Infection Symptoms and Characteristics

Infections

• Asymptomatic persons may be more contagious than those exhibiting symptoms
• Symptoms of localized infections:
  • Redness
  • Pain
  • Warmth
  • Swelling
  • Pus may form
• Patients with generalized infections may not show all signs of infection
• Pain and swelling severity depend on location
• Warmth is expressed as fever in generalized infections
• Other symptoms of generalized infections:
  • Malaise
  • Anorexia
  • Prostration

Types of Infections

• Community Acquired Infections:
  • Acquired in day-to-day contact with the public
  • Examples: childhood illnesses, TB, HIV/AIDS, foodborne illnesses, STIs
  • Prevention methods:
    • Ensure childhood immunizations are complete
    • Adult immunizations
    • Hand washing and proper food handling
    • Sanitation of water supplies
    • Proper hygiene
    • Use of personal barriers like condoms
    • Staying home when sick
• Health-Care Associated Infections (HAIs):
  • Occur within a healthcare facility
  • More serious due to virulent and resistant bacteria
  • Examples: VRE, MRSA
  • Prevention methods:
    • Contact precautions
    • Standard precautions
    • Use of single patient rooms when available

Care of Patients with Infections

• Medical Asepsis:
  • Limiting the spread of microorganisms
  • Also known as clean technique
  • Practices:
    • Changing bed linens
    • Sanitizing bed linens
    • Using personal equipment for each patient
    • Frequent hand hygiene
• Hand Hygiene:
  • Soiled hands are the primary mode of transmission of HAIs
  • Effective hand hygiene methods:
    • Soap and water
    • Waterless antiseptic with at least 60% alcohol
    • Surgical scrub
  • Rub hands together for at least 20 seconds
  • Rub waterless antiseptic until dry
• Surgical Asepsis:
  • Sterile technique
  • Elimination of microorganisms through chemical or physical sterilization
  • Techniques to prevent unsterile surfaces from coming into contact with the patient
• Standard Precautions:
  • Used for all patients in the hospital
  • Practices:
    • Use of gloves, gowns, and masks
    • Hand hygiene
    • Cleaning and disinfecting surfaces
  • Respiratory hygiene and cough etiquette
• Airborne Infection Isolation:
  • For patients with diseases that spread through the air
  • Examples: TB, SARS, varicella, rubeola
  • Practices:
    • Use of negative pressure rooms
    • Properly fitted N95 masks
  • Patients with airborne infections require a surgical mask when leaving their rooms
• Droplet Precautions:
  • For patients with diseases that spread through droplets
  • Examples: COVID-19, rubella, mumps, diphtheria, influenza
  • Practices:
    • Use of surgical masks
    • Placing patients in private rooms
  • Staff and visitors must wear a surgical mask when within 3 feet of the patient
• Contact Precautions:
  • For patients with diseases that spread through direct or indirect contact
  • Practices:
    • Use of gloves and gowns
    • Use of dedicated patient care equipment
    • Cleaning and disinfecting surfaces
  • Examples of diseases that require contact precautions: GI infections, respiratory tract infections, skin and wound infections

Nursing Care of the Patient with an Infection

• Urge patients to consume adequate fluids (at least 2L per day)
• Encourage patients to consume high protein and high vitamin foods
• Isolate patients to prevent spread of infection
• Lab tests used to screen patients for infection:
  • White blood cell count
  • Erythrocyte Sedimentation Rate (ESR)
  • Iron Level
  • Cultures of urine, blood, and sputum
  • White blood cell differential count
• Caution patients not to stop taking medication when they start feeling better

Immunodeficiency

• Definition: When the body's self-defenses against foreign invaders fail to function normally
• Types of immunodeficiencies:
  • Congenital
  • Acquired
• Causes of acquired immunodeficiency:
  • Infections
  • Malignancies
  • Autoimmune diseases
  • Chronic diseases
  • Drugs
  • Aging
  • Stress
  • Malnutrition
• Treatment of immunodeficiency:
  • Congenital: replacement therapy of the deficient immune component
  • Acquired: correcting the underlying condition
• Nursing care for immunocompromised patients:
  • Use good hand hygiene
  • Encourage adequate nutrition
  • Perform effective skin, mouth, perineal, wound, and IV site care
  • Encourage patient to turn, cough, and deep breathe
  • Use protective isolation
  • Use disposable equipment
  • Educate patient on signs and symptoms of infection
  • Provide a supportive listening environment

