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Chapter 12Chapter 12

Caring for Clients with Caring for Clients with

Infectious DisordersInfectious Disorders

Microorganisms and Infectious Microorganisms and Infectious

DisordersDisorders

•• Microorganisms ( Germs)Microorganisms ( Germs)

––They are living plants and animalsThey are living plants and animals

––MicroscopicMicroscopic

MicroorganismsMicroorganisms

•• When invaded by a microorganism, one of When invaded by a microorganism, one of

three things can occur:three things can occur:

––The body’s immune system eliminates The body’s immune system eliminates

themthem

––It lives in the body without causing It lives in the body without causing

diseasedisease

––It causes an infection or infectious It causes an infection or infectious

diseasedisease

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MicroorganismsMicroorganisms

•• The factors that will influence The factors that will influence

infection development are:infection development are:

––The type of microorganismThe type of microorganism

––The microorganisms characteristicsThe microorganisms characteristics

––And the susceptibility of the And the susceptibility of the hosthost

Types of MicroorganismsTypes of Microorganisms

•• Some organisms cause communicable or Some organisms cause communicable or

contagious Diseasescontagious Diseases

–– Measles Measles

–– Streptococcal sore throatStreptococcal sore throat


•• Some organisms cause communicable or Some organisms cause communicable or

contagious Diseasescontagious Diseases

–– STD’sSTD’s

–– TuberculosisTuberculosis

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•• BacteriaBacteria

•• Single CelledSingle Celled

–– Round ~ Round ~ CocciCocci

–– RodRod--shaped ~ Bacillishaped ~ Bacilli

–– Spiral ~ SpirochetesSpiral ~ Spirochetes


BacteriaBacteria

•• Aerobic bacteriaAerobic bacteria

•• Anaerobic bacteriaAnaerobic bacteria


•• Drug resistant bacteriaDrug resistant bacteria

–– MRSAMRSA

–– VREVRE

–– AcinetobacterAcinetobacter

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VirusesViruses

•• Viruses are the smallest disease causing Viruses are the smallest disease causing

agentsagents

•• They can only been seen with a high powered They can only been seen with a high powered

electron microscopeelectron microscope

•• They are filterable and can They are filterable and can

pass through pass through

very small barriersvery small barriers

VirusesVirusesTwo types of viruses Two types of viruses

•• Nucleic acid compositions containing Nucleic acid compositions containing

–– RNARNA

–– DNA DNA

VirusesViruses

•• Viruses use metabolic and reproductive Viruses use metabolic and reproductive materials of living tissue to multiplymaterials of living tissue to multiply

•• minor and self limiting minor and self limiting

common coldcommon cold

•• serious and can result in death serious and can result in death

rabies polio hepatitisrabies polio hepatitis

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VirusesViruses

•• Viruses can be dormant and live in the host Viruses can be dormant and live in the host

until a time when they reactivate and then the until a time when they reactivate and then the

infection can recurinfection can recur

–– Herpes Simplex Fever BlisterHerpes Simplex Fever Blister

RichettsiaeRichettsiae

•• Resemble bacteria but are not the sameResemble bacteria but are not the same

•• They invade living cells and cannot live They invade living cells and cannot live

outside the hostoutside the host

•• Transmitted by fleas, ticks, mites & lice Transmitted by fleas, ticks, mites & lice

( arthropods)( arthropods)

ProtozoanProtozoan

•• Single celled animals, classified according to Single celled animals, classified according to

their motilitytheir motility

–– Amoeboid Motion Amoeboid Motion

–– CiliaCilia

–– FlagellaFlagella

–– Some have little or no movementSome have little or no movement

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MycoplasmasMycoplasmas

•• Single celled microorganisms that lack a cell wallSingle celled microorganisms that lack a cell wall

•• Resemble bacteria but are not the sameResemble bacteria but are not the same

•• Consider Consider pleomorphicpleomorphic –– assumes many shapesassumes many shapes

•• Primarily infect the surface lining of the Respiratory, Primarily infect the surface lining of the Respiratory,

