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113 Cards in this Set
- Front
- Back
MDRO's
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Multidrug-resistant infectious organisms
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Normal Flora
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MO's that live on the skin, in the nasopharynx, GI tract and other body surfaces that normally pose no threat to the body
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Anatomic, Mechanical and Chemical Barriers
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- intact skin and mucus membranes
- chemical composition - skin, secretions - normal flora use local nutrients and O2 - peristalsis - secretion of specific substances - interferon |
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Interferon
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nonspecific chemical inhibitor that is secreted by body cells in response to viral invasion
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WBC's
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White Blood Cells
- normal WBC count is 5,000 - 10,000 cells/mm3 |
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Granulocytes
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polymorphonuclear cells that contain granules of digestive enzymes
- neutrophils, eosinophils & basophils |
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Agranulocytes
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mononuclear cells tht lack digestive enzymes
- monocytes, lymphocytes |
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Inflammatory Response
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a nonspecific response to tissue injury that can be caused by microbial invasion or by mechanical, chemical, or heat injury. Inflammation attempts to limit an injury's extent. The blood vessels dilate, and plasma flows out of the capillaries into the irritated tissue
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Individual Factors
- Nonspecific Natural Defenses |
Heredity
Good hygiene practices Good nutritional status Immunization history |
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Anatomical Barriers
- Nonspecific Natural Defenses |
Intact skin
Intact mucous membranes |
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Mechanical Removal of Microorganisms
- Nonspecific Natural Defenses |
Gastrointestinal motility
Ciliary action in the respiratory tract Cleansing effect of urine's flow Expulsive effect of coughing and sneezing Lavaging effects of tears and saliva Shedding of uterine lining in menstruation Flow of organ secretions through ducts (e.g., bile) |
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Chemical Factors
- Nonspecific Natural Defenses |
Acidity of gastric secretions, vaginal secretions, and fatty acids of the skin
Lysozyme enzymes in tears, nasal secretions, urine, and saliva Hormones secreted by the adrenal cortex and pancreas Indigenous microflora (competition) |
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Local Tissue Factors
- Nonspecific Natural Defenses |
Tissue surface receptor (occupancy)
Inflammation |
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White Blood Cell Function
- Nonspecific Natural Defenses |
Fever
Phagocytosis |
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Acquired Specific Defenses
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Cellular immunity (T lymphocytes elaborate killer cells and helper cells)
Humoral immunity (B lymphocytes produce antibodies to specific microorganisms) Memory of the organisms produces lasting immunity |
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5 Signs of Local Inflammation
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* Erythema (redness) from blood accumulation in the dilated capillaries
* Warmth from the heat of increased blood flow * Edema (swelling) from fluid accumulation * Pain from pressure or injury to the local nerves * Functional impairment from edema and/or pain |
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Pus
- how formed - mmm |
Inflammation and phagocytosis work together to contain microorganisms. If these processes are successful, a collection of dead leukocytes, digested bacteria, dead tissue cells, and plasma may form into the material called pus.
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Systemic Responses due to Inflammation
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increased WBC production, fever, fatigue, muscle aches, and loss of appetite.
- Due to the rise in body temperature and metabolic rate, the client may also experience an increase in pulse and respiratory rate. - Fatigue, muscle aches, and loss of appetite are a result of increased energy expenditures to support the inflammation process |
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Fever
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The hypothalamus raises the body's thermostat in response to pyrogens released by some phagocytic cells (macrophages) after stimulation by microorganisms or endotoxins .
- The rise in temperature increases cell metabolism. - body temperature greater than 38.2°C [101°F] |
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Endotoxins
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toxins released by the immunogenic part of the bacterial cell wall of gram-negative bacteria, which triggers an immune response
- these effects decrease with elevated temp |
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Antigens
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foreign particles, such as microbes, that enter a host. In some cases, such as in autoimmune diseases, the immune system senses or recognizes the person's own cells as antigens.
