Week 5: Infection, sterility, and pain

infection

the invasion and multiplication of microorganisms in body tissues

types of infections

bacterial, viral, fungal, parasitic/protozoa

infections can be characterized by...

duration and extend of spread

acute

resolving in a few days to weeks

acute infection example

URIs

chronic

persist for months, may be incurable

chronic infection examples

hepatitis, HIV

localized infection

limited to a specific location in the body

localized infection example

sinus infection, pneumonia

systemic infection

spread throughout the entire body

systemic infection example

sepsis

secondary infection

occurs during or after a treatment for a different infection, caused by a disruption of the normal body flora from an antibiotic or a weakened immune system

heathcare associated infection

contracted while receiving healthcare for another condition in a health care facility

what percent of HAIs are preventable?

70%

HAI examples

CAUTI, SSI, CLABSI, VAP

SSI

surgical site infection

CLABSI

central line associated blood stream infection

VAP

ventilator associated pneumonia

why are infants at a higher risk for infection?

they have an immature immune system, weaker

why are older adults at a higher risk for infection?

they have a diminished immune response, immunocompromised

why is it difficult to identify infection in older adults?

they have a muted inflammatory response, classic s/s may be missing (fever, elevated WBC, wound purulence)

how can we notice infections in older adults?

notice subtle and acute assessment changes such as restlessness, fatigue, loss of appetite, dizziness

populations at risk for infection

low socioeconomic status- lack access to good food, can't afford meds, transportation is difficult

individual risk factors for infection

immunodeficiency, chronic illness, invasive treatments, environmental conditions

who is at risk for immunodeficiency?

older age, immunocompromising conditions (HIV, cancer, leukopenia), those on immunosuppressive agents (steroids)

what are examples of invasive treatments that are at risk for infection?

central lines, urinary catheters, surgery, intubation

prodromal period

malaise, headache, fever, lack of appetite

acute phase

specific s/s related to the extent of infection spread

what to focus an assessment on for an infection

HPI, CC, OLDCARTS, known pathogen exposures and recent travels

vital signs s/s of infection

tachypnea, tachycardia, temperature

neurological s/s of infection

HA, vision change, neck pain, altered LOC, high fever

HEENT s/s of infection

swollen lymph nodes, rhinorrhea, otalgia, conjunctivitis, pharyngitis, tonsillitis

wound or incision s/s of infection

erythema, warmth, purulent drainage, induration, slough, eschar, dehiscence

respiratory s/s of infection

worsening cough, productive cough, purulent sputum, abnormal breath sounds, dyspnea

genitourinary s/s of infection

dysuria, hematuria, increased frequency, cloudy urine

GI s/s of infection

loss of appetite, acute abdomen s/s, discolored feces

a CBC includes...

RBC, WBC, platelets, Hgb, Hct

what is a CBC with diff

looks at WBCs, neutrophils, and bands

leukocytosis

increase in WBCs, >12,000

leukopenia

decrease in WBCs, <4,000

neutrophilia

increase in neutrophils, indicates acute infection

immature neutrophils

bands

increase in bands indicates

"left shift", sign of severe infection, >10% bands

inflammatory markers

ESR, CRP

ESR

indirectly measures inflammation, levels increase slowly

CRP

directly measures inflammation, more sensitive to subtle changes, levels increase rapidly

increased lactic acid

indicates there is insufficient O2 at the cellular level, sign of sepsis/septic shock

culture

determines the invading pathogen

sensativity

determines the most effective antibiotic

why do people typically start on a broad spectrum antibiotic?

results from a C&S typically take 24-72 hours

blood C&S

a positive result is a sign of systemic infection

bacteremia

presence of bacteria in blood stream

septicemia

more serious, bacteria in blood stream and multiplying (can lead to sepsis)

how to collect a blood C&S

draw using strict aseptic technique from 2 sites, obtain blood cultures before antibiotics

urinalysis C&S

can be obtained either from a clean catch or a urinary catheter to diagnosis UTI, obtain culture before urinalysis

c. diff testing

collect a pea sized amount of stool and place it in a while stool collection vial, send vial on ice to lab, initiate enteric contact precautions

viral test examples

viral DNA or RNA detection, antigen detection, antibody detection

viral DNA or RNA detection

highly sensitive tests in diagnosing early infection (even if asymptomatic)

viral DNA or RNA detection example

PCR test for COVID-19

antigen detection

less sensitive than DNA/RNA detection, diagnoses early, active infection

antigen detection examples

rapid antigen test for COVID, hepatitis B surface antigen test

antibody detection

low sensivity in detecting current infection, but high sensitivity to determining past infection based off of proteins the body has released

what are radiographic tests helpful for?

