Transcript Chapt70
Chapter 70 Management of Patients With Infectious Diseases Copyright © 2008 Lippincott Williams & Wilkins. Chain of Infection Copyright © 2008 Lippincott Williams & Wilkins. Colonization, Infection, and Disease • Colonization: describes microorganisms present without host inference or interaction • Infection: indicates host interaction with the organism • Disease: the infected host displays a decline in wellness due to the infection Copyright © 2008 Lippincott Williams & Wilkins. Biologic spectrum of Response to Bacterial Infection at the Cellular Level and of the Intact Host Copyright © 2008 Lippincott Williams & Wilkins. 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 assessment of the patient Copyright © 2008 Lippincott Williams & Wilkins. Information Resources • World Health Organization (WHO) • Center for Disease Control and Prevention (CDC) – CDC publications, guidelines, and internet site: see Table 70-1 • Occupational Safety and Health Administration (OSHA) – Mandatory regulations and guidelines • Local agencies • Hospital/facility infection control specialists and facility policies Copyright © 2008 Lippincott Williams & Wilkins. Isolation Precautions • Guidelines to prevent the transmission of microorganisms in hospitals • Standard precautions used for all patients • The primary strategy for preventing HAIs • Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact routes Copyright © 2008 Lippincott Williams & Wilkins. Elements of Standard Precautions • Hand hygiene • Use of gloves and other barriers • Proper handling of patient care equipment and linen • Environmental control • Prevention of injury from sharps and needles • Patient placement Copyright © 2008 Lippincott Williams & Wilkins. Transmission-Based Precautions • Airborne precautions – Hospitalized patient should be in negative pressure room with the door closed; health care providers should wear an N-95 respirator (mask) at all times when in the room • Droplet precautions – Wear a face mask but door may remain open; transmission is limited to close contact • 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 Copyright © 2008 Lippincott Williams & Wilkins. 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 Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process—Diagnosis of the Patient With Sexually Transmitted Disease (STD) • Deficient knowledge • Anxiety • Noncompliance with treatment Copyright © 2008 Lippincott Williams & Wilkins. Collaborative Problems/Potential Complications • Increased risk for ectopic pregnancy • Infertility • Transmission of infection • Neurosyphilis • Gonococcal meningitis • Gonococcal arthritis • HIV-related complications Copyright © 2008 Lippincott Williams & Wilkins. 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 Copyright © 2008 Lippincott Williams & Wilkins. 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 Copyright © 2008 Lippincott Williams & Wilkins. Home-Based Care Measures to Reduce the Risk of Infection • Health care workers should follow standard precautions in the home setting • Patient and family teaching: see Chart 70-4 – Establish an environment that facilitates hand hygiene and aseptic technique – Family caregivers should receive annual influenza vaccine – Equipment care – Implement “Common sense cleanliness” – Exercise food preparation and personal hygiene – Establish reasonable barriers to protect family members Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process—Assessment of the Patient With an Infectious Disease • Health history: investigate the likelihood and probable source of infection, associated pathology, and symptoms • See questions listed in text • Administer a physical exam Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process—Diagnosis of the Patient With an Infectious Disease • Risk for infection transmission • Deficient knowledge • Risk for ineffective thermoregulation Copyright © 2008 Lippincott Williams & Wilkins. Collaborative Problems/Potential Complications • Septicemia, bacteremia, or sepsis • Septic shock • Dehydration • Abscess formation • Endocarditis • Infectious disease-related cancers • Infertility • Congenital abnormalities Copyright © 2008 Lippincott Williams & Wilkins. Nursing Process—Planning the Care of the Patient With an Infectious Disease • Major goals include prevention of the spread of infection, increased knowledge about the infection and its treatment, control of fever and related discomforts, and absence of complications Copyright © 2008 Lippincott Williams & Wilkins. Interventions • Prevent the spread of infection – Perform handwashing – Exercise Standard Precautions – Recognize mode of transmission and establish Transmission-Based Precautions as indicated • Teach about infectious process and the prevention of the spread of infections • Assess and treat fever Copyright © 2008 Lippincott Williams & Wilkins.