Med-Surg: Chapter 21: Coordinating Care for Patients with Multidrug-Resistant Organism Infectious Disorders

Question 1

What is needed for a pathogen to cause a disease?

Answer 1

• a susceptible host

- mode of transmission

Question 2

Routes of Transmission

Answer 2

• contact
• airborne
• vehicle
• vector

Question 3

Who is a susceptible host?

Answer 3

has a weakened immune system or has had a breakdown in the body’s defense mechanism

Question 4

Contact Transmission

Answer 4

when a person or object comes in contact with a pathogen

• direct: person to person
• in-direct: microorganisms spread from a source to a susceptible host by passive transfer from an inanimate object or fomite, an object or substance capable of carrying an infectious organism

Question 5

Airborne Transmission

Answer 5

pathogens are carried through the air

Question 6

Vehicle Transmission

Answer 6

indirect mode of transmission

-a disease carrying agent touches a person’s body or is ingested

Question 7

Vector Transmission

Answer 7

indirect mode of transmission

-when a vector, an organism that transmits a pathogen, bites or infects a person

Question 8

Nosocomial Infections

Answer 8

infections that are acquired in the hospital and were ot present on admission

Question 9

What is a common cause to nosocomial infections?

Answer 9

Multidrug-resistant (MDR) Organisms

Question 10

Examples of Multidrug-resistant (MDR) Organisms that cause nosocomial infections

Answer 10

• Methicillin-resistant Staphylococcus aureus (MRSA)
• Vancomycin-resistant Enterococci (VRE)
• Clostridioides difficile (C. diff)
• Acinetobacter baumannii
• Carbapenem-resistant Enterobacteriaceae (CRE)

Question 11

Colonized

Answer 11

the host carries the bacteria without active infection

Question 12

Best Treatment of MDR organism

Answer 12

prevention- hand washing

Question 13

Clostridioides and Handwashing

Answer 13

• alcohol-based hand sanitizers do not kill C. diff but just displace spores
• must use soap and water

Question 14

Patients in healthcare setting who are either colonized or infected with MDR organisms are placed on?

Answer 14

Contact isolation precautions

-placed in private rooms when available or placed in a room with other patients colonized or infected with same organism

Question 15

Contact Isolation Precautions

Answer 15

reduce patient-to-patient spread of the organism within the hospital

• wearing gowns and gloves on entry to room
• removing gown and gloves prior to exiting
• perform hand hygiene before exiting

Question 16

Isolation Precautions

Answer 16

• must be used for patients with MRSA, VRE, C. diff, Acinetobacter, and CRE
• hand hygiene must be performed before healthcare workers put on isolation gowns and gloves
• isolation gowns must be secured at the neck and waist to effectively prevent bacteria transmission
• isolation gowns and glove must be removed before leaving the room
• hand hygiene performed before leaving the room

Question 17

Discontinue criteria of contact isolation for patients with MRSA

Answer 17

• may occur when clearance of the organism has been documented with 3 or more surveillance tests
• retesting patients to document clearance is one 3 to 4 months after the last positive test result

Question 18

Antibiotic Treatments for MRSA

Answer 18

• Vancomycin
• Linezolid
• Clindamycin (for CAMRSA)
• Sulfamethoxazole/Trimethoprim (Bactrim) (for CAMRSA)

Question 19

Antibiotic Treatment for VRE

Answer 19

Quinupristin-dalfopristin

Question 20

Antibiotic Treatment for C. diff

Answer 20

• Metronidazole
• Vancomycin
• Probiotics

Question 21

Antibiotic Treatment for Acinetobacter

Answer 21

• Ampicillin-sulbactam
• Tobramycin
• Doxycycline

Question 22

Antibiotic Treatment for CRE

Answer 22

Ceftazidime-avibactam

Question 23

Clinical Manifestations seen with MDR organism infections are consistent with typical signs of infection:

