20G- Unit 2- 2- Risk of Infection

What are opportunistic pathogens?

cause disease only in immunocompromised patients (normal bacteria)

What are the 4 categories causing infections in humans

Bacteria Virus Fungus Protozoa

2 types of infections?

Local

Systemic

What is a local infection

An infection that is limited/restricted to one part of the body where the MO's remain/multiply until eliminated

Ex: proper care prevents spread

What is a systemic infection

An infection that spreads and damages different parts of the body

These are all signs and symptoms of which type of infection

• warm to touch

• edema/swelling

• redness

• discharge

• tender or painful

• distinction

Local

These are all signs and symptoms of which type of infection

• fever

• weakness

• fatigue

• low appetite

• hypertension

• tachycardia

• tachypnea

Systemic

What is the term?

• develops during pt's stay or after discharge

Health-care associated infections (HAI)

Synonyms of HAI

Nosocomial infection Iatrogenic infection

What are the 2 types of HAI

Endogenous Exogenous

Which type of HAI

• pt's own flow become altered and overgrowth results

• MO (sufficient numbers) in one body cavity are transferred to another; eg fecal material on the hands transferred to the skin causes wound infection

Endogenous

Which type of HAI

• MO external to the individual, not normal flora

• hospital environment, hospital personnel

Exogenous

What are common sites for HAI's

surgical wounds, urinary and respiratory tracts, bloodstream

What are the 3 lines of defense?

Which ones are non-specific/specific defences

1- Anatomical and physical barriers (non-specific) 2- inflammatory response (non-specific) 3- immune response (specific)

Which line of defense?

• physical barriers: skin, mucous membranes, endothelia

• chem barriers: sweat, mucus, tears, saliva, urine, semen, stomach

First line

Which mechanism of defence

• no differentiation between different types of pathogen and respond the same way upon every infection

• phagocytic leukocytes migrate to infection sites and engulf foreign bodies

• inflammatory responses increase capillary permeability at infected sites, leading to localized swelling

• fever increases body temp to activate heat- shock proteins and suppress microbial growth and propagation

Second, inflammatory process

What line of defense

• vasodilation

• increased permeability of blood vessels

• recruitment of phagocytes to site of infection

• release of inflammatory mediators that cause swelling, heat, pain

Third line - immune response

What makes a pt more susceptible to infection

Age Stress Nutritional status Obesity Smoking Medications/therapies

What are lab data tests you can perform for infections

WBC

ESR

C-reactive protein

Cultures (urine, stool, blood, wound, nasal culture)

Nursing diagnosis for infection?

UNM need for safety, due to infection/risk of infection, related to IV site, surgical wound, urinary catheter, Jackson Pratt....

What are 3 types of wound complications

Infection Dehiscence Evisceration

What type of wound complication

• contaminated or traumatic wounds show signs of infection early, within 2-3 days

• may not develop until 4-5 days post op

SSI (surgical site infection)

What are the 2 types of SSI

1. Incisional - surgical or deep

2. Organ/space - organs or spaces other than the incision through which the surgery was performed

These are signs and symptoms of what

• inflammation beyond the incision line, lasting more than 5 days

• fever

• malaise and anorexia

• increased WBC

• spontaneous dehiscence

• abscess present

SSI

What is the term

An abscess is a collection of pus in any part of the body. In most cases, the area around an abscess is swollen and inflamed

Abscess

3 abscess treatments

Incision & drainage Drains Antibiotics

What are preoperative interventions to risk of infection

Check nutritional status, preop antibiotic, treat infection, preop skin prep, etc

What are intraoperative interventions to risk of infection

Making sure everything is sterilized, minimum personnel, making sure everyone is wearing proper PPE and normothermia

What are postoperative interventions to risk of infection

Wash your hands, dressing changes, educate pt

What is the wound complication

• if an incision separates following surgery

Dehiscence

Causes of dihiscence

• causes: infection; granulation tissue not strong enough to withstand the forces imposed on wound; obesity

Risk factors for dehiscence

obesity, poor nutrition, multiple trauma, excessive coughing, vomiting, dehydration, suture failure, smoking, SSI, poor circulation

dehiscence prevention

splinting, prevent straining, avoid heavy lifting, proper nutrition, education, early mobilization, infection control

What is the wound complication

• severe surgical complication where the surgical incision opens (dehiscence) and the abdominal organs then protrude or come out of the incision

Evisceration (MEDICAL EMERGENCY)

Steps to treat a wound evisceration

1. Place stérile, saline soaked gauze over protruding tissue

2. Notify surgeon

3. Place pt in bed with knees bent

4. Keep pt NPO

5. Monitor V/S

Respiratory Assessment

• Breathing (pattern, depth, rate, rhythm, WOB, activity)

• breath sounds (decreased, absent, crackles, wheezes)

• chest movements (symmetry)

• secretions (sputum characteristics) & coughing

• VS and O2 sat

• hypoxemia

What are 2 post op respiratory complications

• atelectasis

• pneumonia

What is the term

• complete or partial collapse of the entire lung or area (lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid

Atelectasis

What is the term

• an infection of one or both of the lungs caused by bacteria, viruses or fungi. It is a serious infection in which the air sacs fill with pus and other liquid. Lobar pneumonia affects one or more sections (lobes) of the lungs

Pneumonia

Signs and symptoms of atelectasis

Dyspnea, low o2 sat, tachycardia, tachypnea, diaphoretic, anxiety and febrile

Risks for Atelectasis

pre age, obesity, nutrition, smoking, lung disease, reduced mobility

Nursing interventions related to atelectasis (preop & post op teaching)

• teaching deep breathing and coughing

• inspirameter

• ambulating

• oxygen therapy

Organisms that cause pneumonia reach the lungs by 3 mechanisms. What are they?

