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Timby/Smith: Introductory
Medical-Surgical Nursing, 11/e
Chapter 12: Infection
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Infectious Agents and Infectious
Disorders
• Infection: invasion of the body with agents that have the
potential to cause disease
• Infectious disorder
– Cause: infectious agents
– Microorganisms: invasion—eliminate, reside, and
cause infection
– Factors affecting infection development
• Characteristics of microorganisms
• Components of infectious process cycle
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Infectious Agents
• Bacteria
– Single-celled; shapes: round, rod-shaped, spiral
– Types: aerobic and anaerobic
– Multidrug resistance: ability to remain unaffected by
antibiotics
• Examples: Staphylococcus aureus, Streptococcus
pneumoniae, and Escherichia coli
– Greater risk of death
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Types of Infectious Agents—(cont.)
• Viruses
– Two types: nucleic acid—DNA and RNA
– Use metabolic and reproductive materials of living
cells or tissues to grow and reproduce
– Self-limiting; dormant in living host
– Examples: cold sores, shingles, viral hepatitis
• Fungi
– Two groups: yeasts and molds
• Fungal infections: superficial, intermediate, deep
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Types of Infectious Agents—(cont.)
• Rickettsiae
– Invade living cells and cannot survive outside a living
organism or host
– Transmitted by arthropods; fleas, lice, ticks,
mosquitoes
– Examples: Lyme disease, malaria, West Nile virus
• Protozoans
– Single-celled organisms classified according to their
motility
– Example: Giardia
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Types of Infectious Agents—(cont.)
• Mycoplasmas
– Single-celled that lack a cell wall; infect surface
linings of respiratory, genitourinary, and GI tract
– Examples: autoimmune disorders, Crohn’s disease
• Helminths
– Infectious worms
– Groups: roundworms, tapeworms, flukes
• Prions—Alzheimer’s disease
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Question
Examples of arthropods, which cause the diseases
including Lyme disease, malaria, West Nile virus, Rocky
Mountain spotted fever, and bubonic plague, are spread by
the following, except:
A) Fleas
B) Ticks
C) Mosquitoes
D) Mice
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Answer
D) Mice
Rationale: Intermediate life forms such as fleas, ticks, lice,
mosquitoes, or mites transmit rickettsial diseases to
humans.
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Characteristics of Infectious Agents
• Types
– Nonpathogens: harmless
– Pathogens: cause infectious disease
• Responses
– Body’s immune defense mechanisms eliminate them.
– They reside in the body without causing disease.
– They cause an infection or infectious disease.
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Infection Transmission
Chain of infection
• All six components in the
chain of infection must be
present to transmit an
infectious disease.
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Defenses Against Infection
• Mechanical: physical barriers
– Skin and mucous membranes; normal flora, mucus
– Physiologic reflexes; sneezing, coughing, vomiting
– Macrophages
• Chemical: natural biologic substance
– Enzymes; tears, saliva, mucus
– Antibodies
– Secretions; interferon
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
An older adult client is admitted to the hospital with an
infected leg wound. Older adults are at an increased risk
for infections due to:
A) Intact skin
B) Sensitive to antibiotics
C) Decrease in vascular supply to the skin
D) Hypersensitive cough reflex
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Answer
C) Decrease in vascular supply to the skin
Rationale: For a wound to become infected, an opening in
the skin barrier must allow pathogens to enter. In the older
adult, thinning, drying, and decreased vascular supply
predispose the older person to skin infections.
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Pathophysiology of Infection
• Localized infection
– Leukocytosis: activates the inflammatory process
• Cellular response results in leakage of fluid,
colloids, and ions, producing swelling
– Vascular response: redness and heat
– Chemical response: pain
– WBCs destroy toxins and remove debris.
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Care of the Client With Infection
• Signs and symptoms
– Localized, generalized, sepsis
– Table 12-2
• Gerontologic considerations
• Symptoms of infections: subtle, atypical
– Lower normal or baseline temperature
– Changes in behavior and mental status
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Pathophysiology of Infection
• Generalized infection
– Sepsis: systemic inflammatory response syndrome
resulting from infection
• Characteristics: temperature, heart rate,
respiratory rate, and WBC count
– Severe sepsis: organ dysfunction, hypotension, and
hypoperfusion
• Manifestation: lactic acidosis, oliguria, and
alteration in mental status
• Treatment: antimicrobial drugs; Xigris
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Types of Infection
• Community-acquired: produce clusters of signs and
symptoms that reflect dysfunction of the organs or
tissues that the microorganisms have invaded
– Examples: TB and meningitis
• Nosocomial: acquired in a healthcare agency
• Opportunistic /superinfection: nonpathogenic or remotely
pathogenic microorganisms overwhelm host
– Antibiotics: biologic imbalance
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Emerging Infectious Diseases
• Zoonotic pathogens: spread from animal to humans
– Examples: avian influenza, Lyme disease
• Reemerging infectious diseases
– Resurgence in time and geographic range
– Examples: tuberculosis, malaria, influenza
• Gerontologic considerations: varicella-zoster virus—
reactivate as shingles
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Infection Control and Prevention
• Standard precautions: measures for reducing the risk of
transmitting pathogens
• Transmission-based precautions
– Clean uniforms
– Do not wear jewelry
– Remain home when ill; advise sick visitors
– Protect immunosuppressed clients from pathogens
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Question
The major cause of nosocomial infection in the hospital
setting is:
A) Excessive use of disposable equipment
B) Arrangement of the bed in a semiprivate room
C) Infrequent handwashing
D) Excessive use of oral antibiotics
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Answer
C) Infrequent handwashing
Rationale: Handwashing is the major infection control
measure to reduce the risk of transmission of MRSA and
other nosocomial pathogens.
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Prevention Infection: Needlestick Injuries
• Blood-borne infections
– Hepatitis B (HBV)
– AIDS
– Use of new needleless access devices
– Postexposure recommendations
• Report injury, document injury in writing, identify
source, receive appropriate postexposure
prophylaxis, antibodies testing
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Diagnostic Tests
• White blood cell count and differential
– WBC: elevation in the number and type
– Differential: percentage of WBC subtypes
• Culture and sensitivity test
– Culture: identifies bacteria
– Gram stain: positive; negative
– Coagulase test: positive; negative
– Sensitivity studies: determine which antibiotic will be
most effective in treating infection
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Diagnostic Tests—(cont.)
• Examination for ova and parasites
– Stool examination
– Client teaching: scrupulous handwashing
• Skin tests
– Determines active or inactive infection
– Diseases: histoplasmosis, mumps, TB, diphtheria
– Intradermal injection
• Immunologic tests: presence of antigens
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Medical Management
• Supportive therapy
– Rest, fluids, adequate nutrition, antipyretics
• Drug therapy: antimicrobials, antiviral
• Wound debridement: irrigations, hydrotherapy
• Immunosuppressed clients: bone marrow transplantation
or administration of drugs that boost WBC production;
Neupogen
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Nursing Management
• Focuses on preventing or controlling the transmission of
infection
– Maintaining the client’s skin integrity
– Administering drug therapy
– Monitoring vital signs—temperature, pulse rate
– Following aseptic principles
– Reviewing WBC levels and culture; report elevations
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Nursing Care Plan: Potential/Actual
Infection
• Nursing diagnosis: Risk for Infection
– Follow hand hygiene guidelines
– Monitor food intake; offer nutritious supplements
– Keep dressings dry, clean, and intact
• Nursing diagnosis: Sepsis
– Monitor vital signs; monitor for impaired circulation
– Observe the client’s mental status
– Administer antimicrobials as prescribed
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