Transcript Infectious Disease Boogies

Adult Health Nursing II
Block 7.0
Topic: Infectious Disease & HIV
Module: 3.1
Infectious Disease & HIV
Selected Topics:
--Chain of Infection & Epidemiological
Triangle
--Methods of Infection control
--Types of Infection; viral, bacterial,
parasitic, and drug resistant
--HIV – Human Immunodeficiency Virus
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Module 3.1
Infectious Disease
Learning Outcomes:
--Describe the principles of infection control in inpatient and
community based settings.
--Differentiate between the four types of transmission precautions
--Identify the different types of infections; viral, bacterial,
parasitic, and fungal.
--Identify drug resistance and laboratory monitoring of cultures.
--Assess the common clinical and manifestations of various
infections.
--Interpret lab test findings in different types of infections.
--Prioritize and evaluate nursing interventions for the
management of the client with an infection.
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Module 3.1
Infectious Disease
•
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Outcomes (continued)
--Interpret lab tests for a patient with HIV.
--Identify appropriate nursing and medical interventions for
patients with HIV.
--Compare the different classes of HIV drugs with side effects and
method of action
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Module 3.1
Infectious Disease
• Chain of Infection
Agent
Host
Environment
The Epidemiological Triangle
• Pathogen
• Reservoir
(i.e. fake fingernails)
• Portal of exit
(from the reservoir)
• Mode of transmission
• Portal of entry
• Susceptible host
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Infectious Disease
• Methods of Infection Control –
depends on the pathogen’s mode of
transmission and it’s virulence
• Inpatient Infection Control:
Standard precautions
Airborne precautions
Droplet precautions
Blood and secretion precautions
Contact precautions Block 7.0 Module 3.1
Infectious Disease
WHO global response video
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Infectious Disease
• Methods of Infection Control
• Community based infection control
#1 Handwashing
Universal precautions during procedures
i.e. gloves, splash goggles, masks,etc
Isolation
Disinfection
Sterilization of areas and equipment
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Infectious Disease
• Important Subjects: (MEMORIZE ALL THE
LIST-will help on the NCLEX)
• Standard Precaution is needed for all patients.
• Airborne Precautions
• Diseases:
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Measles,
Chickenpox
Disseminated Varicella zoster
TB
• Protection:
• Single room under negative pressure and keep door closed
• Mask or personal respiratory protection device
• Need mask when client leaves the room.
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Infectious Disease
• Droplet Precautions:
• Diseases:
• Swine Flu
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Adenovirus
Pharyngeal Diphtheria
Epiglottitis
Influenza
Meningitis
Mumps
Mycoplasmal pneumonia
Meningococcal pneumonia
Parovirus B19
Pertussis
Rubella
Scarlet fever
Sepsis
Streptococcal pharyngitis
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Infectious Disease
• Droplet precautions
• Protection:
• Private room or cohort with similar organisms.
• Mask
• Mask placed on client leaves the room
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Infectious Disease
• Contact Precautions:
• Organisms:
• Clostridium Difficile
• Respiratory syncytial virus
• Staphylococcus
• Varicella zoster
• Wound infections
• Cutaneous Diphtheria
• Herpes simplex
• Impetigo
• Pediculosis
• Scabies
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Infectious Disease
• Contact Precautions:
• Protection:
• Private room or cohort
• Gloves and gown
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Infectious Disease
• Types of
Infections:
• Viral
• Bacterial
• Parasitic
• Fungal
• Drug resistant
worms or rod bacterium?
