Infectious Disease 1 Flashcards
(86 cards)
1
Q
Infectious Disease
A
- we are continually exposed to vast array of microorganisms → small portion results in infection and disease
- immunization efforts → e.g., MMR, Poliomyelitis, and Hep B
- natural systems are weakened/altered by ecologic stresses → infectious pathogens mutate
- resistant organisms spread quickly w/o adequate precautions → health care professionals must remain vigilant toward preventing disease
2
Q
anti-infectious drugs may have ___________ that impair neuro-musculoskeletal fxn and other systems that limit patient’s performance and response to PT
A
side effects
3
Q
signs and sx of infectious diseases
A
- fever, chills, malaise (most common early sx’s)
- enlarged lymph nodes
- increased # of leukocytes/change in types of leukocytes
- rash w/ fever
- red streaks (acute lymphangitis)
- joint effusion
4
Q
signs and sx of infectious diseases in integument
A
- Purulent drainage from abscess, open wound, or skin lesion
- Skin rash, red streaks
- Bleeding from gums or into joints; joint effusion or erythema
5
Q
signs and sx of infectious diseases in cardiovascular
A
- Petechial lesions
- Tachycardia
- Hypotension
- Change in pulse rate (may increase or decrease depending on type of infection)
6
Q
signs and sx of infectious diseases in CNS
A
- Altered level of consciousness, confusion, seizures
- Headache
- Photophobia
- Memory loss
- Stiff neck, myalgia
7
Q
signs and sx of infectious diseases in GI
A
- Nausea
- Vomiting
- Diarrhea
8
Q
signs and sx of infectious diseases in GU
A
- Dysuria or flank pain
- Hematuria
- Oliguria
- Urgency, frequency
9
Q
signs and sx of infectious diseases in Upper Respiratory
A
- Tachypnea
- Cough
- Dyspnea
- Hoarseness
- Sore throat
- Nasal drainage
- Sputum production
- Oxygen desaturation
- Decreased exercise tolerance
- Prolonged ventilatory support
10
Q
signs and sx of infectious diseases in the older adult
A
- Change in mental status
- Subnormal body temperature
- Bradycardia or tachycardia
- Fatigue (or increased fatigue)
- Lethargy
- Decreased appetite
11
Q
elevated WBC count is called ___________
A
leukocytosis - infection/other inflammatory response
12
Q
WBC 5,000-10,000 /mm3
A
normal values
13
Q
WBC >10,000/mm3
A
trending upward - leukocytosis
14
Q
WBC <4,000/mm3
A
trending downward - leukopenia
15
Q
decreased WBC count is called __________
A
leukoopenia - result of bone marrow disease, radiation, or meds, including chemo
16
Q
the most abundant WBC type is the ___________
A
neutrophil
17
Q
a reduction of the neutrophil count is termed ___________ and __________ the risk for nosocomial infections (health care-associated infection; HAI)
A
neutropenia; increases
18
Q
fever
A
- sustained temp above normal
- normal 96.8 F to 99.5 F w/ an avg of 98.6 F
19
Q
Hypothalamus involvement in fevers
A
- temperature-regulating center
- pyrogens, which are certain protein substances (cytokines) and toxins (endotoxin of some bacteria), cause the set-point of the hypothalamic thermostat to rise
- results in activation of the hypothalamus to conserve heat and increase heat production
20
Q
fever and infection
A
- a change in body temp is a characteristic systemic sx of infectious disease
- fever may accompany non-infectious causes such as inflammatory, neoplastic, and immunologically mediated diseases
21
Q
common infectious causes of fever in hospitalized person
A
- UTI
- Respiratory tract infection
- Catheter-related infection
- Surgical wound infection
- infected pressure injuries
- other (less common): colitis, peritonitis, meningitis
22
Q
common noninfectious (injured or abnormal cells incite production of pyrogens) causes of fever in hospitalized person
A
- drug rxn
- pulmonary emboli
- neoplasm
- tissue necrosis (e.g., stroke, myocardial infarction)
- autoimmune diseases
23
Q
fever patterns - intermittent
A
- temperature returns to normal at least once every 24 hours
- usually associated with sepsis, abscesses, and infective endocarditis
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Q
fever patterns - remittent
A
- temperature fluctuates but does not return to normal
- associated with viral upper respiratory infection, Legionella, and Mycoplasma infections
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fever patterns - sustained or continuous
temperature remains above normal with minimal variations
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fever patterns - recurring or relapsing
episodic fevers lasting 1 to 3 days with 1 or more days of normal temperatures between episodes
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most common causes of prolonged fever
**just know generalized diseases that induce high/low fevers
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some people w/ serious infection do not initially develop fever but instead express:
- become tachypenic and confused
- develop hypotension
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abscess
rupture of the abscess and drainage into other tissues can spread the infection
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aging and infectious diseases - older adults
- immunosenescence (e.g., thymus ages and involutes) and comorbidities
- more susceptible to infectious diseases
- experience ↑ morbidity and mortality (especially in the frail and debilitated older adult)
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aging and infectious diseases - changes in cell-mediated or T-cell function
- ↓ in # of naive T cells
- ↑ in # of memory T cells
- slower to respond and require a stronger stimulus
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extrinsic factors apart from the immune system can lead to increased susceptibility to infection in the older adult:
- atrophic skin is more easily damaged
- ↓ cough and gag reflexes make it more difficult to control secretions
- ↓ bronchiolar elasticity and mucociliary activity
- denture-associated infections
- more likely to have an implanted device
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infectious disease sx in older adults are often ________, _________, or ___________
vague, blunted, or atypical
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infectious disease in older adults results in more serious infections w/ little or no fever bc of an impaired __________ ___________ or _________ _________ of drugs
thermoregulatory system; masking effects
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should a higher or lower threshold of temp for infection be used in older adults?
