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Med/Surg-Infection
Infection
| Question | Answer |
|---|---|
| chain of infection steps | pathogen reservoir portal of exit means of transmission portal of entry new host |
| type of precaution for TB, varicella, measles, and other _____ pathogens; negative pressure room with door closed; health care providers should wear an N-95 respirator (mask) at all times when in the room | airborne precautions |
| type of precaution used for organisms transmitted by close contact with respiratory or pharyngeal secretions: influenza, meningococcus; wear a face mask but door may remain open; transmission is limited to close contact | droplet precautions |
| type of precaution used for organisms spread by skin-to-skin contact (ie ATB-resistant organisms or C. diff); masks not needed | contact precautions |
| a common cause of HAIs; the spore is relatively resistant to disinfectants and can be spread on the hands of health care providers after contact with equipment previously contaminated; spores are resistant to alcohol | C. difficile |
| Nursing Process: Infection. Goals? | -Prevention of spread of infection -Increased knowledge about the infection and Tx -Control of fever and related discomforts -Absence of complications |
| Nursing Process: Infection. Interventions? | -Preventing spread of infection (handwashing, standard precautions, recognition of mode of transmission, establishment of transmission-based precautions) -Education about infectious process and prevention of spread of infections -Assess/Tx of fever |
| possible reactions that might occur following an MMR vaccination | fever, transient lymphadenopathy, or hypersensitivity reaction |
| incubation period for chickenpox? when is a pt with chickenpox no longer contagious? | 10-21 days; when lesions have crusted |
| when should varicella vaccine be held? | -severely depressed immune function -pregnant -moderate or severe concurrent illnesses -allergy to the vaccine |
| Zostavax, a vaccine to reduce the risk of shingles, is recommended for people older than ___ years of age because it reduces the risk of shingles by approximately 50% | 60 |
| what age group is more susceptible to influenza? | older adults |
| disease? skin symptoms are initially mistaken for spider or bug bites; this type of infection can cause serious skin and soft tissue infections, pneumonia, and, in rare cases, death | CA-MRSA |
| prevention of CLABSI: bundle approach | -hand hygiene -max. barrier precautions -chlorhexidine skin antisepsis -optimal catheter site selection (w/avoidance of femoral vein for central venous access) -daily review of line necessity w/prompt removal of unnecessary lines |
| common site of acquired infection | lower urinary tract |
| community-acquired infection; common in young women and not usually recurrent | uncomplicated lower or upper UTIs |
| often acquired in hospital and r/t urinary catheterization; occurs in pts w/urologic abnormalities, pregnancy, immunosuppression, diabetes, and obstructions; often recurrent | complicated lower or upper UTIs |
| pathophysiology of a lower UTI | bacteria: gain access to bladder, colonize epithelium of urinary tract, avoid being washed out with voiding, evade host defense mechanisms, initiate the inflammatory process |
| many UTIs are caused by? | fecal organisms ascending from the perineum to the urethra/bladder and then adhering to the mucosal surfaces |
| How does urethrovesical reflux contribute to UTIs? | With coughing, sneezing, or straining, bladder pressure increases, which may force urine from bladder into urethra. When pressure returns to normal, urine flows back into bladder, bringing into bladder bacteria from the anterior portions of the urethra. |
| How does ureterovesical (or vesicoureteral) reflux contribute to UTIs? | When the ureterovesical valve is impaired by congenital causes or ureteral abnormalities, the bacteria may reach the kidneys and eventually destroy them. |
| What three ways can bacteria enter the urinary tract? Which one is the most common? | -transurethral route (ascending infection) (most common) -bloodstream (hematogenous spread) -by means of a fistula from the intestine (direct extension) |
| S/Sx of uncomplicated lower UTI? | -burning on urination -urinary frequency -urgency -nocturia -incontinence -suprapubic or pelvic pain -hematuria and back pain may also be present |
| -S/Sx of complicated UTI? -Caused by narrow or broad spectrum of organisms? -Higher or lower response rate to Tx? -Do they tend to recur? | -range from asymptomatic bacteriuria to gram-negative sepsis with shock -are often caused by a broader spectrum of organisms -lower response rate to Tx -tend to recur |
