Transcript Infectious Disease and Immune - Faculty Sites

Infectious
Disease and
Immune
By: Diana Blum MSN
Metropolitan Community College
NURS 2150
History
• http://www.youtube.com/watch?v=TteIB1oo4C0&f
eature=related
Immune System
• Protects the body against infection and cancer
development
• Stimulates tissue growth and repair after injury
• Inflammation causes damage
• Are able to fail to recognize self and launch a
defense against own cells= autoimmune response
• Those compromised include but are limited to:
cancer pts, HIV patients, etc.
Anatomy Parts
• Bone Marrow
• Granulocytes
o Neutrophils
o Basophils
o Eosinophils
• NonGranulocytes
o Monocytes
o Lymphocytes
• Lymph System
o Nodes
o Tonsils and adenoids
o spleen
Natural Immunity
• Body provides its own protection
• Includes
o Skin
o MM
o Gastric pH
Acquired Immunity
• After birth includes:
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Antibodies
Tcells
Bcells
cytokines
• Active
o Production of antibodies in response to foreign antigen.
o Get by getting disease or vaccine
o Involves lymphocytes
Hypersensitivity
• Aka: Allergy
o Responds to antigen that we have been exposed too; ex. Cat dander
o s/s: itchy, watery eyes, sneezing..to more life threatening like asthma,
anaphylaxis, bronchoconstriction, or circulatory collapse
• Example: allergic rhinitis
Contact can be: inhaled, ingested, injected, tactile
Life threatening like anaphylaxis involve blood vessel and bronchial smooth
muscle with systemic dilation, decreased cardiac output, and
bronchoconstriction
5 types
1: rapid IgE hypersensitivity: most common, increase in IgE, causes release of
histamine from basophils, eosinophils, and mast cells
anaphylaxis, asthma, etc
caused from hay fever, latex allergy,
peanuts, bees, etc.
2: cytotoxic: rx of IgG w/ host cell membrane; ex. Myasthenia gravis, blood
transfusions
3: immune complex: formation of immune complex in walls of blood vessels; ex
lupus, rheumatoid arthritis
4: delayed or cell mediated: rx of sensitized T cells w/ antigen and release of
lymphokines that induce inflammation; ex. Poison ivy, positive TB test, graft
rejection
5: stimulated: rx of auto antibodies with normal cell surface receptors that cause
an overreaction of the target cell; ex. Graves’ dx
Immunocompromised
Population
assessment
• Ask for onset, duration, and detailed history
• Ask about, work, school, hobbies, home, sports
• Ask about allergies of family members b/c some are
inherited
• Assess for rhinorrhea, itchy watery eyes, headache
especially over sinuses, dry scratchy throat
• Obtain CBC, Immunoglobin E level, scratch test,
perform a food challenge
interventions
• Avoidance of allergen
• Symptom relief
• Medications: antihistamines, mast cell stabilizers,
decongestants, corticosteroids, allergy shots
Anaphylaxis
Most life threatening
Affects many organs within seconds
Not that common
Teach avoidance of allergen
If food related instruct to ask if present in foods at
restaurants
• Epinephrine shots should be carried with them
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• s/s: impending doom, weakness, apprehension,
general itching, hives, angioedema (lips, eyes,
tongue), audible wheezes, anxiety, stridor,
respiratory failure may occur, may be hypotensive,
may have rapid irregular pulse, confusion may
occur
• Eventually could lose consciousness and cardiac
arrest
• Treatment
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Assess respiratory function first
This is an EMERGENCY, CALL 911
Establish airway if needed
CPR may be needed
Administer epinephrine 0.3 to 0.5ml of the 1:1000 concentration
Benadryl given IV 25-100mg
Oxygen as needed
Monitor sats
Latex Allergy
• May be contact type
• May be anaphylactic like
• Healthcare workers, clients with spina bifida, and
those that use latex condoms are most at risk
• Tx: use non latex items
Respiratory interventions
for immunity
Pneumonia
Excess fluid in lungs from inflammatory process
May be nosocomial in nature
If untreated it can go to blood and cause sepsis
s/s: atelectasis, hypoxemia, flushed cheeks,
myalgia, chills, fever, cough, tachycardia, dyspnea,
sputum production, pain, crackles
• Causes: bacteria, virus, fungi, protozoa, helminths,
etc. , toxic gases, smoke, aspiration
• Tx: sputum culture, cbc, HIV, abg’s, cxr,
bronchoscopy, biospy, antibiotics,
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TB
• Highly infectious
• Transmitted via airborne route when someone
infected laughs, coughs, sneezes, whistles, or sings.
