Infection Flashcards
(87 cards)
1
Q
What is nosocomial infection?
A
Infection acquired after admission to a health care facility that was not present or incubating at the time of admission
2
Q
What is in the first line of defense?
A
Nonspecific Defenses
Skin, mouth, eye, respiratory tract, urinary tract, GI, vagina
Normal flow out unless normal flora disrupted.
3
Q
What is an infection?
A
- Invasion of body tissue by a microorganism and its subsequent proliferation there
- causes damage to host tissue
4
Q
What are ex of third line of defense?
A
- Lymphocytes
- antibodies
5
Q
What are ex of second line of defense?
A
- phagocytic wt blood cells
- antimicrobial proteins
- inflammatory response
6
Q
What are ex of first line of defense?
A
- skin
- mucous membranes
- secretions of skin and mucous membranes
7
Q
What are 2 body defenses against infection?
A
- Nonspecific defenses: protect prs againt all microorganisms regardless of prior exposure
- Specific defenses: r/t immune sys. Respond to foreign protein in the body called antigens
8
Q
Tissue injury caused by physical/chemical agent effects?
A
- Capillary widening => increased blood flow => heat
- Increased permeability => fluid release into tissues => redness
=> swelling - Attraction of leukocytes => extravasation of leukocytes to site of injury => tenderness
- systemic response => fever and proliferation of leukocytes => pain
9
Q
What initiates inflammatory response?
A
Damage to host cells => first response to injury
=> local response
10
Q
What are three phases of nonspecific defenses?
A
- Vascular and cellular responses
- Exudate production
- Reparative phase
11
Q
What is the vascular and cellular responses?
A
- Damaged cells release chemical
- Fluid and WBCs (phagocytes) leak into tissues (edema and elevated WBCs)
12
Q
What are the chemicals released in phase 1?
A
Histamine, bradykinin, prostaglandins
- b.v. to dilate
- more blood flow to injured area => redness, heat
13
Q
What causes pain in phase 1?
A
- Pressure of accumulating fluid on local nerve endings
- Stimulation of nociceptors by prostaglandins
14
Q
What consists of inflammatory exudate?
A
Inflammatory exudate => fluid escaped from b.v., dead and live phagocytic cells, dead bacteria, dead tissue cells
15
Q
What are the exudate production?
A
- Serous
- Serousanguinous
- Sanguinous
- Purelent.
16
Q
What happens in phase three?
A
Repair injured tissues
- Scar tissue formation and remodeling (
17
Q
What is collagen synthesis?
A
Ongoing to strengthen tissue
18
Q
What are clinical signs of inflammation?
A
- erythema/redness
- heat
- edema/swelling
- pain or tenderness
- exudate production (maybe
- loss of fct (if severe)
19
Q
What ex could cause loss of fct?
A
Edema or mucus production in airway => alter gas exchange => hypoxia
20
Q
What are the specific defenses?
A
Immune sys recognizes and respond to foreign proteins (antigens) in body
21
Q
How immune sys fct?
A
- Macrophages swallow dead, dying cells or bacteria
- leave behind parts of invading bacteria (antigens)
- Body attacks antigens
- B-lymphocytes (defensive WBCs) => make antibodies to attack
- T-lymphocytes (memory cells) go into action quickly if body encounter same bacteria.
- When antigens detect, B-lymphocyte produce antibodies
22
Q
What is active immunity?
A
Body make own antibodies in response to antigen
23
Q
What is natural active immunity?
A
From contact with the disease => dev of the disease
- Lifelong
24
Q
What is artificial active immunity?
A
Vaccination introduce disease => make antigen => stimualte immune sys => T-lymphocytes + antibodies but not produce disease
25
What is passive (acquired) immunity?
Provides temporary protection against disease-producing antigens
- Antibodies from one source transferred to host
26
What is natural immunity?
Antibodies from the immune mother through placenta or in colostrum
- Last 6 m to 1 y
27
What is artificial immunity?
Admin of antibodies from animal or other prs by injection
- Immune serum used as preventative measure after pathogen exposure to stop illness dev (rabies, hepatitis A)
- Last 2-3+ wks
28
What is a local infection?
- Not affect whole body
- Not in bloodstream
- Limited to outer surface of body (ex: infected wound)
- may be internal (pneumonia, UTI)
29
What is systemic infection?
Affect entire body of single organ or part
- Affect bloodstream
- Symptoms => whole body (pathogen thorughout whole body rather than concentrated in one area)
- may dev after failed treatment localized infection
- can be fatal
30
What is bacteremia?
Culture of prs blood => bacteria
31
Sepsis?
Bacteremia => systemic symptoms
32
What are clinical manifestations of local infection?
*inflammation & acute infection BUT inflammation not mean infection
- erythema/redness
- heat
- edema / swelling
- pain/tenderness
- may have exudate (purulent, pus)
- severe => loss of fct
- fever: only systemic symptom caused by local infection
33
What are clinical manifestations of systemic infection?