| most common infection of older adults and increases in prevalence with age | UTI |
| early Sx of UTI in older adults | -burning -urgency -fever -some develop incontinence and delirium |
| Nursing Process: UTIs. Nursing diagnoses? | -Acute pain r/t infection -Risk for fluid volume deficit -Deficient knowledge about: Factors predisposing patient to infection and recurrence; Detection and prevention of recurrence; Pharmacologic therapy |
| nursing interventions for UTIs | -meds as prescribed: ATBs, analgesics, antispasmodics -apply heat to perineum to relieve pain and spasms -increased fluid intake -avoidance of UT irritants (coffee, tea, citrus, spices, cola, ETOH) -frequent voiding -wiping front to back |
| bacterial infection of the renal pelvis, tubules, and interstitial tissue of one or both of the kidneys; causes: upward spread of bacteria or systemic sources reaching the kidneys via the bloodstream; may be acute or chronic | pyelonephritis |
| most common cause of recurrent UTIs in older adult males | chronic bacterial prostatitis |
| (some) risk factors for UTIs | female, diabetes, pregnancy, neurologic disorders, gout, incomplete emptying of bladder, urinary stasis, immunosuppression, inability/failure to empty bladder completely, catheterization, cystoscopic procedures, obstructed urinary flow |
| factors that may contribute to UTIs in older adults | cognitive impairment, frequent use of antimicrobial agents, high incidence of multiple chronic medical conditions, immunocompromised, immobility and incomplete emptying of bladder, obstructed flow of urine |
| acute viral infection; occurs as an epidemic, usually in the fall and winter months; periodically causes worldwide epidemics; older adults are more susceptible | influenza |
| epidemic of an influenza virus that spreads on a worldwide scale and infects a large proportion of the world population; examples: H1N1, H5N1 | pandemic influenza |
| most common infectious cause of lower leg edema; can occur as a single isolated event or a series of recurrent events; sometimes misdiagnosed as recurrent thrombophlebitis or chronic venous insufficiency | cellulitis |
| S/Sx: edema, pain, localized redness, warmth, systemic signs (fever, chills, sweating), lymph node tenderness/enlargement | cellulitis |
| patho: break in skin and bacteria enters, toxins are released into the SQ tissue; pathogen is typically either Streptococcus species or Staphylococcus aureus | cellulitis |
| medical management: mild cases can be treated outpatient with PO ATB therapy; severe cases need IV ATBs; need to identify site of bacterial entry | cellulitis |
| nursing management: elevate extremity above heart; cool/moist packs followed by warm/moist packs when swelling resolves; educate on prevention and recurrence; reinforce education about skin and foot care (esp pts w/peripheral vascular disease or diabetes) | cellulitis |
| types of conjunctivitis | microbial (bacterial, viral), allergic, toxic |
| coagulated exudate that adheres to the surface of the inflamed conjunctiva | pseudomembranes |
| exudate adheres to the superficial layer of the conjunctiva, and removal results in bleeding | true membranes |
| multiple, slightly elevated lesions encircled by tiny blood vessels; look like grains of rice | follicles |
| hyperplastic conjunctival epithelium in numerous projections that are usually seen as a fine mosaic pattern under slit-lamp examination | papillae |
| type of conjunctivitis: can be acute or chronic; most common causative microorganisms are Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus | bacterial conjunctivitis |
| S/Sx: eye redness, burning, discharge (purulent in severe form, mucopurulent in mild cases); exudate upon waking (eyes may be difficult to open because of adhesions caused by the exudate); pseudomembranes may be present | bacterial conjunctivitis |
| an infectious disease caused by the bacterium Chlamydia trachomatis, an ancient disease and the leading cause of preventable blindness in the world | trachoma |
| type of conjunctivitis: can be acute or chronic, watery discharge, prominent follicles, severe cases include pseudomembranes, common causative organsisms are adenovirus (highly contagious) and herpes simplex | viral conjunctivitis |
| S/Sx: usually preceded by URI, eye tearing, redness, foreign body sensation in eye(s), lid edema, ptosis, and conjunctival hyperemia; s/sx vary from mild to severe | viral conjunctivitis |
