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Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Infection: Pneumonia, Influenza, Meningitis Brunner ch. 23,

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Presentation on theme: "Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Infection: Pneumonia, Influenza, Meningitis Brunner ch. 23,"— Presentation transcript:

1 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Infection: Pneumonia, Influenza, Meningitis Brunner ch. 23, 64, 70

2 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Infection Concept Review Infection—disease state resulting from the presence of pathogens in the body. May be acute or chronic Pathogens—disease-producing microorganisms—bacteria, viruses, fungi, parasites. The presence of these pathogens usually produces an inflammatory response as well.

3 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Course of Infection Incubation period—time between entry of pathogen and onset of sx Prodromal stage—nonspecific sx, most infectious Illness stage—worst sx Convalescence—recovery time Length of each stage depends on type of infection—may be local or systemic

4 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Chain or Cycle of Infection Infectious agent (pathogen) Reservoir (place it lives) Portal of exit (orifices or breaks) Mode of transmission (how it moves) Portal of entry (orifices or breaks) Susceptible host (stressors)

5 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Defenses Against Infection Normal body flora Body system defenses Inflammatory response –Vascular and cellular responses –Formation of exudates –Tissue repair

6 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. The Susceptible Host Changes in normal body flora Breakdown in body systems Flawed inflammatory response Problems with tissue repair Stressors

7 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Appearance of Infection Localized –Warmth –Swelling –Redness –Drainage –Pain/tenderness –Restricted movement Systemic –Changes in VS –Fatigue –N/V/D –Malaise –Lymphadenopathy –Confusion

8 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Laboratory Data WBC (Totals and differentials) Amount elevated usually indicates severity. –“Left shift” (high neutrophils) usually indicates a severe infection. –Total elevation not seen in viral infections. May see a “right shift” (high lymphocytes) in some viral infections +Cultures and gram stains

9 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Interventions Protect clients Educate clients Maintain own worker health Give antimicrobials Be aware of S&S of infection Practice medical and surgical asepsis

10 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Exemplar # 1: Influenza (205, , 2122, 2131) Acute viral respiratory disease Caused by different strains of A, B, or C virus Flu shot is made from 2 A strains and 1 B strain Spread by droplet. Incubation 24-72h A leading cause of morbidity and mortality; most deaths occur in over 60 age group.

11 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. High-risk Groups Any age with chronic illness Residents of long term care Immunocompromised Pregnant Also recommended for 6 mo-5 yrs, over 50 Required for healthcare workers

12 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Manifestations Abrupt onset with cough, fever, myalgia, HA, sore throat Resolution within 7d unless complications develop. Most common complication is PN Convalescent phase may include malaise and hyperactive airways

13 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care Relieve sx with mild analgesics and cough meds and prevent pneumonia. Antivirals shorten course of illness and inhibit spread of virus to other cells—should be given within 2d of onset of sx or can be given prophylactically. Older adults may be hospitalized. Vaccine is less effective in this group. Encourage flu vaccine esp. in high-risk groups. Reactions to vaccine required to be reported. Pandemics should be planned for by HC agencies.

14 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Exemplar # 2: Pneumonia (PN) p. 554 Acute inflammation of lung caused by microbial organism Leading cause of death in the United States from infectious disease Most common type is streptococcal Causes: aspiration, inhalation of microbes, or spread thru blood from a primary infection site

15 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. LLL Pneumonia

16 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Risk Factors Impaired immunity Chronic respiratory conditions Hospitalization (HCPs, respiratory equipment, NG or ET tubes) Immobility Smoking/pollution Meds that cause respiratory depression ↓ Cough and epiglottal reflexes Malnutrition Pneumonitis

17 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Types of PN Community-acquired (CAP)—usually streptococcal. Occurs in community or within 48h after hospitalization Hospital-acquired (HAP)—occurs after 48h. Most common are the antibiotic-resistant organisms Aspiration—usually streptococcal (normal flora in oropharynx) Pneumonia in the Immunocompromised Host (formally Opportunistic)—fungal, PCP, TB

18 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Pathophysiology of Pneumonia Organism enters respiratory tract and releases toxins causing inflammation In alveoli, serous fluid and mucus are released and bacteria multiply rapidly in the fluid Capillaries dilate adding red cells to alveolar fluid along with bacteria, white cells, and fibrin Venous blood entering the lungs doesn’t get proper oxygenation leading to hypoxemia Lobar involves entire lobe; bronchopneumonia is patchy

19 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations Common to most – Sudden onset of fever, chills – Tachycardia, tachypnea, orthopnea – Cough productive of purulent sputum unless dehydration is present. Color of sputum not necessarily indicative of organism – Pleuritic chest pain – Confusion or stupor in elderly or symptoms may not be readily apparent

20 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations Lung examination findings – Dullness to percussion – ↑ Fremitus (vibration) – Usually fine crackles – Bronchial breath sounds—high-pitched and loud, normally only heard around the trachea. No air exchange in the alveoli causes no vesicular sounds to be heard and the high-pitch sound that is heard is from the tracheobronchial tree and being transmitted to the chest wall.

