Chapter 11: Infectious Disease Prevention & Control

immunizations are available for ____ of childhood illnesses

15

historical perspectives

1900: communicable diseases were the leading causes of death in the US 2000: improved nutrition and sanitation, vaccines, and antibiotics put an end to the epidemics as people live longer, chronic diseases have replaced infectious diseases as the leading cause of death infectious diseases are still the number 1 cause of death worldwide new killers are emerging, and old familiar diseases are taking on different, more virulent characteristics

vaccines are available for hepatitis ___ & ___

A and B

Which of the following is the number one cause of death worldwide? a. Chronic diseases (heart disease, cancer, stroke) b. Infectious diseases c. Injuries (accidental or purposeful) d. Terrorism

B Infectious diseases, however, are still the number one cause of death worldwide. In countries with higher standards of living, where people live longer, chronic diseases—heart disease, cancer, and stroke—are the leading causes of death. Injuries and terrorism are not the number one cause of death worldwide

A student reports to the college health nurse that her academic work has been going downhill because of lack of sleep. "My 3-year-old probably misses her babysitter since she has started going to the big daycare center. She hasn't been sleeping well and keeps scratching her bottom. Hopefully, she'll adapt to daycare soon." Which of the following information should the nurse provide to the student? a. "Dry skin in winter weather can cause itchiness; try to put on lotion before bedtime." b. "Your daughter may have pinworms; let me teach you how to check for this." c. "Perhaps your child is not developmentally ready for group play." d. "Try to arrange more one-on-one time with your 3-year-old."

B Enterobiasis (pinworm infection) is the most common helminthic infection in the United States with about 42 million cases a year. This infection is seen most often among children in institutional settings. Pinworms cause itching, especially around the anus, which can result in a lack of sleep for both child and caregiver. The nurse should suspect that the underlying problem is pinworms, not dry skin. These symptoms do not demonstrate a developmental delay or the need for additional one-on-one time

The advanced practice nurse explains that the client has an upper respiratory infection (URI) and suggests several measures that might make the client more comfortable. Which of the following best describes why the nurse doesn't just prescribe antibiotics as the client repeatedly requests? (Select all that apply.) a. Antibiotics are expensive, whereas the support measures would be almost free of cost. b. Viral diseases are not affected by antibiotics. c. Clinics cannot afford to continually give antibiotics to anyone who asks for them. d. The more antibiotics are prescribed, the more infectious agents develop resistance to such drugs. e. Antibiotics are not particularly effective against coughs and nasal congestion.

B D

Five students order meals at a local restaurant. Which of the following students are at highest risk for illness? (Select all that apply.) a. The first student asks for a salad with chicken strips and dressing on the side. b. The second student asks for a hamburger, very rare. c. The third student orders a tuna salad sandwich with extra mayonnaise. d. The fourth student orders a breakfast meal with two very soft-poached eggs and toast. e. The fifth student asks for a vegetable platter and a side of hummus.

BDE

Which of the following symptoms suggests smallpox as opposed to the more common and much less dangerous chickenpox? (Select all that apply.) a. Child appears only mildly ill until late stages in smallpox. b. Lesions appear in various stages in the same area of the body rather than all at once. c. Rash lesions are most abundant on the face and extremities, not on the trunk. d. Rash occurs 2 to 4 days after sudden onset of fever rather than with the fever. e. Vesicles do not collapse when punctured

C D E

rubella

German measles moderately contagious cause problems if contracted by pregnant women vaccine preventable

name a disease related to migration

Lyme disease HIV

A client is using a primary prevention strategy to prevent infectious disease. Which of the following actions is the client most likely taking? a. A client receives a tetanus booster every 10 years. b. A client receives a tetanus booster after stepping on a nail. c. A client receives tetanus immunoglobulin after stepping on a nail. d. A client with tetanus is given antibiotics and is placed on seizure precautions.