- Portions of digested microbes, antigenic particles, stay with the phagocyte and are carried to the lymphoid tissue in the lymph node or the spleen |
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T & B Lymphocytes & Memory Cells
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immune system conveys lasting resistance to infection by forming a “memory” of the antigen
- accumulate in lymph nodes along lymphatic vessels and are exposed to all antigens except those that enter the bloodstream directly |
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Cellular Immunity
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stimulated by fungi, protozoa, bacteria and some viruses
- At the site, the lymphocytes produce proteins called lymphokines that draw more phagocytes to the area, keeping them there to fight the invader and increasing their killing power. Lymphokines disappear after the antigen has been eliminated. - Some T cells, however, remain in the tissues and keep a memory of the antigen |
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Humoral Immunity
- in the blood stream |
- Antibodies - specific resistance
- Complement System - aid in antigen-antibody response |
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Antibodies
- also called Immunoglobulins |
- produced by B-Lymphocytes which make Plasma Cells that produce antibodies
- make bacteria more susceptibal to phagocytosis, help in bacterial cell lysis, neutralize virus, cause microbes to clump together or precipitate, and make easier to digest for phagocytes |
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Active Immunity
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produced when the immune system is stimulated (artificially or naturally) to produce antibodies
- vaccinations |
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Vaccination
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process of injecting weakened or killed organisms into a person, stimulating antibody production
- artificially acquired active immunity |
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Passive Immunity
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woman to fetus by placenta
woman to baby through breastmilk - provides temporary protection |
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Newborn/Infant Immunity
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not fully operational till 6 mo old
- difficulty localizing infections - viral diseases can cause severe widespread disease |
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Toddler/Preschooler Immunity
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childhood vaccinations are timed to take advantage of developing immunocompetence
- Respiratory Tract Infections are most common - Middle ear infections common because nasopharynx to ear canal passage is shorter and straigher |
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Child/Adolescent Immunity
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skin diseases (impetigo, roundworm, lice)
- high incidence of streptococcal infections - STD's - Trichomonas Vaginalis, HPV, chlamydia, herpes simplex, syphilis, gonorrhea & AIDS are epidemic in adolescents |
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Adult/ Older Adult Immunity
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Fewer Respiratory Tract infections, but more Chronic lung diseases
- STD's - Thymus shrinks --> decline in cell-mediated & humoral immunity - skin thins, pH changes, secretions slow, flora change, reflexes slow, urine retention |
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Opportunistic Infections
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even normal flora can cause disease under the right circumstances
- "in right place at the right time" |
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Bacteria
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Gram-Positive/Negative
Anaerobes-require reduced O2 |
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Exotoxins
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able to easily move into healthy tissue and cause injury
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Endotoxins
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potent poisons that can cause hemorrhagic shock when large amounts are release into the blood
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Viruses
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A virus invades a living cell many times its size, uses the cell's metabolism, and replicates itself while destroying the cell or changing the cell's genetic makeup.
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Fungi
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are often normal flora of skin
- antibiotics can contribute to fungal infections by killing bacterial flora |
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Parasites
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protozoa,helminths or arthropods
-Trichomoniasis, malaria, pinworms, fleas Arthropods serve as vectors for some protozoal and/or bacterial infections |
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Compromised Host
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Before an infectious process becomes a disease, a breakdown or impairment must occur in the physical and chemical barriers to bacterial colonization, the inflammatory and febrile response, and the response of the WBCs, including those involved in immunity
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Breaks in Skin and Mucous Membranes
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can be altered by natural and therapeutic processes
- infant and elderly skin is thin and more easily broken or penetrated |
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Invasive Devices
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provide a portal of entry for microorganisms
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Stasis of Body Fluids
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provide a warm, moist environment that fosters bacterial growth
- cough & sneezing - smoking - tumors or obstructions -urinary stasis |
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Inadequate Nutrition
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malnutrition depresses almost every normal defense to body infection
- inadequate protein stores decrease the body's ability to manufacture antibodies and WBCs |
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Stress and Hyperglycemia
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Physical or emotional stress causes the body to release cortisol, which can increase the risk of infection by suppressing the immune response. Cortisol increases the level of serum glucose, providing a good medium for bacterial growth
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Immune System Dysfunction
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AIDS
Cancer |
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Coexisting Medical Problems
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Cancer- increases risk of infection
inflammatory disorders cardiovascular conditions WBC transport |
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Chemotaxis
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factors that attract neutrophils and circulating macrophages to the site of infection
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Drug Therapy
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can cause defects in the host's response to infection. Steroids, chemotherapy, antimetabolites, and inappropriate or prolonged use of antibiotics can increase the risk of infection.