lower (e.g., 99 or 100 F)
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infection
- an organism establishes a parasitic relationship w/ its host
- begins w/ transmission of an infectious organism
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A pathogen may do the following in an infection:
1. contaminate the body surface and be destroyed by 1st line defenses such as intact skin/mucous membranes that prevent further invasion
2. a sub-clinical infection may occur in which no apparent sx are evident other than an identifiable immune response of the host (antibodies levels increase)
3. a clinically apparent infection n which the host-parasite interaction causes obvious injury and is accompanied by 1(+) clinical sx. this outcome is called infectious disease
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incubation period
- the period btwn the pathogen entering the host and the appearance of clinical sx
- disease sx's herald the end of the incubation period
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latent infection
occurs after a microorganism has replicated but remains dormant or inactive in then out, sometimes for years
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the host may harbor a pathogen in sufficient quantities to be shed at any time after __________ and toward the end of the ___________ period
latency; incubation period
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the time period when an organism can be shed is called the ____________
period of communicability
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T/F: an asymptomatic host can still transmit a pathogen
TRUE
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types of organisms
- viruses
- mycoplasmas
- bacteria
- rickettasiae
- chlamydiae
- protozoa
- fungi (yeasts and molds)
- helminths
- mycobacteria
- prions
**know size differences
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viruses
- subcellular organisms made up of only an RNA or a DNA nucleus covered with proteins
- smallest known organisms, visible only through an electron microscope
- completely dependent on host cells and cannot replicate unless they invade a host cell and stimulate it to participate in the formation of additional virus particles
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mycoplasmas
- unusual, self-replicating bacteria that have no cell wall components and very small genomes
- antibiotics that are active against bacterial cell walls have no effect on mycoplasmas
- require a strict dependence on the host for nutrition and sustenance and are able to pass through many bacteria-retaining filters or barriers because they are very small
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bacteria
single-celled microorganisms with well-defined cell walls that can grow independently on artificial media without the need for other cells
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rickettsiae
- primarily animal pathogens that typically produce disease in human beings through the bite of an insect vector such as a tick, flea, louse, or mite
- require a host for replication
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chlamydiae
- smaller than rickettsiae and bacteria but larger than viruses
- depend on host cells for replication, but unlike viruses, they always contain both DNA and RNA and are susceptible to antibiotics
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protozoa
- single-cell unit or a group of nondifferentiated cells loosely held together and not forming tissues
- have cell membranes rather than cell walls, and their nuclei are surrounded by nuclear membranes
- Larger parasites include roundworms and flatworms
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fungi
- unicellular to filamentous organisms possessing hyphae (filamentous outgrowths) surrounded by cell walls and containing nuclei (eukaryocyte)
- show relatively little cellular specialization and occur as yeasts (single-cell, oval-shaped organisms) or molds (organisms with branching filaments)
- Fungal diseases in human beings are called mycoses
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helminths
parasitic worms (tapeworms)
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prions
- proteinaceous, infectious particles consisting of proteins but without nucleic acids
- transmitted from animals to human beings and are characterized by a long latent interval in the host
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infection begins w/ transmission of a __________ to the ___________
pathogen; host
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chain of transmission
1. pathogen or agent
2. reservoir
3. portal of exit
4. mode of transmission
5. portal of entry
6. host susceptibility
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pathogens are also called ___________
pathogenic agents
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chain of transmission - pathogens
- the microorganism that has the capacity to cause disease (arouse a pathologic response) in the host
- the characteristics of the organism and the susceptibility of the host influence the likelihood of a pathogen producing infectious disease and the type of disease produced
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why are pathogens ineffective parasites?