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Infectious Disease
• Viral infections – have the ability to
transfer DNA or RNA by enzymes to
another cell or host cell, cannot
replicate by itself, has a protein coat
• Influenza
• Measles
Rubella and Rubeola
• Mumps
• Polio
• Flavoviruses
• Hepatitis – all types
• HIV
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Infectious Disease
•Viral infections
• Epstein – Barr virus – mononucleosis
• Ebola
• HIV
• Avian Flu
• Herpes
• West Nile virus
• Papillovirus
• Hanta virus
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Infectious Disease
•Viral infections
• CMV – cytomegalovirus
• RSV
• Poliovirus
• Coxsackie family
• Rabies
• Type A and B influenzas
• Rhinoviruses – the common cold
• Rotavirus & Enteroviruses
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Infectious Disease
• Bacterial Infections – can be aerobic
or anaerobic asexual prokaryotes with a
single DNA strand, can replicate by itself as
long as it has nutrients available.
• Genus includes: (Note: Iggy has
mycoplasmas and Rickettsiae as separate
classes, but are in the same family)
• Bacterium/Spirochetes
• Mycobacterium
• Mycoplasmas
• Rickettsiae
• Chlamydiae
• Ehrlichieae
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Infectious Disease
•Bacterial Infections
• Most common in children are:
• Streptococcus
• Maxarella
• Staphylococcus
There are more bacterial species than
any other life form on the planet.
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Infectious Disease
4 bacterial colonies
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Infectious Disease
anthrax
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Infectious Disease
Heliobacter pylori
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Infectious Disease
Radiation resistant colonies
nicknamed the “Conan” bacteria
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Infectious Disease
•Parasitic Disease – live off the host
and require a host to replicate, are
animals themselves
• Protozoans – often water-borne
• Helminths – worms, includes
nematodes, trematodes, and
flukes – they lay eggs
• Arthropods
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Infectious Disease
• Parasitic Diseases
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Tape worms
Pin worms
Roundworms
Entamoeba histolytica
Malaria
Toxoplasma gondii
Trichomonas
Leishmaniasis
Treatments- anti-microbials:
Flagyl, Vermox,
albendazole, amphotericin- B, pentamidine
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Infectious Disease
•Fungal diseases
Racquet hyphae
on slide
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Infectious Disease
•Fungi – self-replicating eukaryotes,
includes the class of yeasts and molds
• Candida albicans
• Aspergillus
• Coccidiomycoses
• Cryptococcus neoformans
• Histoplasmosis
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Infectious Disease
• Nosocomial – from the Greek word
“nosocomia” which means “Nurse”.
• This term was coined by Hippocrates –
the Father of Medicine, who
determined that nurses were
responsible for nosocomial infections.
• Nosocomial infections are infections
that are acquired by a patient who is
undergoing medical treatment, and
who did not present with that
particular organism originally but
acquired it while receiving care.
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Infectious Disease
• Drug Resistant Organisms – these
organisms are becoming more prevalent
with the over-use of antibiotics. They have
cellular memory and enzymes which
make certain antibiotics ineffective, i.e.
penicillinase.
• Examples:
• Streptococci
• Methicillin Resistant Staph. Aureus (MRSA)
• Vancomycin Resistant Enteroccocci (VRE)
• E. coli
• PseudomonasBlock 7.0 Module 3.1
MRSA – resistant to all drugs
except Vancomycin & Linezolid
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Infectious Disease
• Laboratory testing for Viruses:
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Enzyme immunoassay = EIA
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ELISA test
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Titers - measures past exposure and present level of exposure
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Direct fluorescent antibody technique
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IgM and IgG antibody levels
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Viral loads
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Viral RNA or DNA count
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Viral cultures – on urine, blood, sputum, secretions, stool, tissue, or semen
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Viral serology
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PAP – High risk HPV profile
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Monotest
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Infectious Disease
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Infectious Disease
• Laboratory testing for Bacterium
• Cultures & Sensitivity – blood cultures
have to be taken from three different
sites. Otherwise secretions, pus,
sputum, urine, or skin may be used.
• Acid Fast Bacilli culture and smear
• Gram stain
• CBC with diff
• Macroscopic and microscopic
evaluation
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Infectious Disease
Unknown bacterium
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Infectious Disease
• Laboratory testing for Bacterium
• Cultures and sensitivities
• MIC = minimal inhibitory concentration
• MIC is the minimal level of a certain drug or antibiotic that it
takes to kill a specific species of bacteria. The lower the MIC
number, the faster the bacteria are killed by that drug.
