Chapter 11

The patient's sputum culture returns a positive result for Streptococcus pneumoniae. As the RN, you are aware this capsule-forming bacterium possesses virulence factors to make it difficult to treat. In providing education to the patient regarding the disease process, which of the following statements is most appropriate?

"Fluid is building up in your lungs because of the body's persistent inflammatory response to the microbe."

Upon admission to the inpatient unit, a respiratory sputum culture and blood culture are sent. Prior to obtaining the blood culture, you provide education to the patient. Which of the following statements, by the patient, best demonstrates understanding of the rationale for the blood culture?

"The blood culture will be able to determine if the microbe causing the infection is present and multiplying in my blood, putting me at risk for septicemia."

Select the four most prevalent types of healthcare-associated infections.

- Surgical site infections - Urinary tract infections - Respiratory infections - Gastrointestinal Infections

Select all of the statements that correctly describe the infectious dose.

- The infectious dose is the minimum number of organisms that must be present for an infection to proceed. - Microbes with low infectious doses are usually highly virulent. - Certain infections, like tuberculosis and giardiasis, may proceed even if only a small number of microbial cells are present.

What mode of transmission would fit disease pattern D?

Biological vector

Epidemiology is the study of disease in the ________.

Community

Select characteristics exhibited by endotoxin, but not exhibited by exotoxins.

Composed of lipopolysaccharide Heat-stable Fever-inducing

You are diligent to prevent the spread of disease to other patients. Which of the following is the most appropriate type of isolation for this patient, considering the portal of exit for the pathogen in this case?

Droplet isolation (gown, gloves, and mask)

Select characteristics exhibited by exotoxins, but not exhibited by endotoxin.

Require very small doses to cause toxic effects Secreted from a living cell Have very specific targets

As the RN, you document the care and assessment of the patient in the chart prior to transfer to an inpatient unit. What is the most appropriate term for the clinical manifestations of disease as noted in your assessment?

Signs

Move the microbes and descriptions to their correct category to review portals of entry and the organisms typically involved in these areas of the human body.

Skin: Microbes enter via insect bites, conjunctiva, or oral mucous membranes Staphylococcus aureus, Herpes simplex (type 1), West Nile virus Gastrointestinal tract: Microbes enter via food, water or fomites Salmonella, Shigella, Hepatitis A Respiratory tract: Microbes enter via inhalation Influenza, Mycobacterium tuberculosis, Cryptococcus Urogenital tract: Microbes enter through mucosa of penis or vagina Hepatitis B, HIV, Trichomonas

Which of the following could serve as a reservoir of infection for disease pattern B?

Soil

Rabies is an example of this type of infection, which is indigenous to animals but naturally transmissible to humans ________.

Zoonotic infection

Assess the following statements, and select those that correctly apply to the properties of exotoxins and endotoxins.

Exotoxins are made of protein that are synthesized and secreted by a living cell, whereas endotoxins are comprised of lipopolysaccharide found in the outer membrane of gram-negative bacteria. Endotoxin is a pyrogen that routinely causes a fever whereas exotoxins do not usually cause a fever.

A teacher walking through her first-grade classroom pauses to pick up a used tissue that had ended up on the floor instead of in the waste basket. Unfortunately, after discarding the tissue, she doesn't immediately wash her hands, and acquires a strain of rhinovirus. Several days later she begins to experience symptoms of a cold. Based upon this scenario, please select the mode of disease transmission demonstrated here.

Fomite

Select the patterns of indirect transmission of infectious disease.

Food, water Fomites Air

Give an example of a disease that would fit pattern E.

Genital herpes

Label the images to examine patterns of infectious disease occurrence.

Googel Docs

Label the image to review the major portals of exit.

Google Doc

Cindy was diagnosed with an opportunistic fungal infection. Drag the descriptions to their correct categories to contrast "true" and opportunistic pathogens.

Google Docs

Drag the images to their corresponding type of epidemic to review how the frequency and distribution of disease are depicted graphically through epidemic curves.

Google Docs

Move the descriptions or examples to their correct category to review various types of microbial virulence factors.

Google Docs

Move the images to the correct category to review your understanding of disease transmission.

Google Docs

Move the terms into the correct empty boxes to complete this concept map about epidemiological statistics.

Google Docs

Move the terms into the correct empty boxes to complete this concept map on the progression of an infection to disease.

Google Docs

Please complete these sentences by dragging the correct terms into the blanks to demonstrate your understanding of the use of fecal transplants.

Google Docs

Review the phases of infection and disease by completing each sentence. Then, arrange the sentences in chronological order.