- Fever
- Fatigue
- Body aches
- Tachycardia and tachypnea
- N&V
- Anorexia
- Weakness, decreased energy
- Lymph nodes that drain the area of infection often become enlarged, swollen, and tender during palpation
34
What does infection in older adult entail?
- typical symptoms not present sometimes: fever, pain and swelling
Atypical: change in behaviour (new/increased confusion, incontinence or agitation)
Often dx when infection advanced
35
What are HAI?
pneumonia, surgical site infection, c.diff, UTI, catheter-related blood infection
36
What are predisposing factors to HAI?
- breakdown of barriers (surgery)
- foreign bodies (catheters)
- inhibit reflexes (cough, gag)
- antibiotic use
37
What are drug-resistant organisms?
- MRSA
- Pseudomonas and other Gram-negative rods (GNRS)
38
What is pneumonia?
Inflammation of the resp. bronchioles and alveoli.
39
What causes INFECTIOUS pneumonia?
- 2nd most common infection
Bacteria, virus
HAI
- contaminated resp. equipment
- aspirating normal inhabitants in the pharynx
- immuno-suppressive therapy
Community acquired
Opportunistic: organism => infection in immunocomprimised prs
40
What causes NON-infectious pneumonia?
Caused by aspiration of gastric contents
Aspiration pneumonia
Risk factor: tube feedings, dysphagia
41
How do organisms that cause pneumonia reach the lung?
1. Aspiration of secretions from nasopharynx or oropharynx. Microorganisms normal inhabitants of pharynx
2. Inhalation of microbes present in air
3. Hematogenous spread (carried in blood) from primary infection elsewhere in body
42
HA pneumonia?
Risk factors
Pathogenesis
Pathogens
Dx
Prevention
Risk factors: intubation, low gastric pH (bacterial overgrowth)
Pathogenesis: aspiration of GI/oral contents
Pathogens: MRSA, pseudomonas, GNRs
Dx: Clinical (fever, high WBC, hypoxia, x-ray)
Prevention: elevate head of bed > 30, drain subglottic secretions
43
What are clinical manifestations of pneumonia?
- fever/chills
- productive cough w/purulent sputum
- pleuritic chest pain (sharp localized chest pain that increases w/breathing and coughing)
- signs of pulmonary consolidation (lung tissue filled with liquid instead of air)
- decreased breath sounds
- crackles
44
What is diagnostic testing for pneumonia?
X-ray: determine extent and pattern of lung involvement
Sputum C&S: identifies infecting organism and determine most effective antibiotic therapy
45
What are nursing interventions to post-op pneumonia?
- mobilize (postural changes and ambulation):
- Fluids (liquefy secretions)
- DB&C (10x qh of inspiromete)
- Monitor VS, O2 stat, resp assessment
- resp support: correct hypoxia
- rest: decrease oxygen demand
- antimicrobial therapy
46
What are medications to treat pneumonia?
- antibiotics (broad-spectrum antibiotic ordered until results of C&S)
- bronchodilators: reduce bronchospasm and improve ventilation
- Mucomyst: break up mucus or reduce viscosity => easier to expectorate
- Analgesics for chest pain
- Antipyretic for fever
47
What are viral infections?
NOT respond to antibiotic => pt still receive antibiotic prescription
- Coloured sputum (yellow or green) => bacterial infection
48
What is a SSI?
Surgical site infection
- Wound infected w/microorganism during surgery or postop
- increase hospital stay, mortality, readmission rate for treatment
49
What causes SSI?
- pt own flora entering
- outside contamination
- malnutrition
- hyperglycemia
- smoking: reduce O2 to blood capacity => hypoxiemia risk
- prolonged pre-op stay
50
What is dehiscence?
Separation or splitting open layers of surgical wound
51
What is evisceration?
Extrusion of viscera or intestine through surgical wound.
52
What... for SSI?
Risk factors
Pathogenesis
Pathogens
Dx
Prevention
Risk factors: obesity, DM, immunosuppression
Pathogenesis: entry of pt flora or exogenous source
Pathogens: MRSA
Dx: erythema, purulence
Prevention: preop antibiotics and skin prep
53
What are obj signs of wound infection?
- Erythema / Redness
- Heat
- Edema / Swelling
- Pain or tenderness
- Exudate: dorous and purulent . Yellow, green, or brown colour (depend on microorganism)
- Immobility / Loss of function (if injury is severe)
- Induration (increased firmness of the tissue)
- Fever
- Elevated WBC
- Delayed healing / dehiscence
54
What are subj complaints for wound infection?
- Pain and tenderness at the wound site
- Fatigue
- Loss of appetite
- Headache
- Nausea
55
How to prevent SSI postop?
- Aseptic technique principles
- Use sterile or clean gloves w/aseptic technique, aseptic dressing changes and wound care
- hand washing
- good hydration
- proper nutrition
56
What to teach before discharge for SSI?
- Dev after pt discharged: teach S&S of infection to be reported
57
What is a UTI?
- Second most common bacterial disease human body is subjected to
- In healthy tract: no bacteria
58
What are... for UTI?