GI, & GU tractsGI, & GU tracts

HelminthsHelminths

Infectious wormsInfectious worms

•• Considered parasitesConsidered parasites

•• Some are microscopic Some are microscopic

•• 3 Major groups3 Major groups

–– Nematodes ~ round wormNematodes ~ round worm

–– Cestodes ~ tape wormCestodes ~ tape worm

–– Trematodes ~ flukesTrematodes ~ flukes

HelminthsHelminths

Infectious wormsInfectious worms

•• Some enter host in the egg stageSome enter host in the egg stage

•• Others spend the larval stage in an intermediate host Others spend the larval stage in an intermediate host

and then enters the human hostand then enters the human host

•• The organisms mate and reproduce in the definitive The organisms mate and reproduce in the definitive

host and then are excreted and the cycle begins host and then are excreted and the cycle begins

againagain

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PrionsPrions

•• Protein without nucleic acidProtein without nucleic acid

•• Normal prions in brain cells protect against Normal prions in brain cells protect against

dementiadementia

•• If it mutates prions are capable of causing a If it mutates prions are capable of causing a

infectioninfection

•• This will cause other This will cause other

prions to mutateprions to mutate

PrionsPrions

•• The mutation can be cause by genetic The mutation can be cause by genetic predispositionpredisposition

•• Or acquired by transmission from an infected Or acquired by transmission from an infected animalanimal

•• Can be transferred from sheep or cattle, which Can be transferred from sheep or cattle, which then can be transmitted to humans then can be transmitted to humans

–– Mad Cow DiseaseMad Cow Disease

Characteristics of MicroorganismsCharacteristics of Microorganisms

•• Non Pathogen: not dangerous to healthy Non Pathogen: not dangerous to healthy

humanhuman

•• Normal Flora: in the intestine they help to Normal Flora: in the intestine they help to

synthesizesynthesize

–– Vitamin BVitamin B--12, biotin, vitamin K and folic acid12, biotin, vitamin K and folic acid

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•• Pathogens have a high potential for causing Pathogens have a high potential for causing

infectious diseasesinfectious diseases

•• The ability to cause disease depends onThe ability to cause disease depends on

–– the organism ability to move or be movedthe organism ability to move or be moved

–– Its virulence Its virulence

QUESTION???QUESTION???

Is the following statement true or false?Is the following statement true or false?

Only pathogenic microbes cause disease or Only pathogenic microbes cause disease or

infection.infection.

PathogensPathogens

•• The ability to cause disease depends onThe ability to cause disease depends on

–– The number presentThe number present

–– Duration of exposureDuration of exposure

–– Ability to invade the hostAbility to invade the host

–– Susceptibility of the Host Susceptibility of the Host

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•• If the circumstances are right, BOTH pathogens and If the circumstances are right, BOTH pathogens and

non pathogens can produces an infectionnon pathogens can produces an infection

•• Opportunistic disease Opportunistic disease

•• Most Infections are caused by common pathogensMost Infections are caused by common pathogens

Infection TransmissionInfection Transmission

•• Infection process cycleInfection process cycle

–– resembles a chain and must be present to resembles a chain and must be present to

transmit an infectious disease from a human or transmit an infectious disease from a human or

animal to a susceptible host animal to a susceptible host

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QUESTION????QUESTION????

Is the following statement true or false?Is the following statement true or false?

All links in the infectious process cycle must be All links in the infectious process cycle must be

present for infection to occur.present for infection to occur.

ReservoirReservoir

Portal of ExitPortal of Exit

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Means of TransmissionMeans of Transmission

•• The way a microorganism is moved out of the The way a microorganism is moved out of the

reservoir to the susceptible hostreservoir to the susceptible host

•• 5 Potential Means5 Potential Means

–– ContactContact

–– DropletDroplet

–– AirborneAirborne

–– VehicleVehicle

–– VectorVector

Portal of EntryPortal of Entry

Defense MechanismsDefense Mechanisms

•• Mechanical defensesMechanical defenses

•• Chemical defensesChemical defenses

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Defense MechanismsDefense Mechanisms

