Nursing Care of Patients With Infections

Chapter 8: Nursing Care of Patients With Infections

Kelli Verdecchia

KEY TERMS

• aerobic (air-OH-bik)
• anaerobic (an-air-OH-bik)
• antibodies (AN-ti-bah-dees)
• antigens (AN-tih-jenz)
• asepsis (ah-SEP-sis)
• bacteria (bak-TEER-ee-ah)
• clostridioides difficile (klos-TRID-e-OY-dees dih-fih-SEEL)
• colonization (col-in-ih-ZAY-shun)
• coronavirus disease (co-RONA-VY-rus diz-EZE)
• dormant (DOOR-mant)
• epidemic (eh-puh-DEH-mik)
• fungi (FUNG-guy)
• hand hygiene (HAND HY-jeen)
• herd immunity (herd ih-MYOO-nih-tee)
• host (HOHST)
• morbidity (more-BIH-dih-tee)
• mortality (more-TAH-lih-tee)
• pandemic (pan-DEH-mik)
• pathogen (PATH-o-jen)
• personal protective equipment (PUR-sun-al pro-TEK-tiv i-KWIP-ment)
• phagocytosis (fay-go-sy-TOH-sis)
• protozoa (pro-tow-ZOH-ah)
• reservoir (REZ-er-vwar)
• rickettsia (rah-KET-see-ah)
• sepsis (SEP-sis)
• standard precautions (STAN-derd pre-KAW-shuns)
• Staphylococcus aureus (staff-il-oh-KOK-us AW-ree-uhs)
• trichinosis (TRIK-in-OH-sis)
• vector (VEK-tur)
• virulence (VEER-you-lence)
• viruses (VY-rus-iz)

LEARNING OUTCOMES

1. List the links in the chain of infection.
2. Explain how to interrupt the routes of transmission for infections.
3. Describe the body's defense mechanisms to fight infection.
4. Describe the principles of anti-infective medication administration.
5. Describe nursing care for a patient with an infection.

THE INFECTION PROCESS

• A pathogen is defined as an organism capable of causing disease in a host (an infected person).
• Colonization occurs when pathogenic microbes persist in the body without causing symptoms or a detectable immune response.
• An infection is indicated when a microbe multiplies within a host. An infection characterized solely by an immune response (increased antibody level) without symptoms is termed a subclinical infection.
• To prevent infection, it is essential to break the links in the chain of infection. If an infection occurs, treatment focuses on breaking this chain to prevent spreading it to others.

Infectious Agents

• Types of microorganisms that cause infection include:
  • Bacteria
  • Viruses
  • Fungi
  • Protozoa
  • Helminths
  • Prions
• Organisms that naturally reside in or on body parts are referred to as normal flora. Typically, these are nonpathogenic and provide assistance to the host; for example, intestinal bacteria help synthesize Vitamin K necessary for blood clotting. However, if they enter other parts of the body, like the bloodstream, they can act as pathogens.

Bacteria

• Bacteria are single-celled organisms that can live and reproduce outside a host as well. Most bacteria possess cell walls susceptible to antibiotics, although mutations may occur allowing them to survive antibiotic treatment.
• Bacteria are classified by their shape:
  • Spherical (coccus)
  • Rod (bacillus)
  • Spiral (spirillum)
• Staining properties are used to classify bacteria, mainly through the Gram stain method, yielding results as:
  • Gram-positive: retain a purple stain.
  • Gram-negative: lose the purple stain upon exposure to alcohol, but stain pink with a secondary dye.
  • Acid-fast bacteria: retain purple staining when treated with acid.

Table 8.1: Common Infections

• Growth Conditions: Bacterial growth requires specific conditions:
  • Aerobic bacteria require oxygen (e.g., skin flora)
  • Anaerobic bacteria can survive without oxygen (e.g., gastrointestinal tract flora)
  • Optimal growth temperature is typically around 98.6°F (37°C).

Rickettsiae

• Rickettsiae are small bacteria that necessitate a living cell to reproduce, which typically involves vectors like fleas, ticks, and lice that transmit disease.