• More are infected than have active version
• Caseation Necrotic tissue can be turned into a
granular mass in the center of the lesion..if found on
xray it is called ghon tubercle or prime lesion
• The lesions then calcify or liquefy
• Greatest risk: frequent contact, immune
suppressed, HIV, those that live in crowded areas,
homeless, drug users, low social class, foreign
immigrants
• Assess: country of origin, travels, previous hx,
anyone with BCG vaccine will test positive
• s/s: fatigue, lethargy, nausea, anorexia, wt loss,
irregular menses, fever, night sweats, cough, bloody
purulent sputum, chest tightness, local wheezing
• Diagnostics: culture, gram stain, TB tine, cxr
Once positive always positive
Place in negative pressure room.
Airborne precautions
Wear n95 mask when working with client
Teach prevention
Vitamin c, iron , and protein are important for those
infected
• Watch client swallow meds
• Tx: meds
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Sinusitis
• Inflamed mucous membranes
• Causes: deviated septum, polyps, tumors, cocaine,
facial trauma, nasal intubation, dental infection,
decreased immune response
• s/s: obstructive swelling, facial pressure, pain, fever,
headache, congestion, cough, tenderness,
drainage
• Complications: meningitis, abcesses, cellulitis
• Most common in frontal and maxillary sinuses
• Tx: broad spectrum antibx, analgesics, humidity,
saline irrigation, lavage, removal of infection by way
of surgery
Pharyngitis
• Sore throat
• Causes: group a strep or virus
• Highest incidence b/w late fall and spring in colder
climates
• s/s: dry sore throat, pain w/ swallowing, dysphagia, fever,
hypermia (redness), may or may not have enlarged
tonsils, drainage can be thin or thick and even purulent
• Tx: throat cultures, cbc, lozenges, antibiotics
• Instruct client to complete full course of antibx tx
• If it does not improve, the client should check on getting
HIV testing or the client could be immunosuppressed
HIV/AIDS
By: Diana Blum RN BSN
Metropolitan Community College
Nursing 2150
Immune System
• Helps prevent infection
• Failure is caused by 1 of 2 things
o Congenital abnormalities
• Present at birth
o Acquired after birth
• Infection, toxin, medical therapy
HIV/AIDs
HIV
Found
In 1981
Death is
Result of
Opportunistic
infection
Poor
prognosis
Class=
Retrovirus
Aids
Attacks
CD4/
T cell
• http://video.google.com/videoplay?docid=5219920342681496180&q=hiv+%22aids%22+educ
ational+duration%3Amedium+is%3Afree&pr=go
og-sl
3 categories
A
1. HIV positive
2. Asymptomatic
Or
3. Persistent Lymphadenopathy
4. Prone to Acute infections
B
1. Bacterial Endocarditis,
pneumonia or sepsis
2. Candidiasis for 1 or more
months
3. Severe cervical dysplasia or
carcinoma
4. Fever or diarrhea x 1month or
more
5.Oral hairy leukoplakia
6.Shingles (Herpes Zoster)
7.Idiopathic thrombocytopenic
purpura
8. Pelvic inflammatory disease
9.Peripheral neuropathy
C
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1. Pulmonary candidiasis
2. Invasive cervical cancer
3. Cytomegaly virus
4. HIV related encephalopathy
5.Herpes simplex
6.Kaposi’s Sarcoma
7. Lymphoma
8. Tuberculosis
9. Pneumocystis Carinii pneumonia
10. Toxoplasmosis
11. Wasting syndrome
12.Salmonella Septicemia
Pictures of cell with
HIV/AIDS
Causes
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Sexual: genital, anal, or oral
sex with exposure of the
mucous membranes to
infected semen or vaginal
secretions
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Parenteral: sharing of needles
or equipment contaminated
with infected blood or
receiving contaminated
blood products
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Perinatal: from the placenta.
