Infectious Disease Flashcards

Question

When can HIV be transmitted?

Answer 1

For transmission to occur there must be a sufficient viral load and a susceptible host Viral loads are high in the first few months after initial infection and during an AIDS-related illness Prolonged or repeated exposure to infected fluids greatly increases the risk of transmission

Answer 2

Vary and may affect almost any organ in the body Specific clinical manifestations are related to opportunistic infections As CD4+ counts drop to <200 cells/uL the incidence of opportunistic infections accelerates rapidly Malignancies are common

Answer 3

Rapid HIV test Western Blot tests CDC recommends HIV screening as a routine part of medical care

Answer 4

Rapid HIV tests screen for HIV antibodies and provide results in 15 to 60 minutes - Enables easy post-test counseling - Negative result require no further testing, positive result confirmed by Western Blot

Answer 5

Western Blot tests screen for HIV antibodies and provide results in 1 to 3 days - 99% accurate - Greater sensitivity and specificity

Answer 6

Progression to AIDS is confirmed with a CD4+ T cell count of <200 cells/uL and/or documentation of an AIDS defining condition -Mycobacterium avium complex, Pneumocystis jiroveci, Histoplasmosis that has spread, etc.

Answer 7

The virus mutates frequently which makes vaccine development and even treatment difficult Antiretroviral drugs (HAART) Treatment of opportunistic infections

Answer 8

Antiretroviral drugs are the cornerstone of treatment, HAART -Treatment begins when HIV RNA levels >55,000 copies/mL or <350 CD4+ T cells/uL -Prevents viral replication Adherence to the treatment plan is essential to avoid drug resistance. Noncompliance can be caused by: -Complexity of dosing -Side effects include fatigue, anorexia, diarrhea, N&V -Socioeconomic issues

Answer 9

``` Education about -Prevention -Transmission -Medication regime -Prevention of opportunistic infections -When to see the doctor -Laboratory testing Emotional care Referrals for social services Counseling should be open, honest and nonjudgmental ```

Answer 10

Fungal opportunist infection that affects virtually all clients with AIDS Small amounts of the candidal fungus are present in the mouth in healthy people Oral candidiasis creates white patches in the mouth that can extend into the esophagus and stomach Oral lesions provide a portal for candidiasis into the bloodstream causing a life-threatening fungal infection Cause pain and difficulty swallowing which further impairs nutrition Treatment is Mycostatin oral rinse Monitor oral intake ability

Answer 11

Fungal infection that proliferates in the alveoli causing bronchial consolidation S&S include: mild, dry cough, tachypnea, fever, SOB, decreased O2 sats Chest x-ray shows bilateral patchy infiltrates Sputum culture Treatment is Bactrim and corticosteriods It does not respond to antifungals If untreated can lead to respiratory arrest and death Monitor ABGs, pulse oximeter, respiratory rate and quality, lung sounds, may need supplemental oxygen or ventilator support

Answer 12

Histoplasma fungus grows as mold in the soil enriched with bird or bat droppings. Spores are inhaled when the soil is disturbed or when around areas with a large amount of birds Those with AIDS often have disseminated histoplasmosis The most common S&S include fever, hepatomegaly, splenomegaly, and generalized lymphadenopathy may also have skin, GI, or neuro involvement Diagnosis through urine and serum culture Amphotericin B therapy is the treatment of choice for patients with AIDS

Answer 13

Very common virus that has no or mild symptoms in healthy adults 50-80% of adults have the CMV virus Those that are immunocompromised can have reactivation of the CMV virus Inflamed oral mucosa, GI pain and cramping, bloody diarrhea, weight loss Major contributor to wasting syndrome Diagnosis through stool specimen, endoscopic exam and tissue biopsy Treatment with antivirals such as foscarnet, ganciclovir, and cidofovir Monitor I&Os, BM, electrolytes

Answer 14

Usually found in food, water, and soil Most often infect the GI tract causing chronic diarrhea, anorexia, N&V, weight loss and abdominal pain Major contributor to wasting syndrome Diagnosis made through stool specimen or small bowel biopsy Treatment with antibiotics such as Biaxin, Zithromax, and Cipro Monitor I&Os, BM, electrolytes

Answer 15

Caused by a single-celled parasite called Toxoplasma gondii Eating undercooked, contaminated meat, drinking contaminated water, contact with cat feces Toxoplasmic encephalitis in AIDS patients in the United States is almost always caused by reactivation of a chronic infection S&S include headache, altered mental status, fever, motor weakness, speech disturbances, and seizures Diagnosed through serologic tests, direct observation of the parasite in stained tissue sections or CSF Treatment consists of Pyrimethamine (antiparasitic) plus Sulfadiazine

Answer 16

Fungal infection of the meninges Comes on slowly, over a few days to a few weeks S&S include: fever, headache, mental status change, N&V, photophobia, stiff neck, seizures If untreated it can lead to brain damage, hearing loss, coma, and death Diagnosed by CSF, CT scan, serum antigen test Treated with antifungals such as Amphotericin B Monitor the LOC and symptoms of infection

Answer 17

Type I reactions are IgE-mediated hypersensitivity reactions that involves production of antigen-specific IgE antibodies after exposure to an allergen Type I reactions occur immediately, histamine release S& S of Type I include: redness, hives, asthma, itching, conjunctivits

Answer 18

Type IV, cell mediated reactions are mediated by the T cells of the immune system instead of by antibodies Type IV have a delayed onset, 4-48 hours after exposure S&S include: dryness, itching, cracking of the skin, swelling

Answer 19

Allergies to bananas, avocado, kiwi, and strawberry can trigger an allergic reaction Those at risk include health care workers, neural tube defects, chronic bladder catheterization, multiple surgeries

Answer 20

Localized or systemic hypersensitivity response to an antigen that can quickly progress to a medical emergency if not treated S&S include itching, redness, vomiting, laryngeal edema, respiratory distress, vascular collapse, shock, and death Symptoms are usually immediate, within 30 minutes of exposure

Answer 21

Treatment immediate administration of epinephrine, supplemental oxygen, IV access, fluids, corticosteroids May also need antihistamines, inotropic and antiarrhythmic agents

Answer 22

The result of systemic anaphylaxis is distributive shock that results in massive vasodilation, hypotension, and inadequate perfusion Concurrently bronchoconstriction and laryngeal edema that can progress to complete airway obstruction

Answer 23

When the immune system fails to recognize self antigens an autoimmune response occurs The exact mechanism that simulates and autoimmune response is unknown but is probably multifactorial Clinical manifestations vary depending on the system that is the target Initiation of an autoimmune disorder is commonly associated with the onset of another illness or stressor Diagnosis is through an autoantibody tests specifically the antinuclear antibody (ANA). An elevated ANA means the body is making antibodies to self proteins Examples of autoimmune disorders include Rheumatoid arthritis, Graves' disease, Autoimmune hemolytic anemia

Answer 24

Inflammation of the meninges by a bacteria or virus Bacterial meningitis is less common, 4 cases per 100,000 but is associated with a higher morbidity and mortality rate Viral meningitis is more common but less likely to be fatal unless the client has a weakened immune system Bacteria enter the brain through various routes such as bloodstream, dural tear, skull fractures, unsterile lumbar puncture Virus penetration into the CNS in not well understood but probably through the bloodstream or nerve root

Answer 25

Clinical triad is fever, stiff neck, altered mental status Also have photophobia, Kernig's sign and Brudzinski sign Kernig's sign: flex the client's hip 90 degrees, straighten the leg at the knee, pain in the hamstring prevents straightening the leg, if present bilaterally it is a positive Kernig's sign Brudzinski sign: positive when flexion of the client's neck elicits flexion of the hips and knees Headache, seizures

Answer 26

CT scan to look for lesions Lumbar puncture -Bacterial meningitis will have cloudy CSF with high protein and low glucose -Viral meningitis will have clear CSF with high protein and normal glucose C-reactive protein CBC Blood cultures

Answer 27

Bacterial meningitis is treated with IV or intrathecal antibiotics. Type and route depends on the causative organism Antibiotics need to be started within 30 minutes of clinical presentation because of rapid progression of the disease Mortality is between 5-40% depending on causative agent, client age, degree of neurological impairment, severity of infection, client's general health, timeliness of treatment Viral meningitis is treated with supportive measures

Answer 28

Acute infection and inflammation of the brain tissue Caused by bacteria, viruses, fungi, or a parasite with virus being most common (Herpes Simplex & Rabies) Viruses enter the CNS through the bloodstream or nerve pathways Symptoms include severe headache, fever, N&V, confusion, lethargy, seizures If there is cerebral edema there may be agitation, personality changes, loss of sensation, problems with speech or hearing, loss of consciousness Diagnosis through CSF, MRI, CBC, blood cultures Treatment consists of antivirals such as acyclovir and famciclovir, dexamethasone to reduce cerebral edema, phenytoin (Dilantin) for seizures

Answer 29

Localized infection carried from other sites of the body into the cerebral tissue Most often occur in the cerebellum Caused by bacteria, viruses, fungi, and parasites Organisms enter the brain through direct extension or through the bloodstream. Direct extension occurs from the sinuses, infections of the teeth, trauma, surgery. Can also be idiopathic S&S include headache, malaise, fever, N&V, chills. Neurological deficits depend on the location of the abscess. Symptoms may develop slowly over a period of several weeks or suddenly Diagnosis is through CT or MRI Treatment consists of surgical drainage if possible, antibiotics and steroids

Answer 30

Pain management Darkened room, quiet calm environment, limit visitors Anxiety reduction strategies Monitor temp and vital signs Assess respiratory status Administer oxygen and prepare for intubation if needed Skin care and turning Monitor for seizure activity and implement precautions if necessary

Answer 31

Inflammation of the nasal cavity and paranasal sinuses Can be acute (less than 4 weeks), subacute (4-12 weeks), or chronic (more than 12 weeks) Caused by virus, bacteria, or fungus S&S: nasal congestion, purulent drainage, fever, maxillary tooth pain, headache Diagnosed through S&S Treatment is antibiotics, nasal endoscopy, supportive 50% of bacterial infections will clear on their own

Answer 32

Inflammation of the pharynx which results in a sore throat Upper respiratory infections can lead to pharyngitis Treatment is supportive, increase fluid intake, NSAIDS, gargle with warm saltwater If bacterial, antibiotics

Answer 33

Inflammatory process that results in edema of the alveoli and bronchioles Bacteria are the most common cause. Can also be caused by viruses, fungi, and parasites Community-acquired: microaspiration of secretions usually during sleep, inhalation of aerosolized agents, spread of bloodstream infection Hospital-acquired: mechanical ventilation Normally we have a good defense system: nasal hair, saliva, cough, epiglottic reflexes, alveolar macrophages

Answer 34

Fever, Chills, Increased respiratory rate, Increased heart rate, Bloody sputum, Crackles, Dyspnea, Cough, X-ray abnormalities, Headache, Abdominal pain, N&V, Diarrhea, Muscle aches

Answer 35

Signs & Symptoms with physical exam Chest x-ray showing infiltrates Positive sputum or blood cultures

Answer 36

