Ch 30 - Infection Prevention And Management

Front 1

MDRO's

Back 1

Multidrug-resistant infectious organisms

Front 2

Normal Flora

Back 2

MO's that live on the skin, in the nasopharynx, GI tract and other body surfaces that normally pose no threat to the body

Front 3

Anatomic, Mechanical and Chemical Barriers

Back 3

- intact skin and mucus membranes
- chemical composition - skin, secretions
- normal flora use local nutrients and O2
- peristalsis
- secretion of specific substances - interferon

Front 4

Interferon

Back 4

nonspecific chemical inhibitor that is secreted by body cells in response to viral invasion

Front 5

WBC's

Back 5

White Blood Cells
- normal WBC count is 5,000 - 10,000 cells/mm3

Front 6

Granulocytes

Back 6

polymorphonuclear cells that contain granules of digestive enzymes
- neutrophils, eosinophils & basophils

Front 7

Agranulocytes

Back 7

mononuclear cells tht lack digestive enzymes
- monocytes, lymphocytes

Front 8

Inflammatory Response

Back 8

a nonspecific response to tissue injury that can be caused by microbial invasion or by mechanical, chemical, or heat injury. Inflammation attempts to limit an injury's extent. The blood vessels dilate, and plasma flows out of the capillaries into the irritated tissue

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Individual Factors
- Nonspecific Natural Defenses

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Heredity
Good hygiene practices
Good nutritional status
Immunization history

Front 10

Anatomical Barriers
- Nonspecific Natural Defenses

Back 10

Intact skin
Intact mucous membranes

Front 11

Mechanical Removal of Microorganisms
- Nonspecific Natural Defenses

Back 11

Gastrointestinal motility
Ciliary action in the respiratory tract
Cleansing effect of urine's flow
Expulsive effect of coughing and sneezing
Lavaging effects of tears and saliva
Shedding of uterine lining in menstruation
Flow of organ secretions through ducts (e.g., bile)

Front 12

Chemical Factors
- Nonspecific Natural Defenses

Back 12

Acidity of gastric secretions, vaginal secretions, and fatty acids of the skin
Lysozyme enzymes in tears, nasal secretions, urine, and saliva
Hormones secreted by the adrenal cortex and pancreas
Indigenous microflora (competition)

Front 13

Local Tissue Factors
- Nonspecific Natural Defenses

Back 13

Tissue surface receptor (occupancy)
Inflammation

Front 14

White Blood Cell Function
- Nonspecific Natural Defenses

Back 14

Fever
Phagocytosis

Front 15

Acquired Specific Defenses

Back 15

Cellular immunity (T lymphocytes elaborate killer cells and helper cells)
Humoral immunity (B lymphocytes produce antibodies to specific microorganisms)
Memory of the organisms produces lasting immunity

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5 Signs of Local Inflammation

Back 16

* Erythema (redness) from blood accumulation in the dilated capillaries
* Warmth from the heat of increased blood flow
* Edema (swelling) from fluid accumulation
* Pain from pressure or injury to the local nerves
* Functional impairment from edema and/or pain

Front 17

Pus
- how formed - mmm

Back 17

Inflammation and phagocytosis work together to contain microorganisms. If these processes are successful, a collection of dead leukocytes, digested bacteria, dead tissue cells, and plasma may form into the material called pus.

Front 18

Systemic Responses due to Inflammation

Back 18

increased WBC production, fever, fatigue, muscle aches, and loss of appetite.
- Due to the rise in body temperature and metabolic rate, the client may also experience an increase in pulse and respiratory rate.
- Fatigue, muscle aches, and loss of appetite are a result of increased energy expenditures to support the inflammation process

Front 19

Fever

Back 19

The hypothalamus raises the body's thermostat in response to pyrogens released by some phagocytic cells (macrophages) after stimulation by microorganisms or endotoxins .
- The rise in temperature increases cell metabolism.
- body temperature greater than 38.2°C [101°F]

Front 20

Endotoxins

Back 20

toxins released by the immunogenic part of the bacterial cell wall of gram-negative bacteria, which triggers an immune response
- these effects decrease with elevated temp

Front 21

Antigens

Back 21

foreign particles, such as microbes, that enter a host. In some cases, such as in autoimmune diseases, the immune system senses or recognizes the person's own cells as antigens.
- Portions of digested microbes, antigenic particles, stay with the phagocyte and are carried to the lymphoid tissue in the lymph node or the spleen

Front 22

T & B Lymphocytes & Memory Cells

Back 22

immune system conveys lasting resistance to infection by forming a “memory” of the antigen
- accumulate in lymph nodes along lymphatic vessels and are exposed to all antigens except those that enter the bloodstream directly