from contact with maternal
blood and body fluids during
birth or from breast milk from
infected mother to the child
HIV and the Healthcare
Worker
• # 1 transmission between healthcare worker and
client is NEEDLE STICKS
• ALWAYS use standard precautions
• Page 1926
Staging
• Initial: lasts 4-8 weeks
o High levels in blood
o Flulike symptoms
• Latent: inactive until a virus presents than replication
begins
o Lasts 2-12 years
o Asymptomatic
• Third stage=opportunistic infections
o 2-3 years
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Flu like symptoms
Fever
Night sweats
Swollen lymph nodes
Headache
Skin lesions that don’t
heal
Sore throat
Dyspnea
Burning with urination
diarrhea
S/S
• Fatigue
• Weight loss
Complications
Opportunistic Infections
• These occur because Aids patients are immune
suppressed
• More than one can occur at the same time
• Can be
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Protozoan
Fungal
Bacterial
Viral
Protozoan
• Pneumocystitis carinii pneumonia
o DOE, tachypnea, persistent dry cough, fever, fatigue, wt loss
• Toxoplasmosis encephalitis
o Caused by toxoplasma gondii contact w/ cat feces or
undercooked meat
o Change in mental status, neurological deficits, HA, fever, diff
speaking, vision and gait problems, seizures, lethargy, confusion
• Cryptosporidiosis
o Intestinal infection caused by cryptosporidium organisms
o Mild diarrhea to severe wasting with electrolyte imbalances
Fungal
• Candida albicanspart of natural flora in GI
tract (Stomatitis or esophagitits is common in the AIDS pt.)
o Overgrowth in AIDS clients
• Cottage cheese like yellow/white plaques and
inflammation (mouth), pruritis, perineal irritation, thick
white vaginal discharge
• Frequent yeast infections is common in the female AIDS
pt.
• Cryptococcosis mengititis
o Fever, HA, blurred vision, N/V, nuchal rigidity,
confusion, seizures
• Histoplasmosisbegins as respiratory
infection then to systemic infection
o Dyspnea, fever, cough weight loss, enlarged
lymph nodes spleen and liver
Bacterial
• Recurrent Pneumonia
o CP, productive cough, fever, dyspnea
• Mycobacterium avium complex is most
common
o Affects respiratory and GI tract
o + cultures are found in blood, bone marrow, and
lymph nodes
o s/sfever, debility, wt loss, malaise, swollen lymph
glands and/or organs
• TB
o Fever, chills, night sweats, wt loss, anorexia, cough
dyspnea, CP,
Viral
• CMV (cytomegaly virus) can be in eyes, lungs, GI
tract, and CNS
o Fever, malaise, wt loss, fatigue, swollen lymph glands,
blindness, colitis, diarrhea, abd bloating, discomfort,
encephalitis, pneumonitis, adrenalitis, hepatitis, etc.