Google Docs

An infection that is acquired or develops during a person's stay in a hospital or other health facility is called a(n) _______ or nosocomial infection.

Healthcare-associated

During 2007, there were 3.6 new cases of pertussis per 100,000 susceptible individuals in the United States, part of a steady increase that has been occurring since the 1980s. Please select the term that is illustrated by this statistic.

Incidence

If the patient develops rabies infection, the time from the bite to the appearance of symptoms is referred to as the ________.

Incubation period

The ______ is the time between an encounter with a pathogen and the first symptoms.

Incubation period

Match the terms to their descriptions to test your understanding of colonization, infection, and disease.

Infectious Disease: Disruption of a tissue or organ caused by microbes or their products Infection:Pathogenic microorganisms penetrate the host defenses, enter the tissues, and multiply Colonization: Presence of organisms living in or on the body, but not causing any pathology

Give an example of a disease that would fit pattern A.

Influenza

Select the patterns of direct transmission of infectious disease.

Kissing, touching Droplet

Which of the following terms most appropriately describes the role of the raccoon in the patient's exposure to infection?

Living reservoir

Select the basic ways in which microbes cause damage to the host.

Microbes release toxins that cause tissue damage. Microbes release enzymes that break down host tissue. Microbes activate a host response that is itself destructive to host tissue. Microbes induce epigenetic changes in host cells.

Select all of the sites where it was previously known that normal microbiota existed in large populations in/on the human body.

Mouth Throat Large Intestine Skin Vagina

The best descriptive term for the resident microbiota is _______.

Mutualistic

1. The RN advises the employee that she is at risk for which of the following diseases? 2. All of the following are important topics to teach the employee, except _______. 3. If the employee is found to test positive for HIV, hepatitis B, or hepatitis C, which of the following actions is legally required by the hospital facility?

1. All of the choices are correct 2. A patient's infectious status must be known when reporting to employee health so immediate treatment may be initiated 3. Reporting the employee's positive test result to public health authorities

1. In the case, the patient was on continual antibiotic therapy for prevention of urinary tract infections, indicating that most urinary tract infections are caused by ________. 2. True or false: Urine is normally a sterile fluid. 3. Which of the following is a symptom of urinary tract infections?

1. Bacteria 2. False 3. Painful urination

1. In the case, the patient was started on antibiotic therapy for treatment indicating that the physicians believed his infection was caused by a ______. 2. What factors may have played a role in the patient's development of pneumonia after surgery? 3. Which of the following is a symptom of pneumonia?

1. Bacterium 2. His caregiver at the hospital did not use proper hand-washing technique. 3. Difficulty breathing

1. Infections that are transmitted by ticks and other biting arthropods use which of the following portals of exit? 2. What portal of exit is used by the varicella-zoster virus (agent that causes chickenpox)? 3. True or false: All pathogens that leave via the urogenital tract are considered agents of sexually transmitted infections. 4. Pathogens that leave through feces are usually transmitted through _______ contact. 5. Pathogens that leave through the respiratory portal by sneezing or coughing are usually transmitted through _______.

1. Blood removal 2. Respiratory droplets 3. False 4. Indirect 5. Droplets

Place the steps in the correct order to assess your knowledge of Koch's postulates.

1. Find Evidence of a particular microbe in every case of a disease 2. Isolate the microbe from an infected subject, and characterize the microbe through testing 3. Inoculate a susceptible healthy subject with the laboratory specimen and observe the same disease 4. Isolate the same agent from the test subject

1. All of the following factors increase the patient's risk for Clostridium difficile infection, except _______. 2. The patient developed the infection since hospitalization. Which of the following terms best describes this type of infection? 3. In order to prevent the spread of disease to other patients, the RN observes all of the following precautions, except _______. 4. The patient is experiencing severe diarrhea every 6 hours. Which phase of infection is she most likely experiencing?

1. Genetic defect 2. Healthcare-associated infection 3. Disinfection of needles following injections 4. Period of invasion

1. The RN has administered a dose of antibiotics to the mother as ordered. Which of the following statements by the patient demonstrates understanding of the rationale for antibiotics? 2. Which of the following is the first exposure of the infant to environmental microbes? 3. The mother displays no evidence of active Hepatitis B disease and her carrier status was discovered with routine prenatal screening. Which term best describes her carrier state? 4. If an infant is exposed to Hepatitis B during delivery, which term best describes the pattern of transmission?

1. I need antibiotics because my child is at risk of infection due to premature rupture of membranes. 2. Passage through vaginal canal 3. Asymptomatic carrier 4. Vertical transmission

1. According to the case, Jaelyn's urine cultures showed Pseudomonas aeruginosa. If a Gram stain was conducted on the bacterial cells in her urine, what color would the cells appear under the microscope? 2. What was the portal of entry for Pseudomonas in Jaelyn's current infection? 3. Why is Pseudomonas a current health concern?

1. Red/Pink 2. Urinary Tract 3. Many stains are highly resistant to antibiotics

1. Infections transmitted by arthropod biological vectors use which of the following portals of entry? 2. Which portal is used by the greatest number of pathogens? 3. True or False: All agents that use a portal of entry to initiate an infection are called exogenous agents. 4. True or False: Nervous system diseases must always use the respiratory tract as a portal of entry because of its proximity to the brain.

1. Skin 2. Respiratory tract 3. False 4. False

1. Permanent impairments in the patient can arise due to healthcare-associated infections. 2. Which of the following is thought to be most effective in reducing healthcare-associated infections? 3. Hand hygiene adherence among healthcare workers in the United States is estimated to be ______. 4. The introduction of alcohol-based hand gels in a hospital setting is beneficial because 5. The WHO's 5 Moments for Hand Hygiene establishes the need for hand cleansing _______. 6. True or False: Patient education prior to hospital admission is important to hand hygiene adherence.

1. True 2. Proper Hand-washing 3. Below 50% 4. it often makes hand hygiene possible immediately before patient contact takes place. 5. before an aseptic procedure 6. True

1. The staff at your hospital were most compliant with established hand washing protocols _______. 2. You observe one of your staff adhering to hand hygiene practices prior to touching a patient. Immediately before he touches the patient, he pulls out his cell phone to respond to an urgent text message. He puts the phone away and continues on his task of repositioning the patient. True or False: You note that the staff member is adhering to acceptable hand hygiene practices in this case. 3. Based upon the data presented, which of the following is a valid statement?

1. after exposure to body fluid 2. False 3. The use of a CDC video on hand hygiene prior to patient admission may increase staff compliance with established protocols.

1. The staff at your hospital were most compliant with established handwashing protocols ______. 2. You observe one of your staff adhering to hand hygiene practices prior to touching a patient. Immediately before he touches the patient, he pulls out his cell phone to respond to an urgent text message. He puts the phone away and continues on his task of repositioning the patient. True or False: You note in iScrub Lite that the staff member is adhering to acceptable hand hygiene practices in this case. 3. Based upon the data presented, which of the following is a valid statement?

1. after exposure to body fluid 2. False 3. The use of the CDC video on hand hygiene prior to patient admission may increase staff compliance with established protocols.

1. The bone marrow transplant affected Cindy causing __________. 2. Aspergillus is a(n) ______ pathogen. 3. Which of the following is symptom that Cindy presented with 10 days posttransplant? 4. Aspergillus was most likely transmitted to Cindy through _____ transmission.

1. an immunocompromised state 2. Eukaryotic 3. Chest Pain 4. Indirect

1. Which iPhone application has been developed to assist hospitals with data collection on hand hygiene practices? 2. Which of the following organizations have played a major role in the development of new hand hygiene practices? 3. True or False: As a healthcare worker prepares to check on the IV of a patient, he picks up the TV remote to turn off the television since the patient is asleep. He does not need to wash his hands again before touching the patient since he did not come in contact with the patient's body or body fluids.

1. iScrub Lite 2. Centers for Disease Control and the World Health Organization 3. False

Order the four steps of Koch's postulates as they would normally be applied.

2- Isolate the suspected microbe from an infected host and cultivate it in pure culture in the laboratory 1- Find evidence of a particular microbe in every case of a particular disease 3- Inoculate a susceptible healthy subject with the laboratory isolate of the potential pathogen and observe the resultant disease. 4- Reisolate the disease agent from the test subject, which now shows signs of disease

Order the four stages in the course of an infection.

2- Prodromal stage 1- Incubation period 4- Convalescent period 3- Acute Phase

Drag the images to their corresponding statement to test your knowledge of statistical information related to healthcare-associated infections.

22%- Percentage of healthcare-associated infections involving surgical sites 10%- Percentage of shifts where nurse scrubs are contaminated with dangerous pathogens 13%- Percentage of healthcare-associated infections involving the urinary tract 4%- Average rate of healthcare-associated infections in all admitted patients

A serious case of norovirus was reported on a cruise ship, with over a thousand passengers treated for acute diarrhea. Which disease pattern illustrates this scenario?

C

Which of the following are virulence factors?

Capsules Toxins Enzymes

Choose the best definition of virulence factors.

Characteristics of a microorganism that enable it to establish infection and cause disease

If the patient develops rabies infection, you know that it must be reported to local and state public health officials. Which of the following diseases is also reportable in the United States?

Cholera

Move the terms to their correct descriptions to review the definitions of infection types.

Chronic Infection: Infection that persists over a long period of time (e.g., HIV) Secondary Infection: An example is influenza complicated by pneumonia Systemic Infection: Infection spreads to several sites and tissue fluids, and may travel via nerves and CSF Mixed Infection: Several microbes establish themselves simultaneously at the infection site Localized Infection: Microbes enter the body and remain confined to a specific tissue Focal Infection: The infectious agent spreads to other tissues from a local site Acute Infection: Infection comes on rapidly, with severe but short-lived effects Primary Infection: The initial infection

Move the descriptions to the correct category below to show your understanding of true and opportunistic pathogens.

Opportunistic Pathogens: - Causes infection in immunocomprised host - Examples include Pseudomonas species and the yeast Candida - Can cause infection when they become established in a body area that they do not naturally inhabit - Common cause of infections in AIDS patients True Pathogens: - Can cause infection even in otherwise healthy persons - Examples include influenza virus, malaria, and Salmonella - Possess virulence factors to allow organisms to establish and damage host

Move the terms to their correct description to review the types of carrier states.

Passive carrier --> Health care workers who accidentally transfer pathogens to patients Asymptomatic carrier --> Infected, but shows no symptoms of disease Convalescent carrier --> Recuperating patients without symptoms; may shed viable microbes Chronic carrier --> Shelters the infectious agent in a latent form for a long period after recovery Incubating carrier --> Spreads the infectious agent before the appearance of the first symptoms

Please choose the answer that best completes the blanks of this sentence in the correct order. ______ is the ability of a microbe to cause disease, whereas ______ refers to the relative severity of a disease caused by a particular microorganism.

Pathogenicity; virulence

Match the outbreak type to its corresponding example to test your understanding of point-source,common-source, and propagated epidemics.

Point-Source Epidemic: An outbreak of staphylococcal food poisoning among individuals who attended a family reunion and ate the potato salad. Common-Source Epidemic: The persistent cholera epidemic studied by John Snow in London during the mid-1050s, during which he traced the source to a sewage-contaminated community pump. Propagated Epidemic: An outbreak of chickenpox among unvaccinated children in a large Amish community

Match the term to its corresponding description to examine different types of epidemics.

Point-source epidemic: Epidemic in which the infectious agent came from a single source and all victims were exposed to that source, at approximately the same time. Common-source epidemic: An outbreak resulting from common exposure to a single source of an infection that occurred over a period of time. Propagated epidemic: An epidemic that is sustained over time by its spread from person to person.

Match the description of the epidemic curve to the type of epidemic. Epidemic curves are prepared byplotting the number of cases of disease on the y-axis and dates on the x-axis.

Point-source epidemic: Graph would show a single prominent spike, restricted to a few days. Common-source epidemic: Graph would show a sustained increase in cases over a period of time until source is identified and removed. Propagated epidemic: Graph would show a steady increase in number of cases over time, followed by a slow tapering.

During a recent survey, 0.014% of the population showed evidence of a particular respiratory infection. Please select the term that is illustrated by this statistic.

Prevalence

The number of cases, including new cases as well as already existing cases, in a defined period of time is the _______.

Prevalence

By law, certain _________ diseases must be recorded with the public health authorities in order to maintain proper surveillance at the local, state, national, and international levels.

Reportable

As the emergency department RN, you document the care and assessment of the patient in the chart prior to transfer to an inpatient unit. What is the most appropriate term for the clinical manifestations of disease as reported by the patient?

Symptoms

Select those circumstances in which Koch's postulates cannot be readily applied or would beinappropriate to establish the cause of a disease.

The suspected pathogen cannot be cultured in the laboratory There is not a suitable experimental host for the suspected pathogen The disease is polymicrobial, caused by more than one pathogen

Which of the following statements is true regarding reportable diseases?

There are over 75 reportable diseases caused by a large variety of microorganisms.

Select the two major goals of the Human Microbiome Project.

To enumerate all of the members of the human microbiota, both those that can be cultured and those that are nonculturable To determine the role the human microbiota plays in health and disease

Candida or Pseudomonas are ______ pathogens, meaning they are not usually pathogenic to healthy persons with normal immune system functions because these microbes do not have well-developed virulence factors.

opportunistic