T Tetanus boosters given before exposure are a measure of primary prevention because exposure has not yet occurred. If given after exposure (i.e., the client may be infected but disease has not developed), they are considered secondary prevention (similar to the textbook examples of immunoglobulin and rabies immunizations given after exposure). Immunoglobulin would be given if the client had not been previously immunized; however, this again is after exposure, so it is secondary prevention. Because the client has the condition, treatment is aimed at prevention of further injury

Which population is best protected against pertussis by the DTaP vaccine? a. Young children b. The pre-teen c. The teen d. Adult

a More than 200,000 children previously got pertussis each year. Two vaccines protect again this disease: DTaP protects young children from diphtheria, tetanus, and pertussis; and Tdap protects preteens, teens, and adults

Which of the following is the most probable cause of the increase in new emerging infectious diseases? a. Activities or behavior of humans, including changes in the environment b. Increasing urbanization and growth in new housing materials c. New infectious agents are evolving throughout the world d. Overpopulation in many areas, creating a need to reduce global population ANS: A

a Most of the emergence factors are consequences of activities and behavior of the human hosts and of environmental changes such as deforestation, urbanization, and industrialization. For example, the rise in households with two working parents has increased the number of children in daycare, and with this shift has come an increase in diarrheal diseases such as shigellosis. Urbanization is not a problem, but increasing development into formerly unaffected areas such as rainforests is. The environmental changes around the world are causing new infectious agents to emerge, not evolve. The environmental changes that occur because of overcrowding is the issue, not the population itself.

Which of the following places best describes where the incidence of Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) is currently rising? a. Areas where people share dressing or bathing facilities b. Daycare centers and schools c. Long-term care facilities d. Senior citizen centers

a Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) remain problems for people who acquire the bacteria in the hospital, but there is a growing incidence of community-acquired MRSA in places where people closely share facilities such as locker rooms, prisons, and other close bathing areas. Daycare centers, schools, long-term care facilities, and senior citizen centers are not places where the incidence of VRSA and MRSA is rising. These are not places where people are closely sharing dressing and bathing facilities.

Which of the following best represents an example of infectious disease spreading via a vector? a. Being bitten by an infected mosquito b. Disease spreading from infected mother to infant via the placenta c. A group of partygoers hugging and shaking hands d. Two persons, one of whom is infected, sharing a glass of soda

a Vectors include mosquitoes, which can transmit the infectious agent by biting the host. Vertical transmission is the passing of infection from parent to offspring via placenta. Horizontal transmission is the person-to-person spread of infection through (among other ways) contact. Common vehicle refers to transportation of the infectious agent from an infected host to a susceptible host via food, water, milk, or other substance

Which of the following biological warfare agents poses the greatest bioterrorism threat to a community? a. Anthrax b. Botulism c. Smallpox d. Tularemia

a Because of factors such as the ability to become an aerosol, the resistance to environmental degradation, and a high fatality rate, inhalational anthrax is considered to have an extremely high potential for being the single greatest biological warfare threat. Botulism, smallpox, and tularemia do not have the ability to be transmitted through a resistant aerosol that is highly fatal.

the nurse at a local health department is preparing for the upcoming influenza season. which of the following is an example of a primary prevention strategy to prevent an influenza epidemic? a. organizing a community flu shot drive to offer the vaccine free of charge b. teaching residents with the influenza virus the signs and symptoms of pneumonia c. encouraging residents with the influenza virus to stay home d. offering counseling for patients who test positive for the flu

a. organizing a community flu shot drive to offer the vaccine free of charge

a teenage boy presents to the public health department with complaints of muscle and joint pains, malaise, stiff neck, and occasional fever. upon assessment, Mr. Brady notes a ring-like lesion on the back of the neck. what information does the nurse include in his assessment? a. recent camping trips where there may have been exposure to deer or ticks b. recent visits to the zoo c. recent dog bites or cat scratches d. recent consumption of undercooked hamburger

a. recent camping trips where there may have been exposure to deer or ticks Lyme disease is transmitted by ixodid ticks that are associated with white-tailed deer (Odocoileus virginianus) and the white-footed mouse (Peromyscus leucopus). Lyme disease usually occurs in summer during tick season, and it has been reported throughout the U.S. stage I is characterized by erythema chronicum migrans, a distinctive skin lesion often called a bull's-eye lesion because it begins as a red area at the site of the tick attachment that spreads outward in a ringlike fashion as the center clears. the skin lesion may be accompanied or preceded by fever, fatigue, malaise, headache, muscle pains, and a stiff neck, as well as tender and enlarged lymph nodes and migratory joint pain.