Front 23

Cellular Immunity
-

Back 23

stimulated by fungi, protozoa, bacteria and some viruses
- At the site, the lymphocytes produce proteins called lymphokines that draw more phagocytes to the area, keeping them there to fight the invader and increasing their killing power. Lymphokines disappear after the antigen has been eliminated.
- Some T cells, however, remain in the tissues and keep a memory of the antigen

Front 24

Humoral Immunity
- in the blood stream

Back 24

- Antibodies - specific resistance
- Complement System - aid in antigen-antibody response

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Antibodies
- also called Immunoglobulins

Back 25

- produced by B-Lymphocytes which make Plasma Cells that produce antibodies
- make bacteria more susceptibal to phagocytosis, help in bacterial cell lysis, neutralize virus, cause microbes to clump together or precipitate, and make easier to digest for phagocytes

Front 26

Active Immunity

Back 26

produced when the immune system is stimulated (artificially or naturally) to produce antibodies
- vaccinations

Front 27

Vaccination

Back 27

process of injecting weakened or killed organisms into a person, stimulating antibody production
- artificially acquired active immunity

Front 28

Passive Immunity

Back 28

woman to fetus by placenta
woman to baby through breastmilk
- provides temporary protection

Front 29

Newborn/Infant Immunity

Back 29

not fully operational till 6 mo old
- difficulty localizing infections
- viral diseases can cause severe widespread disease

Front 30

Toddler/Preschooler Immunity

Back 30

childhood vaccinations are timed to take advantage of developing immunocompetence
- Respiratory Tract Infections are most common
- Middle ear infections common because nasopharynx to ear canal passage is shorter and straigher

Front 31

Child/Adolescent Immunity

Back 31

skin diseases (impetigo, roundworm, lice)
- high incidence of streptococcal infections
- STD's - Trichomonas Vaginalis, HPV, chlamydia, herpes simplex, syphilis, gonorrhea & AIDS are epidemic in adolescents

Front 32

Adult/ Older Adult Immunity

Back 32

Fewer Respiratory Tract infections, but more Chronic lung diseases
- STD's
- Thymus shrinks --> decline in cell-mediated & humoral immunity
- skin thins, pH changes, secretions slow, flora change, reflexes slow, urine retention

Front 33

Opportunistic Infections

Back 33

even normal flora can cause disease under the right circumstances
- "in right place at the right time"

Front 34

Bacteria

Back 34

Gram-Positive/Negative
Anaerobes-require reduced O2

Front 35

Exotoxins

Back 35

able to easily move into healthy tissue and cause injury

Front 36

Endotoxins

Back 36

potent poisons that can cause hemorrhagic shock when large amounts are release into the blood

Front 37

Viruses

Back 37

A virus invades a living cell many times its size, uses the cell's metabolism, and replicates itself while destroying the cell or changing the cell's genetic makeup.

Front 38

Fungi

Back 38

are often normal flora of skin
- antibiotics can contribute to fungal infections by killing bacterial flora

Front 39

Parasites

Back 39

protozoa,helminths or arthropods
-Trichomoniasis, malaria, pinworms, fleas
Arthropods serve as vectors for some protozoal and/or bacterial infections

Front 40

Compromised Host

Back 40

Before an infectious process becomes a disease, a breakdown or impairment must occur in the physical and chemical barriers to bacterial colonization, the inflammatory and febrile response, and the response of the WBCs, including those involved in immunity

Front 41

Breaks in Skin and Mucous Membranes

Back 41

can be altered by natural and therapeutic processes
- infant and elderly skin is thin and more easily broken or penetrated

Front 42

Invasive Devices

Back 42

provide a portal of entry for microorganisms

Front 43

Stasis of Body Fluids

Back 43

provide a warm, moist environment that fosters bacterial growth
- cough & sneezing
- smoking
- tumors or obstructions
-urinary stasis

Front 44

Inadequate Nutrition

Back 44

malnutrition depresses almost every normal defense to body infection
- inadequate protein stores decrease the body's ability to manufacture antibodies and WBCs

Front 45

Stress and Hyperglycemia

Back 45

Physical or emotional stress causes the body to release cortisol, which can increase the risk of infection by suppressing the immune response. Cortisol increases the level of serum glucose, providing a good medium for bacterial growth

Front 46

Immune System Dysfunction

Back 46

AIDS
Cancer

Front 47

Coexisting Medical Problems

Back 47

Cancer- increases risk of infection
inflammatory disorders
cardiovascular conditions
WBC transport

Front 48

Chemotaxis

Back 48

factors that attract neutrophils and circulating macrophages to the site of infection

Front 49

Drug Therapy

Back 49

can cause defects in the host's response to infection. Steroids, chemotherapy, antimetabolites, and inappropriate or prolonged use of antibiotics can increase the risk of infection.

