Medical Surgical Nursing Infectious Diseases PDF

Quidato Jan Lyre A. | BSN 3 – A | 2024 Table of Contents I. The Anatomy and Physiol- XII. Hepatitis ogy of The Immune System  Hepatitis A II. Immunity  Hepatitis B  Phagocytic Immune Response...

Quidato Jan Lyre A. | BSN 3 – A | 2024 Table of Contents I. The Anatomy and Physiol- XII. Hepatitis ogy of The Immune System  Hepatitis A II. Immunity  Hepatitis B  Phagocytic Immune Response  Hepatitis C  Cellular Immune Response  Hepatitis D  Humoral or Antibody Immune  Hepatitis E Response XIII. Guillain-Barre Syndrome III. Types of Antibodies  Types IV. Types of Lymphocytes  Pathophysiology V. Cellular Response to Injury:  Clinical Manifestation Inflammation  Medical and Nursing Manage- VI. Infectious Disorders of ment XIV. Sexually Transmitted Dis- Adults eases  Pneumonia  Community-Acquired Pneu-  Vulvovaginal Infections monia  Human Papilloma Virus  Health Care–Associated  Herpes Simplex Virus Pneumonia XV. Ebola Virus Disease  Hospital-Acquired Pneumo-  Transmission and Nursing nia Management  Ventilator-Associated Pneu- XVI. Isolation Precautions in monia Detail  Immunocompromised Host  Standard Precautions Pneumonia  Room Placement, Visitors, Pa-  Aspiration Pneumonia tient Transport, Special Room VII. Clinical Manifestations of Characteristics Pneumonia  Contact Precautions VIII. Assessment and Diagnos-  Room Placement, Visitors, Pa- tics for Pneumonia tient Transport, Special Room Characteristics IX. Preventive Measures for  Droplet Precautions Pneumonia  Room Placement, Visitors, Pa- X. Medical and Pharmacologic tient Transport, Special Room Management for Pneumo- Characteristics nia  Airborne Precautions XI. Tuberculosis  Room Placement, Visitors, Pa-  Transmission and Risk Factors tient Transport, Special Room  Pathophysiology Characteristics  Clinical Manifestation  Assessment and Diagnostics 1|Pa ge  Quidato Jan Lyre A. | BSN 3 – A | 2024 Medical Surgical Nursing Antibodies Infectious Diseases Are large proteins, called immunoglobulins. Mobilize other com- The Anatomy and Physiology of The Immune System ponents of the immune system to defend against the invader. ❖ Immunity is the body’s specific protective response to a for- ❖ The Five Types of Antibodies eign agent or organism  igG ❖ Immune system functions as the body’s defense mechanism  Binds to phagocytes. Main blood antibody for sec- against invasion and allows a rapid response to foreign sub- ondary responses. Crosses placenta. stances in a specific manner.  Assumes a major role in bloodborne and tissue in- ❖ White blood cells (WBCs) involved in immunity are pro- fections. Activates the complement system. En- duced in the bone marrow hances phagocytosis  B lymphocytes (B cells)  igA  T lymphocytes (T cells)  Secreted into mucous, saliva, tears, and colostrum.  Lymphocytes originate from stem cells in the bone Tags pathogens for destruction. marrow. B lymphocytes mature in the bone marrow  Protects against respiratory, gastrointestinal, and before entering the bloodstream, whereas T lympho- genitourinary infections. Prevents absorption of an- cytes mature in the thymus, where they also differ- tigens from food. Passes to neonate in breast milk for entiate into cells with various functions. protection  igM  Fixes complements. Main antibody of primary re- sponses. B-cell receptors. Immune system memory  first immunoglobulin produced in response to bacte- rial and viral infections. Activates the complement system  igE  Binds to mast cells and basophils. Allergy and an- tiparasitic activity.  Takes part in allergic and some hypersensitivity re- actions. Combats parasitic infections  igD  B-cell receptor. Stimulates release of igM. Possibly ❖ The Spleen influences B-lymphocyte differentiation, but role is  Spleen, composed of red and white pulp, acts some- unclear what like a filter Types of Lymphocytes  The red pulp is the site where old and injured red blood ❖ Effector Helper T Cells cells (RBCs) are destroyed  Activated on recognition of antigens and stimulate the  White pulp contains concentrations of lymphocytes. rest of the immune system. When activated, helper ❖ Lymph Nodes T cells secrete cytokines, which attract and activate B  Lymph nodes, which are connected by lymph channels cells, cytotoxic T cells, NK cells, macrophages, and and capillaries, are distributed throughout the body other cells of the immune system  They remove foreign material from the lymph system ❖ Effector Cytotoxic T Cells before it enters the bloodstream  (killer T cells) Attack the antigen directly by altering the  Lymph nodes also serve as centers for immune cell pro- cell membrane, causing cell lysis (disintegration), and liferation. releasing cytolytic enzymes and cytokines Immunity ❖ Regulatory or Suppressor T cells Acquired (adaptive) immunity usually develops as a result of  have the ability to decrease B-cell production, thereby prior exposure to an antigen through immunization (vaccination) keeping the immune response at a level that is compat- or by contracting a disease, both of which generate a protective ible with health (e.g., sufficient to fight infection ade- immune response quately without attacking the body’s healthy tissues ❖ Memory T Cells  Are responsible for recognizing antigens from pre- vious exposure and mounting an immune response. Cellular Response to Injury: Inflammation Is a localized reaction intended to neutralize, control, or elimi- nate the offending agent to prepare the site for repair. Major function of the natural immune system that is elicited in re- sponse to tissue injury or invading organisms Pathophysiology ❖ Sequence involves changes in the microcirculation, includ- ing vasodilation, increased vascular permeability, and in leu- kocytic cellular infiltration ❖ As these changes take place, five cardinal signs of inflam- Response To Invasion mation are produced: redness, warmth, swelling, pain, and ❖ Phagocytic Immune Response loss of function.  