MODULE 2: Nursing Care Management Of Clients With Problems In

Infectious, Inflammatory, Immunologic Response

NCM112 NCM LECTURE — DAY 1: Infection, Infectious Disease, and Isolation
BSN 3E | A. DARACAN | 1ST SEM | 9/5/2022

Unit 1: Colonization, Infection, Unit 2: Elements of Infection

Disease Chain of Infection
Basic Concept & Terminologies
1. Colonization
● used to describe microorganisms
present without host interference or
interaction.
● Organisms reported in microbiology
testresults often reflect colonization
rather than infection.
● The patient’s health care team must
interpret microbiology test results
accurately to ensure appropriate
treatment.
● A patient colonized with 1. Susceptible Host – For infection to
Staphylococcus Aureus may have
2. occur, the host must be susceptible
staphylococci on the skin without
3. Portal of Entry – needed for the
any skin interruption or irritation
2. Infection organism to gain access to the host
● indicates a host interaction with an 4. Mode of Transmission – serves as
organism an intermediate means to transport
● if the patient has an incision, S. and introduce an infectious agent
aureus could enter the wound, into a susceptible host through a
resulting in an immune system suitable port of entry
reaction of local inflammation and
5. Reservoir – to provide nourishment
migration of white cells to the site
● Clinical evidence of redness, heat, for microorganisms and enables
and pain and laboratory evidence of further dispersal of the organism
white blood cells on the wound 6. Portal of Exit – to shed organisms
specimen smear and microbiologic to another or to the environment for
organism identification transmission to occur
3. Infectious Disease
Measures to break Chain of Infection
● the state in which the infected host
displays a decline in wellness due to
the infection
● when the host interacts
immunologically with an organism
but remains symptom-free, the
definition of infectious disease has
not been met.
● severity ranges from mild to
life-threatening
Importance of Microbiology Report
Unit 3: Infection Control & Prevention
Organizations involved in Infection
Control
a. Occupational Safety and Health
Administration (OSHA) – Inspects
the workplace for potential hazards,
Microbiology report is a tool to be used keeping records of workplace
along with clinical indicators to determine injuries and illness, training
if a patient is colonized, infected, or employees to recognize safety and
diseased. health hazards, and educating
 employees on precautions to prevent
accidents
b. Centers for Disease Control and
Prevention (CDC) & World Health
Organization (WHO) – Principal
agencies involved in setting
guidelines about infection
prevention
Prevention of Infection in the
Community
1. Vaccination Programs – The goal of
vaccination programs is to use
wide-scale efforts to prevent specific
infectious diseases from occurring in
a population
2. Planning for a Pandemic –
Influenza pandemics are likely to be
more catastrophic than other
anticipated public health problems
because they last longer than other
emergency events, often occur in
“waves” deplete the available health
care workforce, and reduce the
supply of medical equipment
because of their widespread nature
The late Senator Miriam Defensor Santiago
filed Senate Bill no. 1573 Pandemic &
All-Hazards Preparedness Act
Common Vaccines
1. Measles, Mumps, and Rubella
Vaccine (MMR)
● should be given to children at
12 to 15 months of age, with
repeat dosing at 4 to 6 years
of age, adults who have not
received the MMR vaccine
should receive 1 to 2 doses.
● Transmission: droplet and
direct contact
● fever, transient
lymphadenopathy or
hypersensitivity reaction
might occur following an MMR
vaccination
2. Varicella (Chickenpox) Vaccine and
Zoster (Shingles) Vaccine
a. Varicella-zoster is the virus
that causes chickenpox and
herpes zoster
● Transmission: droplet and
airborne and contact routes.