• Herpes Simplex Virusoccurs in perirectal, oral, and
genital areas
o Longer lasting
o Numbness/tingling at site of infection, lesions that are
painful, fever, bleeding, lymph node enlargement,
headache, myalgia, malaise
• Varicella Zoster (shingles)(chicken pox)
o HA, fever, pain, rash,fluid filled blisters sometimes
Malignancies
• Kaposi’s Sarcomamost common
o Related to herpes virus
o Small purplish brown raised lesion that are not usually
painful or itchy
o Lesions found in lymph nodes, intestinal tract, lungs
o Diagnosed by biopsy
o Assess #, size, and location of lesions and monitor
progression
• Lymphomas non Hodgkin’s B cell lymphoma,
immunoblastic lymphoma (Burkitt’s) and
primary brain lymphoma
o Weight loss, fever, night sweats
Endocrine Complications
• Gonadal dysfunction change in libido
• Body shape changes buffalo humps or abd fat,
other areas of body appear to be wasting away
• Adrenal insufficiency manifests as fatigue, wt loss,
N/V, hypotension, electrolyte imbalances
• DM
• Hypercholesterolemia
• Men with AIDS tend to have low testosterone levels
• Women with AIDS tend to have irregular menstrual
cycles
OTHER Complications
• Dementia may be from infection,
medication
o Neuropathies, pain, gait disturbance, confusion
• Wasting Syndrome not because of any
one problem, usually from metabolism issue
o Diarrhea, malabsorption, anorexia, oral and
esophageal lesions
• Skin changes dry, itchy skin with possible
rashes
o Low platelet level can mean petechiae or
bleeding gums may also be present
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TESTING
Positive ELIZA test
Positive Western Blot test
Lymphocyte Counts
CD4/CD8 Counts
Antibody tests
Viral Culture
Viral Loading Test
Quantitative RNA Assays
P24 Assay
• See pages 1934-1935
Treatment
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No cure
Treat symptoms
Prevent infections
Encourage to eat balanced diet
Exercise regularly
Maintain good dental hygiene
Smoking/illegal drug cessation
Limit alcohol
Minimize stress
Practice safe sex
Nursing Care
• Early stages- usually treated outpatient
• Late stages- more intensive in nature
• Infection is the leading cause of death in those with
HIV
• Education!
• Education!
• Education!
• This is the key!!!
• The higher the blood level of HIV (Viremia) the
greater risk of transmission!!!
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Client education
Use latex condoms
Store condoms in a cool dry place
DON’T use condoms from a damaged package
Handle condoms with care so as to not puncture
them
Teach clients how to properly apply condoms and
to use adequate water based lubricant
Replace a broken condom immediately
Follow recommended drug regimens
Encourage ways to maintain immune function
o Diet
• Avoid raw or rare fish fowl or meat
• Thoroughly was fruit and veggies
o Adequate rest
o Exercise
o Stress reduction
Nursing Diagnosis
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Ineffective therapeutic regimen
Anxiety
Infection
Impaired oral mucosa
Imbalanced nutrition less than body requirements
Disturbed thought process
pain
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Interventions
Provide education
Offer support group
Encourage questions
Encourage them to express self
Anti infectives
Medication education
Encourage regular dental hygiene
Have dietician see
Appetite stimulants
Saftey precautions
Monitor pain
• Your client is a 32 year old white male who is
new to the outpatient clinic. He presents with
fatigue, abd pain, low grade fever, nausea,
and anorexia. Upon assessment you notice
yellowing eyes and darkening urine. He states,
“I try to eat right, take vitamins, and get rest.”
he feels like he is getting worse. He was in a
monogamous gay relationship for 6 yrs that
recently broke up. He had unprotected sex 2
weeks ago. His last HIV test was 1 year ago and
it was negative.
• He asks if his current symptoms are related to his
recent sexual encounter. How do you respond?
• Wound you counsel this man to have an HIV test?
Why or why not?
• Should you teach the client about safe sex
practices? Why or why not?
• You are the charge nurse on a busy med surg
unit at the hospital. Right before change of
shift, one of the new hires tell you that she was
giving her 78/f client insulin and accidentally
stuck herself when placing the needle in the
sharps container…in talking with other nurses
she doubts that this is a high risk needle stick
and thinks she will be fine. She washes off the
blood throroughly and applies betadine to her
finger. She wants to fill out the incident report
and go home.
• How will you consel this nurse about needle stick
injuries?
• What rights and obligations does she have?
• What other blood borne diseases could she have
been exposed to?
• Should the nurse notify her sexual partner(s) of this
incident? Why or why not?