bc they stimulate a disease response, which may harm the host and eventually kill the pathogen
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opportunistic pathogens
they don't cause disease in people w/ intact host defense systems but can clearly cause devastating disease in people w/ severe defects in host defense mechanisms (e.g., hospitalized and immunocompromised clients)
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pathogenicity
the ability of an organism to induce disease, depends on the organism's speed of reproduction in the host, the extent of damage it causes to tissues, and the strength of any toxin released by the pathogen
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virulence
the potency of the pathogen in producing severe disease and is measured by the case fatality rate (i.e., the # of people who die of the disease divided by the # of people who have the disease)
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chain of transmission - reservoir
- an environment in which an organism can live and multiply → animal, plant, soil, food, or other organic substance/combo of substances
- human and animal reservoirs can be symptomatic/asymptomatic carriers of the pathogen
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a carrier maintains what kind of environment?
one that promotes growth, multiplication, and shedding of the parasite w/o exhibiting signs of disease (e.g., hepatitis)
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chain of transmission - portal of exit
the place from which the parasite leaves the reservoir
- secretions and fluids (respiratory secretions, blood, vaginal secretions, semen, tears)
- excretions (urine and feces)
- open lesions
- exudates (pus from an open wound or ulcer)
- HIV has more than one portal of exit
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knowledge of the ______________ is essential for preventing transmission of a pathogen
portal of exit
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chain of transmission - mode of transmission
contact transmission
- direct contact
- indirect contact = inanimate and intermediate objects (fomite)
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examples of indirect contact mode of transmission
telephone, sphygmomanometer, bedside rails, tray tables, countertops, and other items that come into direct contact w/ the infected person
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mode of transmission - airborne transmission
- small particles (less than 5 µm) that are capable of floating on air currents w/in a room and remain suspended in the air for several hours
- e.g., tuberculosis, chickenpox, rubeola measles
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mode of transmission - droplet transmission
- larger particles ( >5 µm) than airborne particles
- don't remain suspended in air but fall out w/in 3 ft of the source
- travel only a short distance (e.g., influenza)
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mode of transmission - vehicle transmission
occurs when infectious organisms (e.g., salmonellosis) are transmitted through a common source (e.g., contaminated food, water, and IV fluid) to many potential susceptible hosts
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mode of transmission - vector-borne transmission
involves insects and/or animals that act as intermediaries btwn 2(+) hosts
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chain of transmission - portal of entry
- a pathogen may enter a new host by ingestion (GI tract), inhalation (respiratory tract), or bites or injury of the skin
- microbes commonly enter through contact w/ mucous membranes and, less frequently, transplacentally
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chain of transmission - host susceptibility
- biologic and personal characteristics
- immunosuppressive agents and corticosteroids
- inadequate or absent hand hygiene
- presence of underlying medical disorders
- breaches of body integrity
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1st line of defense
includes microbial antagonism of normal flora of microorganisms
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2nd line of defense
inflammatory response
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3rd line of defense
immune response
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goal of controlling transmission
to break the chain of transmission at the most cost-effective point(s)
- education for everyone
- isolation and barriers
- comprehensive immunizations
- prophylactic antibiotic therapy
- improved nutrition, living conditions, and sanitation
- avoiding risk-taking behaviors
- correction of environmental factors
→ proper handling and disposal of secretions, excretions, and exudates
→ isolation of infected clients and quarantine of contacts
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Type of Transmission-Based Precautions and Prevention Guidelines
look at table 8.3 in book
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CDC Recs for Immunization of HCWs
table 8.4
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health care-associated infection (HAI) was formerly known as ___________
nosocomial infections
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health care-associated infection (HAI)
infections that develop in hospitalized persons/persons admitted to a health care facility that weren't present before admission
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health care-associated infection (HAI) are most caused by...
pneumonia, GI tract infection (w/ C. difficile accounting for the majority of cases), and surgical site infections (SSIs)
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health care-associated infection (HAI) result in....
- prolonged hospital stays
- ↑ in cost of care
- ↑ significant morbidity and mortality
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causes of HAI
- frequent use of invasive devices for monitoring/therapy
- ↑ use of immunosuppressants and antibiotics
- more colonization and infection by multidrug-resistant organisms
- > debilitation and severity of illness of hospitalized clients who acquire these infections
- lack of hand hygiene predispose people to such infections and superinfections
- central-line associated bloodstream infections (CLABSIs)
- Catheter-associated urinary tract infections (CAUTIs)
- ventilator-associated pneumonia (VAP)
- surgical site infections (SSIs)
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___________ ____________ is the easiest and most effective means of preventing HAIs and must be done routinely, even when gloves are used
hand hygiene
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Prevention of HAI
look at Box 8.6 and Table 8.5
86
specific infectious diseases
most infectious diseases are confined to specific organ systems
- bacterial infections
- viral infections
- miscellaneous infectious diseases