● Incubation period: 2
weeks; newly infected host
is already infectious during
the prodromal stage, with
rare exception, varicella
infects a person only once
● When all lesions crusted, the
patient is no longer
contagious
b. Herpes zoster, also known as
shingles, is a painful, localized
rash caused by recurrent
varicella with vesicles
restricted to areas supplied by
single associated nerve
groups
● The vaccine should not be
given to those:
○ Pregnant
○ Severely depressed
immune function
○ have moderate or
severe concurrent
illnesses, allergy to
varicella vaccine
● Zostavax vaccine is
recommended for 60 yo. >
3. Influenza Vaccine
● an acute viral respiratory disease
that predictably and periodically
causes worldwide epidemics known
as pandemics
● vaccine is given as an injection with
inactivated virus or as a nasal spray
with live-attenuated virus and
reduces the risk of illness from flu by
50% to 60% overall
● Advantageous in preventing
hospitalization for children, those
with diabetes or pulmonary disease,
and those over the age of 50
4. Human Papillomavirus Vaccine (HPV)
● HPV is the most prevalent of all
sexually transmitted viruses and is
the principal cause of cervical
cancer
● Vaccination at age 11 or 12 is
recommended for both males and
females and is given in a 3-dose
series
● Not recommended for those with
history of hypersensitivity to any
vaccine component, those with a
history of anaphylactic latex allergy,
or for women who are pregnant
Home-based Care of an Infectious
Person
1. Reducing Risk to the Patient
a. Equipment Care – disinfection and
aseptic technique while using
medical equipment. Watch out for
Catheter-related sepsis (redness,
swelling, or drainage around a
catheter insertion site) for a patient
who has unexplained fever
b. Patient Education – intrinsic
colonizing bacteria and latent viral
infections present a greater risk than
do extrinsic environmental
contaminants. Home needs to be
clean but not sterile. Restrict visits to
people with potentially contagious
illnesses. Follow recommendations
for hygiene, storage, and safe
cooking times and temperatures.
2. Reducing Risk to Household Members
● Education about strategies to
reduce their risk of infection
● Food preparation and personal
hygiene (hand washing)
● Establishing reasonable barriers to
infection transmission in the
household
● Public health agency coordination
for screening and treatment
● Physical separation from an
immunosuppressed family member
(varicella)
● Using common household
disinfectants in controlling
environmental contamination
(enteric organism infection)
● Proper collection and disposal of
sharps and waste (blood-borne
infection)
What are Isolation Precautions?
Isolation precautions are guidelines
created to prevent transmission of
microorganisms in hospitals
Prevention of Infection in the Hospital
The CDC recommends 2 Tiers of
Isolation Precautions:
1. Standard precaution (1st tier)
● is designed for the care of all
patients in the hospital and is the
primary strategy for preventing
HAIs
● all patients are colonized or
infected with microorganisms,
whether or not there are s/s, and
that a uniform level of caution
should be used in the care of all
patients
● HCW should use additional
barriers depending on the
expected degree of exposure to
patient excretions or secretions
2. Transmission-based precautions
(2nd tier)
● is designed for the care of
patients with known or suspected
infectious diseases spread by:
○ Airborne Precautions
■ negative air pressure, rapid
turnover of air, and air
either highly filtered or
exhausted directly to the
outside
■ HCW should wear an N95
respirator
■ Examples are Measles,
Varicella, Tuberculosis
 ○ Droplet precautions
■ can be transmitted by close
contact with respiratory or
pharyngeal secretions
■ HCW wear a facemask
within 3 to 6 feet of the
patient; the door may
remain open because the
risk of transmission is
limited to close contact
■ Examples: Influenza,
Meningitis, Pneumonia.
Epiglottitis, Diphtheria,
Mumps, Rubella,
Streptococcal A
pharyngitis, Scarlet fever
○ Contact precautions
■ used for organisms that are
spread by skin-to-skin
contacts, such as
antibiotic-resistant
organisms
■ patient is placed in a private
room to facilitate hand
hygiene and decreased
environmental
contamination
■ Masks are not needed, and
doors do not need to be
closed
■ Examples: Clostridium
difficile, Skin infections,
Impetigo, cellulitis, or
pressure ulcers, Pediculosis
Scabies, Viral conjunctivitis
Specific Organisms with Nosocomial
Infection Potential
A. Clostridium Difficile – is a
spore-forming bacterium that has
significant HAI potential. Infection is
usually preceded by antibiotic
agents that disrupt normal intestinal
flora and allow the
antibiotic-resistant C. difficile spores
to proliferate within the intestine
releasing toxins into the lumen of the
bowel resulting destruction of such a
large anatomic area causing sepsis.
Control is best achieved by using:
a. contact precautions
b. hand hygiene
c. Bleach-based cleaning
products
d. Disinfection of frequently
touch equipment (IV poles,
charts)
● Severe cramping
B. Methicillin-resistant
Staphylococcus Aureus (MRSA) – a
common human pathogen, refers to
S. aureus that is resistant to
methicillin or its comparable
pharmaceutical agents, oxacillin,
and nafcillin. HCW transmits MRSA
to patients easily because S. aureus
has an affinity for skin colonization
and later on infection especially
when invasive procedures, such as
IV therapy, respiratory therapy, or
surgery, are performed. The patient
who is colonized also serves as a
reservoir for MRSA transmission to
others and may persist as normal
flora in the patient for an extended
time
C. Vancomycin-resistant
enterococcus (VRE) – This
gram-positive bacterium, which is
part of the normal flora of the
gastrointestinal tract, can produce
significant disease when it infects
blood, wounds, or the urinary tract.