Front 50

Superinfection

Back 50

a new infection caused by an organism different from an initially infecting organism and usually resistant to treatment

Front 51

Clinical Disease

Back 51

condition when an obvious complex of symptoms occurs, the infection

Front 52

Subclinical Disease

Back 52

condition when the body successfully resists being overwhelmed by the infection

Front 53

Colonization

Back 53

introduction of microorganisms onto a body surface where they grow and multiply but do not invade the body or cause an immune response or symptoms

Front 54

Primary Infection

Back 54

occurs in an otherwise healthy person

Front 55

Secondary Infection

Back 55

develops in a weakened client

Front 56

Systemic Infection

Back 56

spreads to other body systems

Front 57

Localized Infection

Back 57

a single body area is affected

Front 58

Bacteremia

Back 58

bacteria spread through the bloodstream

Front 59

Septicemia

Back 59

the presence of microorganisms (or their toxic products) in the bloodstream that are disrupting normal body functions

Front 60

Blood Poisoning

Back 60

common term for the presence of infectious agents such as Staphylococcus or Streptococcus in the blood

Front 61

Acute Infection

Back 61

usually develops rapidly, causes symptoms, climaxes, and then fades fairly quickly
- can become chronic if body cannot rid itself of the organism

Front 62

Chronic Infection

Back 62

can linger; symptoms develop slower that acute I's, and convalescence may take many months

Front 63

Nosocomial Infection

Back 63

hospital acquired

Front 64

HAI

Back 64

healthcare associated infection
- any infection associated with healthcare delivery
- often result from poor hand hygiene and invasive procedures
- frequently occur in nursing homes, jails and residential facilities

Front 65

Progress of an Infection

Back 65

disease results from organisms multiplication and growth within the host

Front 66

Communicable Period

Back 66

time frame during which a disease can be passes from one person to another

Front 67

Stages of Communicable Period

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*Incubation - entrance of host till appearance of symptoms
*Prodromal - nonspecific symptoms
*Acute - specific symptoms occur
*Convalescent - body systems return to normal

Front 68

Communicable Disease

Back 68

the causative agent of the disease is transmissible between one person and another

Front 69

Contagious Disease

Back 69

the agent passes with ease from one host to the next

Front 70

Latent Disease

Back 70

the agent is not present in body secretions but is hidden within the host's cells
- Latent Period- time between exposure and first signs of infection

Front 71

Latent Period

Back 71

usually shorter than incubation period
- infected person usually shedding microorganisms before any signs/symptoms occur
- all body secretions should be considered infectious

Front 72

Malaise

Back 72

general sense of feeling not completely well

Front 73

Hyperpyrexia

Back 73

A temperature elevation above 38.2°C is considered a high-grade fever, and a temperature greater than 40.5°C (104.9°F)

Front 74

Low-Grade Fever

Back 74

a temperature that is slightly elevated (37.1°C to approximately 38.2°C [98.8°F to 100.6°F])

Front 75

Very Young Children and Older People with Fever

Back 75

very young children tend to produce high fevers with infection (up to 40°C [104°F]). Conversely, older people may not develop a fever or may produce only a low-grade fever when infection is present. Therefore it is important with this population to observe for other signs of infection, which may include acute confusion.

Front 76

1st Postoperative day with Fever

Back 76

During the first postoperative day, an elevated temperature is most likely caused by the physiologic stress of surgery or by atelectasis.

Front 77

Fever during the second to fifth postoperative day

Back 77

most likely results from pneumonia.

Front 78

A fever on the second to eighth postoperative day

Back 78

suggests UTI.

Front 79

One occurring from the third to the eleventh postoperative day

Back 79

often suggests a wound infection.

Front 80

A fever developing weeks or months after surgery

Back 80

may suggest a deep operative infection or infected prosthetic device.

Front 81

Phases of Febrile Episodes

Back 81

*Chill - feeling cold, shivers, goosebumps, pale
*Fever - higher set point, skin feels warm, appears flushed/vasodilation, client does not feel hot or cold
*Flush/Crisis - profuse diaphoresis, decreased shivering, flushed and warm skin

Front 82

Pulse & Respiratory Rate w/ Infection

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Infection increases the body's metabolic rate, which increases the heart rate. The pulse may become bounding. The rate and depth of respiration also increase as the body attempts to rid itself of excess waste produced during increased metabolism.

Front 83

Purulent Drainage

Back 83

increased numbers of WBCs, body fluids such as urine or sputum may become cloudy or whitish-yellow

Front 84

Abscesses

Back 84

occur when the body attempts to localize infection by walling off the purulent drainage.

