1. Nursing Care of Patients with Infections
Chapter 8
Nursing Care of Patients with Infections

2. Infectious Process Chain of Infection Required Six Links in the Chain
Treatment Breaks the Chain

3. Chain of Infection

4. Link 1: Reservoir Environmental Home for Infectious Agents
Animate: People, Insects, Animals, Plants
Inanimate: Water, Soil, Medical Devices

5. Link 2: Causative Agents
Bacteria
Virus
Fungi
Protozoa
Helminth
Prion

6. Key Terms Normal Flora: Microbes Occurring Naturally in a Body Part
Pathogens: Disease-causing Microbe

7. Link 3: Mode of Transmission
Direct Contact
Indirect Contact
Airborne

8. Direct Contact Direct Contact Touching Biting Kissing Sexual Contact
Droplet Spray

9. Direct Contact (cont’d)
Prevention
Hand Hygiene
Aseptic Technique
Personal Protective Equipment (Gloves, Surgical Masks, Goggles, Gowns, Shoe Covers)

10. Personal Protective Equipment

11. Indirect Contact
Vehicle-borne Transmission by Contact with Contaminated Object
Prevention
Hand Hygiene, Excellent Cleaning
Stethoscope Cleaning
Clean Water/Food

12. Indirect Contact (cont’d)
Vector-borne Transmission by Living Source Other Than Humans
Prevention
Insect Repellants
Rodent Control

13. Airborne Transmission by Particles Floating in Air
Inhaled or Deposited on Mucous Membranes
Prevention
High-efficiency Particulate Air (HEPA) Respirators

14. Link 4: Portal of Entry
Entry into Susceptible Host

15. Portals Respiratory Tract Skin Mucous Membranes Gastrointestinal Tract
Genitourinary Tract
Placenta

16. Link 5: Susceptible Host
From Defense Breakdown

17. Increased Risk Very Young or Old Age Malnourishment Immuno-compromised
Chronic Disease
Stress
Invasive Procedures

18. Link 6: Exit Portal Route Infectious Agent Uses to Leave
Host Who Has Become Reservoir for
Infection

19. Body’s Defense Mechanisms
Skin and Mucous Membranes
Cilia
Gastric Juices
Immunoglobulins
Leukocytes and Macrophages
Lysozymes

20. Body’s Defense Mechanisms (cont’d)
Interferon
Inflammatory Response

21. Inflammatory Response
Vascular Response
Inflammatory Exudate
Phagocytosis and Purulent Exudate

22. Immune System Body’s Final Defense Against Infection
Immune Cells and Lymphoid Tissue

23. Infectious Disease
Results When Immune System Protection Fails

24. Localized Infection Microbes in One Area
Pain, Redness, Swelling, Site Warmth

25. Generalized Infection
Systemic Involvement
Signs and Symptoms
Headache, Muscle Aches, Fever, Anorexia
Sepsis
Infection That Has Spread to Bloodstream

26. Laboratory Assessment
Gram’s Staining
Culture and Sensitivity
Antibody Test
CBC with Differential
Erythrocyte Sedimentation Rate

27. Immunity
Ability of Body to Protect Itself from Disease

28. Immunity (cont’d)
Natural Immunity
Innate Immunity
Acquired Immunity

29. Example of Infectious Disease
Mononucleosis

30. Mononucleosis Epstein-Barr Virus Contagious (“Kissing Disease”)
Extreme Fatigue, Anorexia, Chills
Red Sore Throat, Headache, High Fever, Tonsils with a White Coating
Supportive Care

31. Community Infection Control
World Health Organization
Centers for Disease Control and Prevention
Local Health Departments
Home Health Nurse

32. Infection Control in Health-Care Agencies
Community-acquired Infection
Nosocomial Infection
Hand Hygiene

33. Nosocomial Infections
Infection from Stay in Health-care Agency
Risk Factors
Host’s Condition
Multiple Antibiotic Therapy
High-risk Units

34. Nosocomial Infections (cont’d)
Common Pathogens
Escherichia coli (E. coli)
Staphylococcus aureus
Pseudomonas aeruginosa

35. Hand Hygiene
Before and After
Patient Contact
Glove Use

36. Hand Hygiene (cont’d) Wet Hands, Soap, Lather 15 Seconds
Interlace Fingers
Clean Nails Against Palms
Rinse with Fingertips Downward
Dry with Paper Towels
Turn off Faucet with Towel

37. Asepsis Freedom from Organisms Medical Asepsis Surgical Asepsis
Clean Technique
Surgical Asepsis
Sterile Technique

38. Infection Prevention Standard Precautions
Assume All Patients Infectious
Blood, Body Fluids, Body Substances
Hand Hygiene, Gloves, Gowns, Masks, Goggles, Face Shields

39. Infection Prevention (cont’d)
Transmission-based Precautions
Specific Communicable Diseases
Used with Standard Precautions

40. Example: Vancomycin-Resistant Enterococci

41. Respiratory Tract Infection Prevention
Risk Factors
Invasive Tubes
Prevention
Oral Hygiene
Coughing and Deep Breathing
Ventilator-associated Pneumonia Bundles

42. Genitourinary Tract Infection
Risk Factors
Urinary Catheters

43. Genitourinary Tract Infection Prevention
Appropriate Use of Urinary Catheters
Intermittent Catheterization
Strict Aseptic Technique
Secure Tubing to Leg
Closed System
Drainage Bag Below Bladder Level

44. Surgical Wound Infection Prevention
Sterile Technique for Dressing Changes
Monitor Wound

45. Septicemia Prevention
Sterile Technique for Catheters
Uncontaminated Solutions
Report Indications Promptly

46. Septicemia Indications
Fever
Tachypnea
Tachycardia
Hypotension
Elevated White Blood Cell Count

47. Septicemia Treatment Blood Cultures Antibiotics
IV Drotrecogin alfa (Xigris)
Severe Sepsis

48. Antibiotic-Resistant Infections
Methicillin-resistant Staphylococcus aureus (MRSA)
Difficult to Treat
High Mortality Rate
Treatment: Vancomycin Hydrochloride

49. Antibiotic-Resistant Infections (cont’d)
Vancomycin-resistant Enterococci (VRE)
Difficult to Treat
Combination Antibiotic Therapy
Treatment
Quinupristin/Dalfopristin (Synercid)
Linezolid (Zyvox)

50. Treatment of Infectious Diseases
Type of Organism Guides Drug Selection
Antibiotics: Bacterial Infections
Antivirals: Viral Infections
Antifungals: Fungal Infections

51. Nursing Responsibilities
Check Allergies
Monitor Side Effects
Signs of Superinfection

52. Patient Education
Take All Medication
Report Side Effects

53. Nursing Diagnoses Risk for Infection Acute Pain Imbalanced Nutrition
Ineffective Protection
Deficient Knowledge

54. Respiratory Tract Infections
Assessment
Signs and Symptoms
Sputum Culture
Nursing Diagnosis
Risk for Infection

55. Gastrointestinal Tract Infections
Assessment
Signs and Symptoms
Dehydration
Stool Culture
Nursing Diagnosis
Risk for Infection

56. Genitourinary Tract Infections
Assessment
Signs and Symptoms
Urinalysis
Urine Culture
Nursing Diagnosis
Risk for Infection