primarily involves the WBCs (granulocytes and macro- ❖ Vasodilation and an increased rate of blood flow through the phages), which have the ability to ingest foreign parti- microcirculation to the area of tissue damage, Local warmth cles and destroy the invading agent and redness result ❖ Cellular Immune Response ❖ Increase in vascular permeability, plasma fluids leak into the  also involves the T lymphocytes, which can turn into inflamed tissues, producing swelling special cytotoxic (or killer) T cells that can attack the ❖ Pain that occurs is attributed to the pressure of fluids or pathogens. swelling on nerve endings AND irritation of nerve endings ❖ Humoral or Antibody Immune Response by chemical mediators  antibody response begins with the B lymphocytes, ❖ Loss of function is most likely related to the pain and swell- which can transform themselves into plasma cells that ing. manufacture antibodies 2|Pa ge  Quidato Jan Lyre A. | BSN 3 – A | 2024 ❖ Leukocytes (white blood cells) exit, and migrate to the site ❖ S. pneumoniae (pneumococcus) is the most common of injury to engulf offending organisms and to remove cellu- cause of CAP in people younger than 60 years without lar debris comorbidity and in those 60 years and older with comorbid- ❖ Fibrinogen in the leaked plasma fluid coagulates, forming fi- ity brin for clot formation, which serves to wall off the injured ❖ A gram-positive organism that resides naturally in the upper area and prevent the spread of infection respiratory tract, colonizes the upper respiratory tract and can cause disseminated invasive infections. ❖ H. influenzae causes a type of CAP that frequently af- fects older adults and those with comorbid illnesses (e.g., chronic obstructive pulmonary disease [COPD], alco- holism, and diabetes). ❖ Mycoplasma pneumonia is caused by M. pneumoniae; spread by infected respiratory droplets through person-to- person contact. The inflammatory infiltrate is primarily in- terstitial rather than alveolar. It spreads throughout the entire respiratory tract. ❖ Viruses are the most common cause of pneumonia in in- fants and children Health Care Associated Pneumonia ❖ An important distinction of HCAP is that the causative pathogens are often MDR (Multiple drug resistant) ❖ HCAP is often difficult to treat, ❖ Initial antibiotic treatment of HCAP is often different from that for CAP due to the possibility of MDR bacteria Infectious Disorders of the Adults Hospital Acquired Pneumonia Pneumonia ❖ HAP develops 48 hours or more after admission and A is an inflammation of the lung parenchyma caused by various does not appear to be incubating at the time of admission. microorganisms, including bacteria, mycobacteria, fungi, and vi- ❖ Certain factors may predispose patients to HAP because of ruses impaired host defenses (e.g., severe acute or chronic illness), ❖ Pneumonia can be classified into four types: a variety of comorbid conditions, supine positioning and as-  Community-acquired pneumonia (CAP), piration, coma, malnutrition, prolonged hospitalization, hy-  Health care–associated pneumonia (HCAP), potension, and metabolic disorders.  Hospital acquired pneumonia (HAP), ❖ Common organisms responsible for HAP include:  Ventilator Assisted Pneumonia (VAP)  Enterobacter species Pathophysiology  Escherichia coli ❖ Resident macrophages serve to protect the lung from for-  H. influenzae eign pathogens  Klebsiella species ❖ Inflammatory reaction triggered by these very macrophages  Proteus is what is responsible for the histopathological and clinical  Serratia marcescens findings seen in pneumonia.  Pseudomonas aeruginosa ❖ Macrophages engulf these pathogens and trigger signal mol-  Methicillin-sensitive or methicillin-resistant Staphylo- ecules or cytokines that recruit inflammatory cells like neu- coccus aureus (MRSA) trophils to the site of infection  S. pneumoniae. ❖ Causes inflammation of the lung parenchyma and makes the Ventilator Associated Pneumonia lining capillaries "leaky," which leads to exudative conges- ❖ The patient has been endotracheally intubated and has re- tion and underlines the pathogenesis of pneumonia. ceived mechanical ventilatory support for at least 48 hours. ❖ Is a complication in as many as 28% of patient who require mechanical ventilation. Immunocompromised Host Pneumonia ❖ Includes Pneumocystis pneumonia (PCP), fungal pneu- monias, and Mycobacterium tuberculosis. The organism that causes PCP is now known as Pneumocystis jiroveci in- stead of Pneumocystis carinii. ❖ Occurs with the use of corticosteroids or other immunosup- pressive agents, chemotherapy, nutritional depletion, the use of broad-spectrum antimicrobial agents, acquired im- mune deficiency syndrome. Aspiration Pneumonia ❖ Aspiration pneumonia refers to the pulmonary conse- quences resulting from entry of endogenous or exogenous substances into the lower airway. Community-Acquired Pneumonia ❖ Common form of aspiration pneumonia is bacterial infection Occurs either in the community setting or within the first 48 from aspiration of bacteria that normally reside in the upper hours after hospitalization or institutionalization airways. ❖ Substances other than bacteria may be aspirated into the lung, such as gastric contents, exogenous chemical contents, or irritating gases. ❖ This type of aspiration or ingestion may impair the lung de- fenses, cause inflammatory changes, and lead to bacterial growth and a resulting pneumonia. 3|Pa ge  Quidato Jan Lyre A. | BSN 3 – A | 2024 Clinical Manifestation ❖ Antipyretics may be used to treat headache and fever; ❖ Predominant symptoms may be headache, low-grade fe- ❖ Antitussive medications may be used for the associated ver, pleuritic pain, myalgia, rash, and pharyngitis. After cough. a few days, mucoid or mucopurulent sputum is expecto- ❖ Warm, moist inhalations are helpful in relieving bronchial ir- rated. ritation. ❖ In severe pneumonia – the cheeks are flushed, and the lips ❖ Antihistamines may provide benefit with reduced sneez- and nail beds demonstrate central cyanosis. ing and rhinorrhea. ❖ Orthopnea (shortness of breath when reclining or in the ❖ Nasal decongestants may also be used to treat symptoms supine position), → preferring to be propped up or sitting in and improve sleep. bed leaning forward (orthopneic position) in an effort to ❖ If hypoxemia develops, oxygen is given achieve adequate gas exchange without coughing or breath- ❖ Hydration (2 to 3 L/day) ing deeply. ❖ Humidification may be used to loosen secretions and im- ❖ Appetite is poor, and the patient is diaphoretic and tires eas- prove ventilation. ily. Sputum is often purulent. ❖ Chest physiotherapy (percussion and postural drainage) Assessment and Diagnostics ❖ Position to promote rest and breathing (e.g., semi-Fowler’s ❖ Health History position) ❖ Sputum Examination ❖ Avoid overexertion and to engage in only moderate activity ❖ Physical Examination during the initial phases of treatment ❖ Chest X-Ray Tuberculosis ❖ Blood Culture Is an infectious disease that primarily affects the lung paren- chyma. Also, may be transmitted to other parts of the body, in- cluding the meninges, kidneys, bones, and lymph nodes. Infec- tious agent, M. tuberculosis ❖ Transmission  Airborne transmission  An infected person releases droplet nuclei (usually par- ticles 1 to 5 mcm in diameter) through talking, cough- ing, sneezing, laughing, or singing ❖ Risk Factors  Close contact with someone who has active TB  Living in overcrowded, substandard housing.  Any person without adequate health care  Immunocompromised status Pathophysiology ❖ begins when a sus- ceptible person in- hales mycobacteria and becomes in- fected. Preventive Measures ❖ Body’s immune sys- ❖ Promote coughing and expectoration. Encourage smoking tem responds by ini- cessation. tiating an inflamma- ❖ Initiate special precautions against infection. tory reaction. Phago- ❖ Encourage smoking cessation. cytes (neutrophils ❖ Reposition frequently and promote lung expansion exer- and macrophages) cises and coughing. Initiate suctioning and chest physical engulf many of the therapy if indicated. bacteria, and TB- ❖ Reposition frequently to prevent aspiration and administer specific lymphocytes medications judiciously. Particularly those that increase risk lyse (destroy) the ba- for aspiration. Perform suctioning and chest physical ther- cilli and normal tis- apy if indicated. sue ❖ Promote frequent oral hygiene. Minimize risk for aspiration ❖ Reaction results in by checking placement of tube and proper positioning of pa- the accumulation of tient. exudate in the alveoli ❖ Elevate head of bed at least 30 degrees. ❖ Granulomas, new tissue masses ❖ Monitor patients receiving antibiotic therapy for signs and of live and dead bacilli, are sur- symptoms of pneumonia rounded by macrophages, Medical Management which form a protective wall. ❖ Make sure that respiratory equipment is cleaned properly; ❖ Then transformed to a fibrous participate in continuous quality improvement monitoring tissue mass, the central portion with the respiratory care department. of which is called a Ghon tuber- ❖ Use strict hand hygiene and gloves. Implement health care cle/ Ghon Foci provider education ❖ Becomes necrotic, forming a Pharmacologic Therapy cheesy mass. This mass may ❖ Appropriate antibiotic as determined by the results of a cul- become calcified and form a ture and sensitivity collagenous scar. ❖ With known multidrug resistance, a three-drug combination ❖ The bacteria become dormant, therapy may be used; this drug regimen may include an an- and there is no further progres- tipseudomonal cephalosporin or ceftazidime (Fortaz) or an- sion of active disease tipseudomonal carbapenem or piperacillin/tazobactam (Zosyn) plus antipseudomonal fluoroquinolone or aminogly- coside plus linezolid (Zyvox) or vancomycin (Vancocin) ❖ Treatment of viral pneumonia is primarily supportive ❖ Hydration is a necessary part of therapy 4|Pa ge  Quidato Jan Lyre A. | BSN 3 – A | 2024 ❖ After initial exposure and infection, active disease may de-  Polydrug-resistant TB – Resistance to more than velop because of a compromised or inadequate immune one first-line anti-TB drug (other than both Isoniazid system response and Rifampicin) ❖ Active disease also may  Multidrug-resistant TB (MDR-TB) – Resistant to occur with reinfection at least both Isoniazid and Rifampicin and activation of  Extensively drug-resistant TB – Resistant to any dormant bacteria. fluoroquinolone and at least one of the three second- ❖ Ghon tubercle ulcerates, line injectable drugs (Capreomycin, Kanamycin and releasing the cheesy ma- Amikacin), in addition to multidrug resistance. terial into the bronchi.  Rifampicin-resistant TB (RR-TB) – Resistance to The bacteria then be- Rifampicin detected using phenotypic or genotypic come airborne, resulting methods, with or without resistance to other anti-TB in the further spread of drugs. It includes any resistance to Rifampicin, the disease. whether monoresistance, multidrug resistance, pol- Clinical Manifestation ydrug resistance or extensive drug resistance. ❖ A low-grade fever, cough, night sweats, fatigue, and weight Medical Management loss Commonly used agents Adult Daily Dosage Most Common Side Effects Drug Interactions Nursing Consider- ations ❖ Cough may be nonproductive, or mucopurulent sputum 5 mg/kg (300mg max- imum daily) Peripheral neuritis, hepatic enzymes el- Phenytoin-synergis- tic Antabuse alcohol Bactericidal Pyridoxine is used Isoniazid ❖ Hemoptysis also may occur (INH) evation, hepatitis, hypersensitivity as prophylaxis for neuritis. Monitor Assessment And Diagnostics 10 mg/kg (600 mg Hepatitis, febrile re- Rifampicin in- AST and ALT Bactericidal ❖ Tuberculin Skin Test maximum daily) action, purpura (rare), nausea, vom- creases metabolism of oral contracep- Orange urine and other secretions  Mantoux method is used to determine whether a per- iting tives, quinidine, cor- ticosteroids, couma- Discolouring of con- tact lenses Rifampicin son has been infected with the TB bacillus and is used (Rifadin) rin derivatives, and methadone, digoxin, Monitor AST and ALT widely in screening for latent M. tuberculosis infection oral hypoglycemics. PAS may interfere  Screening tool for TB infection among children with absorption of rifampicin  Tubercle bacillus extract (tuberculin), purified protein Pyra- 15-30 mg/kg (2 g maximum daily)4 Hyperuricemia, hepatotoxicity, skin Bactericidal Monitor uric acid, derivative (PPD), is injected into the intradermal layer zinamide rash, arthralgias, GI distress AST and ALT of the inner aspect of the forearm. 15-25 mg/kg (1.6 g maximum daily dose)4 Optic neuritis (may lead to blindness; Bacteriostatic Use with caution  The test result is read 48 to 72 hours after injection. Ethambutol (Myambu- vert rare at 15 mg/kg), skin rash with renal disease or when eye testing is  Reaction occurs when both induration and erythema tol) not feasible. Monitor visual acuity, colour, (redness) are present. TB Management Per Category and discrimination.  0 to 4 mm is considered not significant Category of Treatment Classification and Registration Group Treatment Regimen Pulmonary TB, new (whether bacteriologically con-  5 mm or greater may be significant in people who firmed or clinically diagnosed) are at risk. It is defined as positive in patients who Category I Extrapulmonary TB, new (whether bacteriologically 2HRZE/4HR confirmed or clinically diagnosed) except CNS/bones are HIV positive or joints Category Ia Extra-pulmonary TB, new (CNS/bone or joints) 2HRZE/10HR  10 mm or greater is usually considered significant Pulmonary or extra-pulmonary, previously treated drug-susceptible TB (whether bacteriologically con- in people who have normal or mildly impaired im- firmed or clinically diagnosed) Relapse munity Category II Treatment after failure 2HRZE/1HRZE/5HRE Treatment after lost-to-follow-up (TALF)  Significant reaction indicates past exposure to M. tu- Previous treatment outcome unknown other berculosis or vaccination with bacille Calmette- Extra-pulmonary, previously treated drug-susceptible Guérin (BCG) vaccine Category IIa TB (whether bacteriologically confirmed or clinically diagnosed – CNS/bones or joints) 2HRZES/1HRZE/9HRE  Significant (positive) reaction does not necessarily Standard Regimen ZKmLfxPtoCs Individualized once DST mean that active disease is present in the body; all Drug-resistant SRDR Rifampicin-resistant TB or multidrug-resistant TB result is available Treatment duration for significant reactors are candidates for active TB. at least 18 months Individualized based on ❖ Sputum Culture XDR-TB Regimen Extensively drug-resistant TB DST result and history of previous treatment  Direct sputum smear microscopy (DSSM) is funda- LEGEND R - Rifampicin Km - Kanamycin H – Isoniazid S – Streptomycin Pto - Protionamide Z – Pyrazinamide C – Cycloserine mental to the detection of infectious cases and is rec- Nursing Management ommended for case finding among adults and children ❖ Increasing the fluid intake promotes systemic hydration and who can expectorate serves as an effective expectorant.  