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Management of
Patients With Infectious
Diseases
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Chain of Infection
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Causes of Infection
• Bacteria (eg, streptococci)
• Viruses (eg, hepatitis B)
– Not cells
– Contain RNA or DNA, can only reproduce inside
a living cell
• Fungi (eg, Candida)
– Organisms similar to plants
• Protozoa (eg, Giardia)
– Single celled, animal-like organisms
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Colonization, Infection, and
Disease
• Colonization: describes microorganisms present
without host inference or interaction (eg, S. aureus
lives on skin - “colonized”)
• Infection: indicates host interaction with the
organism (eg, bacteria enters wound, causes local
inflammation)
• Disease: the infected host displays a decline in
wellness due to the infection (eg, 10 of people
infected with TB have clinically significant disease)
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Biologic spectrum of Response to
Bacterial Infection at the Cellular
Level and of the Intact Host
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Interpreting the Microbiology
Report
• A tool to determine colonization, infection, or
disease
• The organism reported may reflect colonization
rather than infection
• Mix of cells in smear and stain report may
indicate cellular response
• Culture and sensitivity specify the organism and
which antibiotic will inhibit growth
• Analyze results in conjunction with the clinical
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assessment of the patient
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Information Resources
• World Health Organization (WHO)
• Center for Disease Control and Prevention (CDC)
– CDC publications, guidelines, and internet site
• Occupational Safety and Health Administration
(OSHA)
– Mandatory regulations and guidelines for the workplace
• Local agencies, such as county facilities
• Hospital/facility infection control specialists and
facility policies
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Infection Precautions
• Guidelines to prevent the transmission of
microorganisms in hospitals
• Standard precautions used for all patients
– The primary strategy for preventing hospital-acquired
infections (nosocomial infections)
– Applies to blood, all body fluids, nonintact skin, and
mucous membranes
• Transmission-based precautions are for patients with
known or suspected infectious diseases spread by
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airborne, droplet, or contact routes
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Elements of Infection Precautions
(see table 15-9)
• Hand hygiene
• Use of gloves and other barriers
• Mask, eye protection, face shield
• Gown
• Proper handling of patient care equipment and
linen
• Environmental control
• Prevention of injury from sharps and needles
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Transmission-Based Precautions
• Airborne precautions
– Hospitalized patient should be in negative pressure
room with the door closed; health care providers may
need to wear an N-95 respirator (mask) when in the
room (eg, Varicella and TB)
• Droplet precautions
– Wear a face mask but door may remain open;
transmission is limited to close contact (eg, pertussis,
influenza)
• Contact precautions
– Use of barriers to prevent transmission; emphasize
cautious technique as organism is easily transmitted by
contact between the health care worker and the patient
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(eg, C. diff, VRE, impetigo)
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Specific organisms with HealthCare Associated Potential
• Clostridium difficile
– Usually results as a superinfection in patients on
antibiotic therapy; kills off “good bacteria” in the gut and
result in overgrowth and infection with C. difficile
– Manifests as diarrhea, possible colitis and sepsis
• Methicillin-resistant Staphylococcus aureus
(MRSA)
• Vancomycin-resistant Enterococcus (VRE)
– MRSA and VRE are drug-resistant bacteria common in
healthcare facilities; also emerging in community
settings
– Often transmitted to patients via healthcare workers
• See table 15-7 for patient teaching
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Health-Care Associated
(Nosocomial) Bloodstream
Infections
• High morbidity and mortality
• Most often due to vascular access device
– Bacteremia
– Fungemia (less common, poor prognosis)
• Prevention
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Hand hygiene
Strict sterile technique during insertion
Strict sterile technique during dressing change
Skin disinfection
Infusion set and stopcocks changed per hospital policy
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Emerging Infections
• A disease whose incidence has increased in
the past 20 years or threatens to increase in
the immediate future
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Severe Acute Respiratory Syndrome (SARS)
West Nile Virus
Lyme disease
HIV
Hepatitis C
H1N1 influenza
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Reemerging Infections
• Vaccines and proper medications have
led to near eradication of some
infections, which have the potential to
reemerge under the right condition
– Tuberculosis
– Pertussis (whooping cough)
– Dengue fevver
– Giardiasis