transmission of communicable diseases depends on the successful interaction of 3 factors

agent host environment

zoonoses

an infection transmitted from a vertebrate animal to a human under natural conditions rabies (hydrophobia) vaccinate pets

surveillance for agents of bioterrorism especially after 9/11

anthrax smallpox

worldwide concern about infectious diseases has increased with the risk of human migration

as people move, they bring their diseases, levels of immunity and resistance, and the viruses or bacteria they may harbor, that have not emerged as diseases includes study of a wide range and variety of organisms, the pathology they may cause, and their diagnosis, treatment, prevention, and control

A student comes to the college health clinic with typical cold symptoms of fever, sneezing, and coughing, but the nurse also notes small white spots on the inside of the student's cheeks. Which of the following actions should be taken by the college health nurse? a. Inform all students, staff, and faculty of a possible rubella epidemic. b. Inform all students, staff, and faculty of a possible measles epidemic. c. Reassure the student that it is just a bad cold and will soon pass. d. Tell the student to take two acetaminophen and drink lots of fluids.

b

Which of the following best describes the current goal in relation to communicable diseases? a. To control political borders so diseases cannot spread further b. To exterminate specific infectious agents one by one c. To expand health care facilities to improve infectious disease treatment d. To achieve worldwide immunization to control new cases

b

Which of the following is the most common vector-borne disease is a result of travelers introducing the disease to the United States? a. Dengue b. Malaria c. Onchocerciasis (river blindness) d. Yellow fever

b Globally, malaria is the most prevalent vector-borne disease, with over 2.4 billion people at risk and more than 275 million cases reported each year. About 2000 cases of malaria are diagnosed in the United States each year. The vast majority of cases in the United States are in travelers and immigrants returning from countries where malaria transmission occurs, many from sub-Saharan Africa and South Asia. Dengue is rarely transmitted in the United States. Onchocerciasis and Yellow fever are not reported as common vector-borne diseases

Which of the following components of the epidemiologic triangle contributes most to a female client developing a vaginal infection caused by fungi after successful treatment of her strep throat with antibiotics? a. Agent b. Environment c. Host d. Agent and host

b The antibiotic therapy eliminates a specific pathological agent, but it also may alter the balance of normally occurring organisms in the woman's body, which causes a change in the vaginal environment and allows normally present fungi to proliferate, resulting in a yeast infection. The agent is the factor that is causing the disease or illness. The host is the human or animal that becomes infected.

a local school nurse calls the public health department to report that several students may have symptoms of pertussis. what symptoms does Mr. Brady expect to hear about? a. enlarged lymph nodes and a fine, pink rash b. an irritating cough that becomes paroxysmal c. fever, runny nose with full body rash d. viral respiratory infection similar to a common cold

b. an irritating cough that becomes paroxysmal pertussis (whooping cough) begins as a mild upper respiratory infection that progresses to an irritating cough and in 1-2 weeks may become paroxysmal (a series of repeated violent coughs). the repeated coughs occur without intervening breaths and can be followed by a characteristic inspiratory "whoop". pertussis is caused by the bacterium Bordetella pertussis and is transmitted via an airborne route through contact with infected droplets.

Tammy brings her baby to the doctor with complaints of coughing spells that end with the child making the sound of a "whoop" afterwards. the mother explains this has been going on for several weeks. the doctor examines the baby and asks about what specific immunization? a. influenza b. pertussis c. tetanus d. measles

b. pertussis

agent

bacteria, fungi, parasite, virus

Which of the following data would most likely be collected in a syndromic surveillance system? a. Incidence of bioterrorism attacks b. Number of air travelers c. Incidence of school absenteeism d. Number of influenza vaccines administered

c

An instructor is reviewing Salmonella infections with her class. Which of the following comments indicates that the student needs further review on how Salmonella is spread? a. "Certain pets and farm animals may be Salmonella carriers." b. "It is possible to transmit Salmonella by person-to-person contact." c. "Salmonella may be spread by spores that form once contaminated blood is exposed to the air." d. "Salmonella outbreaks are usually due to contaminated meat, poultry, and eggs."