| a hypersensitivity reaction that occurs as part of allergic rhinitis (hay fever), or it can be an independent allergic reaction; S/Sx: extreme pruritis, epiphora (excessive tearing), severe photophobia | allergic conjunctivitis |
| can be the result of medications, chlorine from swimming pools, exposure to fumes among industrial workers, or exposure to other irritants such as smoke, hair sprays, acids, and alkalis | toxic conjunctivitis |
| medical management: depends on the type; mild and viral may not need Tx; more severe may need topical ATB eye drops/ointment; cold compresses | conjunctivitis |
| form of eye inflammation; affects the middle layer of tissue in the eye wall; warning signs often come on suddenly and get worse quickly; eye redness, pain and blurred vision; can affect one or both eyes | uveitis |
| inflammation of tissues around eye that may result from bacterial/fungal/viral inflammatory conditions of structures (ie-face, oropharynx, dental structures); can also result from foreign bodies and pre-existing ocular infection or sepsis | orbital cellulitis |
| most frequently seen in children; pathogens are most commonly bacterial or viral; S/Sx: otalgia (ear pain), fever, purulent exudate is usually present in middle ear (leads to hearing loss); Tx: ATB therapy, myringotomy (or tympanotomy) | acute otitis media |
| risk factors for acute otitis media | younger age, chronic URIs, medical conditions that predispose the patient to ear infections (e.g., Down syndrome, cystic fibrosis, cleft palate), chronic exposure to secondhand cigarette smoke |
| fluid in middle ear w/o evidence of infection; mostly seen after radiation therapy or barotrauma; Sx: hearing loss, fullness in ear, popping/crackling sounds; tympanic membrane appears dull, air bubbles may be seen in middle ear; no Tx unless infected | serous otitis media (or middle ear effusion) |
| result of recurrent acute otitis media; chronic infection damages the tympanic membrane, ossicle, and involves the mastoid; Tx: prevent by Tx of acute otitis media, surgery (tympanoplasty, ossiculoplasty, or mastoidectomy) | chronic otitis media |
| S/Sx: may be minimal w/varying degrees of hearing loss and foul-smelling otorrhea; pain w/acute mastoiditis; otoscopic exam may show perforation; cholesteatoma (white mass behind tympanic membrane or coming through to external canal from a perforation) | chronic otitis media |
| most common ear surgical procedure; reconstruction of the tympanic membrane (ossicles may also be required); reestablish middle ear function, close the perforation, prevent recurrent infection, and improve hearing | tympanoplasty |
| reconstruction of the bones of the middle ear; prostheses are used to reconnect the ossicles to reestablish sound conduction | ossiculoplasty |
| removal of diseased bone, air cells, and cholesteatoma to create a noninfected, healthy ear | mastoidectomy |
| inflammation of the lung parenchyma (functional lining) caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses | pneumonia |
| an inflammatory process in the lung tissue that may predispose or place the patient at risk for microbial invasion | pneumonitis |
| substantial portion of one or more lobes affected | lobar pneumonia |
| patchy distribution in lungs originating from one or more localized areas | bronchopneumonia |
| ______ and ______ are the most common causes of death from an infectious disease in the US (50,636 deaths in 2012); 1.1 million discharges from hospitals | pneumonia and influenza |
| pneumonia occurring in the community or ≤48 hours after hospital admission or institutionalization of pts who do not meet the criteria for health care–associated pneumonia (HCAP); rate increases with age | community-acquired pneumonia (CAP) |
| pneumonia occurring in a nonhospitalized pt w/extensive health care contact (LTC facility, home care, family member w/infection d/t MDR bacteria, etc); often difficult to treat d/t causative pathogens are often MDR | health care–associated pneumonia (HCAP) |
| pneumonia occurring ≥48 hours after hospital admission that did not appear to be incubating at the time of admission; most pts are colonized by multiple organisms | hospital-acquired pneumonia (HAP) |
| a type of HAP that develops ≥48 hours after endotracheal tube intubation | ventilator-associated pneumonia (VAP) |
| risk factors for pneumonia | advanced age, residency in LTC facilities, immunosuppression, malnutrition, underlying disorders/diseases (heart failure, diabetes, alcoholism, COPD, AIDS, influenza, cystic fibrosis) |
| S/Sx: poss. fever/shaking/chills/fatigue/myalgia; pleuritic CP; SOB/resp distress; orthopnea/crackles; cough (may be prod. w/purulent sputum); tachycardia/tachypnea; occ. HA, low-grade fever, rash, pharyngitis | pneumonia |