CXR is used to complement bacteriologic testing in ❖ Adherence to the prescribed treatment regimen is key in making a diagnosis. However, it has low specificity and treating the disease and controlling the spread of infection does not differentiate drug-susceptible from drug-re- ❖ Take the medication either on an empty stomach or at least sistant disease 1 hour before meals, because food interferes with medica-  TB culture and drug susceptibility test (DST) us- tion absorption ing solid (Ogawa or Lowenstein Jensen) or liquid ❖ Small, frequent meals may be required media (MGIT) is a routine diagnostic test for drug-re- ❖ A progressive activity schedule that focuses on increasing sistant TB cases under the NTP activity tolerance and muscle strength ❖ TB Classification ❖ Important hygiene measures, including mouth care, cover-  3 Classifications based on history of previous ing the mouth and nose when coughing and sneezing, treatment proper disposal of tissues, and hand hygiene.  New case – A patient who has never had treatment Ebola for TB or who has taken anti TB drugs for less than fruit bats of the Pteropodidae family are natural Ebola virus one month. Isoniazid and preventive therapy or hosts. Ebola is introduced into the human population through other preventive regiments are not considered as close contact with the blood, secretions, organs or other bodily previous treatment. fluids of infected animals such as fruit bats, chimpanzees, goril-  Retreatment case – A patient who has been previ- las, monkeys, forest antelope or porcupines found ill or dead or ously treated with anti-TB drugs for at least one in the rainforest. month in the past. ❖ first human outbreak of Ebola virus disease occurred in  4 Classification based on drug-susceptibility test- 1976 ing ❖ Occurred in a village near the Ebola River, from which the  Monoresistant-TB – Resistance to one first-line disease takes its name. anti-TB drug only ❖ In 2014, the virus broke through this usual pattern and ram- paged through the West African countries Liberia, Guinea, 5|Pa ge  Quidato Jan Lyre A. | BSN 3 – A | 2024 and Sierra Leone, with secondary cases in other countries ❖ Swine influenza is a respiratory disease of pigs caused by in Africa, Europe, and the United States. type A influenza viruses that regularly cause outbreaks of ❖ Ebola is spread through direct contact with blood or body influenza in pigs. fluids (urine, vomit, feces, saliva, sweat, semen, and breast ❖ Swine flu viruses do not normally infect humans. However, milk) from the person who is ill from the virus and possibly sporadic human infections with influenza viruses have oc- from contact with semen of a man who has recovered from curred. When this happens, these viruses are called "variant Ebola. viruses. ❖ Occasionally be spread by handling infected bats or infected ❖ The 2009 H1N1 influenza A virus was first detected in peo- wild animals that are sometimes hunted for food ple in the United States in April 2009. Clinical Manifestation ❖ Fever ❖ Lethargy (tiredness) ❖ Lack of appetite ❖ Coughing ❖ Runny nose ❖ Sore throat ❖ Eye irritation ❖ Nausea ❖ Vomiting Management ❖ There are four different antiviral drugs that are recom- mended for use in the United States for the treatment of flu: oseltamivir, peramivir, zanamivir, and baloxavir. ❖ CDC recommends that people who have contact with pigs get a seasonal flu vaccine every year to help prevent being Nursing Management infected with seasonal and variant influenza viruses ❖ Supportive care ❖ Safe handling and preparation of pork ❖ Patient should be isolated in a private room, away from other  People at increased risk for severe influenza complica- patients tions should avoid exposure to pigs. ❖ Health care workers should wear complete PPE  Don't eat, drink or put anything in your mouth in areas ❖ Washing hands, avoiding touching the body fluids of people with pigs. who have, or may have, Ebola  Wash your hands with soap and running water before ❖ Ervebo vaccine has been shown to be effective in protecting and after exposure to pigs outside or inside a swine people from the species Zaire ebolavirus barn. If soap and water are not available, use an alcohol- MERS-COV Middle East Respiratory Syndrome Coronavirus based hand rub. ❖ MERS -CoV is a zoonotic virus, which means that is trans-  To further reduce the risk of infection, avoid or mini- mitted between animals and people. Infected through direct mize contact with pigs in the pig barn or indirect contact with infected dromedary camels. Covid-19 ❖ Middle East respiratory syndrome (MERS) is a viral respira- Coronavirus disease (COVID-19) is an infectious disease caused tory disease caused by Middle East respiratory syndrome by the SARS-CoV2 virus. People who have pre-existing health coronavirus (MERS‐CoV) that was first identified in Saudi problems are at higher risk when they have COVID-19 Arabia in 2012. ❖ Coronaviruses are a large family of viruses that can cause diseases ranging from the common cold to severe acute res- piratory syndrome (SARS) and Coronavirus disease-2019 (COVID-19). ❖ The clinical spectrum of MERS-CoV infection ranges from no symptoms (asymptomatic) or mild respiratory symptoms to severe acute respiratory disease and death. ❖ Fever, cough and shortness of breath. Pneumonia is a com- mon finding, but MERS patients may not always develop this Clinical Manifestation Most Common Less common condition ❖ Fever ❖ Muscle aches and heavy arms or ❖ tight chest or chest pain ❖ Chills legs ❖ shortness of breath ❖ Sore throat ❖ Severe fatigue or tiredness ❖ hoarse voice ❖ Runny or blocked nose, or ❖ numbness or tingling sneezing Headache ❖ appetite loss, nausea, ❖ Sore eyes ❖ vomiting, abdominal pain or ❖ Dizziness ❖ diarrhea ❖ New and persistent cough ❖ loss or change of sense of ❖ taste or smell ❖ difficulty sleeping. People with severe disease and those needing hospital treatment should receive treatment as soon as possible. The consequences of severe COVID-19 include death, respiratory failure, sepsis, thromboembolism (blood clots), and multiorgan failure, includ- ing injury of the heart, liver or kidneys. Medical Management Medical Management ❖ No vaccine or specific treatment are currently available, however several MERS-CoV specific vaccines and treat- ments are in clinical development. ❖ Treatment of MERS patients is supportive and based on the patient’s clinical condition. ❖ Antiviral Medications ❖ Avoid contact with dromedary camels, drinking raw camel ❖ Isolation milk or camel urine, or eating meat that has not been  Confirmed moderate COVID-19 (pneumonia) be iso- properly cooked. lated to contain virus transmission H1N1 Swine Flu 6|Pa ge  Quidato Jan Lyre A. | BSN 3 – A | 2024 ❖ Symptomatic treatment such as antipyretics for fever and Hepatitis B pain, adequate nutrition and appropriate rehydration. ❖ transmitted primarily through blood (percutaneous and per- ❖ Supplemental oxygen therapy - severe cases mucosal routes). ❖ Awake prone positioning of severely ill patients hospitalized ❖ Can be found in blood, saliva, semen, and vaginal secretions with COVID-19 and can be transmitted through mucous membranes and ❖ cautious fluid management in patients with COVID-19 with- breaks in the skin. out tissue hypoperfusion ❖ Transferred from carrier mothers to their infants (NOT ❖ mild ARDS, non-invasive ventilation – continuous positive transmitted via the umbilical vein but from the mother at the airway pressure (CPAP), bilevel positive airway pressure (Bi- time of birth and during close contact) PAP) may be used. ❖ People (more than 90%) who contract HBV infection de- ❖ SEVERE ARDS endotracheal intubation; mechanical venti- velop antibodies and recover spontaneously in 6 monthS lation using lower tidal volumes ❖ 10% of patients who have HBV progress to a carrier state or Hepatitis develop chronic hepatitis with persistent HBV infection and ❖ Viral hepatitis is a systemic, viral infection in which necrosis hepatocellular injury and inflammation. and inflammation of liver cells produce a characteristic clus- ❖ Incubation period (1 to 6 months). Some patients have ar- ter of clinical, biochemical, and cellular changes thralgias and rashes. The patient may have loss of appetite, ❖ five definitive types of viral hepatitis that cause liver disease dyspepsia, abdominal pain, generalized aching, malaise, and have been identified: hepatitis A, B, C, D, and E weakness. ❖ Hepatomegaly → 12 to 14 cm vertically. ❖ Splenomegaly → posterior cervical lymph nodes may also be enlarged Hepatitis A ❖ Formerly called infectious hepatitis. Transmitted primarily through the fecal-oral route, by the ingestion of food or liquids infected with the virus. Assessment and Diagnostic Findings ❖ A child or a young adult acquires the infection at school Each antigen elicits its specific antibody and is a marker for dif- through poor hygiene, hand-to-mouth contact, or other ferent stages of the disease process: close contact. Infected food handler can spread the disease, ❖ Anti-HBc—antibody to core antigen of HBV; persists dur- and people can contract it by consuming water or shellfish ing the acute phase of illness; may indicate continuing HBV from sewage-contaminated waters. in the liver ❖ Hepatitis A is NOT transmitted by blood transfusions. Incu- ❖ Anti-HBs—antibody to surface determinants on HBV; de- bation period is estimated to be between 2 and 6 weeks, tected during late convalescence; usually indicates recovery with a mean of approximately 4 weeks. Illness may be pro- and development of immunity longed, lasting 4 to 8 weeks. Most patients recover from ❖ Anti-HBe—antibody to hepatitis B e-antigen; usually signi- hepatitis A fies reduced infectivity Clinical Manifestation ❖ Anti-HBxAg—antibody to the hepatitis B x-antigen; may ❖ Many patients are anicteric (without jaundice) and symp- indicate ongoing replication of HBV tomless. When symptoms appear, they resemble those of a Prevention mild, flu-like upper respiratory tract infection, with low- ❖ Screening of blood donors grade fever. ❖ Use of disposable syringes, needles, and lancets ❖ Anorexia (severe) ❖ Needleless IV administration systems ❖ Jaundice and dark urine ❖ Gloves are worn when handling all blood and body fluids ❖ Vague epigastric distress, ❖ Active Immunization: HBV nausea, heartburn, and flat- ❖ Passive Immunity: Hepatitis B Immune Globulin ulence Medical Management ❖ Symptoms tend to clear as ❖ Alpha-interferon is the single modality of therapy. Pegylated soon as the jaundice interferon, also referred to as peginterferon. Entecavir (ETV) reaches its peak; 10 days af- and tenofovir (TDF) ter its initial appearance. ❖ Activities are restricted until the hepatic enlargement and Prevention levels of serum bilirubin and liver enzymes have decreased. ❖ Hand hygiene, safe water supplies, and proper control of Protein intake should be 1.2 to 1.5 g/kg/day sewage disposal Hepatitis C ❖ Safe HAV vaccines include Havrix and Vaqta ❖ Blood transfusions and sexual contact once accounted for Medical Management most cases of HCV. Sharing of contaminated needles by ❖ Bed rest during the acute those who use IV or injection drugs and unintentional stage needlesticks and other injuries in health care workers ❖ Restriction of physical ac- now account for a significant number of cases tivity ❖ Risk for HCV include those who use IV or injection ❖ Nutritious diet – frequent drugs, people who are sexually active with multiple small feedings partners, patients receiving frequent transfusions, ❖ Optimal food and fluid lev- those who require large volumes of blood, and health els are necessary to coun- care personnel The incubation period is variable and may teract weight loss range from 15 to 160 days. ❖ The clinical course of acute HCV is similar to that of HBV; symptoms are usually mild or absent. 7|Pa ge  Quidato Jan Lyre A. | BSN 3 – A | 2024 ❖ A chronic carrier state occurs frequently, and there is ❖ Demyelination of the nerves that innervate the diaphragm an increased risk of chronic liver disease, including and intercostal muscles results in neuromuscular respira- cirrhosis or liver cancer, after HCV. tory failure ❖ alcohol and medications that may affect the liver should be ❖ May include tachycardia, bradycardia, hypertension, or or- avoided. thostatic hypotension. ❖ Combination of two antiviral agents, peginterferon and ❖ The symptoms of autonomic dysfunction occur and resolve ribavirin (Rebetol), was effective in producing improve- rapidly. ment in patients with hepatitis C. ❖ GBS does not affect cognitive function or LOC. ❖ Imeprevir (Olysio) plus sofosbuvir (Sovaldi), ledipasvirsofos- ❖ Optic nerve demyelination may result in blindness. buvir (Harvoni) and ombitasvirparitaprevir-ritonavir pack- ❖ Bulbar muscle weakness related to demyelination of the aged with dasabuvir (Viekira Pak) glossopharyngeal and vagus nerves results in the inability Hepatitis D to swallow or clear secretions. ❖ Hepatitis D virus (delta agent) infection occurs in some Medical Management cases of hepatitis B ❖ may include tachycardia, bradycardia, hypertension, or or- ❖ Only people with hepatitis B are at risk for hepatitis D thostatic hypotension. ❖ Hepatitis D is common among those who use IV or injection ❖ The symptoms of autonomic dysfunction occur and resolve drugs, patients undergoing hemodialysis, and recipients of rapidly. multiple blood transfusions. ❖ GBS does not affect cognitive function or LOC. ❖ The symptoms of hepatitis D are like those of hepatitis B ❖ Optic nerve demyelination may result in blindness. ❖ Interferon alfa is the only licensed drug available in the ❖ Bulbar muscle weakness related to demyelination of the treatment for HDV infection. glossopharyngeal and vagus nerves results in the inability to Hepatitis E swallow or clear secretions ❖ Transmitted by the fecal–oral–route. Through contaminated Nursing Interventions water in areas with poor sanitation. Incubation period is var- ❖ Maintaining respiratory function iable, estimated to range between 15 and 65 days -- self-lim-  With incentive spirometry and chest physiotherapy ited course with an abrupt onset.  