21 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Tests Chest x-ray CBC, differential Chemistries (if indicated) Gram stain and C&S of sputum Pulse oximetry and/or ABGs Blood cultures

22 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Most Common Complications Pleurisy Atelectasis Pleural effusion—purulent fluid in pleural space. Usually is sterile and reabsorbed in 1 to 2 weeks or may require thoracentesis. Occurs in 40% of cases. Sepsis Shock and respiratory failure (delayed or inadequate tx or at risk populations)

23 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Atelectasis

24 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Pleural Effusion

25 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care – Assess ability to treat at home. – HCP should check with Case Management to see if patient meets inpatient criteria. – Ultimately, HCP can decide, but hospital may not get paid for inpatient stay.

26 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Collaborative Care Antibiotic therapy (only if bacterial) Oxygen for hypoxemia Analgesics for chest pain Antitussives for cough Antipyretics for fever May need nebulizer treatments Fluid intake at least 3 L per day Caloric intake at least 1500 per day (high calorie fluids if severe anorexia is present)

27 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Commonly Used Antibiotics Penicillins—amoxicillin, penicillin-G Cephalosporins—Ancef, Rocephin Methicillin resistant—vancomycin, linzeloid Fluoroquinolone—Cipro (tendonitis) Levofloxacin—Levaquin (“) Macrolides—azithromycin, erythromycin Antivirals—Tamiflu, Relenza Antifungals—v Anti-TB—isoniazid + rifampin

28 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Preventative Care Influenza drugs and influenza vaccine Pneumococcal vaccine indicated for those at risk: Chronic illness such as heart disease, lung disease, or diabetes mellitus, or asplenia Recovering from severe illness 65 or older In long-term care facility or other environments that may increase risk

29 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Diagnoses Impaired gas exchange Ineffective breathing pattern Ineffective airway clearance Impaired tissue perfusion Acute pain Imbalanced nutrition: Less than body requirements Activity intolerance Deficient fluid volume Deficient knowledge

30 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Planning: Outcome Criteria Clear breath sounds Normal breathing patterns No signs of hypoxia Normal chest x-ray No complications related to pneumonia

31 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Admission history, med list, and physical assessment Identify risk factors Labs and radiology Monitor O2 status and oxygen therapy Monitor effects of respiratory therapy HOB elevated Promote C&DB and use of IS Monitor IV fluids and encourage po fluids Administer and evaluate antibiotic therapy Balance rest and activity Evaluate activity tolerance Monitor for changes in status

32 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Patient Education Causes Individual risk factors and how to minimize risk such as stopping smoking Managing symptoms Importance of med therapy S & S to report Keeping FU appts May need to teach IV antibiotic therapy Vaccines

33 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Evaluation Dyspnea not present SpO 2 ≥ 95 Free of adventitious breath sounds Clears sputum from airway Reports pain control Verbalizes causal factors Adequate fluid and caloric intake Performs activities of daily living

34 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Developmental Issues Very young and very old are more susceptible to the complications of PN and influenza. Both can become ill very quickly and mortality rates are generally higher Both groups also become dehydrated quicker than adults. Remember that elderly may have atypical symptoms. Children have shorter, straighter passageways in their respiratory system, making spread of infectious organisms more rapid.

35 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Cultural and Socioeconomic Issues Be sensitive to another cultures need to treat infections with alternative therapies and healers: herbal, acupuncture, hot-cold, prayer, charms, etc. Be aware that $ play an important role today with limited access to health care and expense of prescriptions. HCPs should try to be sensitive to what they prescribe.

36 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Exemplar #3: Meningitis (1950-2) Inflammation of the lining around the brain and spinal cord Caused by bacteria or virus 80% are caused by the bacteria Streptococcus pneumoniae and Neisseria meningitides Viral infections are usually caused by mumps, herpes, or mosquitoes or other insects.

37 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Risk Factors Pneumonia Otitis media Mastoiditis URI AIDS Lyme Disease Smoking Immunosuppression Crowded living conditions Facial trauma Invasive procedures

38 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Pathophysiology Bacteria enters bloodstream Crosses blood-brain barrier Invades CSF Inflammation occurs IICP results

39 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Complications Vision and hearing impairments Seizures Hydrocephalus Paralysis Septic shock Brain damage

40 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Manifestations Fever HA Nuchal rigidity Photophobia Hemorrhagic rash Confusion, irritability, lethargy, decreased LOC +Kernig’s sign—flexed hip and knee cannot be extended +Brudzinski sign—neck flexion causes flexion of the hips and knees

41 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostics CT or MRI to detect brain shift LP with evaluation of CSF Blood cultures

42 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Preventative Management Hib vaccine has almost eradicated Hemophilus influenza, a past major cause of meningitis in children. Meningococcal vaccine should be given to all college-bound adolescents, especially those planning on living in dorms. People who have close contact with meningitis should get Rocephin.

43 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Medical Management IV antibiotic therapy usually with Vancomycin and a cephalosporin such as Rocephin. Decadron steroid therapy decreases swelling and inflammation Antiseizure meds if indicated Contact precautions

44 Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management VS and O2 sat Neuro checks Low lights Administration of meds (antibiotics, antiseizure, antipyretics, analgesics) Seizure precautions Monitor IV therapy and fluid status Maintain isolation precautions Prevent complications from decreased mobility Family support


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