| diagnosing pneumonia is done by? | Hx (particularly of a recent resp tract infection), physical exam, CXR, blood culture (bacteremia occurs freq), sputum exam; bronchoscopy may be used for severe infection, chronic or refractory infection, and when a Dx cannot be made from specimen |
| how to obtain sputum sample | (1) rinse the mouth with water to minimize contamination by normal oral flora, (2) breathe deeply several times, (3) cough deeply, and (4) expectorate the raised sputum into a sterile container |
| pneumonia medical management | ATBs; supportive Tx (fluids, O2 for hypoxia, antipyretics, antitussives, decongestants, antihistamines); endotracheal intubation and mechanical ventilation may be required |
| pneumonia--nursing process: assessment | VS/pulse ox/ABGs; secretions (color/amt/odor/consistency); cough (freq/severity); tachypnea/SOB; ausc all lobes (any chest excursion/use of accessory muscles?); older adults--changes in mental status/fatigue/edema/dehydration/concomitant heart failure? |
| pneumonia nursing diagnoses | -Ineffective Airway Clearance -Fatigue and Activity Intolerance -Risk for Fluid Volume Deficit -Imbalanced Nutrition -Knowledge Deficit |
| ways to improve airway patency | encourage hydration, humidification, IS, chest physiotherapy, O2 if needed |
| ways to promote rest and conserve energy at first, but then increase activity as tolerated | promote rest and breathing but change positions frequently, elevate HOB |
| ways to promote maintenance of proper fluid volume | encourage PO fluids, possible IV fluids if ordered |
| ways to promote maintenance of adequate nutrition (r/t infections of lung) | promote nutritional supplements, electrolyte replacement drinks, and small frequent meals |
| patient education: treatment and prevention | provide education about cause of disease/disorder, management of symptoms, S/Sx that should be reported to the primary provider or nurse, and the need for follow-up |
| potential problems/complications of pneumonia | -continuing symptoms after initiation of ATB therapy -sepsis and septic shock -atelectasis -pleural effusion -delirium -severe complications: hypotension, shock, resp. failure |
| reduces the incidence of pneumonia, hospitalizations for cardiac conditions, and deaths in the older adult population; recommended for all adults 65 y.o. or older and 19 y.o. or older w/conditions that weaken the immune system | -pneumococcal vaccination -2 types: pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) |
| protects against 13 types of pneumococcal bacteria; recommended for all adults 65 y.o. or older as well as adults 19 years or older w/conditions that weaken the immune system (ie-HIV, organ transplantation, leukemia, lymphoma, severe kidney disease) | pneumococcal conjugate vaccine (PCV13, Prevnar-13) |
| protects against 23 types of pneumococcal bacteria; recommended for all adults 65 y.o. or older and for those adults 19-64 y.o. who smoke cigarettes or who have asthma; most pts who have previously received PCV13 should receive this vaccine | pneumococcal polysaccharide vaccine (PPSV23, Pneumovax-23) |
| Should adults 65 y.o. or older receive both PCV13 and PPSV23? | yes; should not be co-administered |
| pulmonary consequences resulting from entry of endogenous or exogenous substances into the lower airway; most common form is bacterial infection from inhalation of bacteria that normally reside in the upper airways | aspiration pneumonia |
| inhalation of foreign material into lungs; a serious complication that can cause pneumonia and result in: tachycardia, dyspnea, central cyanosis, hypertension, hypotension, and potentially death | aspiration |
| aspiration risk factors | seizure activity; brain injury; decreased LOC from trauma/drug/alcohol intox, excessive sedation, general anesthesia; flat body positioning; stroke; swallowing disorders; cardiac arrest |
| aspiration prevention | -HOB elevated >30 degrees -avoid stimulation of gag reflex w/suctioning or other procedures -check for placement before tube feedings -thickened fluids for swallowing problems |
| term? describes microorganisms present without host interference or interaction | colonization |
| term? the invasion and multiplication of microorganisms such as bacteria, viruses, and parasites that are not normally present within the body; may cause no symptoms and be subclinical, or it may cause symptoms and be clinically apparent | infection |
| term? the state in which the infected host displays a decline in wellness due to the infection | infectious disease |