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Superinfection
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a new infection caused by an organism different from an initially infecting organism and usually resistant to treatment
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Clinical Disease
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condition when an obvious complex of symptoms occurs, the infection
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Subclinical Disease
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condition when the body successfully resists being overwhelmed by the infection
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Colonization
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introduction of microorganisms onto a body surface where they grow and multiply but do not invade the body or cause an immune response or symptoms
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Primary Infection
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occurs in an otherwise healthy person
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Secondary Infection
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develops in a weakened client
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Systemic Infection
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spreads to other body systems
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Localized Infection
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a single body area is affected
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Bacteremia
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bacteria spread through the bloodstream
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Septicemia
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the presence of microorganisms (or their toxic products) in the bloodstream that are disrupting normal body functions
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Blood Poisoning
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common term for the presence of infectious agents such as Staphylococcus or Streptococcus in the blood
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Acute Infection
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usually develops rapidly, causes symptoms, climaxes, and then fades fairly quickly
- can become chronic if body cannot rid itself of the organism |
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Chronic Infection
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can linger; symptoms develop slower that acute I's, and convalescence may take many months
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Nosocomial Infection
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hospital acquired
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HAI
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healthcare associated infection
- any infection associated with healthcare delivery - often result from poor hand hygiene and invasive procedures - frequently occur in nursing homes, jails and residential facilities |
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Progress of an Infection
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disease results from organisms multiplication and growth within the host
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Communicable Period
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time frame during which a disease can be passes from one person to another
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Stages of Communicable Period
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*Incubation - entrance of host till appearance of symptoms
*Prodromal - nonspecific symptoms *Acute - specific symptoms occur *Convalescent - body systems return to normal |
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Communicable Disease
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the causative agent of the disease is transmissible between one person and another
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Contagious Disease
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the agent passes with ease from one host to the next
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Latent Disease
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the agent is not present in body secretions but is hidden within the host's cells
- Latent Period- time between exposure and first signs of infection |
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Latent Period
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usually shorter than incubation period
- infected person usually shedding microorganisms before any signs/symptoms occur - all body secretions should be considered infectious |
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Malaise
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general sense of feeling not completely well
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Hyperpyrexia
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A temperature elevation above 38.2°C is considered a high-grade fever, and a temperature greater than 40.5°C (104.9°F)
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Low-Grade Fever
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a temperature that is slightly elevated (37.1°C to approximately 38.2°C [98.8°F to 100.6°F])
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Very Young Children and Older People with Fever
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very young children tend to produce high fevers with infection (up to 40°C [104°F]). Conversely, older people may not develop a fever or may produce only a low-grade fever when infection is present. Therefore it is important with this population to observe for other signs of infection, which may include acute confusion.
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1st Postoperative day with Fever
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During the first postoperative day, an elevated temperature is most likely caused by the physiologic stress of surgery or by atelectasis.
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Fever during the second to fifth postoperative day
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most likely results from pneumonia.
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A fever on the second to eighth postoperative day
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suggests UTI.
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One occurring from the third to the eleventh postoperative day
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often suggests a wound infection.
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A fever developing weeks or months after surgery
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may suggest a deep operative infection or infected prosthetic device.
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Phases of Febrile Episodes
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*Chill - feeling cold, shivers, goosebumps, pale
*Fever - higher set point, skin feels warm, appears flushed/vasodilation, client does not feel hot or cold *Flush/Crisis - profuse diaphoresis, decreased shivering, flushed and warm skin |
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Pulse & Respiratory Rate w/ Infection
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Infection increases the body's metabolic rate, which increases the heart rate. The pulse may become bounding. The rate and depth of respiration also increase as the body attempts to rid itself of excess waste produced during increased metabolism.
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Purulent Drainage
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increased numbers of WBCs, body fluids such as urine or sputum may become cloudy or whitish-yellow
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Abscesses
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occur when the body attempts to localize infection by walling off the purulent drainage.