Mechanical ventilation ❖ Jaundice is almost always present. Hepatitis E resem-  Suctioning may be needed to maintain a clear airway bles hepatitis A. Management and interventions are those ❖ Enhancing physical mobility like of Hepatitis A  Passive range-of-motion exercises are performed at ❖ Avoiding contact with the virus through good hygiene, in- least twice daily cluding handwashing. Chronic forms do not develop  Anticoagulation, the use of antiembolism stockings and Guillain-Barre Syndrome sequential compression boots ❖ Also known as acute idiopathic polyneuritis, is an autoim-  Padding may be placed over bony prominences mune attack on the peripheral nerve myelin.  Need for frequent position changes ❖ Campylobacter jejuni (implicated in 24% to 50% of ❖ Nursing Interventions cases), cytomegalovirus, Epstein–Barr virus, Myco-  IV fluids and parenteral nutrition as a supplement plasma pneumoniae, H. influenzae, and HIV are the  Gastrostomy tube may be placed to administer nutrients most common infectious agents that are associated with the  Carefully assesses the return of the gag reflex and bowel development of GBS. sounds before resuming oral nutrition. ❖ Guillain-Barre Syndrome Types  Establishing some form of communication →the patient  I – The most well-known type, the patient experiences cannot talk, laugh, or cry weakness in the lower extremities, which progresses Sexually Transmitted Diseases upward and has the potential for respiratory failure Vulvovaginal Infections  II – The second type is purely motor with no altered ❖ Allergies ❖ Perimenopause/Menopause ❖ Diabetes ❖ Poor personal hygiene sensation. ❖ Frequent douching ❖ Pregnancy  III – A third type, called descending GBS, is much more ❖ HIV infection ❖ Premenarche difficult to diagnose; it mostly affects the head and neck ❖ Intercourse with infected part- ❖ Synthetic clothing muscles. ner ❖ Tight undergarments ❖ Long-term or repeated use of ❖ Use of oral contraceptives  IV – The rarest type, the Miller–Fisher variant, presents broad-spectrum antibiotics with ataxia, areflexia, and ophthalmoplegia ❖ Low estrogen levels Pathophysiology ❖ Oral-genital contact (yeast ❖ Myelin - speeding the can inhabit the mouth and in- testinal tract) conduction of impulses from the cell body to the dendrites ❖ Cell that produces my- elin - Is the Schwann cell - the Schwann cell can be spared, allowing for remyelination ❖ GBS is the result of a cell-mediated and hu- moral immune attack on peripheral nerve myelin proteins that causes inflammatory demyelination Clinical Manifestation ❖ Begins with muscle weakness and diminished reflexes of the lower extremities. ❖ Hyporeflexia and weakness may progress to tetraplegia ❖ Paresthesia of the hands and feet and pain 8|Pa ge  Quidato Jan Lyre A. | BSN 3 – A | 2024 Nursing Interventions ❖ Close human contact by the mouth, oropharynx, mucosal ❖ Sitz baths - provide temporary relief of symptoms. surface, vagina, or cervix appears necessary to acquire the ❖ Wearing cotton underwear, and not douching. infection ❖ Promotion of adequate rest, reduction of life stress, and a ❖ Same prevention methods as that of Huma papilloma virus healthy diet low in refined sugars Human Immunodeficiency Virus ❖ Abstaining from sexual intercourse when infected, ❖ The projected number of Filipinos living with HIV may in- ❖ Treatment for sexual partners crease significantly by 2030 -- from an estimated 215,400 in ❖ Area needs to be kept clean by daily bathing and adequate 2024 to 401,700. In Iloilo - The data also underscored a hygiene after voiding and defecation worrying trend of 218 cases with 15 deaths reported be- ❖ Educating the patient about medications such as supposito- tween January and September 2023 alone. Among the lo- ries and devices such as applicators to dispense cream or calities in Iloilo, the municipality of Oton has recorded the ointment highest number of cases within the province, with 138 cases, Human Papilloma Virus followed by Pavia with 118 cases ❖ Genital warts are more resistant to treatment in patients ❖ HIV (human immunodeficiency virus) is a virus that attacks with diabetes, those who are pregnant, who smoke, or are the body's immune system. - CD4+ T CELL. immunocompromised Women with HPV should have an- ❖ There is currently no effective cure. Once people get HIV, nual Pap smears potential to cause dysplasia. they have it for life. But proper medical care can control the ❖ Application of trichloroacetic acid, podophyllin (Podofin, virus. Podocon), cryotherapy, as well as surgical removal. ❖ HIV is spread from the body fluids of an infected person, ❖ Podofilox (Condylox) and imiquimod (Aldara) including blood, breast milk, semen and vaginal fluids. It is ❖ Appearance: not spread by kisses, hugs or sharing food. It can also spread  Discrete, papillary, cauliflower-like lesions involving from a mother to her baby multiple sites on moist surfaces Clinical Manifestations  Keratotic warts: Often seen on dry surfaces such as the ❖ Others may have an influenza-like illness including: labia majora.  Fever  Discrete papules: 1-3 mm in size can present on the  Headache shaft of the penis.  Rash  Sore throat ❖ The infection progressively weakens the immune system. This can cause other signs and symptoms:  Swollen lymph nodes  Weight loss  Fever ❖ Human Papillomavirus – Causative Agent. Infections are  Diarrhea self-limiting and without symptoms, and others can cause  Cough cervical and anogenital cancers. HPV can be found in le- Pathophysiology sions of the skin, cervix, vagina, anus, penis, and oral cavity. ❖ Behaviours and conditions that put people at greater risk of Most common strains of HPV, 6 and 11, usually cause con- contracting HIV include: dylomata (warty growths) HPV types 16 and 18 account for  Having anal or vaginal sex without a condom. 