ul>
  22. 22. Health Teaching <ul><li>Education on these topics is vital to client’s understanding of transmission prevention precautions: </li></ul><ul><ul><li>Infection control </li></ul></ul><ul><ul><li>Drug therapy </li></ul></ul><ul><ul><li>Psychosocial support </li></ul></ul><ul><ul><li>Health care resources </li></ul></ul>
  23. 23. Methods of Describing Bacteria <ul><li>Basic Shapes </li></ul><ul><ul><li>Bacilli—rod shape </li></ul></ul><ul><ul><li>Cocci—spherical shape </li></ul></ul><ul><ul><li>Spirilla—spiral shape </li></ul></ul>
  24. 24. Methods of Describing Bacteria <ul><li>Ability to use Oxygen </li></ul><ul><ul><li>Aerobic—with O 2 </li></ul></ul><ul><ul><li>Anaerobic—without O 2 </li></ul></ul><ul><li>Staining Characteristics </li></ul><ul><ul><li>Gram positive </li></ul></ul><ul><ul><li>Gram negative </li></ul></ul>
  25. 25. Anti-infective Drugs <ul><li>Known as antibacterial, antimicrobial, antibiotic </li></ul><ul><li>Classified by </li></ul><ul><ul><li>Chemical structures (e.g., aminoglycoside, fluoroquinolone) </li></ul></ul><ul><ul><li>Mechanism of action (e.g., cell-wall inhibitor, folic-acid inhibitor) </li></ul></ul>
  26. 26. Actions of Anti-infective Drugs <ul><li>Affect target organism’s structure, metabolism, or life cycle </li></ul><ul><li>Goal is to eliminate pathogen </li></ul><ul><ul><li>Bactericidal—kill bacteria </li></ul></ul><ul><ul><li>Bacteriostatic—slow growth of bacteria </li></ul></ul>
  27. 27. Mechanisms of Action of Antimicrobial Drugs
  28. 28. Widespread Use of Antibiotics <ul><li>Resistance not caused by but is worsened by over prescription of antibiotics </li></ul><ul><ul><li>Results in loss of antibiotic effectiveness </li></ul></ul><ul><li>Only prescribe when necessary </li></ul><ul><li>Long-time use increases resistant strains </li></ul>
  29. 29. Widespread Use of Antibiotics (continued) <ul><li>Nosocomial infections often resistant </li></ul><ul><li>Prophylactic use sometimes appropriate </li></ul><ul><li>Nurse should instruct client to take full dose </li></ul>
  30. 30. Acquired Drug Resistance
  31. 31. What Can Nurses do to Prevent Infection in our Patients?
  32. 32. Role of the Nurse <ul><li>Obtain specimens for culture and sensitivity prior to start of therapy </li></ul><ul><li>Monitor for indications of response to therapy </li></ul><ul><ul><li>Reduced fever </li></ul></ul><ul><ul><li>Normal white blood count </li></ul></ul><ul><ul><li>Improved appetite </li></ul></ul><ul><ul><li>Absence of symptoms such as cough </li></ul></ul>
  33. 33. Role of the Nurse (continued) <ul><li>After parenteral administration, observe closely for possible allergic reactions </li></ul><ul><li>Monitor for superinfections </li></ul><ul><ul><li>Replace natural colon flora with probiotic supplements or cultured dairy products </li></ul></ul>
  34. 34. Drug Therapy in Infectious Disease
  35. 35. Penicillin <ul><li>Tx applications: pneumonia, meningitis, skin, bone, joint infections, stomach, blood & valve infections, gas gangrene, tetanus, anthrax, sickle-cell in infants. </li></ul><ul><li>One of the safest class of drugs around for > 60 years </li></ul>
  36. 36. Cephlasporin <ul><li>Tx applications: serious infections of lower respiratory tract, CNS, Genitourinary, bone & joint. </li></ul><ul><li>Avoid in patient with history of SEVERE penicillin reaction </li></ul><ul><li>Primarily used for ampicillin-resistance hemophilus influenza and staphylococci which are penicillin resistant. </li></ul><ul><li>Duricef, Kefzol, Keflex, Ceclor, Cefotan, Mefoxin, Rocephin, Lorabid </li></ul>
  37. 37. Tetracycline <ul><li>Tx applications: Lyme disease, cholera, typhus, rocky mountain spotted fever, Helicobacter pylori, chlamydial infections. </li></ul><ul><li>Contraindicated in pregnant or lactating clients </li></ul><ul><ul><li>Effect on linear skeletal growth of fetus and child </li></ul></ul><ul><li>Contraindicated in children less than 8 yrs </li></ul><ul><ul><li>Permanent mottling and discoloration of teeth </li></ul></ul>
  38. 38. Macrolide Therapy <ul><li>Safe alternative to penicillin </li></ul><ul><li>Tx applications: whooping cough, Legionnaires’ disease, H. influenza, Mycoplasma pneumoniae (infections caused by streptococcus ) </li></ul><ul><li>E-mycin, Erythromycin, Biaxin, Zithromax </li></ul><ul><li>Almost no serious side effects, mild GI upset, diarrhea & abdominal pain most common. </li></ul><ul><li>Drug to drug interaction with Coumadin </li></ul>
  39. 39. Aminoglycosides <ul><li>Reserved for serious systemic infections caused by aerobic gram-negative organisms </li></ul><ul><li>Streptomycin is usually restricted to tx of TB </li></ul><ul><li>Amikin, Gentamicin, Kantrex </li></ul><ul><li>May cause nephro and ototoxicity even at normal doses. </li></ul>