•• Skin and Mucous MembranesSkin and Mucous Membranes

•• Mucus secretionMucus secretion

Susceptibility of HostSusceptibility of Host

•• ImmunosuppressionImmunosuppression

•• DiabetesDiabetes

•• SurgerySurgery

•• BurnsBurns

•• ElderlyElderly

Physiologic ReflexesPhysiologic Reflexes

•• Physiologic Reflexes Physiologic Reflexes

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MacrophagesMacrophages

•• MacrophagesMacrophages

–– Ingest dead cells and foreign materialIngest dead cells and foreign material

–– In the liver, spleen and lymphoid tissueIn the liver, spleen and lymphoid tissue

Chemical DefensesChemical Defenses

•• Biologic SubstancesBiologic Substances

•• LysozymeLysozyme


•• Antibodies or Immunoglobulins Antibodies or Immunoglobulins

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•• Antibodies and other white cells work Antibodies and other white cells work

together to make microorganism more easily together to make microorganism more easily

ingested byingested by


•• WBC also produces INTERFERON WBC also produces INTERFERON

–– A chemical protein A chemical protein

–– Causes the infected cells to manufacture an Causes the infected cells to manufacture an

antiviral proteinantiviral protein

–– Used in cancer treatmentUsed in cancer treatment

PathophysiologyPathophysiology

•• Localized infectionLocalized infection

•• Inflammatory ResponseInflammatory Response

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PathophysiologyPathophysiology

Generalized InfectionsGeneralized Infections

•• Microorganisms can reach the blood stream Microorganisms can reach the blood stream

and cause and cause septicemia or sepsissepticemia or sepsis..

•• The Pathophysiology of this type of infection The Pathophysiology of this type of infection

depends on thedepends on the

–– Virulence of the pathogen Virulence of the pathogen

–– Condition of the host Condition of the host


•• In the early stages of the disease there may be no In the early stages of the disease there may be no symptoms or pt may be acutely illsymptoms or pt may be acutely ill

•• Fever rises as the body attempts to destroy pathogen Fever rises as the body attempts to destroy pathogen with heatwith heat

•• Pt feels chilled Pt feels chilled -- surface blood vessel constrictsurface blood vessel constrict

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•• Circulation is diverted to deep blood vessels and Circulation is diverted to deep blood vessels and

sweating stopssweating stops

•• The pulse and resp rate rise in proportion to the The pulse and resp rate rise in proportion to the

feverfever

•• Some will have a drop in B/P Some will have a drop in B/P –– septic shock, septic shock,

bacteremic shock, or toxic shock may occurbacteremic shock, or toxic shock may occur

Diagnostic TestDiagnostic Test

•• Physical ExamPhysical Exam

•• HistoryHistory

•• Lab ~ WBC with DifferentialLab ~ WBC with Differential

––[[ of WBC over 10,000 occurs with infection of WBC over 10,000 occurs with infection ––LeukocytosisLeukocytosis

–– Differential count is valuable in isolating an Differential count is valuable in isolating an infectioninfection-- it gives a % of WBC subtypes it gives a % of WBC subtypes

––[[ of neutrophils of neutrophils –– body’s in early stage of body’s in early stage of response to infectionresponse to infection

Diagnostic TestDiagnostic Test

•• Lab ~ WBC with DifferentialLab ~ WBC with Differential

–– As WBC’ s are depleted, the bone marrow makes As WBC’ s are depleted, the bone marrow makes new cells ~ new cells ~ Band Cells Band Cells -- which mature and take which mature and take the place of old cellthe place of old cell

–– An increase in monocytes (the largest sized An increase in monocytes (the largest sized subtype of WBC’ s) is the body’s second line on subtype of WBC’ s) is the body’s second line on defense.defense.