c Anthrax (not Salmonella) forms spores when infected blood is exposed to air. Meat, poultry, and eggs are the foods most often associated with salmonellosis outbreaks. Animals are the common reservoir for the various Salmonella serotypes, although infected humans may also fill this role. Animals are more likely to be chronic carriers. Reptiles such as iguanas have been implicated as Salmonella carriers, along with pet turtles, poultry, cattle, swine, rodents, dogs, and cats. Person-to-person transmission is an important consideration in daycare and institutional settings

Which statement made by the nurse best describes the effect vaccines have had on tuberculosis (TB)? a. Tuberculosis is no longer a threat in most of the world. b. Tuberculosis has developed resistance to the all antibiotics. c. The treatment has helped greatly reduce the incidence of TB in the United States. d. The incidence of TB has remained constant since the 20th century

c In 1900, communicable diseases were the leading causes of death in the United States. Since that time, improved sanitation and nutrition, the discovery of antibiotics, and the development of vaccines has ended some epidemics such as diphtheria and typhoid fever and greatly reduced the incidence of others such as tuberculosis (TB).

Which of the following public health actions has been particularly instrumental in reducing childhood infectious diseases in the United States? a. Answering parents' questions about the safety and importance of vaccines today b. Educational campaigns to all health care providers about the importance of immunizations whenever a child is seen c. "No shots, no school" legislation, which legally requires children be immunized before school d. Offering all immunizations to all children free of any charge

c Vaccines are one of the most effective methods of preventing and controlling communicable diseases. One of the most effective programs has been the "no shots, no school" legislation, which has resulted in the immunization of most children by the time they enter school. Hopefully, all nurses answer questions, remind colleagues to think about immunizations whenever a child is seen, and encourage continuing free or low-cost immunization clinics. These interventions have not been particularly instrumental in reducing childhood infections.

A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. "Why," he asks, "should my tax dollars be used to pay for their children to be immunized?" Which of the following would be the best response by the nurse? a. "Immunizations are required by law, and if their parents can't afford it, you and I will have to pay for it." b. "It's just the right thing to do." c. "Only by making sure most kids are immunized can we stop epidemics that might hurt all of us." d. "We're a religious God-fearing community, and we take care of each other."

c Herd immunity is the resistance of a group of people to invasion and spread of an infectious agent because a high proportion of individual members of a group are resistant to the infection. Higher immunization coverage will lead to greater herd immunity, which in turn will block the further spread of the disease. The purpose of immunization laws is to promote herd immunity. Receiving immunizations helps to block the further spread of the disease as more members of the community become resistant to the infection.

Which of the following is the most common vector-borne disease in the United States? a. Babesiosis b. Ehrlichiosis c. Lyme disease d. Rocky Mountain spotted fever

c Lyme disease became a nationally notifiable disease in 1991 and is now the most common vector-borne disease in the United States. Babesiosis, Ehrlichiosis, and Rocky Mountain spotted fever are all diseases borne by ticks as the vectors. These are not the most common vector-borne diseases

the public health nurse partners with the school nurse to provide education about influenza. what are the primary educational points? a. symptoms follow a characteristic pattern b. transmission is through GI contamination so handwashing after bowel movements is crucial c. annual immunization is necessary in early fall d. immigrants are immune to influenza

c. annual immunization is necessary in early fall influenza (flu) is a viral respiratory infection often indistinguishable from the common cold or other respiratory diseases. transmission is airborne and through direct contact with infected droplets. unlike many viruses that do not survive long in the environment, the flu virus may survive for many hours in dried mucus. outbreaks are common in the winter and early spring in areas in which people gather indoors, such as in schools and nursing homes. gastrointestinal and respiratory symptoms are common. because symptoms do not always follow a characteristic pattern, many viral diseases that are not influenza are often called flu.