Viruses

• Viruses are smaller than bacteria and require host cells for reproduction. Host cells will produce viral materials until the host cell is destroyed or it releases viral particles. Some viruses may remain dormant within cells (e.g., varicella-zoster virus).
• Antiviral drugs help reduce viral load in the patient’s blood; however, they do not treat or cure viral infections.

Fungi

• Fungi comprise yeasts and molds, often living as normal flora in humans. While most fungi are nonpathogenic, antifungal treatments are available for serious infections.

Protozoa

• Protozoa are single-celled parasitic organisms that infect through fecal-oral contamination, or via food, water, or insect vectors.

Helminths

• Helminths are parasitic worms that can infect humans through skin penetration or ingestion and may include roundworms, flatworms, and flukes.

Prions

• Prions are infectious agents that cause abnormal folding of proteins, damaging brain tissues without producing inflammatory responses (e.g., Creutzfeldt-Jakob disease).

Reservoir

• The reservoir is the environment where infectious agents live, multiply, and reproduce, which can be animate (people, insects) or inanimate (water, soil).

Portal of Exit

• The portal of exit is the route by which the infectious agent leaves the reservoir and can include bodily fluids or secretions.

Mode of Transmission

• Infectious agents can be transmitted by different pathways, including direct contact, droplet transmission, and airborne transmission.
• Direct Transmission: Involves contact or droplet spread (sneezing, coughing).
• Indirect Transmission: More complicated routes including vehicle-borne pathogens (e.g., contaminated food, water) and vector-borne transmissions (e.g., insects).
• Airborne Transmission: Involves pathogens carried by particles in the air (e.g., TB, chickenpox).

Portal of Entry

• Infectious organisms enter a susceptible host through various routes: blood, respiratory tract, skin, or mucous membranes.

Susceptible Host

• Factors influencing host susceptibility include burns, chronic disease, immunocompromised states, invasive procedures, malnourishment, etc.

Human Body’s Defense Mechanisms

• First-line defenses include intact skin, mucous membranes, cilia, gastric acid, and normal flora residing within the body.

Immune Response

• Antibodies are proteins produced in response to antigens on the surface of cells, marking them for destruction.
• Leukocytes (white blood cells), specifically neutrophils and macrophages, play significant roles in detecting and destroying pathogens through phagocytosis.

Inflammatory Response

• Upon infection or injury, the body mounts an inflammatory response characterized by vascular changes resulting in increased blood flow, tissue swelling, and leukocyte activity to destroy pathogens.

Common Changes During Infections

• Localized Infections: Symptoms include pain, swelling, and redness.
• Sepsis: It is marked by severe organ dysfunction stemming from a dysregulated immune response to infection.

Laboratory Assessment

• Diagnostic tests like Gram stain, culture and sensitivity (C&S), serum antibody tests, and complete blood cell counts assist in diagnosing infections and tailoring treatment plans.

Pandemic vs Epidemic

• An epidemic is a rapid increase in infection cases within a specific region, while a pandemic is a global spread of infectious diseases affecting large populations.

Immunity

• The body's ability to protect itself from disease can be categorized into natural immunity, innate immunity, and acquired immunity.
• Herd immunity occurs when a significant portion of a population becomes immune, providing indirect protection to susceptible individuals.

COVID-19

• A novel coronavirus emerged as a global health threat in 2019 (SARS-CoV-2), with specific transmission routes and preventive measures including vaccination and hygiene protocols.

Antimicrobial Resistance

• Antibiotic-resistant infections, such as MRSA and VRE, pose serious health threats. Strategies to combat resistance include responsible antibiotic prescribing and increasing awareness among healthcare providers and patients.

Nursing Care Guidelines

1. Assess patient knowledge and risk factors leading to infections.
2. Administer anti-infective medications as prescribed and educate patients on their importance and usage.
3. Follow strict hand hygiene and aseptic principles when providing patient care.
4. Monitor for signs of infection, side effects of treatment, and efficacy of intervention.

Conclusion

• Healthcare professionals play crucial roles in infection prevention and control through education, adherence to guidelines, and appropriate patient care.