Chapter 23 Infection

Common Infections Urinary tract infections Prostatitis Pneumonia Influenza Tuberculosis Vaginitis

Common Infections (cont.) Herpes zoster Scabies HIV and AIDS Antibiotic-resistant microorganisms

Causes of UTIs Poor hygienic practices Improper cleansing after bowel elimination Predisposition created by low fluid intake and excessive fluid loss Hormonal changes Debilitated states

Gerontological Nursing Interventions for Infections Prevention Early identification Adequate treatment

Signs and Symptoms of UTIs Early indicators include burning, urgency, and fever. Some elders develop incontinence and delirium with UTIs. Many UTIs in older adults seem asymptomatic. Bacteriuria greater than 105 CFU/mL confirms the diagnosis of UTI. As a UTI progresses, retention, incontinence, and hematuria may occur.

Treatment of UTIs Establish adequate urinary drainage. Control the infection through antibiotic therapy. Note fluid intake and output. Force fluids. Observe for new symptoms.

Signs and Symptoms of Prostatitis Acute: systemic symptoms of fever, chills, and malaise. Chronic: these symptoms are uncommon. Both types: –Urinary symptoms of frequency, nocturia, and dysuria –Varying degrees of bladder obstruction secondary to an edematous, enlarged prostate –Lower back and perineal pain

Treatment of Prostatitis Identify pathogen with urinalysis. Use antibiotic therapy. –Chronic prostatitis does not respond as well to antibiotics.

Pneumonia Incidence –One of the leading causes of death in the elderly. Contributing Factors –Age-related changes to respiratory system –High incidence of debilitating conditions –Hospitialization Symptoms – Restlessness, confusion, and behavioral changes

Influenza Facts Most deaths from influenza occur in the older population. Influenza A is the most frequent cause of serious illness and death in elders. Age-related changes cause older persons to be highly susceptible to influenza. Symptoms include fever, myalgia, sore throat, and nonproductive cough.

Preventive Measures for Influenza Annual influenza vaccinations Daily vitamin and mineral supplements Avoiding people with respiratory infections

Tuberculosis Classic symptoms may not be demonstrated: –Anorexia, weight loss, and weakness may be the primary symptoms. –Night sweats may not occur because of reduced diaphoresis with advanced age. –Fever may not be detected because of alterations in body temperature in late life. Screening for tuberculosis should be performed for all patients entering institutions.

Treatment for Tuberculosis Rest Good nutrition Medications

Symptoms and Treatments for Vaginitis Symptoms –Soreness, pruritus, burning, and a reddened vagina –Clear, brown or white vaginal discharge –Can cause bleeding and adhesions Treatment –Local estrogens in suppository or cream

Herpes Zoster Symptoms –Pain and itching of the skin –In several days, the formation of vesicles Treatment –Analgesics, corticosteroids, and topical preparations to dry the lesions.

Vaginitis: Age Related Considerations Vaginal epithelium thins. Tissue elasticity lessens. Secretions become alkaline and of lesser quantity. The flora changes.

Symptoms of Scabies Intense pruritus that worsens at night Excoriation of the skin Rash with a burrow –Diagnosis is made by scraping the lesions with a scalpel and examining the material.

Initial Symptoms of HIV Low-grade fever Headache Sore throat Fatigue Nausea Rash

Symptoms That Can Develop Years After HIV Invades the Body Persistent fever Drenching night sweats Headaches Fatigue Chronic diarrhea Thrush Persistent vaginitis

Symptoms That Can Develop Years After HIV Invades the Body (cont.) Herpes zoster Lymph node swelling Meningitis Palsies Pain Dementia

MRSA Staphylococcus aureus can cause infections. –Minor (e.g., boils; pimples) –Serious (e.g., pneumonia; septicemia) Resistance of Staph to antibiotics progressed throughout the years. –Linezolid (Zyvox) and the combination of quinupristin with dalfopristin (Synercid) are treatment options.

Vancomycin-Resistant Enterococcus (VRE) VRE is a significant nosocomial infection. VRE infections tend to be resistant to most previously used drugs. –At present, Zyvox and Synercid are the only drugs effective against VRE.

Persons Affected by VRE Those who are severely ill Debilitated persons Immunosuppressed persons Those having had major surgical procedures Those having an indwelling urinary or central venous catheter Those on antibiotic therapy

Source Eliopoulos, C. (2005). Gerontological Nursing, (6 th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN ).