NURS 317: Inflammation & Infection

Describe how healing is compromised in elderly patients?

-delayed healing -

Describe the tertiary healing process:

-delayed primary intention due to delayed suturing of the wound -contaminated wound left open or primary wound becomes infected and is opened; after infetcion is controlled. -larger, deeper scar

What factors delay healing?

-nutritional deficiencies. inadequate blood supply, corticosteroids, infection , smoking, anemia, obesity, mechanical friction.

How are infectious diseases spread?

-respiratory droplets -fecal-oral (Hep A, Hep B) -In-direct contact (objects) -Common vehicle (blood, food) Body fluids: blood, urine, saliva Insects (vector-borne)

Describe the primary intention of the healing process:

-wound edges are approximated and sutured/stapled/glued -initial phase 3-5 days -granulation phase 5days-4 weeks (collagen starts forming scar tissue) -Maturation phase and scar contraction (scar tissue matures)

Describe the secondary intention of the healing process:

-wounds that occur from trauma, ulceration, and infection have extensive tissue loss -wide, irregular margins, edges cannot be approximated -more debris, cells, exudate, may need debridement to clean-up edges -granulates from edges in and from bottom up; larger scar

Name 7 areas where pressure injuries can occur:

1. Back of head and ears 2. Shoulder 3. Elbow 4. Lower back and buttocks 5. Inner knees 6. hip 7. Heel

Standard precautions apply to (1) blood; (2) all body fluids, secretions, and excretions; (3) nonintact skin; and:

4. Mucous membranes

Fever management, administering antipyretic or antibiotics and monitoring for seizures are examples of what kind of care?

Acute Care

Sponge baths, corticosteroids for older adults, and cooling blankets to lower temperature is an example of what kind of care?

Acute Care

This type of inflammation lasts 2-3 weeks, usually no residual damage, mostly neutrophils at site

Acute Inflammation

An infection characterized by sudden onset, rapid progression, and often includes sever symptoms is:

Acute infection (demand for neutrophils causes the release of immature neutrophils from bone marrrow)

What are CAUTI infections?

All patients undergoing catheterization of the urinary tract are at risk for CAUTICAUTI in our older populations can be deadly

Opportunistic diseases in HIV infection

Are curable with appropriate drug interventions

What is the most appropriate nursing intervention to help patients with HIV adhere to their treatment plan?

Assess pt's routines and find adherence cues that fit into their life circumstances

What can health care providers do to prevent CAUTI in their patients?

Avoid unnecessary catheterization• Early removal• Hand washing (before and after procedure)• Aseptic technique• Wear gloves for any and all catheter care

The risk of central venous catheter colonization increases with catheter duration, and catheter colonization is the precursor to CLABSI. Thus, one of the most effective ways to reduce CLABSIs is to remove central venous catheters as soon as they are no longer necessary for the care of the patient.

CLABSI Prevention

What is an example of an opportunistic infection?

Candida albicans (thrush), Hep B, Hep C, HSV, mycobacterium avium complex (gastroenteritis, diarrhea, weight loss), mycobacterium tuberculosis, pneumocystitis (pneumonia), toxoplasma gondii(encephalitis)

An infection characterized by delayed onset and slow progression is:

Chronic Infection (injurious agent persists and/or repeatedly injures tissue)

This type of inflammation may last weeks, months, injurious agents persist or repeats injury to tissues, mostly lymphocytes and macrophages. May result in autoimmune disease.

Chronic Inflammation

What is required with droplet precautions?

Clean hands, mask, eye protection Ex: influenza, rhinovirus, pertussis, and Group Streptoccocus

Contractions may cause:

Deformity -can compromise the movement of joints -most common on palms, soles, thorax

Where do emerging Infections come from?

Ebola, H1N1, covid-19, measles, TB, MERS, Zika, Pertussis

Physical facility plan must meet quality and infection control measures• Cleaning of hospital environment• Proper air ventilation• Proper waste collection & disposal• Cleaning and disinfection of equipment• Proper linen collection, cleaning and distribution is referred to:

Environmental control

What extends above wound surface?

Excess granulation tissue

The formation abnormal passage between organs or organ and skin is:

Fistula

What S/S would you expect to see in the elderly population with UTI?

Frequent falls• Confusion (altered LOC)• Dizziness• Agitation or aggression• Fatigue and/or lethargy• Decreased appetite• Decreased urine output• Possible tachycardia• Fever• Hypotension (vasodilation)

Why do these types of bacteria become resistant to antibiotics?

HCPs have contributed to the development of drug-resistant microorganisms by:• RX'ing ABX for viral infections• giving in to pt pressure to RX unnecessary ABX therapy• Using inadequate drug regimes to treat infections• Using broad-spectrum ABX instead of more appropriate 1st line ABX

what types of people are susceptible to infection?

Immunocompromised (cancer, autoimmune disease, diabetics, HIV, AIDS) etc.

What are examples of systemic manifestations of the inflammatory response?

Increased WBC count "left shift" Malaise, nausea, anorexia, increased pulse and resp rate, fever

Fever triggers which beneficial defense mechanisms?

Increased killing of microorganisms, increased phagocytosis, increased proliferation of T cells, increased interferon activity.

Most common infections in older adults:

Infections common in older adults include pneumonia, urinary tract infections (UTIs), skin infections, and TB. UTIs are more common in those who live in long-term care facilities. Patients with indwelling catheters are at particular risk.

Sequential response to cell injury that neutralizes and dilutes inflammatory agent, removes necrotic materials, establishes an environment suitable for healing and repair:

Inflammatory response

Increased numbers of immature neutrophils, most common cause of inflammation and can be seen in leukemia is referred to as:

Left Shift (Immature WBC)

An infection that is restricted to a specific location or region within the body of the host

Localized Infection

What is required with sharp precautions?

Never recap needles, dispose of used needles in appropriate sharps

Describe how a fever is a clinical manifestation of the inflammatory response?

Onset is triggered by release of cytokines. Initiate metabolic changes in temperature-regulating center in hypothalamus to raise thermostatic set point. Hypothalamus stimulates ANS to increase muscle tone and shivering and reduced perspiration and peripheral blood flow

An infection caused by microorganisms that occur more frequently and are more severe in people with compromised immune systems, including people with HIV.

Opportunistic infection

Skipping doses, not taking ABX for prescribed full duration of therapy and saving unused ABX to use later if needed is an example of:

Patient contribution to ABX resistant organism

What re four ways to promote health with your pt's related to inflammation/infection?

Prevention of injury, adequate nutrition and hydration, early recognition of inflammation, immediate treatment (drug therapy)

An infection that develops in an otherwise healthy individual

Primary Infection

Replacing cells and tissues with same type is called:

Regeneration

The most common component of the healing process consisting of connective tissues replacing lost cells is called:

Repair

An infection that develops in an individual who is already infected with a different pathogen

Secondary infection

What are examples of Antibiotic-resistant infections?

Several types of enterococcus• Klebsiella pneumonia• Staphylococcus aureus• Staphylococcus epidermidis• Streptococcus pneumonia

Non-blanchable erythema of intact skin is:

Stage 1 pressure injury

Partial-thickness skin loss with exposed dermis is:

Stage 2 pressure injury

Full-thickness skin loss is:

Stage 3 pressure injury

Full thickness skin and tissue loss, muscle/bone present is:

Stage 4 pressure ulcer

What are examples of hospital infection control?

Standard Precautions, isolation precautions, safe injection practices. needlestick injury prevention, medical and surgical asepsis, environmental control. This applies to: blood, all body fluids, secretions, excretions, non-intact skin, hand hygiene, PPE.

An infection that has spread to several regions or areas in the body of the host

Systemic Infection

How would you teach your pt the importance of taking their prescribed ABX?

Take it all don't forget to take it take as prescribed

Airborne precautions, droplet precautions, contact precautions are examples of:

Transmission-based precautions

Slough and black tar visible

Unstageable pressure ulcer

What can health care providers do to prevent/decrease CLABSI in their patients?

Use appropriate hand hygiene• Use chlorhexidine for skin preparation• Use full-barrier precautions during central venous catheter insertion.• Avoid using the femoral vein for catheters in adult patients.• Remove unnecessary catheters.

5. Which factors place the patient at increased risk for severe COVID-19? (select all that apply)

a. Obesity b. Thyroid disease c. Cigarette smoking d. Pernicious anemia e. Chronic kidney disease

Interventions to prevent health care-associated infections include (select all that apply)

a. following hand-washing protocols. e. decontaminating equipment used for patient care.

Factors associated with an increase in reemerging infections include (select all that apply) a. international travel.

a. international travel. b. poor immunization rates. c. poor sanitation standards. d. not completing a full course of antibiotics.

is the main treatment for many infections. Laboratory testing helps to determine the right antimicrobial.

antimicrobial infection

are one-celled organisms that are common throughout nature. Many are normal flora. They live harmoniously in or on the human body without causing disease under normal circumstances.

bacteria

Adhesions are:

bands of scar tissue

How does bacteria cause disease?

by entering the body and growing inside human cells (e.g., TB) or by secreting toxins that damage cells (e.g., Staphylococcus aureus).

4. When working with a patient who has suspected tuberculosis, the nurse would

c. place the patient on airborne precautions.

an infectious disease that has recently increased in incidence or that threatens to increase in the immediate future.

emerging infection

organisms similar to plants, but they lack chlorophyll. Mycosis is any disease caused by a fungus. infections that are usually local

fungi

What is required with contact precautions?

hand hygiene, gown, gloves, ex: C. diff, herpes, scabies, MRSA, fungal infections.

The final phase of the inflammatory response is:

healing

When a pathogen invades the body, multiplies, and causes disease, usually causing harm to the host, this is called a:

infection

What is required with airborne precautions?

private room, negative pressure, keeping door closed, N95 mask ex: TB and Aspergillus

single-cell, animal-like microorganisms. normally live in soil and bodies of water. If they enter the body, they can cause infection.

protozoa

occurs when pathogenic organisms change in ways that decrease the ability of a drug (or a family of drugs) to treat disease. 3 Microorganisms can become resistant to classic treatments (e.g., penicillin) as well as to newer antimicrobial agents.

resistance

Redness, swelling, warmth, tachycardia, and drainage are examples of what?

s/s of infection

do not have a cellular structure. They are simple infectious particles that consist of a small amount of genetic material (either ribonucleic acid [RNA] or deoxyribonucleic acid [DNA]) and a protein envelope.

viruses

The nurse caring for a patient with HIV who has been on ART for many years plans care with the knowledge that the patient

will inevitably develop drug resistance or more likely to requrie treatment for opportunistic diseases

Describe how wounds are assessed:

wound charactersitics: location, size, depth, undermining, tunneling, margins, base -assess on admission and on a regular basis -measure wound -take picture -document wound

Name 5 HCP on your care team?

wound, ostomy, continence (WOC) nurse, RN, LPN/VN, Dietician, MD, family members