1. Chapter 70 Management of Patients With Infectious Diseases

2. Chain of Infection

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

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

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

13. 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

14. 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

15. 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

16. 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

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

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

19. 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

20. 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