Nur 122

  1. Why are we talking about infectious processes?
    • So the RN can prevent the acquisition of infection
    • Recognize the S&S if infection does occur
    • Implement treatment of infection
  2. Pathogens
    Organisms that are capable of producing disease.
  3. What kind of pathogens is there?
    • Bacteria
    • Viruses
    • Fungi
    • Helminths
    • Priors
  4. What things are making it better?
    • Better nutrition
    • Immunization
    • Sanitation
    • Antimicrobials
  5. What are two top leading causes of death that are pathogens?
    • Pneumonia/ Influenza 6th
    • HIV 8th in US (Virus)
  6. What increases death from infection?
    • Very young
    • Very old
    • Debillitated
    • Poorly nourished
    • Immunosuppressed
  7. Epidemiology
    Study of how a disease is produced in a population; not only infectious diseases.
  8. Epidemic
    A significant increase in the number of cases of a particular infection, much more than expected.
  9. Endemic
    An infection that is routinely found in certain populations
  10. Pandemic
    A world-wide epdiemic, i.e. Aids and certian flu
  11. When is an organism termed a pathogen?
    When its capable of producing disease in the host
  12. Virulence
    The ability to produce disease, "Pathogencity"
  13. Pathophysiology
    • The pathogen usually attaches itself to the host
    • This is a parasitic realtionship- the pathogen damage the host
    • Infection occurs when the host- pathogen relationship is established.
    • Infectious disease occurs when observable S&S indicate that the host has been damaged
    • Each organisms is distinct- how it invades and reproduces, and how it is transmitted.
  14. Factors that promote infectious disease
    • P= N x V
    • R
    • P= probability of infection
    • N= number of organisms
    • V= virulence of organisms
    • R= resistance of host
  15. Body defenses
    • Physical=skin and mucous membranes
    • Chemical= secretions (hydrochloric acids in stomach. acidity in urine and normal flora
    • Immune system=targets pathogens for destruction immune system is affected bay age, genetics, psych and enviromental factors
  16. Bacteria
    Do not require a host, merely use the host as a source of nutrition or enviromental for growths
  17. Hows is bacteria classified?
    • Shape
    • Staining
    • Oxidative state
    • & how they produce disease
  18. Typical bacteria
    • Rods or cocci (spheres)
    • Gram + & Gram - (accept a stain or not)
    • Aerobic (require 02)
    • Anaerobic (without air)
  19. Mode of infection
    • Infection occur when the bacteria ovecome the host defense.
    • Organisms invades, multiplies spreads
    • Some produce adherens (allows them to attach strongly) (strep)
    • Some develope capsules that protect them from phagocytes (pneumooccous)
    • Some produce leukocidins which detroy the pathogen (staph)
  20. Bacteria produce toxins=
    Allows for growth and causes illness
  21. Exotoxins
    • Proteins secreted into surrounding medium highly antigenic, specific or general small quantities may be fatal
    • A posionous substance produced by bacteria.
  22. Examples of exotoxins
    • Toxic shock syndrome
    • HUS
    • Diptheria
    • Cholera
  23. Endotoxins
    Component of the cell wall of Gram - bacteria, released during cell divison or cell distruction
  24. Pyrogenic endotoxins
    Are ones that produce pain and fever in the host and cause release of vasoactive peptides--vasodiliation--hypotension--| perfusion --septic shock
  25. Atypical bacteria
    • Special chatacteristics with regard to shape, size, staining properties
    • Little relationship to each other, except that they cause disease in humans
    • Gram - bacteria
  26. Viruses
    • Small intracellular organsims
    • Nt complete cells exist as parasites on living cells
    • Use the biochemical products & machinery of the host to replicate
    • Classified as RNA or DNA according to genetic material
  27. Multiplication occurs in several steps:
    • Attach to host cell
    • penetrate or inject its DNA into host cell
    • synthesize nucleic acid and assembles new viral particles
    • release viral particles into the extracellular enviroment
  28. What do viral infections stimulate?
    Antibody production
  29. What is the best defense?
    Cell-mediated immunity
  30. Cell-mediated immunity
    • Caused by T-lymphocyte activity
    • Mediated thru contact between T cell and antigen and by cytokines
    • Reaction produces memory and subsequent exposure triggers the antigen repsonse.
  31. Cytokines
    Small soluble proteins
  32. 4 groups of cytokines
    • interleukins
    • interferons
    • tumor necrosis factor
    • transformation growth factor
    • Essentially these are immunotransmitters
  33. T Lymphocyte recognizes the antigen and activates macrophages and B-cell production of antibodies
    Destruction of antigen may occur
    • Antigen specific cells accumalte ---inflammatory response
    • Macrophages attach to virus---synthesis of IgM & IgA
    • When coated with antibody-- rendered non-infectious

    Viruses also-- production of interferon proteins that inhibit viral spread.
  34. clinical manifestation of Viral Disease
    • Eah virus affects the host differently --S&S unique to virus
    • Vary from no apparent damage to death
    • Viruses attack virtually every system

    Many remain latent for years, active disease with exposure to other virus
  35. Manifestations of Infectious Disease
    • Early
    • malasie
    • weakness
    • myalgia
    • headache
    • fatigue
    • anorexia
  36. Manifestations of Infectious Disease
    • As disease progresses
    • Flushing
    • Chills
    • Dehydration
    • Lymphadenopathy
    • Increased WBC's
    • confusion
    • Delirium
  37. Hematological Effects
    • Bacterial -
    • ↑Neutrophils
    • ↓Eosinphils and lymphocytes

    as infection ↑ monos and lymphs
  38. Prolonged infection
    ↓RBC, H&H, compromised Fe delivery

    ↑ESR Platelets an fibrinogen
  39. Cardiovascular Effects
    • Usually only with severe infection
    • Vasodilation → hypotension
    • ↑ Heart rate and cardiac output
    • May develope septic shock
  40. Renal Effect
    • Proteinuria - 2˚ fever or direct infection of kidney (protein in urine)
    • Glycosuria - 2˚ ↓ reabsorption (glucose in urine)
    • Oliguria 2˚ hypotension or septic shock (less than 400ml/day)
  41. Nursing Process and Infection Control
    • Age→ very young and very old most vunerable
    • Nutritional state-inadequate protein stores
    • Stress --general adaptation syndrome→↑cortisone(↓ resistance
    • Heredity
  42. Disease Process
    Immune system disease -leukemia, AIDS, Lymphoma, aplastic anemia

    chronic disease - diabetes and MS

    Diseases that impair defenses- COPD, cancer, PVD, burns
  43. Medical thearpy:
    Drugs may compromise immunity: steroids, chemo amd immunosupressants
  44. Clinical assessments
    • Local - redness and swelling 2˚ inflammation
    • drainage
    • pain/ tenderness

    Local infection may become systemic (gets in the blood or becomes and abbcess)
  45. systemic infections
    fever, malaise and fatigue

    • lymphadenopathy
    • n/v
    • anorexia
    • May also have resp. GI GU Sx

    Elderly often have advanced infection before clinical sign become apparent

    Assess specifically the likely sites
  46. Interventions
    • Wash your hands
    • Nutritional support-great nutrition good protein
    • Immunizations
    • Control of transmission - early discharge
  47. AIDS
    2nd leading cause of death in americans 25-44
  48. AIDS
    Most sever form of a continuum of illness assocaiated with HIV
  49. HIV
    Is a retrovirus (RNA as opposed to DNA)
  50. Tansmission of HIV
    • By way of body fluids that contain the CD4+ T Lymphocytes or the HIV virus:
    • serum
    • amniotic fluid
    • seminal fluids
    • breast milk
    • vaginal secretions
  51. Transmission of HIV
    Sexual transmission
    • anal intercourse taumatizes the rectal mucose which increase chance of transmission
    • Multiple partners
    • Heterosexual transmission is increased
  52. Transmission of HIV
    • direct clood exposure to contaminated needles and syringes
    • sharing needles increases risk
    • Blood and blood products risk greatly decreased
    • Risk health care workers estimated 0.3%
  53. Transmission of HIV
    Risk to health care workers 0.3%
  54. Clinical Manifestations
    • Resp: SOB dyspnea cough chest pain
    • = PCP, Mycobacterium TB
    • Gastro: Anorexia N/V thrush (canadice) weight loss
    • Skin: KS lesions dermatitis eczema psoriasis
    • Neurologoical: HIV encephalopathy AIDS dementtia complex CNS changes end stage
    • In woman: Yeast infection HPV PID Vernearl warts
  55. Diagnosis
    • Based on clinical history:
    • identification of risk factors
    • physical exam
    • lab evidence of immune dysfunction
    • ID HIV antibdodies
    • T cell counts
  56. Antibody test
    • ELISA
    • Western Blot assay
    • IFA
  57. Treatment
    • Treat infection and malignancies
    • Antiviral agents to arrest HIV replication
    • Support and restore the immune system

    Supportive care: malnutrition Skin Mobility and altered mental state
Card Set
Nur 122
Infectious Processes