Medical Surgical Nursing Ch. 8

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Medical Surgical Nursing Ch. 8

  1. 1. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Chapter 8 Nursing Care of Patients with Infections
  2. 2. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Infectious Process  Chain of Infection Required  Six Links in the Chain  Treatment Breaks the Chain
  3. 3. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Chain of Infection
  4. 4. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Link 1: Reservoir  Environmental Home for Infectious Agents  Animate: People, Insects, Animals, Plants  Inanimate: Water, Soil, Medical Devices
  5. 5. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Link 2: Causative Agents  Bacteria  Virus  Fungi  Protozoa  Helminth  Prion
  6. 6. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Key Terms  Normal Flora: Microbes Occurring Naturally in a Body Part  Pathogens: Disease-causing Microbe
  7. 7. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Link 3: Mode of Transmission  Direct Contact  Indirect Contact  Airborne
  8. 8. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Direct Contact  Direct Contact  Touching  Biting  Kissing  Sexual Contact  Droplet Spray
  9. 9. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Direct Contact (cont’d)  Prevention  Hand Hygiene  Aseptic Technique  Personal Protective Equipment (Gloves, Surgical Masks, Goggles, Gowns, Shoe Covers)
  10. 10. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Personal Protective Equipment
  11. 11. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Indirect Contact  Vehicle-borne Transmission by Contact with Contaminated Object  Prevention  Hand Hygiene, Excellent Cleaning  Stethoscope Cleaning  Clean Water/Food
  12. 12. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Indirect Contact (cont’d)  Vector-borne Transmission by Living Source Other Than Humans  Prevention  Insect Repellants  Rodent Control
  13. 13. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Airborne  Transmission by Particles Floating in Air  Inhaled or Deposited on Mucous Membranes  Prevention  High-efficiency Particulate Air (HEPA) Respirators
  14. 14. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Link 4: Portal of Entry  Entry into Susceptible Host
  15. 15. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Portals  Respiratory Tract  Skin  Mucous Membranes  Gastrointestinal Tract  Genitourinary Tract  Placenta
  16. 16. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Link 5: Susceptible Host  From Defense Breakdown
  17. 17. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Increased Risk  Very Young or Old Age  Malnourishment  Immuno-compromised  Chronic Disease  Stress  Invasive Procedures
  18. 18. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Link 6: Exit Portal  Route Infectious Agent Uses to Leave Host Who Has Become Reservoir for Infection
  19. 19. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Body’s Defense Mechanisms  Skin and Mucous Membranes  Cilia  Gastric Juices  Immunoglobulins  Leukocytes and Macrophages  Lysozymes
  20. 20. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Body’s Defense Mechanisms (cont’d)  Interferon  Inflammatory Response
  21. 21. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Inflammatory Response  Vascular Response  Inflammatory Exudate  Phagocytosis and Purulent Exudate
  22. 22. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Immune System  Body’s Final Defense Against Infection  Immune Cells and Lymphoid Tissue
  23. 23. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Infectious Disease Results When Immune System Protection Fails
  24. 24. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Localized Infection  Microbes in One Area  Pain, Redness, Swelling, Site Warmth
  25. 25. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Generalized Infection  Systemic Involvement  Signs and Symptoms  Headache, Muscle Aches, Fever, Anorexia  Sepsis  Infection That Has Spread to Bloodstream
  26. 26. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Laboratory Assessment  Gram’s Staining  Culture and Sensitivity  Antibody Test  CBC with Differential  Erythrocyte Sedimentation Rate
  27. 27. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Immunity Ability of Body to Protect Itself from Disease
  28. 28. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Immunity (cont’d)  Natural Immunity  Innate Immunity  Acquired Immunity
  29. 29. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Example of Infectious Disease  Mononucleosis
  30. 30. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Mononucleosis  Epstein-Barr Virus  Contagious (“Kissing Disease”)  Extreme Fatigue, Anorexia, Chills  Red Sore Throat, Headache, High Fever, Tonsils with a White Coating  Supportive Care