Answer 23

• fever
• tachycardia
• tachypnea
• hypovolemia

Question 24

Prominent manifestation of C. diff

Answer 24

diarrhea

Question 25

Prominent Manifestation of MRSA

Answer 25

wound infections can be red, warm, with purulent drainage

Question 26

Nursing Assessments

Answer 26

- Vital Signs - Oxygen Saturation - Pain - Skin turgor and mucus membranes - Urine output - Wound or surgical sites - Bowel movement frequency and consistency - Skin integrity - Laboratory Tests (WBC count, Serum creatinine, Electrolyte and albumin levels)

Question 27

Assessments: Vital Signs

Answer 27

- increased body temperature is an immune response to an infection - a persons body temperature rises to try to kill the bacteria or virus causing the infection - increased heart rate due to fever and metabolic rate increases or hypovolemia - tachypnea secondary to pneumonia from infection with MDR organism; secondary to fever, which increases metabolic rate, which then increases work of breathing - low blood pressure (hypotension) may indication vasodilation due to systemic infection and hypovolemia - hypovolemia secondary to fluid loss from C. diff diarrhea

Question 28

Assessment: Oxygen Saturation

Answer 28

decreased oxygen saturation can = pneumonia caused by MDR organism

Question 29

Assessment: Pain

Answer 29

fifth vital sign - monitor for increased pain - increased pain = sign of infection caused by MDR organism - pain may result from fever

Question 30

Assessment: Skin Turgor and Mucous Membranes

Answer 30

-decreased skin turgor and dry mucous membranes can result from dehydration secondary to a C. diff infection

Question 31

Assessment: Urine Output

Answer 31

- decreased urine output = dehydration; can occur secondary to C. diff diarrhea or may indicate presence of a systemic infection with MDR organism - can be an adverse side effect of antibiotics

Question 32

Assessment: Wound or Surgical Sites

Answer 32

-an infected wound may be red, swollen, painful, warm to touch, and have purulent drainage

Question 33

Assessment: Bowel Movement Frequency and Consistency

Answer 33

- increased bowel movement frequency can result in dehydration - in C. diff infection, the bacteria proliferate and cause the release of toxins, resulting in an inflammatory response in the colon, which causes fluid to be secreted into the colon, resulting in diarrhea

Question 34

Assessment: Skin Integrity

Answer 34

-monitor skin integrity to assess for skin breakdown or incontinence-associated dermatitis (IAD) secondary to C. diff diarrhea

Question 35

Assessment: Lab Tests: WBC count

Answer 35

- increased WBC count part of immune response | - large increase in WBCs occurs in C. diff infections

Question 36

Assessment: Lab Values: Serum Creatinine

Answer 36

- increased when dehydrated | - increased when has an adverse reaction to antibiotic treatment, signaling decreased renal function

Question 37

Assessment: Lab Values: Electrolyte and Albumin Levels

Answer 37

-may be decreased or increased secondary to dehydration from C. diff infection or any MDR organism infection

Question 38

Nursing Actions

Answer 38

- Hand hygiene - Place patient on contact-isolation precautions - Administer medications (antibiotics, fever reducers, pain medication) - Administer IV fluids or encourage to drink fluids - Administer supplemental oxygen (increase O2 sat secondary to MDR pneumonia) - Administer chest physiotherapy (to mobilize secretions in patients with MDR pneumonia and increase O2 sat) - Encourage early mobilization (decrease risk of atelectasis secondary to MDR pneumonia and promote overall health) - Stop administration of causative antimicrobial agent with a C. diff infection (to stop/decrease C. diff-associated diarrhea) - Perform wound care as ordered - Cleanse perineum and apply moisture barriers - Use fecal diversion or containment systems in the stool-incontinent patient (to prevent skin breakdown and increase comfort in C. diff patients) - Encourage family visits and use of telephone and TV

Question 39

Teaching

Answer 39

- Contact-isolation precautions - Hand-washing - Take antibiotics as prescribed; finish the course of antibiotics to prevent the reoccurrence of MDR infections - Clinical manifestations of infection - Sun protection; some antibiotics create sun sensitivities; wear sunscreen, avoid prolonged sun exposure, and appropriate covering clothing