Front 85

Normal Pattern Identification

Back 85

Ask the client or caregiver about measures that are normally taken to avoid illness, including the client's usual pattern of rest and exercise, nutrition, use of vitamins, herbs, and folk remedies, and understanding of germ exposure

Front 86

Common Studies in Initial Blood Workup for Infection

Back 86

* Complete blood count including hemoglobin, hematocrit, and WBC count
* Urinalysis
* Erythrocyte sedimentation rate (ESR or sed rate)

Front 87

Physical Assessment for Infection

Back 87

*General Inspection
*Vital Signs
*Auscultation of Breath Sounds
*Auscultation of Bowel Sounds
*Palpation of Lymph Nodes
*Sepsis Surveillance

Front 88

Bands

Back 88

If the infection is severe or prolonged, the body cannot manufacture neutrophils quickly enough, resulting in the release of immature granulocytes (also called bands) into the blood

Front 89

Leukocytosis

Back 89

A rise in circulating WBCs above the normal adult range of 5000 to 10,000 cells/mm3

Front 90

Neutrophils

Back 90

normally comprise about 50% to 70% of all WBCs. Their numbers increase during infection

Front 91

Shift to the Left

Back 91

increase in the # of bands

Front 92

Neutrophil counts below 2000/mm3

Back 92

often are associated with cancer or chemotherapy
- greatly increase infection risk

Front 93

Clients who cannot produce more WBCs in response to an infection

Back 93

malnourished, elderly, immunosuppressed, or individuals taking steroids, In such cases, the absence of an increase in total WBCs or a lack of clarity on the differential count does not rule out infection.

Front 94

Erythrocyte Sedimentation Rate

Back 94

measures, in millimeters per hour, the rate at which RBCs settle in unclotted blood

Front 95

Lactate Level

Back 95

a byproduct of metabolism that is usually metabolized in the liver. Normal levels are 0.3 to 2.6 mmol/L.
- Obtaining a serum lactate level is essential to identify tissue hypoperfusion in clients who are not yet hypotensive but who are at risk for septic shock. All clients with lactate values of more than 4 mmol/L should be treated with the Severe Sepsis Resuscitation Bundle

Front 96

Serology Tests

Back 96

detect antigen-antibody reactions

Front 97

Culture, Sensitivity and Minimum Inhibitory Concentration

Back 97

specimens obtained from:
blood
sputum
stool
throat
wound exudate
urine
spinal, joint, pleural or other body cavity fluids

Front 98

Minimum Inhibitory Concentration
MIC

Back 98

- quantifies the minimal amount of the drug that is necessary to inhibit microbial growth in the laboratory

Front 99

Blood Cultures

Back 99

usually obtained from two separate venipuncture sites
- don't use indwelling catheter

Front 100

Sputum Culture

Back 100

- from productive cough
- should not contain saliva or postnasal drip
- ideally collected in am before client eats

Front 101

Wound Cultures

Back 101

taken when signs of purulent drainage

Front 102

Stool Culure

Back 102

look for leukocytes, eggs, moving organisms, enteric bacterial or fungal pathogens

Front 103

Urinalysis

Back 103

routinely examined to check for kidney and endocrine function and to identify the presence of UTI. Urinalysis provides information about the color, pH, specific gravity, and presence of protein, glucose, and ketones in the urine.

Front 104

Therapeutic Drug Monitoring

Back 104

used to determine a drug's concentration in blood

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Nephrotoxicity

Back 105

renal damage

Front 106

Ototoxicity

Back 106

eighth cranial nerve damage

Front 107

Peak Level

Back 107

highest level of drug concentration
- soon after administered

Front 108

Trough Level

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lowest level of drug concentration
- just before next dose

Front 109

Diagnostic Imaging

Back 109

Chest Radiographs
Endoscopic Procedures
CT/CAT- computerized axial tomography
MRI - Magnetic Resonance Imaging

Front 110

Planning for Nursing Interventions for Infection

Back 110

* Controlling the spread of infection
* Providing education to modify risk behaviors
* Supporting normal defense mechanisms and behaviors that prevent infection
* Reducing or eliminating the adverse effects of infection on functional abilities
* Detecting behaviors that increase the potential for infection
* Participating in community planning and activities for infection prevention

Front 111

Client Goals and Outcome Criteria

Back 111

Client goals and outcome criteria focus on preventing infections, increasing knowledge about infection and the treatment, controlling fever and related discomforts, and minimizing potential complications

Front 112

Protection of Skin and Mucus Membranes

Back 112

prevent excess dryness
thoroughly dry all areas
avoid trauma, excessive heat, harsh chemicals, friction

Front 113

Vaccinations are contraindicated when:

Back 113

in clients with immunodeficiency states, allergy to eggs, or previous allergic reactions. Clients should not receive live vaccines during pregnancy, acute debilitating disease, or periods of severe malnutrition.