• aspiration (nasopharynx, oropharynx)

• inhalation (microbes in the air)

• hematogenous spread (primary infection elsewhere in the body)

What are factors predisposing to pneumonia

Age Bed rest/immobilized pt's Chronic diseases Malnourishment Long hospital stay Medication that decrease the immune system

Signs and symptoms of pneumonia

Febrile Tachycardia Dyspnea Cough Plural chest pain Tachypnea Blood in mucus

What are post op pneumonia symptoms in elderly

• confusion

• change in behaviour

Nursing diagnosis related to pneumonia

UMN need for oxygenation

Due to altered ventilation, ineffective airway clearance, ineffective breathing pattern, impaired gas exchange

Related to pain, decreased mobility, fluid and exudate accumulation within alveoli and surrounding lung tissue

What is an upper UTI called

pyelonephritis (kidney infection)

What is a lower UTI?

cystitis and urethritis

Causes of UTI

• indwelling catheters ‼️‼️

• urine stasis

• residual urine

• urinary tract instrumentation

• bladder overdistention

What is the most common pathogen for UTIs

E. coli

Signs and symptoms of upper UTI

Fever, chills, flank pain

Signs and symptoms of lower UTI

dysuria, urgency, frequency, nocturia, suprapubic discomfort or pressure, urine may have a cloudy/ bloody appearance, nocturia

Diagnostic tests for uti

Urinalysis: White blood cells, red blood cells, casts, bacteria, positive for nitrites

Urine culture: voided midstream, catheterization, suprapubic aspiration, or via Foley catheter

Nursing interventions for UTI

• Pain relief- analgesics, heating pad, warm shower

• fluids

• antibiotics

Teachings for UTI

Watch for colour/consistency changes in urine, decrease in or cessation of symptoms , no change reported to HCP

What are the 3 antimicrobial therapy classifications

1. Susceptible organism

2. Chemical structures

3. Mechanisms of action

What are the 2 types of chemical classes (antimicrobial therapy)

Broad-spectrum Narrow-spectrum

What are the 2 antimicrobial therapy mechanisms of action

Bactericidal: drugs that kill bacteria

Bacteriostatic: drugs that do not kill bacteria but slow their growth allowing natural body defences to eliminate the MO

Which antimicrobial mechanism of action?

• most common mechanism

• penicillins

Inhibition of cell wall synthesis

Which antimicrobial mechanism of action?

• protein synthesized on ribosomes which have diff structures in humans and bacteria

• aminoglycosides

Inhibition of protein synthesis

Which antimicrobial mechanism of action?

• DNA/RNA

Inhibition of nucleic acid synthesis

Which antimicrobial mechanism of action?

• interfere with plasma cell membrane, substances escape from the cell

Plasma cell membrane

Which antimicrobial mechanism of action?

• drugs fool bacteria thinking they are nutrients and metabolites

Inhibition of metabolic pathways

What mechanism of action are penicillins

Inhibit cell wall synthesis

What mechanism of action are cephalosporins

Inhibit cell wall synthesis

What mechanism of action are aminoglycosides

Inhibit protein synthesis

What mechanism of action are fluoroquinolones

Inhibit nucleic acid synthesis

What mechanism of action are tetracyclines

Inhibit bacterial protein synthesis

What mechanism of action are sulfonamides

Inhibit metabolic pathways

What are the 4 potential antimicrobial therapy adverse drug effects

• hypersensitivity

• organ toxicity

• superinfections

• resistance

What are the signs and symptoms of hypersensitivity (antimicrobial therapy adverse drug effects)

Mild :skin rash, urticaria, itchiness, Severe: swelling, SOB, ANAPHYLAXIS, death

What is organ toxicity (antimicrobial therapy adverse drug effects)

Some antibiotics have a selective toxic effect on certain structures/organs in body

What is the term

• broad-spectrum antibiotics kill offf ALL bacteria- good and bad

• kills host flora present on the skin, upper respiratory, Gu, GI, vaginal sites and allows pathogens to grow unchecked

• report: diarrhea, mucous membrane changes

superinfections (antimicrobial therapy adverse drug effects)

What is the term

• bacteria become resistant: alteration in DNA, mutations that make the antibiotic ineffective

Resistance

Antimicrobial therapy nursing responsibilities

• health history

• C&S

• monitor allergy, toxicity, superinfection

• know your drugs

• rights of med admin

• pt education

• serum concentration lvls prn

• organ function prn

What are true pathogens

Pathogens capable of causing disease to healthy individuals