Understanding Infection
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Understanding Infection Presentation Transcript

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