npn 135

• -pathogenic- capable of producing disease
• -non-pathogenic

• -bacteria
• -viruses
• -fungi
• -parasites
• -prions

• -most common microbe (pathogen)
• - transported via air, water, food, soil, inanimate objects, body tissue, and fluid
• -hundred of different species (staph, strept, E. coli.)
• -aerobic- requiring the presence of air or free of oxygen for life
• -anaerobic- living in the absence of air free of oxygenw

• -resemble bacteria, but different
• -must be inside living cells to reproduce
• - vectors (transmit) include infected

an alteration in normal tissue function having characteristic signs and symptoms

invasion of body tissues by pathogenic organisms that multiply and cause injury and inflammatory response

• -redness
• -pain
• -warmth
• -swelling
• -pus may appear in a specific part (the site)

• -redness
• -pain
• -swelling
• -warmth
• -fever
• -malaise
• -anorexia
• -prostration (extreme physical weakness or exhaustion)

antibiotics

• -colonization
• -local
• -systemic
• -bactermia
• -septicemia
• -acute
• -chronic
• -latent
• -primary
• -secondary
• -community acquired
• -nosocomial

• -groups of living micro-organisms become resident flora
• -resident flora grow and multiply, but do not cause infection
• -infection develops when invades other parts of the body

-EX... E.coli resident flora in intestines, but if invades urinary tract=UTI

-limited to an area of body where pathogens remain

-can develop into systemic infection if not treated

symptomatic systemic infection spread through the blood and can affect blood flow to vital organs

-the first infection occuring in client

infection following a primary infection that occurs frequently in compromised clients

• -pathogens invade lymph or blood and spread throughout the body
• -treated with IV antibiotics

-infection that appers suddenly and short in duration

-slow onset, lasting for weeks, months, or years

-cause no symptoms for long periods of time, even decades

-acquired in day to day contact with public

-EX...colds, Flu, Meningitis, STD's

-hospital acquired, not present when client is admitted

• -orginates from client's normal flora and some form of treatment that cause normal harmless bacteria to multiply=
• infection

example: antibotics destroy normal flora causes yeast infection

pathogens inquired from hospital enviroment

• -common pathogen causing UTI
• -normally lives in intestines
• -transmitted via unwashed hands, contaminated food and water, improper cleansing

• -iatrogenic: due to medical therapy
• EX... catheterizations. IV's

-compromised host: client's normal defense have been lowered by surgery or illness

-insufficient handwashing: by personnel

• -escherichia coli (E.Coli)
• -staphylococcus Aureus (Staph)
• -pseudomonas aeruginosa

-usually lives in nose and on skin of healthy people

-common cause of nosocomial surgical wound infection and nosocomial septicemia

-common pathogen in nosocomial pneumonia

-found around sinks, water, irrigation solution, and nebulizers on respiratory equipment in health care settings

-also found in soil

• -Vancomycin Resistant Enterococci (VRE)
• -Methicillin-Resistant Staph Aureus (MRSA)
• -C Diff

-enterococci normal flora in GI and female genital tracts

-transmitted by direct or indirect contant

• -gram staining
• -culture and sensitvity (C&S)
• -serum Antibody test
• -CBC with differential
• -Erythrocyte Sedimentation Rate (ESR)

• -referred to as C&S
• -organisms in specimen grown on lab plate and identified in 24-48 hours
• -organisms exposed to many different antibiotics to determine which is most effective for treatment (sensitivity)
• -doctor will then Rx appropriate antibiotics

• -neutrophils
• -eosinophils
• -basophils
• -monocytes
• -lymphocytes

CBC with Diff

a method of staining bacteria

-useful in bacterial taxonomy, identification and indicating fundemental differences in cell wall structure

purple/ black

pink

• -measure reaction to a certain antigen
• -positive result does not always mean active infection is present
• -may mean there has been exposure to the antigen
• -not as accurate as a culture