  40. 40. Fluoroquinolones <ul><li>Tx applications: infections of Respiratory, GI, GU, Skin and Soft tissue. </li></ul><ul><li>Postexposure prophylaxix for Anthrax </li></ul><ul><li>Dosing advantage PO as effective as IV, dosing is 1-2 times a day </li></ul><ul><li>Cipro, Floxin, Levaquin, Avelox </li></ul>
  41. 41. Sulfonamide Therapy <ul><li>Tx applications: Pneumocystis carnii pneumonia, shigella infections, UTI, RA, Ulcerative colitis </li></ul><ul><li>Cetamide, Gantrisin, Bactrim, Septra </li></ul><ul><li>Classified by their treatment applications systemic or topical </li></ul><ul><li>Higher incidence of allergies due to sulfer content </li></ul><ul><li>Interacts with anticoagulants </li></ul>
  42. 42. Antituberculosis Therapy <ul><li>Contraindicated for clients with history of alcohol abuse, AIDS, liver disease, or kidney disease </li></ul><ul><li>Isoniazid (INH) Pyrazinamide(PZA) Ethambutol, rifampin, streptomycin </li></ul><ul><li>Use caution for certain clients </li></ul><ul><ul><li>Those with renal dysfunction </li></ul></ul><ul><ul><li>Those who are pregnant or lactating </li></ul></ul><ul><ul><li>Those with history of convulsive disorders </li></ul></ul>
  43. 43. Other Drugs <ul><li>Clindamycin (Cleocin): for oral infections caused by bacteroides </li></ul><ul><li>Metronidazole (Flagyl): used to treat H. pylori infections of stomach </li></ul><ul><li>Vancomycin (Vancocin): effective for MRSA infections </li></ul><ul><ul><li>Adverse effects : ototoxicity, nephrotoxicity, red man syndrome </li></ul></ul>
  44. 44. Selection of an Antibiotic <ul><li>Careful selection of correct antibiotic essential </li></ul><ul><ul><li>Use of culture and sensitivity testing </li></ul></ul><ul><ul><li>For effective pharmacotherapy; to limit adverse effects </li></ul></ul><ul><li>Broad-spectrum antibiotics </li></ul><ul><ul><li>Effective for wide variety of bacteria </li></ul></ul><ul><li>Narrow-spectrum antibiotics </li></ul><ul><ul><li>Effective for narrow group of bacteria </li></ul></ul>
  45. 45. Multidrug Therapy <ul><li>Affected by antagonism—combining two drugs may decrease efficacy of each </li></ul><ul><li>Use of multiple antibiotics increases risk of resistance. </li></ul><ul><li>Multidrug therapy can be used </li></ul><ul><ul><li>When multi-organisms cause infection </li></ul></ul><ul><ul><li>For treatment of tuberculosis </li></ul></ul><ul><ul><li>For treatment of HIV </li></ul></ul>
  46. 46. Superinfections <ul><li>Occur when too many host flora are killed by an antibiotic </li></ul><ul><li>Pathogenic microorganisms have chance to multiply </li></ul><ul><ul><li>Opportunistic—take advantage of suppressed immune system </li></ul></ul><ul><ul><li>Signs and symptoms include diarrhea, bladder pain, painful urination, or abnormal vaginal discharge </li></ul></ul>
  47. 47. Case Study <ul><li>A 78-year-old nursing home patient with a history hypertension, type 2 DM, & COPD, is brought into the ED with a history of fever for 72 hrs & moist cough. The LTC nurse report states that he was very irritable last night, then was difficult to awaken this am. Assessment findings include: </li></ul><ul><li>TPR: 103-122-26 (labored) BP: 100/56 </li></ul><ul><li>Lethargic-Confused, Crackles (rales) throughout lung fields, CXR: Lung consolidation. </li></ul><ul><li>IV fluids are running. </li></ul>
  48. 48. <ul><li>The following orders are written: </li></ul><ul><li>Admit: medical unit </li></ul><ul><li>Sputum C&S </li></ul><ul><li>Cefotetan 1gm IVPB Q12H </li></ul><ul><li>What are nursing responsibilities regarding these orders? </li></ul><ul><li>What type of antibiotic would you expect to be ordered and why? </li></ul>
  49. 49. The Culture & Sensitivity report just came in and is as follows. What should the nurse do? Antibiotic S=Sensitive R=Resistant Amikacin Amoxicillin Azithromycin Cefepime Cefotetan Levofloxacin Pipericillin Tobramycin R R S R R S R R
  50. 50. References <ul><li>Adams, MP; Josephson, DL & Holland, LN (2008). Pharmacology for Nurses a Pathophysiologic Approach (2 nd ed). Upper Saddle River, NJ: Prentice Hall </li></ul><ul><li>Center for Disease Control (CDC – 2007). Recommended Immunization Schedules for Persons Aged 0-18 Years . Retrieved on January 21, 2007 from http://www.cdc.gov/nip/acip </li></ul><ul><li>Ignatavicius, DD & Workman, ML (2006) Medical Surgical Nursing critical Thinking for Collaborative Care 5 th Ed. St Louis, MO: Elsevier/Saunders </li></ul><ul><li>Hockenberry & Wilson (2007) Wong’s Nursing Care of Infants & Children 8 th Ed. St. Louis, MO: Mosby-Elsevier </li></ul>