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Vaccinations (see handouts)
• Goal is to use wide-scale efforts to prevent specific
infectious diseases from occurring in the population
• Common vaccines
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Measles, mumps, rubella
Varicella
Influenza
Tetanus, diptheria
Pneumococcal
Meningococcal
Hepatitis B
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Vaccinations
• Contraindications of vaccines
– Anaphylaxis from previous dose
– Live vaccines are contraindicated for patients with
severe immunosuppression (eg, HIV, leukemia,
immunosuppresant medications)
– MMR contraindicated in pregnant women
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Sexually Transmitted
Diseases
• Acquired through sexual contact with an
infected person
– Portals include skin and mucosal linings of the
urethra, cervix, vagina, rectum and oropharynx
• 19 million Americans become infected
annually
• Risk reduction
– Use of latex condoms
– Minimize number of sexual partners
– Screening high risk individuals
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Sexually Transmitted Diseases
• Syphilis ( caused by Treponema pallidum, a
spirochete)
– Primary syphilis (3-8 weeks)
• Chancre at site of entry
– Secondary syphilis (1-2 years)
• Rash, flu-like symptoms, condylomata lata,
adenopathy
– Latency period (3 - 20 years; may be permanent)
• Absent signs and symptoms
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Sexually Transmitted
Diseases
– Tertiary syphilis (chronic, may be fatal)
• Gumma, cardiac (aortic aneurysms, aortitis),
neurosyhpillis (psychosis, stroke, paresis)
• Diagnosis
• RPR or VDRL; other treponemal tests
– Treatment
• Penicillin G; doxycycline if allergic
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Primary Syphillis - Chancre
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Sexually Transmitted Diseases
• Chlamydia trachomatis and Neisseria gonorrhoeae
– Common bacterial STDs
• Clinical manifestations
– Women often asymptomatic; may have purulent discharge, or
symptoms of UTI
– Men may also be asymptomatic; may have burning with
urination and penile discharge, painful testicles, epididymitis
• Complications
– Women - pelvic inflammatory disease (PID), endometriosis,
infertility
– Men-epididymitis
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– Both - arthritis
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Sexually Transmitted Diseases
• Chlamydia trachomatis and Neisseria gonorrhoeae
• Diagnosis
– Gram stain and culture of genital secretions; anal or
oropharynx secretions if indicated
– CDC recommends routine screening of all pregnant women
and women < 26 years
• Treatment
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Due to frequent coinfection, treatment should cover both!
Chlamydia: azithromycin or doxycycline preferred
Gonorrhea: ceftriaxone, cefixime ciprofloxacin, ofloxacin
All sexual partners must be treated
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Sexually Transmitted Diseases
• Herpes simplex virus
– Type I (“on the face”)
• May cause cold sores
– Type II (“below the waist”)
• May cause genital ulceration
• Many asymptomatic
– *Either virus can cause disease on the mouth or genitals*
– Lifelong carrier; primary episode and recurrent episodes
• Treatment may reduce viral activity
– Acyclovir, valcyclovir, famciclovir
– Barrier protection to prevent transmission
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Genital Herpes
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Nursing Process—Assessment of
the Patient With Sexually
Transmitted Disease (STD)
• Protecting confidentiality and privacy is an important
component in the assessment of a patient with STDs
• Communication needs to be culturally and emotionally
sensitive and clarification of terms may be necessary
• Presenting symptoms
• Specific information regarding sexual contacts
• Patient knowledge
• Physical examination: include rashes, lesions, drainage,
inguinal nodes, genitalia, rectum, mouth and throat;
women need abdominal and uterine exams
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Nursing Process—Diagnosis of
the
Patient With Sexually
Transmitted Disease (STD)
• Deficient knowledge
• Anxiety
• Noncompliance with
treatment
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Collaborative Problems/Potential
Complications
• Increased risk for ectopic
pregnancy
• Infertility
• Transmission of infection
• Neurosyphilis
• Gonococcal meningitis
• Gonococcal arthritis
• HIV-related complications
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Nursing Process—Planning the
Care of the Patient With Sexually
Transmitted Disease (STD)
• Major goals include increased patient
understanding of the natural history and
treatment of the infection, reduction in
anxiety, increased compliance with
therapeutic and preventive goals, and
absence of complications
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Interventions
• Education about STDs and the spread of
infection
• Reduce anxiety
– Encourage patient to discuss anxieties and fears
– Provide factual information and individualized teaching
– Assist in planning discussion with partners
– Provide referral to social worker or other specialist
• Increase compliance
– Provide patient teaching in group or individual settings
– Provide referral to appropriate agencies
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