  31. 31. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Community Infection Control  World Health Organization  Centers for Disease Control and Prevention  Local Health Departments  Home Health Nurse
  32. 32. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Infection Control in Health- Care Agencies  Community-acquired Infection  Nosocomial Infection  Hand Hygiene
  33. 33. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Nosocomial Infections  Infection from Stay in Health-care Agency  Risk Factors  Host’s Condition  Multiple Antibiotic Therapy  High-risk Units
  34. 34. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Nosocomial Infections (cont’d)  Common Pathogens  Escherichia coli (E. coli)  Staphylococcus aureus  Pseudomonas aeruginosa
  35. 35. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Hand Hygiene  Before and After  Patient Contact  Glove Use
  36. 36. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Hand Hygiene (cont’d)  Wet Hands, Soap, Lather 15 Seconds  Interlace Fingers  Clean Nails Against Palms  Rinse with Fingertips Downward  Dry with Paper Towels  Turn off Faucet with Towel
  37. 37. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Asepsis  Freedom from Organisms  Medical Asepsis  Clean Technique  Surgical Asepsis  Sterile Technique
  38. 38. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Infection Prevention  Standard Precautions  Assume All Patients Infectious  Blood, Body Fluids, Body Substances  Hand Hygiene, Gloves, Gowns, Masks, Goggles, Face Shields
  39. 39. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Infection Prevention (cont’d)  Transmission-based Precautions  Specific Communicable Diseases  Used with Standard Precautions
  40. 40. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Example: Vancomycin-Resistant Enterococci
  41. 41. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Respiratory Tract Infection Prevention  Risk Factors  Invasive Tubes  Prevention  Oral Hygiene  Coughing and Deep Breathing  Ventilator-associated Pneumonia Bundles
  42. 42. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Genitourinary Tract Infection  Risk Factors  Urinary Catheters
  43. 43. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Genitourinary Tract Infection Prevention  Appropriate Use of Urinary Catheters  Intermittent Catheterization  Strict Aseptic Technique  Secure Tubing to Leg  Closed System  Drainage Bag Below Bladder Level
  44. 44. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Surgical Wound Infection Prevention  Sterile Technique for Dressing Changes  Monitor Wound
  45. 45. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Septicemia Prevention  Sterile Technique for Catheters  Uncontaminated Solutions  Report Indications Promptly
  46. 46. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Septicemia Indications  Fever  Tachypnea  Tachycardia  Hypotension  Elevated White Blood Cell Count
  47. 47. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Septicemia Treatment  Blood Cultures  Antibiotics  IV Drotrecogin alfa (Xigris)  Severe Sepsis
  48. 48. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Antibiotic-Resistant Infections  Methicillin-resistant Staphylococcus aureus (MRSA)  Difficult to Treat  High Mortality Rate  Treatment: Vancomycin Hydrochloride
  49. 49. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Antibiotic-Resistant Infections (cont’d)  Vancomycin-resistant Enterococci (VRE)  Difficult to Treat  Combination Antibiotic Therapy  Treatment  Quinupristin/Dalfopristin (Synercid)  Linezolid (Zyvox)
  50. 50. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Treatment of Infectious Diseases  Type of Organism Guides Drug Selection  Antibiotics: Bacterial Infections  Antivirals: Viral Infections  Antifungals: Fungal Infections
  51. 51. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Nursing Responsibilities  Check Allergies  Monitor Side Effects  Signs of Superinfection
  52. 52. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Patient Education  Take All Medication  Report Side Effects
  53. 53. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Risk for Infection  Acute Pain  Imbalanced Nutrition  Ineffective Protection  Deficient Knowledge
  54. 54. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Respiratory Tract Infections  Assessment  Signs and Symptoms  Sputum Culture  Nursing Diagnosis  Risk for Infection
  55. 55. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Gastrointestinal Tract Infections  Assessment  Signs and Symptoms  Dehydration  Stool Culture  Nursing Diagnosis  Risk for Infection
  56. 56. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition Genitourinary Tract Infections  Assessment  Signs and Symptoms  Urinalysis  Urine Culture  Nursing Diagnosis  Risk for Infection

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