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• Infection, inflammation, and immunity are interrelated in the body's defense against pathogens.
• Pathogen invasion triggers an inflammatory response as part of the innate immune system.
• Inflammation contains infection and recruits immune cells.
• The adaptive immune system (antibody-mediated and cell-mediated responses) attacks the pathogen.
• Inflammation increases blood flow allowing immune cells to reach the infected area.
• Successful immunity eliminates the pathogen and resolves inflammation.
• Excessive or uncontrolled inflammation can cause tissue damage.
• Proper regulation of inflammation and an effective immune response are crucial for overcoming infections while minimizing harm.

Complications of Impaired Immunity

• Severe, life-threatening infections from common pathogens can occur.
• Opportunistic infections from organisms rarely causing disease in healthy individuals may arise.
• Prolonged, recurrent, or disseminated infections are possible.
• Increased susceptibility to viral, fungal, and parasitic infections can occur.
• Delayed wound healing and poor response to treatments are likely.
• There is an increased risk of cancers like lymphoma.
• Autoimmune disorders may arise due to immune dysregulation.

Causes of Immunosuppression

• Medications like chemotherapy drugs, corticosteroids, and immunosuppressants can cause immunosuppression.
• Diseases such as HIV/AIDS, leukemia, lymphoma, and severe combined immunodeficiency can impair immunity.
• Malnutrition, specifically deficiencies in protein, vitamins, and minerals, reduces immune function.
• The immune system becomes less effective with aging.
• Environmental factors include radiation exposure, extreme stress, and lack of sleep.
• Medical treatments like radiation therapy and stem cell/bone marrow transplants can suppress immunity.
• Congenital disorders: Genetic defects affecting immune cell development or function

Clients at High Risk of Developing Infection

• Newborns and infants have immature immune systems.
• Elderly adults experience age-related immune decline.
• Pregnant women have immunosuppressive effects.
• Individuals with chronic diseases like diabetes, cancer, and HIV/AIDS are at higher risk.
• Those on immunosuppressive medications like chemotherapy.
• Individuals with nutritional deficiencies.
• Patients with burns, trauma, or surgical wounds.
• Smokers and substance abusers with impaired lung defenses
• Individuals on ventilators or with invasive devices like catheters.
• Patients with impaired immunity

Hypersensitivity/Allergic Reactions

• The immune system overreacts to a harmless substance (allergen).
• Reactions range from mild to life-threatening anaphylaxis (throat swelling, low blood pressure).
• Excessive inflammation is triggered by the release of histamine from mast cells and basophils.
• Symptoms can include skin reactions (hives, rash), respiratory issues (wheezing, difficulty breathing), gastrointestinal upset (vomiting, diarrhea), and cardiovascular problems (hypotension).
• Epinephrine is crucial for anaphylaxis

Inflammatory Process

• It is a protective response to injury or infection
• It involves a complex series of events
• Blood vessels dilate and become more permeable, allowing plasma proteins and immune cells to enter the affected area, causing redness, swelling, and warmth.
• White blood cells like neutrophils and macrophages migrate to the site of injury/infection.
• They release inflammatory mediators and enzymes to destroy pathogens and damaged cells.
• Substances like histamine, prostaglandins, and leukotrienes are released, causing increased blood flow, pain, fever, and further recruitment of immune cells.
• Macrophages and neutrophils engulf and digest pathogens and debris through phagocytosis.
• If the injury persists, the inflammatory response becomes chronic.
• Fibroblasts proliferate to repair damaged tissue through collagen deposition and scar formation.

Symptoms of Inflammation and Causes

• Redness (rubor): Increased blood flow from vasodilation of blood vessels
• Heat (calor): Increased blood flow and metabolic activity in the inflamed area
• Swelling (tumor): Accumulation of fluid and cells from increased vascular permeability
• Pain (dolor): Release of inflammatory mediators like prostaglandins stimulating nerve endings
• Loss of function (function laesa): Swelling, pain, and tissue damage impairing normal function

Acute vs Chronic Inflammation

• Acute inflammation has a rapid onset in response to injury or infection.

• It lasts for a short duration, resolving with removal of the stimulus.

• It involves vascular changes and influx of neutrophils.

• It aims to eliminate the injurious agent and initiate healing

• Chronic inflammation is prolonged and persistent, lasting weeks to years.

• It results from failure to eliminate the cause or defective resolution.

• It involves infiltration of lymphocytes, macrophages, and plasma cells.

• It leads to tissue damage and destruction from ongoing inflammation.

• Associated with autoimmune disorders, chronic infections, or exposure to irritants.

How Infection Affects the Body

• Localized effects: Pathogens directly damage cells/tissues at the site of infection, causing inflammation, pain, swelling, and impaired function.
• Systemic effects: Infection spreads through the bloodstream or lymphatic system, causing fever, fatigue, muscle aches, and other flu-like symptoms.
• Toxin release: Some pathogens release toxins, causing widespread effects like diarrhea, paralysis, tissue damage, and shock.
• Immune response complications: Excessive/uncontrolled immune response can lead to autoimmune reactions or sepsis.
• Organ damage: Severe infections can impair lungs (pneumonia), heart (endocarditis), kidneys (pyelonephritis), or brain (meningitis).
• Chronic effects: Infections can become chronic or recurrent, leading to complications like arthritis, cancer, or organ failure if left untreated.

Localized vs Systemic Infection

• Localized affects localized areas like a wound, skin, or specific organ.

• Causes local inflammatory signs: redness, swelling, pain, warmth. Examples: cellulitis, abscess, UTI

• Systemic Spreads through the bloodstream or lymphatic system.

• Causes body-wide symptoms: fever, chills, fatigue, muscle aches.

• Affects multiple organs and systems. Examples: sepsis, meningitis, pneumonia.

• A localized infection can become systemic if untreated or if the immune system cannot contain it.

• Systemic infections are generally more serious and require prompt treatment to prevent complications like organ failure or septic shock.

Stages of the Infection Process

• Exposure
• Entry
• Colonization: Microorganism begins multiplying and establishing itself within host's tissues
• Invasion: Pathogen actively penetrates deeper into the host's cells and tissues evading immune defenses
• Multiplication
• Tissue damage
• Dissemination: Pathogen spreads from the initial site to other areas of the body through the bloodstream or lymphatic system
• Convalescence: Host's immune system controls or eliminates the pathogen, leading to recovery
• Persistence: Pathogens evade clearance and establish a chronic or latent infection

Chain of Infection and Prevention

• Infectious agent: Pathogen (bacteria, virus, fungus, or parasite).
• Reservoir: Where the infectious agent resides and multiplies (humans, animals, soil, or objects).
• Portal of exit: Path by which the agent leaves the reservoir (respiratory secretions, blood, or feces).
• Mode of transmission: How the agent is spread (contact, droplet, airborne, vehicle, or vector).
• Portal of entry: Route by which the agent enters a new host (mucous membranes, broken skin, or respiratory tract).
• Measures to stop the chain of include:
  • Proper hand hygiene and disinfection
  • Covering coughs/sneezes
  • Safe injection practices
  • Adequate ventilation
  • Cleanliness and sterilization
  • Healthy lifestyles and immunizations

Types of Isolation Precautions

• Standard precautions: Basic infection control measures for all patient encounters.
  • Includes hand hygiene and use of PPE.
• Contact precautions: Used for infections spread by direct or indirect contact.
  • Requires gown and gloves upon entry to patient room.
• Droplet precautions: Used when respiratory droplets are the main mode of transmission (influenza).
  • Requires a mask within 6 feet of the patient.
• Airborne precautions: For infections spread over long distances by small airborne particles (tuberculosis).
  • Requires an N95 respirator or PAPR when entering airborne isolation room.

Clostridium Difficile (C. Diff)

• C. Diff is a bacteria that can cause serious intestinal infections, often after antibiotic disrupts the normal gut flora.
• Overgrowth of C. diff is caused due to recent antibiotic therapy that kills beneficial gut bacteria.
• Signs and symptoms include watery diarrhea, abdominal pain, fever, nausea, and loss of appetite.
• Treatment involves stopping the causative antibiotic, fluid/electrolyte replacement, and antibiotics like oral metronidazole or vancomycin.
• Nursing includes contact precautions (gown, gloves), strict hand hygiene, disinfecting surfaces with sporicidal agents, isolating positive cases, and educating family/patient on preventing transmission

Influenza

• Influenza is a highly contagious viral respiratory infection caused by influenza viruses.
• Signs and symptoms include abrupt onset of fever, body aches, headache, fatigue, sore throat, cough, and runny nose.
• Treatment involves relieving symptoms with rest, fluids, and over the counter meds.
• Antiviral drugs may be prescribed for high risk groups.
• Nursing includes respiratory hygiene, droplet precautions (mask within 6 ft), annual flu vaccine, proper handwashing, avoiding touching face, staying home until fever-free for 24 hours, disinfecting surfaces/equipment and monitoring for complications like pneumonia

Patient Education Regarding Antibiotic Usage

• Take the full prescribed course of antibiotics.
• Do not skip doses.
• Take the right amount at right intervals.
• Should be taken alone (w/o) dairy products, antacids, or supplements.
• Be aware of side effects like rash, diarrhea, nausea, and report any concerning symptoms promptly.
• Do not share antibiotics or save for later use
• Practice good hand hygiene
• Finish all doses to ensure infection is fully cleared

Malnutrition Causes

• Insufficient nutrient intake from lack of access to enough food, poverty, famine, or an unbalanced diet.
• Impaired absorption from conditions like Crohn's disease, celiac disease, or short bowel syndrome.
• Increased nutrient losses from severe burns, wounds, diarrhea, or kidney disease.
• Increased nutrient requirements from conditions like cancer, HIV/AIDS, or hyperthyroidism.
• Inability to ingest food due to disorders affecting swallowing or the GI tract.
• Psychiatric illnesses like anorexia nervosa or bulimia nervosa causing intentional food restriction.
• Socioeconomic factors like food insecurity, lack of education about nutrition, cultural practices, or neglect.