identification of infection at a particular site

basic infection prevention strategies

hygiene, vaccinations, and standard precautions

nursing and collaborative interventions for infection

limit damage to body, prevent secondary infection, eradicate infection

common interventions for infection

antimicrobial therapy, rest and comfort care, nutritional support and fluids, maintain a clean environment

antimicrobial therapy

meds used to prevent and treat infections caused by microorganisms in humans, animals, and plants

examples of antimicrobial therapy

antibiotics, antivirals, antifungals, antiparasitics

asepsis

the absence of disease causing organisms

medical asepsis

clean technique, used with all patient care activities

surgical asepsis

sterile technique, used with invasive procedures

indwelling catheter

inserted via the urethra, is held in the bladder with a water filled balloon, and has a sterile preassembles closed drainage system which holds the urine

is inserting an indwelling urinary catheter and independent or dependent nursing intervention?

dependent

CAUTI s/s

suprapubic pain or tenderness, flank pain, new onset fever, sepsis, or new onset AMS in elderly patients

patients with indwelling urinary catheters acquire bacteriuria at rate of....

2-7% per day

virtually, all catheterized patients will have bacteriuria by...

30 days

HOUDINI catheter indication

hematuria, gross?

obstruction, urinary?

urologic surgery?

decubitus ulcer?

I & O for hourly management?

no code/comfort care/hospice care?

immobility due to physical contraints?

if a patient doesn't meet HOUDINI...

take the catheter out

is removal of a catheter and independent or dependent intervetion?

independent

alternatives to indwelling catheters

external catheters, intermittent straight cath., beside commode, incontinence pads

what can a bladder scanner be used for?

assess urine volume and verify urinary retention or incomplete emptying prior to inserting a catheter

other CAUTI preventions strategies

complete daily perineal hygiene and catheter care with CHG, maintain unobstructed urine flow, keep catheter in dependent position, secure to upper thigh

CVC

central venous catheter

central venous catheter

enters the body though a large vein in the chest, neck, arm, or groin, and terminates close to the heart, top located in upper SVC and junction of right atrium

CVC usage

administer short or long term continuous or intermittent infusion, blood draws, and obtain measurements of hemodynamic status

what are CLABSIs?

systemic infection caused by a central line as the portal of entry, 1/3 patients that have a CLABSI at OSU experience mortality

CLABSI s/s

sepsis, erythema, pain, or purulent drainage at site

CLABSI prevention

inserted by a trained physician using sterile technique, leave catheters in place for as short a time as possible, remove when no longer clinically needed, assess daily, clean with CHG

is removing a central line a dependent or independent nursing intervention?

dependent

how often should CHG dressing be changed on a central line?

at least every 7 days

SIRS

an exaggerated, life threatening immune system response to a harmful stressor

when the source of SIRS is an infection, its called...

sepsis

what are examples of infections that can lead to sepsis?

CAUTIs and CLABSIs

what should you initiate if sepsis is suspected?

hour-1 bundle

sepsis best practice alert

alerts the nurses in IHIS if the patient is at high risk for sepsis

suspect sepsis when two or more SIRS criteria are met:

temperature (fever, hypothermia), HR>90, RR>20, leukocytosis, leukopenia, or >10% bands

sepsis hour-1 bundle intervention steps

draw initial lactate, collect blood cultures prior to antibiotics, administer broad spectrum antibiotics (if patient shows s/s of decompensation, they may need IV fluids)

sepsis evaluations

focused ABC assessment, vitals, cap refills, peripheral pulses, skin examination (mottling)

what is the most common reason people seek care and take medication?

pain

pain

whatever the experiencing person says it is