66% of cervical cancer  Having another sexually transmitted infection (STI) Prevention such as syphilis, herpes, chlamydia, gonorrhoea and ❖ Abstains from sexual intercourse during treatment bacterial vaginosis ❖ Appropriate hygiene practices including hand hygiene, per-  Harmful use of alcohol or drugs in the context of sexual ineal cleanliness, gentle washing of lesions with mild soap behavior and running water and lightly drying lesions  Sharing contaminated needles, syringes and other in- ❖ Barrier methods with sexual contact jecting equipment, or drug solutions when injecting ❖ Informs sexual partners of acquired STI - transmission is drugs possible even in the absence of active lesions.  Receiving unsafe injections, blood transfusions, or tis- ❖ Wears loose, comfortable clothing; eats a balanced diet; in- sue transplantation gests adequate fluids gets adequate rest during outbreaks.  Medical procedures that involve unsterile cutting or Herpes piercing; or accidental needle stick injuries, including ❖ No cure for genital herpes infection. cyclovir (Zovirax), among health workers. valacyclovir (Valtrex), and famciclovir (Famvir)—can sup- Assessment and Diagnostics press symptoms. Analgesics and a saline compress ❖ There are three types of HIV tests: antibody tests, anti- ❖ Management goals include preventing the spread of infec- gen/antibody tests, and nucleic acid tests (NAT) tion, making patients comfortable, decreasing potential  An antibody test looks for antibodies to HIV in your health risks, and initiating a counseling and education pro- blood or oral fluid. Most rapid tests and the only HIV gram self-test approved by the U.S. Food and Drug Admin- ❖ Appearance: istration (FDA) are antibody tests.  Bumps, blisters, or open sores (ulcers) around the geni-  An antigen/antibody test looks for both HIV antibod- tals or anus. ies and antigens. Antigen/antibody tests are recom-  Sores and blisters are typically painful. Blisters may mended for testing done in labs break open, ooze and then crust over.  A NAT looks for the actual virus in the blood. This test can tell if a person has HIV or how much virus is present in the blood (HIV viral load test). Acquired Immunodeficiency Syndrome ❖ Acquired means you can get infected with it; Immune Defi- ciency means a weakness in the body’s system that fights diseases; Syndrome means a group of health problems that ❖ (Herpes Genitalis, Herpes Simplex Virus type 2 – Causative make up a disease. Agent. Recurrent, lifelong viral infection that causes her- ❖ Once HIV has killed so many CD4+ T cells cellular immun- petic lesions (blisters). Initial infection is usually very painful, ity is lost. and blisters may take 2 to 4 weeks to heal  HIV disease becomes AIDS when your immune system is seriously damaged. 9|Pa ge  Quidato Jan Lyre A. | BSN 3 – A | 2024  A term that applies to the most advanced stages of HIV Guidelines for Standard Precautions infection. It is defined by the occurrence of any of the ❖ Visitors: Standard precautions alone don't restrict visitors more than 20 life-threatening cancers or “opportunistic unless additional transmission-based precautions are in infections” place.  having a CD4 cell count less than 200 copies ❖ Patient Transport: Standard transport procedures are fol-  Causative agent: Human T-cell lymphotrophic virus 3 lowed. (HTLV-3) ❖ Room: No specific requirements; patients can stay in shared ❖ Opportunistic infections are common. rooms if additional precautions are not needed. ❖ People with AIDS also have an increased risk of develop- ❖ Ventilation/Room Requirements: No special ventilation ing various cancers such as: or pressure requirements.  Kaposi’s sarcoma (cancer of connective tissues) Transmission-Based Precautions  Cervical cancer These are additional measures applied for patients known or  Cancers of the immune system known as lymphomas suspected to be infected or colonized with highly transmissible or epidemiologically significant pathogens. There are three main types: ❖ Contact Precautions  Used to prevent the spread of infections that can be transmitted by direct or indirect contact with the patient Assessment and Diagnostics or the patient’s environment (e.g., MRSA, VRE, C. dif- ❖ CD4 count – less than 200 or 14%. ficile). ❖ Western Blot  PPE: Wear gloves and gowns upon entering the  Confirm the presence of antibodies. room; remove them before leaving the room.  Protein separation technique: a technique that analyzes  Room Placement: Place the patient in a single mixtures of proteins by separating them and then bind- room if possible. If a single room is not available, co- ing them to specific antibodies. hort patients with the same infection. ❖ ELISA (Enzyme-linked immunosorbent assay)  Equipment: Use dedicated or disposable equip-  Reveals HIV antibodies in the blood. ment for the patient when possible or disinfect  Technique for determining the presence or amount of equipment before use on other patients. protein in a biological sample, using an enzyme that  Guidelines for Contact precautions: Used for infec- bonds to an antibody or antigen. tions that spread via direct or indirect contact with a Medical Management patient or their environment, such as MRSA, VRE, and ❖ There is no cure for AIDS. There are drugs that can slow C. difficile. down the HIV virus and slow down the damage to your im-  Visitors: mune system. There is no way to "clear" the HIV out of your  Generally allowed, but visitors should follow all body. PPE protocols (gloves, gowns). ❖ Specific management for opportunistic infections.  Visitors should avoid direct contact with the pa- ❖ The treatment for HIV is called antiretroviral therapy tient and may need to wear additional protective (ART). ART involves taking a combination of HIV medi- equipment, especially in high-risk units like cines (called an HIV treatment regimen) every day. ICUs. ❖ A main goal of HIV treatment is to reduce a person’s viral  Hand hygiene is critical before and after visiting. load to an undetectable level. An undetectable viral load  Patient Transport: means that the level of HIV in the blood is too low to  Minimize transport, only for essential diagnostic be detected by a viral load test. or treatment purposes. ❖ People with HIV who maintain an undetectable viral load  Ensure the patient has clean dressings and is have effectively no risk of transmitting HIV to their HIV-neg- covered appropriately (e.g., with a sheet or ative partners through sex. gown) to avoid environmental contamination. ❖ ART is recommended for everyone who has HIV. ART can-  Transport personnel should use appropriate not cure HIV, but HIV medicines help people with HIV live PPE. longer, healthier lives  Room: Isolation Precautions  Ideally, patients should be placed in private Isolation precautions are infection control measures used in rooms to avoid cross-contamination. healthcare settings to prevent the spread of infectious agents.  