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Culture and SensitivityCulture and Sensitivity

•• Culture Culture –– a Specimen to help identify bacteria a Specimen to help identify bacteria

causing the infectioncausing the infection

•• A specimen is placed in a special growth A specimen is placed in a special growth

medium and incubated for a specific time medium and incubated for a specific time


•• The specimen is the observed under the microscopeThe specimen is the observed under the microscope

•• Dye may be added to the specimen ~ Stained to aid Dye may be added to the specimen ~ Stained to aid

in identificationin identification

•• Gram Stain Gram Stain –– Blue DyeBlue Dye

–– Gram Negative Gram PositiveGram Negative Gram Positive


•• Microorganisms have also be tested for Microorganisms have also be tested for

pathogenicity or virulence with the pathogenicity or virulence with the Coagulase Coagulase

TestTest

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•• Sensitivity studies Sensitivity studies

–– studies that are done to determine which studies that are done to determine which

antibiotic inhibits the growth of a non viral antibiotic inhibits the growth of a non viral

microorganismmicroorganism

Examination for Ova and ParasitesExamination for Ova and Parasites

•• Most ova (eggs) and parasites are intestinal wormsMost ova (eggs) and parasites are intestinal worms

•• Stool is examined for any forms of the microorganismStool is examined for any forms of the microorganism

–– 3 Random stool samples are collected in a clean, dry 3 Random stool samples are collected in a clean, dry

bedpan( not the commode)bedpan( not the commode)

•• Urine and toilet paper may alter the specimenUrine and toilet paper may alter the specimen

•• Teach the pt proper hand washing to prevent reTeach the pt proper hand washing to prevent re--

infestation infestation

Skin TestSkin Test

•• Skin Test: to determine to presence of a specific Skin Test: to determine to presence of a specific active or inactive infectionactive or inactive infection

•• Disease for which skin test are done may include:Disease for which skin test are done may include:

–– Mumps, TB, DiphtheriaMumps, TB, Diphtheria

•• The material for testing is injected intradermallyThe material for testing is injected intradermally

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Skin TestSkin Test

•• The test is read in 48The test is read in 48--72 hours72 hours

•• Size of the indurationSize of the induration-- not the area of not the area of

erythema is measured in mm.erythema is measured in mm.

•• A TB Skin is considered positive if the A TB Skin is considered positive if the

induration is 15mm or greater in pt with no induration is 15mm or greater in pt with no

risk factorsrisk factors

Immunologic TestImmunologic Test

Used to determine the presence of antigens and Used to determine the presence of antigens and antibody reactionantibody reaction

Agglutination testAgglutination test-- the Cold Agglutinins test may the Cold Agglutinins test may reveal the presence of high antibody titers reveal the presence of high antibody titers confirming immunity to rubella (measles)confirming immunity to rubella (measles)

Immunologic TestImmunologic Test

Precipitation testsPrecipitation tests –– The C~Reactive protein test The C~Reactive protein test and erythrocyte sedimentation rate may be and erythrocyte sedimentation rate may be elevated in some inflammatory diseaseselevated in some inflammatory diseases

Complement Complement –– Fixation TestFixation Test –– when elevated when elevated indication an inflammatory processindication an inflammatory process

Immunoflourescence testImmunoflourescence test identifies identifies immunoglobulins, antibodies formed by the immunoglobulins, antibodies formed by the immune systemimmune system

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Other TestsOther Tests

•• Plain XPlain X--rays or Contrast studiesrays or Contrast studies

•• CT scanCT scan

•• MRIMRI

These test may be used to locate abscesses, These test may be used to locate abscesses,

identify displaced organs or structures, or identify displaced organs or structures, or

detect changes in tissue detect changes in tissue

Medical ManagementMedical Management

•• Supportive therapy that may be ordered Supportive therapy that may be ordered while the disease runs its coursewhile the disease runs its course

–– RestRest

–– FluidsFluids

–– Adequate nutritionAdequate nutrition

–– Tylenol Tylenol -- for feverfor fever

–– If disease warrants drug therapyIf disease warrants drug therapy

•• Antibiotics or AntimicrobialsAntibiotics or Antimicrobials

•• Antiviral drugsAntiviral drugs

Medical ManagementMedical Management

•• Infected wounds may beInfected wounds may be

–– DebridedDebrided

–– HydrotherapyHydrotherapy

–– Wet to dry dressingsWet to dry dressings

•• Immunosuppressed pt may be given bone Immunosuppressed pt may be given bone

marrow or drug that increase WBC marrow or drug that increase WBC

productionproduction

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Nursing ManagementNursing Management

•• HANDWASHING !!! HANDWASHING !!!