Effects of Malnutrition

• Muscle wasting and weakness from lack of protein.
• Impaired immune function, increasing infection risk.
• Nutrient deficiencies causing conditions like anemia, osteoporosis, night blindness.
• Fluid and electrolyte imbalances.
• Delayed wound healing.
• Fatigue and lethargy from lack of calories.
• Growth stunting in children.
• Organ failure in SEVERE cases

Fat-Soluble vs Water-Soluble Vitamins

• Fat-soluble vitamins (A, D, E, K) are absorbed through the intestinal tract, stored in fatty tissues and liver.
• Excess intake can lead to toxicity.
• Water-soluble vitamins (B-complex, C) dissolve easily in water and are readily excreted from the body through urine.
• They need to be replenished regularly in the diet as they cannot be stored in significant amount.
• Fat-soluble vitamins are better absorbed when consumed with some dietary fat.
• Water-soluble vitamins are not affected by fat intake.
• Deficiencies of fat-soluble vitamins take longer to develop due to storage in the body.
• Water-soluble deficiencies occur more rapidly.

Lab Values Important to Nutrition

• Albumin: Low levels may indicate protein malnutrition (Half life is 21 days)
• Prealbumin: Preferred for assessing short-term protein status changes (Half-life is 2 days)
• Transferrin: Decreases with protein deficiency (Half-life is 8 days)
• Total lymphocyte count: Impaired with protein-calorie malnutrition
• Hemoglobin/Hematocrit: Low levels suggest anemia from deficiencies in iron, folate, or vitamin B12
• Electrolytes: Imbalances can occur with severe malnutrition affecting fluid regulation
• Nitrogen balance studies: Calculate protein intake vs losses to determine anabolic or catabolic state

BMI Ranges

• Underweight: BMI < 18.5
• Normal weight: BMI 18.5-24.9
• Overweight: BMI 25-29.9
• Obesity Class 1: BMI 30-34.9
• Obesity Class 2: BMI 35-39.9
• Obesity Class 3: BMI > 40
• In children: BMI at or above 85% is overweight, and over 95% is obese

Modified Diets

• Clear liquid diet: Broth, gelatin, juice
• Full liquid diet: Strained soup, milk, pudding
• Soft diet: Soft, moist, and easy to chew (mashed potatoes, yogurt, cooked veggies)
• Low fiber diet
• Low residue diet: Low fiber with low fat and lactose restrictions
• Renal diet: Limits protein, sodium, potassium, phosphorus, and fluids for kidney disease
• Diabetic diet: Controls carbohydrate intake and promotes foods low on glycemic index

Parenteral vs. Enteral Feedings

• Parenteral Nutrients delivered directly into the bloodstream

  • Used when the GI tract is non-functional or inaccessible
  • Can provide complete nutrition requirements
  • Higher risk of complications like infections, metabolic issues

• Enteral Nutrients delivered through the GI tract

  • Preserves gut integrity and function
  • Lower infection risk compared to parenteral
  • Cannot meet full nutritional requirements in some cases
  • May be used as a supplement or transition from parenteral nutrition

Nursing Interventions for Enteral Feeding

• Verify tube placement before initiating feedings or administering medications to prevent aspiration.
• Monitor gastric residual volumes regularly and hold feedings if excessive residuals are present.
• Ensure proper flushing of the feeding tube to prevent clogging.
• Assess for signs of intolerance like abdominal distention, nausea, vomiting, diarrhea, and report concerns immediately.
• The goals are to provide oral care and assess for tube dislodgment.
• Monitor intake and output, weight, and lab values to evaluate hydration and nutrition adequacy.

Roles of UAP, LPN, and RN in Nutrition Care

• Unlicensed Assistive Personnel (UAP): Under nurse supervision assists with basic feeding tasks. This includes
  • Positioning the patient
  • Opening containers
  • Documenting intake
  • Providing oral care
• LPN: Can monitor tube feeding rates, flush feeding tubes, check gastric residuals, and document intake/output
• RN: Responsible for comprehensive assessment of nutritional status, developing the nutrition care plan, verifying tube placement, administering tube feedings/medications, monitoring for complications and educating patients/families