Sjogren’s Dx
• s/s: dry eyes, dry mm of nose and mouth, vaginal
dryness, blurred vision, diff swallowing, epistaxis,
enlarged lymph nodes, may have swollen painful
joints,
• Fibromyalagia can also occur with this
• Insufficient tears cause corneal inflammation and
ulcerations
• Decrease in digestion of carbs, promotes tooth
decay
• Tx: no cure, chemo like drugs, immunosuppressives,
tx symptoms
MENIN
GITIS
• INFLAMMATION OF ARACHNOID AND PIA
MATER OF THE BRAIN, CSF, AND SPINAL CORD
• Can be bacterial or viral, fungal, or protozoal
o Bacterial and viral are the more common types
o Viral is self limiting (not life threatening)
• Organism enters via bloodstream
Viral
 Most common
 May occur with herpes simplex or zoster
 No organisms present in CSF
 Tx: treat symptoms, acyclovir if genital
lesions
 S/S:
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Fever
Photophobia
Headache
Myalgias
Nausea
Poss. Genital lesions
Rash
Fungal
• Cryptococcus is most common fugus
o Especially in AIDS patients
• S/S: vary but can include fungal sinusitis, fever,
headache, nausea, vomiting, decrease LOC
• Tx: treat symptoms, IV antifungal agents
Bacterial
Medical emergency
Mortality rate of 25%
Most in fall/winter
Culprits: streptococcus pneumoniae and neisseria
meningitidis
• Approx. 17,500 new cases each year in the USA
• Meningococcal meningitis is the only bacterial type
that has outbreaks
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Bacterial
• S/S
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Headache
N/V
Fever
Photphobia
Increased ICP that causes hydrocephalus
Nuchal rigidity (neck stiffness)
Seizure
Decreased LOC
Poss. gangrene
bacterial
• Diagnostics
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Lumbar puncture w/ broad spectrum antibx prior
Counterimmunoelectrophoresis- looks for virus/protozoa
C&S of blood,urine, throat, and nose
CBC
BMP
Chest, sinus,mastoid xrays
MRI and/or CT to look for increased ICP
 Treatment
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Bacterial
Neuro checks q 4 hours
Isolation
Broad spectrum antibx til cultures back
Possible to be on steroids
Monitor for complications
 Septic emboli
 Temp, color, pulse,cap refill
 Hand circulation is the most affected
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Shock
Coag disorders
Bacterial endocarditis
Prolonged fever
Encephalitis
• Inflammation of the brain parenchyma and
meninges
• Affects brainstem, cerebrum, and cerebellum
• Virus invades brain tissue and reproduces causing
and inflammatory process
• Demyelination of axons occur
• Widespread edema leads to increased ICP
types
• Arboviruses: example west nile
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Transmitted by infected tick or mosquito
Usually asymptomatic otherwise flu like symptoms
Has IGM antibody affected
Incubation 3-12 days after bite
Transmitted thru breast milk , blood, organ trasplant
• enterovirus: examples:chickenpox, herpes zoster,
mumps are most common causes.
• Amebae: virus found in warm fresh water
o Enters nasal mucosa when swimming
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Assessment/interventions
Fever
n/v
Stiff neck
Changes in LOC
Fatigue
Motor dysfunction
Increased ICP
Weakness
Hemiplegia
Seizure activity
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Monitor vitals
TCDB q2 hrs
Suction as ordered
Neuro check q 2 hrs
Meds
Brain Abcess
Pus like Infection of the brain
Organisms come from ear, sinus, mastoid
Can occur with septic emboli
Can be from penetrating trauma
Usually occurs deep within the cerebral hemisphere
and involves white matter
• Most occur in frontal and temporal lobes
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Assessments/diagnostics
• s/s: headache, fever, lethargy, confusion, increased
ICP, decreased LOC, airway and respirations may
be affected
• Assess neuro function
• Assess visual fields for blindness
• Assess gait
• CBC, CT, EEG, MRI, lumbar puncture
Treatments
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Antibiotics
Antiepileptics
Burr hole surgery to relieve pressure and drain
Crainiotomy
Lyme Disease
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Reportable infection
85% seen in new England, mid Atlantic, and upper Midwest, and
northern California
Caused by spirochete borrelia burgdorfori
From bite of deer tick
s/s:stage 1
o bulls eye rash is tell tale sign
o Malaise, fever, headache, muscle, joint ache/stiffness
Stage 2: 2-12 weeks after tick bite
o Carditis, dysrythmias, dizzy, palpitations, meningitis, facial
paralysis
Stage 3: weeks to yrs after bite
o Arthritis, permanent damage to joints
Tx: antibx
Rocky Mountain Spotted
Fever
• a tickborne disease caused by the bacterium Rickettsia
rickettsii.