If a private room is unavailable, cohorting with a These precautions are generally categorized into Standard Pre- patient with the same infection can be consid- cautions and Transmission-Based Precautions. ered. Standard Precautions  The door may remain open, but the patient area These precautions are used with every patient, regardless of should be cleaned frequently. their diagnosis or presumed infection status, as infectious agents  Ventilation/Room Requirements: can be present in any patient. Standard precautions are the pri-  No special ventilation requirements unless addi- mary strategy for preventing healthcare-associated infections. tional precautions are in place (e.g., Airborne + ❖ Hand Hygiene: Wash hands before and after patient con- Contact Precautions). tact, after removing gloves, and when moving from a con- ❖ Droplet Precautions taminated body site to a clean body site.  Used to prevent the spread of infections transmitted by ❖ Personal Protective Equipment (PPE): Gloves, gowns, large respiratory droplets that travel short distances (up masks, and eye protection are used to protect healthcare to about 3 feet) and may be expelled when a patient workers from contact with blood, body fluids, and other po- coughs, sneezes, or talks (e.g., influenza, pertussis, cer- tentially infectious materials. tain types of meningitis). ❖ Respiratory Hygiene/Cough Etiquette: Encourage pa-  PPE: Wear a surgical mask within 3 feet of the pa- tients and visitors to cover their mouths when coughing or tient. sneezing and provide masks and tissues in waiting areas.  Room Placement: Place the patient in a single ❖ Safe Injection Practices: Use aseptic technique, single- room if possible. If not, cohort patients with the use syringes, and safety-engineered sharps devices. same infection. ❖ Environmental Cleaning: Regular cleaning of equipment  Patient Transport: Have the patient wear a mask and surfaces that may be contaminated with pathogens. when being transported outside their room. 10 | P a g e  Quidato Jan Lyre A. | BSN 3 – A | 2024  Guidelines For Droplet Precautions: Used for infec-  These rooms are designed to protect others by tions spread via large respiratory droplets (up to 3 feet) preventing infectious particles from escaping that are expelled by coughing, sneezing, or talking, like into adjacent areas. influenza and certain types of meningitis. Combination Precautions  Visitors: For some infections, a combination of precautions may be nec-  Visitors are typically allowed but should wear a essary (e.g., Airborne and Contact Precautions for disseminated surgical mask and follow hand hygiene. varicella zoster).  Limit the number of visitors and avoid visits ❖ Additional Precaution Notes: from individuals who may be at risk for severe  Signage: Rooms should have clear signs indicating the complications (e.g., the immunocompromised). type of precautions required.  Maintain a distance of at least 3 feet from the  Visitor Protocol: Visitors should follow all recom- patient when possible. mended precautions, including the use of PPE if  Patient Transport: needed.  Limit transport to essential purposes.  Education: Patients, families, and visitors should be in-  The patient should wear a surgical mask during formed of the importance of isolation precautions to transport to contain respiratory secretions. prevent transmission.  Staff should also wear masks during transport if In cases where infections may spread via multiple routes, such they are in close contact. as disseminated varicella zoster, a combination of airborne and  Room: contact precautions is applied. This approach includes a single,  A single room is preferred to prevent droplet negative pressure room, minimized transport, restricted visita- spread. tion, and strict PPE adherence for both staff and visitors. Each  If a single room is unavailable, cohorting with a type of precaution has clear guidelines to minimize the transmis- patient with the same infection may be done. sion of infection within healthcare settings, and adherence to  The door can be left open, but proximity precau- these standards ensures both patient safety and the protection tions should be observed, maintaining a 3-foot of healthcare workers and visitors. distance.  Ventilation/Room Requirements:  No special ventilation requirements. ❖ Airborne Precautions  Used to prevent the spread of infections transmitted by airborne droplet nuclei, which are small particles that can remain suspended in the air and be inhaled by oth- ers (e.g., tuberculosis, measles, varicella).  PPE: Wear a fit-tested N95 respirator or higher-level respirator before entering the room.  Room Requirements: Place the patient in an air- borne infection isolation room (AIIR) with negative pressure relative to surrounding areas.  Patient Transport: Limit patient transport. If transport is necessary, have the patient wear a surgi- cal mask.  Guidelines For Airborne Precautions: These pre- cautions are for infections spread via airborne particles that can stay suspended in the air, like tuberculosis, measles, and varicella.  Visitors:  Visits are highly restricted and typically allowed only when necessary.  Visitors who must enter should wear an N95 res- pirator (or higher) after fit testing, and they must be educated on donning and doffing PPE.  Avoid visits from individuals who may be at high risk for infection, such as immunocompromised or unvaccinated individuals.  Patient Transport:  Transport is limited to essential procedures.  The patient should wear a surgical mask to con- tain respiratory secretions during transport.  The receiving area should be informed in ad- vance to prepare for the patient's arrival.  Room:  Patients should be placed in a single room with negative pressure to prevent contaminated air from escaping into surrounding areas.  The room should have 6-12 air exchanges per hour and HEPA filtration if available.  The door must always remain closed to maintain the negative pressure environment.  Ventilation/Room Requirements:  Negative pressure isolation rooms (also known as airborne infection isolation rooms or AIIR) with HEPA filtration are required to prevent the spread of airborne pathogens. 11 | P a g e  Quidato Jan Lyre A. | BSN 3 – A | 2024 Medical Surgical Nursing  Macrophages- healing process by engulfing bacteria Inflammatory Diseases V. Destroyed tissue cells are replaced by identical or similar struc- Inflammation and its Characteristics tural and functioning cells and/or fibrous tissue. Promotes tis- ❖ A complex biological response of vascular tissues to harmful sue healing or the formation of fibrous (scar) tissue, which stimuli, such as pathogens, damage cells, or irritants. may reduce the functional capacity of the tissue. ❖ Protective attempt to remove the injurious stimuli and to initiate Goals for Management healing process. ❖ Minimize complications of the edema that accompanies inflam- ❖ It is a non-specific response meant to serve a protective func- mation. tion. ❖ Reduce the inflammatory response. ❖ It is class