``` Antibiotics Respiratory assessment Monitor pulse ox Apply supplemental oxygen ABGs Rest with gradual increase in activity Cough & deep breathing or spirometry exercises Good nutrition and fluid intake ```

Answer 37

Chronic and contagious bacterial infection caused by Mycobacterium tuberculosis Develops after inhaling droplets sprayed into the air from a cough or sneeze by someone who is infected. Requires repeated close contact Most prominent risk factor is HIV infection 95% of infections are asymptomatic and move to a dormant (latent) phase. Those in the latent phase cannot spread TB. A latent infection can turn active. Inhaled bacteria are ingested by macrophages which stimulates an inflammatory response. Develops into a granuloma with a necrotic center.

Answer 38

Often vague and do not develop until the disease is advanced Cough - starts nonproductive progresses to purulent, blood streaked Fever, Night sweats, Dyspnea, Chest pain, Weight loss, Sleep disturbances, Lethargy, Low-grade fever for weeks or months

Answer 39

Mantoux skin test (PPD) -Falsely negative in 20-25% of adults -5 mm or greater is positive for immunocompromised clients -10 mm or greater is positive for healthy individuals TB blood test that can be used instead of a PPD skin test -Both PPD and blood test detect antibodies Chest x-ray -cavitation Sputum for acid-fast bacilli -3 positive samples confirms TB

Answer 40

Most will be treated on an outpatient basis Drug therapy takes 6 to 9 months Multiple drugs used in treatment -isoniazid, rifampin, pyrazinamide, ethambutol Continued until 2-3 sputum cultures are negative Monitor LFT Hospital needs for active infection -negative pressure room -airborne isolation -N-95 or higher mask

Answer 41

Infection or inflammation of the middle ear It can be acute with a rapid onset and short duration or chronic with persistent inflammation for longer duration Caused by food and airborne allergies, bacteria and viruses, blockage of the Eustachian tube S&S of acute infection include earache, headache, fever, discharge from the ear, hearing problems, difficulty sleeping, loss of appetite Chronic otitis media includes tinnitus, hearing loss, pain, feeling of fullness in the ear Treated with symptom relief, antibiotics, or myringotomy tubes

Answer 42

Acute or chronic infection of the mastoid process that can lead to changes in hearing and balance Usually caused by a middle ear bacterial infection Mastoid bone is located just behind the outer ear. It has a honeycomb structure that fills with infected material S&S include ear pain, fever, headache, hearing loss, redness and swelling behind the ear Difficult to treat because antibiotics may not reach the mastoid bone Repeated or long-term antibiotics Mastoidectomy