• -most numerous circulating WBCs
• -body 1^st line of defense in acute infection
• -focuses on bacteria and small particle
• -increased in acute, severe inflammation/ infection
• -phagocytize pathogen
• -respond more quickly to the inflammatory and tissue injury sites than other WBCs

• -increased in allergic and parasitic conditions
• -limited role in phagocytosis

• -increased in the healing process
• -respond to inflammation from injury by releasing histamine and heparin granules as part of the inflammation response

• -play a major role in immune responses as B lymphocytes and T lymphocytes
• -increased lymphocytes (lymphocytosis) occurs in chronic and viral infections
• -severe lymphocytosis commonly caused by chronic lymphocytic leukemia
• -functions include antigen recognition and antibody production

• -body's 2^nd line of defense against bacterial infections and foreign substances
• -stronger than neutrophils and can ingest larger particle of debris
• -respond late during acute phase of infection and continue to function during chronic phase of phagocytosis
• -help clean up damaged or injured tissue
• -increased in some protozoa and rickettsial infection, TB, leukemia

• -also called ESR or Sed Rate
• -early screening test for inflammation
• -not a definite test for infection
• -RBCs become heavier in infection and settle to bottom of test tube
• -the faster they settle, the greater the inflammation

chain of infection stays intact

• -infectious/causative agent
• -reservoir/source
• -portal of exit
• -mode of transmission
• -portal of entry
• -suscepitible host

-the organism responsible for causing infection

-place where pathogens live, multiply and reproduce

• can be:
• animate
• inanimate

-the way the infectious agent leaves the reservoir/ source

• EX...
• -respiratory tract
• -skin
• -GI tract
• -GU tract
• -open lesions
• -placenta

-a method in which microbe moves or is carried from one place to another

• -Routes and Means= Direct
•                                   Indirect
•                                   Airborne

-occurs via touching, biting, kissing, sexual contact

-also via droplet spray into eyes or on mm while sneezing, coughing, spitting, singing, or even talking

-spread is limited to 3 feet or less

• -examples:
• -Flu
• -scabies
• -impetigo
• -conjunctivitis
• -lice
• -STDs

-methods to protect self and client: HANDWASHING, PPE (gloves, masks, googles, shoe covers) and aseptic technique

-spread of infectious organism by coming in contact with contaminated objects (toys, soiled bedding, wound dressing, surgical instruments, water, food, blood, tissues, serum and organ)

• -examples:
• -conjunctivitis
• -hepatitis
• -HIV
• methods to protect self and client : HANDWASHING, thorough cleaning of client's environment, providing clean water and food supplies.

• -spread by living sources other than human
• (insect, flea, mouse)
• examples:
• -malaria
• -plague
• -lyme disease

-openings that allows microbes to enter host

• -respiratory tract
• -GI tract
• -GU tract
• -broken skin
• -placenta
• -MM
• -tubes, IV sites, catheters

-a person who can not resist microbes invading body, multiplying and resulting in infection

-one who is at a very high risk because body defenses are already low due to illness or surgery and are not able to overcome invasion of pathogens

• -incubation
• -prodromal
• -illness
• -decline
• -convalescence

• -1^st stage of an infection
• -interval between entrance of pathogen and apperance of symptoms
• -person does not suspect has been infected, but can infect others

• -chicken pox 2-3 wks
• -common cold 1-2 days
• -flu 1-3 days
• -this stage may last as long as months or years

• -2^nd stage of an infection
• -interval from onset of nonspecific Sx (malaise, fatigue, low grade fever) to more specific Sx
• -microbes are growing and multiplying
• -person is more capable of spreading infection to other in this stage
• -not present in all infections

• -3^rd stage of an infection
• -present when obvious signs and Sx specific to type of infection
• -this stage may end in death if person's immune defenses or medical treatment is ineffective

• -4^th stage of infection
• -immune defenses and medical treatment reduce the number of pathogens
• -signs and Sx of infection begin to diminish