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is a cause of potentially fatal human illness in North and South America, and is
transmitted to humans by the bite of infected tick species.
In the United States, these include the American dog tick (Dermacentor variabilis),
Rocky Mountain wood tick (Dermacentor andersoni), and brown dog tick
(Rhipicephalus sanguineus).
• Symptoms: fever, headache, abdominal pain, vomiting, and
muscle pain. A rash may also develop, but is often absent in
the first few days, and in some patients, never develops.
• can be a severe or even fatal illness if not treated in the first
few days of symptoms.
• Tx: Doxycycline is the first line treatment for adults and children
of all ages, and is most effective if started before the fifth day
of symptoms
• Info from cdc
Conjunctivitis
• Inflammation of the conjuctiva
• Related to allergen exposure
• Is not contagious unless from virus or bacteria
o Pink eye: blood shot eyes, edema, tears, discharge
• Get cultures
• s/s: burning, engorged blood vessels, excessive
tears, itching
• Tx:
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Corticosteroids gtts
Prevent spread if infectious
Anti infectives if needed
Handwashing
• 3 types
Otitis Media
o Acute: r/t infection, sudden onset
o Chronic: r/t infection, reoccuring
o serous
• s/s: inflammation, swelling, irritation, possible
purulent drainage, may cause permanent hearing
loss if left untreated, ear pain, headaches, vertigo,
may lead to perforated ear drum
• Tx: cultures, needle aspiration, cold therapy, heat
therapy, antibiotics, analgesics, antihistamines,
decongestants, surgery to
place tubes
Mastoiditis
• Infection of the mastoid air cells caused by otitis media
• May be acute or chronic
• s/s: swelling behind the ear, pain, cellulitis, poss
perforated ear drum that is also red, and thick, tender
enlarged lymph nodes behind the ear, fever, malaise,
drainage, anorexia
• Tx: IV antibx, cultures, surgical removal of infected tissure
• Complications from surgery: damage to cranial nerves,
decreased ability to look lateral, drooping mouth on
affected side, vertigo, meningitis, brain abcess, wound
infection
Labyrinthitis
• Infection of the labyrinth which could be a result of
otitis media.
• Infection is from erosion of bony capsule
• May follow inner or middle ear surgery
• May be viral in nature or related to mono
• s/s: hearing loss, tinnitis, vertigo, nystagmus to
affected side, n/v
• Meningitis is common complication
• Tx: systemic antibx, antiemetics, stay in bed in dark
room until manifestations subside, gait training, PT
• Hearing loss may be permanent..provide support,
Meniere’s Disease
• Tinnitus, one sided hearing loss, and vertigo
• Attacks last several days
• Unknown cause except that too much or too little
endolymphatic fluid is produced
• Eventually hearing loss is permanant
• Often occurs with infections, allergic reactions, and
fluid imbalance
Cancer
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Neutropenic precautions
Thrombocytopenic precautions
Bleeding precautions
Protect from infections
Skin Infection
Management
• Contact---gown and gloves
• Parasite---gown, gloves, cap, shoe covers, isolation,
hygiene, insecticide ointments, special shampoos,
beding and clothes washed daily on hot water,
dried in hot dryer
• Fungal— antifungals, culture, cool compress, skin off
skin,
• Viral--- antiviral agents,treat symptoms, cryotherapy
if warts, or duct tape for 2 months if wart
• Bacterial—antibiotics, potential debridement and
drainage, cultures and senstivities, no sharing towels
etc. Pain meds, rest contact precautions
Any Questions?