| T or F? In recent years, there has been a decreased incidence of invasive HAIs with MRSA. | true; exact reasons for decline are unknown---likely that infection control efforts (especially those focused on reduction of bloodstream infections) and declining lengths of hospital stay are important factors |
| gram-positive bacterium, which is part of the normal flora of the GI tract, can produce significant disease when it infects blood, wounds, or the urinary tract | Vancomycin-resistant Enterococcus (VRE) **enterococcus is part of the normal GI flora |
| Health care workers should be immune to what diseases? (hint-titers are drawn to check for immunity; if not immune, then you receive the vaccine) | MMR, pertussis, tetanus, Hep B, varicella |
| most vaccines can be given at one visit; if vaccines have to be given at seperate visits, what length of time in between visits is recommended? | one month |
| more than ___ vaccines are currently licensed in the US | 50 |
| the two primary agencies involved in setting guidelines about infection prevention | WHO, CDC |
| the three primary microbes responsible for HAIs | C diff, MRSA, VRE |
| immunosuppressed adults should be vaccinated for ____ and ____ | pneumococcus, meningococcus |
| potential problems/complications of UTIs | kidney disease, sepsis (urosepsis), strictures, obstructions, renal failure |
| S/Sx: chills, fever, leukocytosis, bacteriuria, pyuria; low back/flank pain, N/V, HA, malaise, dysuria; pain/tenderness in area of costovertebral angle; in addition, Sx of lower urinary tract involvement (ie-urgency, frequency) are common | acute pyelonephritis |
| S/Sx: usually no Sx of infection unless an acute exac occurs; fatigue, HA, poor appetite, polyuria, excessive thirst, weight loss; persistent/recurring infection may produce progressive scarring of the kidney, resulting in chronic kidney disease | chronic pyelonephritis |
| most common site of a lower UTI | bladder (cystitis) |
| alpha-adrenergic agents (an antihypertensive) can cause bladder neck relaxation to the point of incontinence with a minimal increase in intra-abdominal pressure, thus mimicking stress incontinence; when does this stop? | as soon as the medication is d/c'd, the apparent incontinence resolves |
| what class of meds help alleviate Sx of urge incontinence? | anticholinergic agents |
| UTIs are often caused by what microbe? | E. coli |
| an infectious disease that primarily affects the lung parenchyma; may also be transmitted to other parts of the body (including the meninges, kidneys, bones, and lymph nodes); infects 1/3 of the global population ; chronic and recurrent | TB |
| a worldwide public health problem that is closely associated with poverty, malnutrition, overcrowding, substandard housing, inadequate health care, immunosuppressed populations (including HIV/AIDS), immigrants | TB |
| S/Sx are insidious; low-grade fever, cough (nonprod or mucopurulent), night sweats, fatigue, weight loss, hemoptysis; both the systemic and the pulmonary symptoms are chronic and may have been present for weeks to months | TB |
| -screening and diagnostic tests for TB? -what test confirms TB? | -PPD/Mantoux (indicates past exposure to M. tuberculosis or vaccination w/BCG vaccine) -CXR -QuantiFERON-TB Gold (serum blood test--signifies that pt has been infected w/TB and additional tests needed) -sputum culture (confirms diagnosis) |
| length of Tx for TB? | 6-12 months |
| resistance to one of the first-line anti-TB agents in people who have not had previous treatment | primary drug resistance |
| resistance to one or more anti-TB agents in patients undergoing therapy | secondary or acquired drug resistance |
| resistance to two anti-TB agents, isoniazid (INH) and rifampin; populations at greatest risk are those who are HIV positive, institutionalized, or homeless | multidrug resistance |
| nursing management/interventions of TB | -promoting airway clearance -advocating adherence to Tx regimen -promoting activity and nutrition -preventing transmission |
| diet for TB patient | -high in protein and calories -small frequent meals -liquid supplements |
| an accumulation of thick/purulent fluid within the pleural space, often w/fibrin development and a loculated area where infection is located | empyema |
| When a non functioning NG tube allows the gastric contents to accumulate in the stomach, a condition known as _____ may result. | silent aspiration |
| suspected when a subsequent infection occurs with another bacterium during ATB therapy | superinfection |
Created by:
nurse savage
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