Answer 43

Inflammation of the inner ear that affects the cochlear and/or vestibular portion of the labyrinth Viral labyrinthitis is the most common and often times follows a viral illness such as a cold or the flu Labyrinth is a maze of interconnected fluid-filled channels and canals. The cochlea comprises half of the labyrinth and sends information about sound to the brain. The vestibule sends information about position and movement. S&S include vertigo, N&V, loss of balance, mild headache, tinnitus, and hearing loss Symptoms can last from days to weeks CT, MRI, and EEG help to rule out other causes Treatment includes supportive measures such as antihistamines and antiemetics, scopolamine patch, sedatives Labyrinthectomy, will cause deafness in the affected ear, or vestibular nerve dissection, involves a crani and risk for increased hearing loss

Answer 44

Metabolic alteration in the labyrinthine fluid of the inner ear that causes spontaneous episodes of vertigo and fluctuating hearing loss Factors that alter the properties of inner ear fluid may contribute to Meniere's disease -Improper fluid drainage, abnormal immune response, allergies, viral infection, genetic predispositio, trauma Episodes last 2-3 hours and then resolve Often occur in clusters with periods of remission between CT or MRI to rule out other causes, hearing and balance testing Treatment involves medications to relieve nausea and motion sickness, diuretics will relieve fluid retention Meniett device: a pulse generator that applies positive pressure to the middle ear through a tympanoplasty tube Endolympatic sac procedure removes bone that encases the endolymph reservoir Labyrinthectomy

Answer 45

Inflammation of the clear mucous membrane that covers the sclera of the eye, the inner lining of the eyelid and the space between the lid and the globe Can be caused by a virus, bacteria, or allergic reaction. Viral is most common

Answer 46

Starts unilaterally but quickly spreads bilaterally S&S include clear, sticky discharge, excessive tearing, foreign body sensation, conjunctival inflammation, preauricular lymph node enlargement Treatment include artifical tears, steroid eyedrop, cold compress -Should clear on its own It is extremely contagious -hand washing, no sharing of towels, washcloths, pillows

Answer 47

Usually unilateral in the early stages but then becomes bilateral S&S include purulent discharge, eyelid edema, crusting, conjunctival inflammation, redness, there is no preauricular node enlargement Treatment includes antibiotic eyedrops or ointment for 7 to 10 days, warm/cold compress Remember good hand hygiene

Answer 48

Often called hayfever Type I hypersensitivity reaction Causative agents include animal dander, dust, smoke, feathers, pollen Usually bilateral S&S include a whitish discharge, swelling, burning, pruritus Treatment includes decongestant eyedrops for 7 to 10 days, cold compress, oral antihistamines, avoiding the allergen if possible

Answer 49

Type IV cell-mediated immune reaction that occurs after contact with an allergen Type IV immune reactions have a delayed onset, 4-48 hours after exposure Mediated by the T cells of the immune system instead of by antibodies There are 3000 chemicals that can cause allergic contact dermatitis One of the most common is poison ivy or oak Extent of the reaction depends on the sensitivity, concentration and quantity of the exposure Dermatitis presents as red, swollen, itchy lesions that may spread beyond the area of contact Treatment is topical corticosteroid, oral steroids may be needed, and antihistamines

Answer 50

Female lice produce hundreds of eggs or nits that they attach to a hair shaft. They secrete toxic saliva that leads to itching and dermatitis. They are spread though close personal contact. Treatment includes application of a pediculocide shampoo.

Answer 51

Female mite tunnels into the skin, creating a burrow and depositing eggs. Causes intense itching that is worse at night. Signs are lesions that are papular, vesicular, or linear on the wrists, web spaces of the hands, sides of hand or feet, genital area, abdomen. Highly contagious and transmitted through close personal contact. Treatment is application of a scabicidal cream for six hours

Answer 52

Reddish brown, oval, flat insects that feed on human blood during the night hours. Bites cause itching, pain, and swelling. Transmission is through infested furniture and clothes. They are hard to eradicate because common insect repellents are not effective.