•• Collect dataCollect data

–– Pt Medical History Pt Medical History –– ex: Lupusex: Lupus

–– Physical Assessment Physical Assessment ––Rash, feverRash, fever

–– Subjective data Subjective data –– loss appetiteloss appetite

•• Follow Standard PrecautionFollow Standard Precaution

•• Follow Transmission Based PrecautionFollow Transmission Based Precaution

Nursing ManagementNursing Management

•• The nurse gives drug therapy and observes for The nurse gives drug therapy and observes for

evidence of improvementevidence of improvement

–– A reduction in TempA reduction in Temp

–– A reduction in Heart RateA reduction in Heart Rate

–– A reduction in WBC countA reduction in WBC count

•• Perform wound care as orderedPerform wound care as ordered

•• Improved nutrition and fluid intakeImproved nutrition and fluid intake

Nosocomial InfectionsNosocomial Infections

•• Nosocomial Infections are infections acquired Nosocomial Infections are infections acquired

while in healthcare facility while in healthcare facility

–– Most common ????? Most common ?????

–– No infection present at the time of admissionNo infection present at the time of admission

•• Hospital pt are more susceptible to infection than Hospital pt are more susceptible to infection than

well individualswell individuals

–– Broken skinBroken skin

–– Poor NutritionPoor Nutrition

–– Disease processDisease process

–– TreatmentTreatment

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Prevention and ControlPrevention and Control

•• Follow Principles of medical and surgical Follow Principles of medical and surgical

asepsis when giving careasepsis when giving care

•• Follow recommendation from agency’s Follow recommendation from agency’s

infection control committeeinfection control committee

TerminologyTerminology

•• Community acquired infectionsCommunity acquired infections

•• Communicable or Contagious diseasesCommunicable or Contagious diseases

•• Most have been contained or eliminated because Most have been contained or eliminated because

of advancesof advances

–– Discovery and use of antibioticsDiscovery and use of antibiotics

–– Development of immunizing agentsDevelopment of immunizing agents

–– Guidelines for proper disposal of human wastesGuidelines for proper disposal of human wastes

–– Legislation controlling the preparation and sale of foodLegislation controlling the preparation and sale of food

–– ImmunizationImmunization

–– Public EducationPublic Education

Childhood ImmunizationsChildhood Immunizations

•• Vaccine Vaccine

–– –– Stimulates the body to produce antibodies Stimulates the body to produce antibodies

against a specific disease organism to reduce against a specific disease organism to reduce

the incidence of infectious diseasethe incidence of infectious disease

•• Public educationPublic education

•• Immunization protect ALL people not just Immunization protect ALL people not just

childrenchildren

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Client and Family TeachingClient and Family Teaching

•• HandwashingHandwashing

•• Daily bathDaily bath-- personal hygiene practicespersonal hygiene practices

•• Clean home environmentClean home environment

•• Immunizations currentImmunizations current

•• Precautions for travelPrecautions for travel

•• Proper use / discard of tissuesProper use / discard of tissues

•• Avoidance of sharing personal itemsAvoidance of sharing personal items

•• Safe sex practicesSafe sex practices

Client and Family TeachingClient and Family Teaching

•• Don’t infect others with colds Don’t infect others with colds ––stay homestay home

•• Avoids crowds and public places during FLU seasonAvoids crowds and public places during FLU season

•• Understand that antibiotic therapy is not always Understand that antibiotic therapy is not always

appropriate for every infectious disease appropriate for every infectious disease

•• If antibiotics prescribed, take the full dose as If antibiotics prescribed, take the full dose as

orderedordered

Special ConsiderationsSpecial Considerations

•• NutritionalNutritional

–– MetabolismMetabolism

–– ProteinProtein

–– FluidFluid

–– Infection controlInfection control

•• PharmacologicalPharmacological

–– Adverse reactionsAdverse reactions

–– Proper AdministrationProper Administration

–– Antibiotics, AntipyreticAntibiotics, Antipyretic

•• GerontonlogicGerontonlogic

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