• -5th stage of an infection
• -acute Sx disappear
• -person returns to health
• -may take a day or 2
• -if severe infection may take a year or longer

prodromal stage

body defenses

• -non-specific
• -specific

•  -1^st line of defense (anatomic response)
• intact skin and MM

• -2^nd line of non-specific defense -inflammatory response
• 2 processes in inflammatory process
• -phagocytois
• -inflammation

-a process in inflammatory process

-helps rid the body of invading microbes and debris via WBCs (leukocytes)

-body's reaction to injury or infection

-is protective vascular reaction that delivers fluid, blood products and nutrients to tissue in affected areas

-not the same as infection

• -physical agents: excess sun, xrays, heat, cold
• -chemical stimuli: insect venom, gastric acid and poisons
• -biologic agents: bacteria and viruses

• -vascular response
• -inflammatory exudate
• -phagocytosis and purulent exudate

• -1^st stage in the inflammatory response
• -local vasodilation occurs resulting in increased blood flow to the injured area
• -the increased blood flow presents as redness and warmth at the injured site
• -more plasma is brought to the area to nourish tissue and carries waste and debris away

3RD Stage = PHAGOCYTOSIS & PURULENT EXUDATE

• -Leukocytes destroy pathogenic organisms & their toxins
• -Purulent exudate may form that contains protein, cellular debris & dead leukocytes

• -2^nd stage in the inflammatory response
• -permeability of blood vessels increased
• -allows plasma to move out of the capillaries and into the tissues
• -swelling occurs resulting in pain and pressure on nearby nerve endings

• -redness
• -warmth
• -edema
• -pain
• -possible purulent drainage if infection is present

• -involves the immune system response
• -main function of immune system is to identify and eliminate threatening foreign elements from the body

• -antigens
• -antibody/ immunoglobulins
• -immunity

-a specific defense, foreign substances in body, referred to as the invaders (rubella virus)

-a specific defense, protective substances body produces to counteract antigens

-innate (natural)

-acquired (active or passive)

-human cells uniniqueness makes us naturally immune to certain disease

active- body produce antibodies in response to an antigen (long)

• natural- antibodies produced in response to active infection (lifelong)
• artifical- vaccines given to stimulate antibodies production (many years, booster)

• Passive: 
• antibodies produced by another source (short)  

• natural: 
• antibodies from an immune mother via placenta/colostrum to   baby (6mos.- 1 yr.)  
• artificial:
• injection of immune serum (immunoglobulin) from animal or another human after exposure   (2-3 wks)

Humoral (circulating) immunity

• -Acts directly on antigens
• -B cells are involved in
• -B cells grow to maturity in the bone marrow
• -In presence of antigen, macrophages & T helper cells stimulate the B cells to produce antibodies (immunoglobulins, IgM)
• -Antibodies  bind to the target antigens & destroy them

• IgM:
•  produced when antigen encountered         for 1st time (can’t pass thru placenta)

• IgG: 
• -most common immunoglobulin
• –Body recognizes antigen, special B memory cells form that remember the antigen
• –Small & can pass thru placenta
• –Infants are born with passive immunity & is maintained as long as the IgG molecule exists

• IgE:
• -primarily responsible for allergic response

• IgA:
• -MM secrete IgA around body openings to provide protection to these vulnerable portals of entry

• IgD: 
• -antibodies form on surface of B cells trapping the pathogen & preventing it from multiplying & causing disease

aka cellular immunity

• -Does not involve production of antibodies
• -Effective against intracellular pathogens
• -Occurs through T cell system
• -Aimed at intracellular pathogens such as cancers, viruses, fungi
• -When exposed to antigens, lymphoid tissue releases activated T cells into lymph system which passes into general circulation
• -With loss cellular immunity, one is defenseless against most viral, fungal & bacterial infections

• -Gloves 1st (most soiled)
• -If gown tied at waist in front, untie before taking off gloves
• -Remove mask by holding strings
• -Remove gown (keeping soiled side rolled inward)
• -Remove eyewear if not attached to mask