HCW transmits MRSA to patients
easily because its normal part of the
gastrointestinal flora of the host so
is able to withstand harsh anatomic
sites, such as the intestine; and it
persists well on the hands of health
care providers and on environmental
objects. Because many strains of
VRE are resistant to all other
antimicrobial therapies, clinicians
are left with few choices for effective
therapy.
Prevention of Bloodstream Infections
A. Bacteremia (bacterial infection in
the bloodstream)
B. Fungemia (fungal infection in the
bloodstream)
Any vascular catheter can serve as the
source of bloodstream infection.
Vascular catheters are used for most
hospitalized patients, and increasingly,
long-term central catheters are used to
provide IV therapy to outpatients in a
clinic or home setting. In all instances, the
nurse must use appropriate care to
reduce the risk of bacteremia and to be
alert to signs of bacteremia
Unit 4: Nursing Process: The Patient
with an Infectious disease
Assessment
● obtain history to establish the
likelihood and probable source of
infection as well as the degree of
associated pathology and symptoms
● physical examination to reveal
signs of infection at any body site:
○ Chronic diseases - significant
weight loss, pallor
○ Acute infection - fever, chills,
rash, or lymphadenopathy,
Localized signs of infection
Nursing Diagnosis
● Knowledge deficit about the disease
and risk for spread of infection and
reinfection
● Anxiety related to anticipated
stigmatization and to prognosis and
complications
● Noncompliance with treatment
Nursing Interventions/Implementation
● Increasing knowledge and
preventing the spread of disease
○ causative organism
○ usual course of the infection,
interval of potential
communicability to others
○ possible complications
○ adherence to therapy as
prescribed and report any side
effects or symptom
progression
● Reducing Anxiety
○ encouraged to discuss
anxieties and fear associated
with the dx, treatment, or
prognosis.
○ individualized education,
factual information applied to
specific needs may offer
reassurance
● Increasing Adherence
○ one-to-one setting, open
discussion about disease
information facilitates patient
education.
○ Referrals to appropriate
agencies can complement
individual educational efforts
and ensure that later
questions or uncertainties can
be addressed by experts.
Unit 5: Emerging Infectious Diseases
What are EID/ Re-emerging Infectious
Diseases?
● Human diseases of infectious origin
that have increased within the past
two decades or that are likely to
increase in the near future (Zika
virus, West Nile Virus, Ebola Virus).
Factors that contribute to EID: Travel,
globalization of food supply and central
processing of food, population growth,
increased urban crowding, population
movements, ecologic changes, human
behavior antimicrobial resistance, and
breakdown in public health measures.
Zika virus
● Was first discovered as a pathogen
in monkeys in the Zika Forest of
Uganda in the 1940s and was found
to cause human disease in the 1950s
● Transmission: bites of infected
mosquitos from the Aedes genus
and pass through sexual
transmission
● Incubation period: few days
● Clinical presentation:
○ self-limiting illness of 2 to 7
days duration
○ mild fever, rash, headache,
conjunctivitis, or joint and
muscle pain
● Associated with microcephaly and
other congenital abnormalities in
infants of some women infected with
Zika during pregnancy
● can cause Guillain–Barré
syndrome, a condition with nerve
and muscle
● Weakness that often quickly
progresses to a paralysis
West Nile virus
● Was first recognized in the 1930s in
Africa and was first seen in humans
in the United States in 1999
● Transmission: bites of infected
mosquitos, transplacental,
breastfeeding, BT
● Reservoir: birds and organ donors
● Incubation period: between 3 and
14 days
● Clinical presentation:
○ headache, fever, and
persistent fatigue that may
continue for several months
and some pts develop more
serious disease, which is
characterized by severe
neuroinvasive illness,
meningitis, encephalitis, and
paralysis or poliomyelitis
● Management consists of fluid
replacement, airway management,
and supportive nursing care
Ebola virus
● first human outbreak of Ebola virus
disease occurred in 1976 with a
sporadic pattern of outbreaksin
remote African villages and went
into rampaged through the West
African countries in 2014
● Transmission: direct contact with
blood or body fluids and handling
infected animals hunted forfood
● Incubation period: 2 to 21 days. If
no symptoms by 21 days after
exposure, no risk of developing
Ebola
● Clinical presentation: high fever,
muscle aches, and fatigue, develops
severe diarrhea, abdominal pain,
and vomiting, neurologic symptoms,
bleeding, or hemorrhage
● Management: contact tracing,
supportive maintenance of the
circulatory system and respiratory
systems (ventilator and dialysis-
acute phase)