Hypersensitivity and Allergy

• Definition: An atypical immune response that is activated by a foreign substance that is normally inoffensive
• Causes of hypersensitivity:
  • Genetic predisposition
  • Environmental factors
• Examples of allergens:
  • House dust
  • Animal dander
  • Pollens
  • Molds
  • Foods
  • Pharmacologic agents
  • Cigarette smoke
  • Feathers
  • Insect venoms
• Local manifestations of allergic reactions:
  • Urticaria
  • Pruritus
  • Conjunctivitis
  • Rhinitis
  • Laryngeal edema
  • Bronchospasm
  • Dysrhythmia
  • GI cramps
  • Malabsorption
  • Angioedema
• Medical treatment of patients with allergies:
  • Antihistamines
  • Bronchodilators
  • Corticosteroids
  • O2 and breathing treatments
  • Topical lotions and ointments
• Nursing care for patients with allergies:
  • Post allergies on the patient's record
  • Never give any drug that the patient is allergic to
  • Alert pharmacy and dietary to the patient's allergies
  • Notify the provider of patient allergies
  • Ensure patients taking allergy medications continue to do so
  • Teach patient to limit exposure or avoid allergens
  • Teach proper use of allergy medications
  • Teach actions and side effects of medications
  • Teach patient to wear a ID band that identifies their allergies

Anaphylaxis

• Definition: A life-threatening allergic reaction
• Causes of anaphylaxis:
  • Antimicrobials
  • Medicines or serums from animal sources
  • Insect venom
  • Iodine radioactive contrast media
  • Local anesthetic
  • Blood products
• Symptoms of anaphylaxis:
  • Anxiety
  • Wheezing
  • Difficulty breathing
  • Cyanosis
  • Hives
  • Facial edema
  • Arthralgia
  • Dizziness
  • Hypotension
  • Cardiac arrest
• Treatment of anaphylaxis:
  • O2
  • IV epinephrine
  • Dopamine or a volume expander (or both) to raise BP
  • Nebulized bronchodilator
  • Diphenhydramine
  • Corticosteroids
• Nursing care for patients with anaphylaxis:
  • Prevent anaphylaxis when possible
  • Prompt recognition of anaphylaxis
  • Minimize patient's anxiety
  • Administer prescribed drugs
  • Monitor vital signs

Autoimmune Diseases

• Definition: When the immune system reacts against and destroys its own tissues
• Causes of autoimmune diseases:
  • Injury to tissue
  • Infection
  • Malignancy
• Treatment of autoimmune diseases:
  • Corticosteroids
  • NSAIDs
  • Immunosuppressive therapies
• Nursing care for patients with autoimmune diseases:
  • Adequate rest
  • Optimal hydration and nutrition
  • Prevention of infection
  • Supportive caring atmosphere

Organ Transplantation

• Definition: When a patient's own healthy immune system may recognize the allograft (implanted organ or tissue) as foreign and try to destroy it
• Types of rejection:
  • Acute rejection
  • Chronic rejection
• Treatment of rejection:
  • Immunosuppressant drugs
  • Corticosteroids
  • Methotrexate
  • Cyclosporine
• Nursing care for patients with transplanted organs:
  • Monitor for signs of rejection
  • Administer immunosuppressant drugs
  • Educate patient on the importance of taking medication
  • Teach patient to recognize signs of rejection

Drugs Used to Treat Immunologic Disorders

• Corticosteroids:

  • Used to suppress the immune response
  • Used to prevent rejection of grafted tissue
  • Treats RA, SLE, and MS

• Calcineurin Inhibitors (CI):

  • Used to prevent rejection of trans### SLE (Systemic Lupus Erythematosus) Patient Care

• Closely monitor the patient's pain level and medication use.

• Encourage the patient to avoid prolonged sun exposure and use sunscreen with an SPF of at least 30 to prevent skin rash.

• Allow patients to express their feelings and ask questions, as a diagnosis of SLE can be shocking.

• Ensure accurate and consistent information from the healthcare team to facilitate patient understanding.

Human Immunodeficiency Virus (HIV)

• HIV causes immune cell destruction and is a retrovirus, transcribing genetic material in reverse.
• Infection occurs through blood and body fluids, and HIV attaches to macrophages and T4 helper cells, infusing its genetic material into the host cell.
• Over time, HIV destroys CD4+T cells faster than the body can replace them, leading to opportunistic infections when the immune response is severely impaired.

Stages of HIV Infection

• Initial stage: lasts 4-8 weeks from exposure, with 50% of people experiencing flu-like symptoms and the other 50% being asymptomatic.
• Latent stage: virus is inactive in infected resting CD4 host cells, lasting 2-12 years, during which the patient is asymptomatic and CD4 cells decline.
• Third stage: patient experiences opportunistic infections, with declining CD4 cell levels (<500) and increasing virus levels in the blood.

HIV Complications and Characteristics

• Opportunistic infections occur when CD4 cell levels fall below 200, and the patient is considered to have AIDS, with high virus levels in the blood.
• Antiretroviral drug regimens are abbreviated as ART or HAART.
• Clinical manifestations of HIV include malaise, nausea/vomiting, decreased appetite, rash, diarrhea, fever, night sweats, and others.
• Risk factors for HIV include unprotected sexual contact, IV drug use with shared needles, and blood transfusions before 1989.

HIV Complications

• Opportunistic infections, wasting, secondary cancers, and dementia.
• Patients with AIDS are at high risk for opportunistic fungal, parasitic, and viral infections, including oral candidiasis, pneumonia, herpes simplex, meningitis, and toxoplasmosis.