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Normal Pattern Identification
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Ask the client or caregiver about measures that are normally taken to avoid illness, including the client's usual pattern of rest and exercise, nutrition, use of vitamins, herbs, and folk remedies, and understanding of germ exposure
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Common Studies in Initial Blood Workup for Infection
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* Complete blood count including hemoglobin, hematocrit, and WBC count
* Urinalysis * Erythrocyte sedimentation rate (ESR or sed rate) |
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Physical Assessment for Infection
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*General Inspection
*Vital Signs *Auscultation of Breath Sounds *Auscultation of Bowel Sounds *Palpation of Lymph Nodes *Sepsis Surveillance |
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Bands
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If the infection is severe or prolonged, the body cannot manufacture neutrophils quickly enough, resulting in the release of immature granulocytes (also called bands) into the blood
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Leukocytosis
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A rise in circulating WBCs above the normal adult range of 5000 to 10,000 cells/mm3
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Neutrophils
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normally comprise about 50% to 70% of all WBCs. Their numbers increase during infection
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Shift to the Left
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increase in the # of bands
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Neutrophil counts below 2000/mm3
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often are associated with cancer or chemotherapy
- greatly increase infection risk |
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Clients who cannot produce more WBCs in response to an infection
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malnourished, elderly, immunosuppressed, or individuals taking steroids, In such cases, the absence of an increase in total WBCs or a lack of clarity on the differential count does not rule out infection.
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Erythrocyte Sedimentation Rate
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measures, in millimeters per hour, the rate at which RBCs settle in unclotted blood
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Lactate Level
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a byproduct of metabolism that is usually metabolized in the liver. Normal levels are 0.3 to 2.6 mmol/L.
- Obtaining a serum lactate level is essential to identify tissue hypoperfusion in clients who are not yet hypotensive but who are at risk for septic shock. All clients with lactate values of more than 4 mmol/L should be treated with the Severe Sepsis Resuscitation Bundle |
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Serology Tests
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detect antigen-antibody reactions
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Culture, Sensitivity and Minimum Inhibitory Concentration
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specimens obtained from:
blood sputum stool throat wound exudate urine spinal, joint, pleural or other body cavity fluids |
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Minimum Inhibitory Concentration
MIC |
- quantifies the minimal amount of the drug that is necessary to inhibit microbial growth in the laboratory
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Blood Cultures
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usually obtained from two separate venipuncture sites
- don't use indwelling catheter |
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Sputum Culture
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- from productive cough
- should not contain saliva or postnasal drip - ideally collected in am before client eats |
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Wound Cultures
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taken when signs of purulent drainage
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Stool Culure
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look for leukocytes, eggs, moving organisms, enteric bacterial or fungal pathogens
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Urinalysis
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routinely examined to check for kidney and endocrine function and to identify the presence of UTI. Urinalysis provides information about the color, pH, specific gravity, and presence of protein, glucose, and ketones in the urine.
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Therapeutic Drug Monitoring
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used to determine a drug's concentration in blood
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Nephrotoxicity
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renal damage
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Ototoxicity
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eighth cranial nerve damage
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Peak Level
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highest level of drug concentration
- soon after administered |
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Trough Level
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lowest level of drug concentration
- just before next dose |
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Diagnostic Imaging
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Chest Radiographs
Endoscopic Procedures CT/CAT- computerized axial tomography MRI - Magnetic Resonance Imaging |
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Planning for Nursing Interventions for Infection
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* Controlling the spread of infection
* Providing education to modify risk behaviors * Supporting normal defense mechanisms and behaviors that prevent infection * Reducing or eliminating the adverse effects of infection on functional abilities * Detecting behaviors that increase the potential for infection * Participating in community planning and activities for infection prevention |
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Client Goals and Outcome Criteria
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Client goals and outcome criteria focus on preventing infections, increasing knowledge about infection and the treatment, controlling fever and related discomforts, and minimizing potential complications
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Protection of Skin and Mucus Membranes
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prevent excess dryness
thoroughly dry all areas avoid trauma, excessive heat, harsh chemicals, friction |
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Vaccinations are contraindicated when:
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in clients with immunodeficiency states, allergy to eggs, or previous allergic reactions. Clients should not receive live vaccines during pregnancy, acute debilitating disease, or periods of severe malnutrition.
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