development of a chancre is a sign of which STD? a. herpes b. gonorrhea c. syphilis d. chlamydia

c. syphilis

Lyme disease

characteristic bull's eye rash

ten golden rules for safe food preparation

choose food processed for safety cook food thoroughly eat cooked food immediately store cooked food carefully reheat cooked foods thoroughly avoid contact between raw foods and cooked foods wash hands repeatedly keep all kitchen surfaces meticulously clean protect foods from insects, rodents, and other animals use pure water

good surveillance system

collects, organized, and analyzes current, accurate, and complete data for a defined disease condition

agent of bioterrorism: smallpox

considered eradicated since 1979 stopped routinely immunizing in 1982 leading candidate for bioterrorism susceptibility is 100% in the unvaccinated, and the fatality rate is 20-40%

role of nurse in prevention

control and teach about disease screen for disease treat persons with disease

During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to selected susceptible persons. Which of the following best describes the type of immunity that will follow the administration of these injections? a. Active immunity b. Acquired immunity c. Natural immunity d. Passive immunity

d Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a non-immunized individual, such as the transfer of antibody by the administration of an antibody-containing preparation (immune globulin or antiserum). Passive immunity from immune globulin is almost immediate but short-lived. It often is induced as a stopgap measure until active immunity has had time to develop after vaccination. Active immunity occurs as antibodies develop due to exposure to the antigen. Acquired immunity is the resistance acquired by a host as a result of previous natural exposure to an infectious agent. Natural immunity refers to a species-determined, innate resistance to an infectious agent.

There is great concern in the nurse's community over three local cases of West Nile virus. Which of the following actions should the nurse take to get the community involved in addressing this problem? a. Ask the state department of health for assistance. b. Demand that everyone over age 65 become immunized immediately. c. Encourage immunization of all children under 12. d. Have an educational campaign to remove any containers of standing water.

d Periodic outbreaks of West Nile virus appear to result from a complex interaction of multiple factors, including weather—especially hot, dry summers followed by rain, which influences mosquito breeding sites and population growth. Removing standing water will remove mosquito breeding sites. Currently, there is not a vaccine available for humans; an equine vaccine does exist, and work is under way to develop a vaccine for both birds and humans. The state health department would most likely not become involved in this local health problem, rather this may be the role of a local health department

The nurse is trying to determine if a disease occurrence needs to be reported to the state health department. Which of the following resources should the nurse use to answer this question? a. Centers for Disease Control and Prevention Weekly Report b. Communicable Diseases Weekly Report c. Nationally notifiable infectious diseases on the CDC website d. State health department website

d Requirements for disease reporting in the United States are mandated by state rather than federal law. The list of reportable diseases varies by state. State health departments, on a voluntary basis, report cases of selected diseases to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. The CDC updates these conditions annually, and the list can be found under the heading of Nationally notifiable infectious diseases on the CDC website. The weekly reports may provide information about the current incidence or prevalence of certain diseases, but it will not provide the nurse with information about what is required to be reported

Which of the following infectious disease interventions best represents the use of secondary prevention? a. Clients with HIV infection are encouraged to use condoms to protect sexual partners. b. Clients with HIV infection are given medications to improve immunological response. c. Health care workers are encouraged to receive annual vaccinations for influenza. d. Health care workers are required to have a tuberculosis skin test or chest X-ray

d Tuberculosis screening for health care workers is an example of secondary prevention. TB skin tests and chest X-rays are methods of tuberculosis screening. Encouraging clients with HIV to use condoms is an example of primary prevention, because the goal is to prevent exposure to the partner. Encouraging annual influenza vaccinations is also an example of primary prevention. Giving clients with HIV medications is an example of tertiary prevention, because the goal is to reduce complications in those already having the infection

At a town meeting with public health officials to discuss a communicable disease outbreak, a nurse is asked to explain what is meant by the phrase "a virulent organism." The nurse explains that this means the organism causing the disease is able to do which of the following? a. Bypass normal immunological response mechanisms b. Invade major organ systems c. Produce toxins and poisons that weaken the body d. Produce very severe physical reactions

d Virulence is the ability to produce a severe pathological reaction. Bypassing the normal immunological response mechanisms, invading major organ systems, and producing toxins and poisons that weaken the body are not correct definitions of virulence.

what is Mr. Brady aware of with regards to immunizations of students in the community? a. parents who claim religious or philosophical objections to immunizations must home school their children. b. inner-city children have higher rates of vaccination because of the free clinics that are offered. c. adolescents have higher rates of vaccination. d. ethnic groups are at risk for incomplete immunization.