Risk factors
Pathogenesis
Pathogens
Dx
Prevention
Risk factors: Foley
Pathogenesis: Bacterial overgrowth and poor drainage
Pathogens: Pseudomonas
Dx: WBC in urine, bacteria in urine
Prevention: remove Foley
59
What are clinical manifestations for UTI?
- Dysuria: painful urination
- Urgency
- Suprapubic discomfort or pressure
- blood in urine (hematuria)
- Sediments causing cloudy appearance
- Flank pain, Chills, fever (upper UTI => pyelonephritis)
60
What are clinical manifestations in older adult?
- nonlocalized abd discomfort rather than dysuria and suprapubic pain
- cognitive impairments
- less likely dev fever for upper UTI
61
What diagnostic test for UTI?
U/A: dipstick urinary analysis to determine presence of bacteria
if + : urine sent for culture to indicate type of bacteria
62
How to treat UTI?
- after dx, px of proper antibiotics
- fluid intake
- analgesics
- educate pt to reduce risk of infection
63
What are super infections?
Most common: pt receiving broad-spectrum antibiotics (kill off more normal flora than narrow-spectrum)
- Unable distinguish b/w normal flora and pathogenic organisms => kill flora => more space for pathogenic organisms to grow
- MD prefer wait for C&S : px narrow-spectrum antibiotic.
64
Where do superinfections commonly occur?
- skin
- upper resp. tract
- GU and GI sys
65
What is the superinfection: c.diff?
small # ppl carry c.diff in large intestine w/no ill effect
- When antibiotic taken, drug destroy normal flora
- w/no healthy flora => c.diff grow
66
What is the characteristic of the bacteria in c diff?
- Passed in feces => spead when lack hand hygiene
- Bacteria produce spores that presist for wks to months
67
What food prevent superinfections?
- Probiotics
- Products w/Lactobacillus or cultured dairy products (yogurt, probiotic, kefir (milk from sheep and goat).
68
When to do asepsis isolation?
MRSA
69
when to use PPE?
- gown and gloves for dressing changes or wound irrigation on infected wounds
- splattering: eyewear and masks
- soiled dressing and supplies are bagged in plastic bags in biohazard
- infected wound dressings: never in pt trash container
70
What is a gram stain?
Guide antibiotic therapy: antibiotic effective against either + or - Gram
To categorize bacteria: stained sample under microscope
- differentiates b/w two large grps of bacteria
71
What is the meaning of purple stain?
Gram +
ex: staphylococcus, streptococcus, enteroccocus
72
What is the meaning of red stain?
Gram -
- more difficult to treat bc hard for drug penetrate complex cell walls
ex: pseudomonas, klebsiella, escherichia
73
What is the meaning of the enzyme beta-lactamase?
Bacteria breakdown commonly used antibiotics
- Resistant to penicillin and other antibiotics
- difficult to treat
74
How to treat beta-lactamase?
Chemicals to inhibit enzyme => prevent breakdown of antibiotic
chemicals: clavulanic acid, tazobactam
Penicillin- beta-lactamase inhibitor combo drugs
- amoxicillin/clavulanic acid (Clavulin)
- piperacillin / tazobactam (Tazocin)
75
How to test for infection?
- WBC count: normal 5–10 × 10 to power of 9/L
- C-reactive protein: elevated in presence of acute inflammatory response
normal: <10 mg/L
- ESR (erythrocyte sedimentary rate): elevated in presence of inflammation, acute/chronic infection
- C&S: in medium for bacteria growth and identify
76
What is the meaning of culture and sensitivity?
culture: what organism is causing infection
sensitivity: determine how organism can be treated
77
When to perform C&S?
Before antibiotic therapy: presence of antibiotic result in misleading results
78
How to manage before receiving results of C&S?
48-72 hrs
- broad-spectrum antibiotic or antibiotic to kill suspected bacteria => narrow-spectrum antibiotic
79
What is bactericidal?
antibiotic: kill bacteria
80
What is bacteriostatic?
antibiotic: inhibit bacteria growth => eventual bacteria death
- Stops bacteria reproduction/division => WBC and antibodies get rid/kill them
81
How to grp antibiotics?
Mechanism of action
82
What to assess for w/antibiotics?
- WBC, neg culture, ect
- Superinfection: when antiobiotics eliminate/reduce normal flora => new infections dev
83
What is nephrotoxicity when using antibiotics?
Toxic to kidneys
- abnormal results for kidney fct: BUN, creatinine lvls
- Maintain accurate I&O: output below 30 mL/h
84
What is hepatoxicity when using antibiotics?
Liver
- Anorexia, N&V, jaundice
- Elevated bilirubin, AST, ALT, GGT, alkaline phosphatase lvls
85
What is ototoxicity?
- Damage to CN VIII
- Dizziness, tinnitus, progressive hearing loss
- intentionally speak soflty and note if heard
- Assess for difficulty walking unaided
86
What to before admin antibiotics?
1. Allergies?
2. Med hx
3. Teach pt to take meds around the clock: consistent blood lvls
87
How does antibiotic affect birth control?
Effectiveness of oral contraceptives decreased and should be informed to use backup method
