Chapter 70 Management of Patients With Infectious Diseases

Chain of Infection

Colonization, Infection, and Disease Colonization: describes microorganisms present without host inference or interaction Infection: indicates host interaction with the organism Disease: the infected host displays a decline in wellness due to the infection

Biologic spectrum of Response to Bacterial Infection at the Cellular Level and of the Intact Host

Interpreting the Microbiology Report A tool to determine colonization, infection, or disease The organism reported may reflect colonization rather than infection Mix of cells in smear and stain report may indicate cellular response Culture and sensitivity specify the organism and which antibiotic will inhibit growth Analyze results in conjunction with the clinical assessment of the patient

Information Resources World Health Organization (WHO) Center for Disease Control and Prevention (CDC) CDC publications, guidelines, and internet site: see Table 70-1 Occupational Safety and Health Administration (OSHA) Mandatory regulations and guidelines Local agencies Hospital/facility infection control specialists and facility policies

Isolation Precautions Guidelines to prevent the transmission of microorganisms in hospitals Standard precautions used for all patients The primary strategy for preventing HAIs Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact routes

Elements of Standard Precautions Hand hygiene Use of gloves and other barriers Proper handling of patient care equipment and linen Environmental control Prevention of injury from sharps and needles Patient placement

Transmission-Based Precautions Airborne precautions Hospitalized patient should be in negative pressure room with the door closed; health care providers should wear an N-95 respirator (mask) at all times when in the room Droplet precautions Wear a face mask but door may remain open; transmission is limited to close contact Contact precautions Use of barriers to prevent transmission; emphasize cautious technique as organism is easily transmitted by contact between the health care worker and the patient

Nursing Process—Assessment of the Patient With Sexually Transmitted Disease (STD) Protecting confidentiality and privacy is an important component in the assessment of a patient with STDs Communication needs to be culturally and emotionally sensitive and clarification of terms may be necessary Presenting symptoms Specific information regarding sexual contacts Patient knowledge Physical examination: include rashes, lesions, drainage, inguinal nodes, genitalia, rectum, mouth and throat; women need abdominal and uterine exams

Nursing Process—Diagnosis of the Patient With Sexually Transmitted Disease (STD) Deficient knowledge Anxiety Noncompliance with treatment

Collaborative Problems/Potential Complications Increased risk for ectopic pregnancy Infertility Transmission of infection Neurosyphilis Gonococcal meningitis Gonococcal arthritis HIV-related complications

Nursing Process—Planning the Care of the Patient With Sexually Transmitted Disease (STD) Major goals include increased patient understanding of the natural history and treatment of the infection, reduction in anxiety, increased compliance with therapeutic and preventive goals, and absence of complications

Interventions Education about STDs and the spread of infection Reduce anxiety Encourage patient to discuss anxieties and fears Provide factual information and individualized teaching Assist in planning discussion with partners Provide referral to social worker or other specialist Increase compliance Provide patient teaching in group or individual settings Provide referral to appropriate agencies

Home-Based Care Measures to Reduce the Risk of Infection Health care workers should follow standard precautions in the home setting Patient and family teaching: see Chart 70-4 Establish an environment that facilitates hand hygiene and aseptic technique Family caregivers should receive annual influenza vaccine Equipment care Implement “Common sense cleanliness” Exercise food preparation and personal hygiene Establish reasonable barriers to protect family members

Nursing Process—Assessment of the Patient With an Infectious Disease Health history: investigate the likelihood and probable source of infection, associated pathology, and symptoms See questions listed in text Administer a physical exam

Nursing Process—Diagnosis of the Patient With an Infectious Disease Risk for infection transmission Deficient knowledge Risk for ineffective thermoregulation

Collaborative Problems/Potential Complications Septicemia, bacteremia, or sepsis Septic shock Dehydration Abscess formation Endocarditis Infectious disease-related cancers Infertility Congenital abnormalities

Nursing Process—Planning the Care of the Patient With an Infectious Disease Major goals include prevention of the spread of infection, increased knowledge about the infection and its treatment, control of fever and related discomforts, and absence of complications

Interventions Prevent the spread of infection Perform handwashing Exercise Standard Precautions Recognize mode of transmission and establish Transmission-Based Precautions as indicated Teach about infectious process and the prevention of the spread of infections Assess and treat fever