d. ethnic groups are at risk for incomplete immunization vaccines are one of the most effective methods of preventing and controlling communicable diseases. diseases such as polio, diphtheria, pertussis, and measles, which previously occurred in epidemic proportions, are now controlled by routine childhood immunization. they have not, however, been eradicated, so children need to be immunized against these diseases. in the U.S., "no shots, no school" legislation has resulted in the immunization of most children by the time they enter school; however, many infants and toddlers, the group most vulnerable to these potentially severe diseases, do not receive scheduled immunizations on time despite the availability of free vaccines. surveys show that inner-city children from minority and ethnic groups are particularly at risk for incomplete immunization. children from religious communities whose beliefs prohibit immunization and children with parents who have philosophical objections to immunization may receive no protection at all. research also suggests that adolescents have lower rates of coverage than children or adults perhaps because they do not as frequently access preventive care.

salmonellosis

eating infected food or from infected animal common in meat, poultry, and eggs

disease spectrum

endemic epidemic pandemic

pertussis

endemic whooping cough mild cough: paroxysmal followed by a whoop sound contagious deadly to infants

environment

external to the host

foodborne diseases

food poisoning

surveillance

gather the who, when, where, and what to answer why

routine childhood immunization vaccines

hep A & B diphtheria, tetanus, and pertussis polio MMR influenza Haemophilus influenza type B meningitis varicella (chickenpox) Streptococcus pneumonia rotavirus

when a large percentage of population within a community has become immune to a disease it is called ______________________

herd immunity

measles

highly contagious rash with Koplik spots rubeola virus spread via air

host

human or animal: resistance immunity herd immunity infectiousness

vector-borne diseases

illnesses for which the infectious agent is transmitted by a carrier (vector) Lyme disease rocky mountain spotted fever

waterborne diseases

incident in which two or more persons experience similar illnesses after consuming contaminated water hepatitis A cholera typhoid fever bacillary dysentery

emergency factors

increased households with 2 working parents increased number of IVDU increased travel increased number of immigrants

common vehicle

infected host to susceptible host

nosocomial infections

infections acquired during hospitalization or developed within the hospital setting HAIs may involve patients, healthcare workers, visitors, or anyone who has contact with a hospital

endemic

local outbreak

diseases of travelers

malaria foodborne and waterborne diseases diarrheal diseases infected mosquito don't drink the water Montezuma's revenge

parasitic diseases

more prevalent in tropical climates and countries with inadequate prevention and control methods intestinal parasitic infections: pinworms parasitic opportunistic infections: PCP PNU

agent of bioterrorism: anthrax

not spread human-to-human spore-forming bacterium Bacillus anthracis cutaneous GI respiratory or inhalational has the greatest risk of death

epidemic

outbreak

vertical transmission

parent to offspring

horizontal transmission

person to person

primary prevention

preventing the incidence of disease before it happens

secondary prevention

preventing the spread of disease once it occurs

universal precautions

procedures to prevent exposure to blood-borne diseases

tertiary prevention

reducing complications through treatment and rehabilitation

Zika virus

spread via mosquitos mild signs and symptoms serious in pregnant women nationally notifiable disease

primary, secondary, or tertiary teaching about prevention treatment with medication screening for TB no shots, no school prophylactic treatment if exposed immunization clinics

teaching about prevention (1) treatment with medication (3) screening for TB (2) no shots, no school (1) prophylactic treatment if exposed (2) immunization clinics (1)

how does herd immunity impact disease prevention?

the risk for an outbreak decreases

emerging infectious diseases

those in which the incidence has increased in the past two decades or has the potential to increase in the near future Ebola hantavirus pulmonary syndrome: Native Americans HIV/AIDS: Africa West Nile virus: Uganda

vectors

ticks or mosquitoes

Escherichia coli

undercooked hamburger is common cause

influenza (flu)

viral respiratory infection transmission is airborne and through direct contact with infected droplets antiviral medications for control Tamiflu and relenza

prevention and control of tick-borne diseases

wear protective clothing wear repellant containing DEET check for tics vaccine for Lyme disease recommended for those living in high-risk areas

herd immunity

when a large percentage of population in a community has become immune decreases the risk for an outbreak

pandemic

widespread outbreak

disease development

you can be infected without developing an infection or a disease