Answer 53

Caused by Candida fungus Most common cause of fungal infection in immunocompromised clients Normally found in the GI tract, mouth, and vagina and causes no harm Intact immune system, intact skin, and other microoganisms keep it controlled Predisposing factors: wet clothing, obesity, hyperglycemia Treatment: antifungal cream such as miconazole, cool compress, dry skin, loose clothing, topical agents such as mycostatin Systemic infections are treated with oral or IV antifungal agents

Answer 54

Also known as ringworm, jock itch, athlete's foot Predisposing factors: depressed immune system, crowded conditions, poor hygiene, tight clothing Signs & symptoms: abnormal pigmentation, itchy rash shaped in a ring, thick, dry, scaly skin. Between fingers and toes may be moist with open sores Treatment is usually topical or oral antifungal agent, ex: Lotrimin, Lamisil Potassium hydroxide wet mount- to identify if fungus is cause of skin disorder

Answer 55

Herpes Simplex Type 1 and Type 2 cause oral and genital lesions- Spread by direct contact with infected lesions or genital secretions Herpes Zoster also known as shingles- Reactivation of a latent varicella-zoster virus Warts are caused by the human papillomavirus- Spread by contact when there are small breaks in the skin Genital warts are sexually transmitted- These cannot be cured so treatment is aimed at symptom management Nursing management includes education: Avoid contact with immunocompromised people when a lesion is present, Wash your hands, Avoid sharing glasses, utensils, toothbrushes, Avoid kissing and sexual contact while the disease is active, Condoms

Answer 56

Non-necrotizing inflammation of the skin and subcutaneous tissues, usually caused by staphylococcus or streptococcus infections that does not involves the fascia or muscles Organisms gain entrance through a fissure, cut, laceration, bite, etc. Common on the legs, face, ears, and buttocks Those with compromised immune systems, are obese, have venous insufficiency are susceptible S&S: red, swollen, tender, with indefinite border, blisters, regional lymphadenopathy, fever, chills, headache, vomiting Diagnosed through exam, increased WBC, wound culture Treatment: antibiotics, rest, elevation, moist wound care

Answer 57

Infection of the superficial fascia or connective tissue surrounding muscle Bacteria release enzymes and toxins Infection causes: tissue ischemia, superficial nerve damage, vascular thrombosis and occlusion, tissue liquification, septicemia Risk factors: diabetes, chronic renal failure, obesity, malnutrition, drug use, PVD

Answer 58

Early -begin in the first 24 to 48 hours -flu like symptoms, localized pain, redness, swelling -pain beyond what is expected Advanced -2 to 4 days -skin is swollen, tight, and dusky, fluid filled blister, lack of sensation Critical -4 to 5 days -gangrene, skin sloughing, septic shock Mortality is high 40% with treatment, 100% without

Answer 59

``` Three pronged Broad spectrum antibiotics -PCN, clindamycin Surgical debridement -daily until margins are clear -may have to amputate Supportive therapies -high calorie diet -negative pressure wound therapy -hyperbaric oxygen therapy ```

Answer 60

Bacterial infection that affects the organs and joints Transmitted by deer ticks The bacteria is transferred slowly over a couple of days of feeding Most prevalent in the northeast, southwest, and west coast Hiking, camping, gardening

Answer 61

Three stages of Lyme Disease 1. Early Localization: days to 1 month - bull's eye reddened area, 70-80% of cases - fatigue, malaise, lethargy, joint and muscle pain, stiff neck 2. Early Disseminated: days to 10 months - 5% carditis - 15% CNS involvement - encephalitis, peripheral neuropathy, meningitis - 60% arthritis - rash, lymphadenopathy, inflammation of the eye, liver, kidneys 3. Late or Chronic Disease: months to years - arthritis and CNS involvement

Answer 62

Diagnosed by blood test for antibodies Early phase involves treatment with oral antibiotics (doxycycline) for 14 to 21 days If the disease has progressed to the early disseminated phase IV antibiotics for 14 to 28 days is recommended Other signs and symptoms are treated through supportive measures Rest, antipyretics, NSAIDS, etc. Education and prevention

Answer 63

Affects the vasculature causing it to leak Tickborne disease caused by Rickettsiae Carried by the American dog tick, Rocky Mountain wood tick, brown dog tick Most prevalent in the southeast

Answer 64

Most people become ill within the first week of infection Some may not exhibit signs for up to 14 days Signs include: high fever, chills, headache, muscle aches, nausea & vomiting, fatigue Red non-itchy rash that appears a few days after initial symptoms -Starts on the wrists and ankles and spreads outward Severe, untreated cases can lead to heart, lung, or kidney failure, seizures, gangrene of the fingers and toes

Answer 65

Appearance of rash and skin biopsy Can be diagnosed by blood test but Rickettsiae do not circulate in large volumes. May take 7-10 days after initial symptoms for a positive result. This may be to late to avoid long term damage or death Start antibiotics (doxycycline) within five days of development of signs and symptoms to avoid complications Can be treated with oral or IV antibiotics Without prompt treatment it can be fatal within the first 8 days