• Treatment – specific antibiotics
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Infectious Disease
• Lab testing for Bacterium
• Cultures and Sensitivities Example
• MR FEBRE was treated for a sore throat for two weeks
with Z-packs and did not get better. The culture and
sensitivity of an oropharyngeal swab done
December 30, 2010, results read on January 2, 2011
= Beta streptococcus at 3,000 colonies/mm3.
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Drug tested
Penicillin
Erythromycin
Azithromycin
Cefuroxime
Vancomycin
Amoxicillin
Amoxicillin clavunate (Augmentin)
Presence of + penicillinase noted
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MIC
1000
280
87
5
0.05
490
400
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ug/ml
ug/ml
ug/ml
ug/ml
ug/ml
ug/ml
ug/ml
Infectious Disease
Pseudomonas
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Infectious Disease
• Lab testing for Fungi
• Microscopic exam with KOH
• Gram stain
• Fungal culture
• Skin scrapings
• Treatments
• PO or IV Diflucan, miconozole,
tetraconazole
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Infectious Diseases - HIV
• Vital Statistics for Human Immune Deficiency
Virus
• Worldwide:
• Over 22 million people have died from AIDS.
• Over 42 million people are living with HIV/AIDS, and 74 percent of
these infected people live in sub-Saharan Africa.
• Over 19 million women are living with HIV/AIDS.
• By the year 2010, five countries (Ethiopia, Nigeria, China, India,
and Russia) with 40 percent of the world's population added 50 to
75 million infected people to the worldwide pool of HIV disease.
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Infectious Disease - HIV
• Vital Statistics for Human Immune
Deficiency Virus
• United States:
• An estimated one million people are currently living with HIV in
the United States, with approximately 40,000 new infections
occurring each year.
• 70 percent of these new infections occur in men and 30
percent occur in women.
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Infectious Disease - HIV
• By race, 54 percent of the new infections in the United
States occur among African Americans, and 64
percent of the new infections in women occur in
African American women.
• 75 percent of the new infections in women are
heterosexually transmitted.
• Half of all new infections in the United States occur in
people 25 years of age
or younger
Source: http://www.until.org
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Infectious Disease
• HIV Pathophysiology
• HIV is transmitted as a viral particle in semen, blood, and other
bodily fluids in small amounts. This particle must find a way
into the host’s bloodstream.
• The HIV virus has a specific target in the blood, and it attacks
the CD4 - T- Cells. The T-cells are the primary defense against
all pathogens. Like a general in the army, the T-cell either calls
in the bodies defenses i.e. B-Cells and macrophages, or acts
as the Killer cells themselves.
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The virus uses an enzyme called Protease to attack the Cell
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Infectious Disease - HIV
• HIV Pathophysiology (continued)
• The infected T-cell takes the protease and breaks
into the cell’s RNA, changing the function of the cell
so that it only produces more HIV virus.
• Then it releases the virus back into the bloodstream.
• In the end, the viral load goes up and the functional
T-Cells and CD-4 count goes down.
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Infectious Disease – HIV
A picture of the retrovirus
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HIV
History
– 1950s: Blood samples from Africa have
HIV antibodies.
– 1976: First known AIDS patient died.
– 1980: First human retrovirus isolated
(HTLV-1).
– 1981: First reports of “Acquired Immunodeficiency Syndrome” in Los Angeles.
– 1983: Virus first isolated in France (LAV).
– 1984: Virus isolated in the U.S. (called
HTLV-III and AIDS-Related Virus, ARV).
– 1985: Development and implementation
of antibody test to screen blood donors.
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HIV
History (Continued)
– 1986: Consensus name Human
Immunodeficiency Virus (HIV-1).
Related virus (HIV-2) identified.
– 1992: AIDS becomes the leading cause of
death among adults ages 25-44 in the U.S.
– 1997: Mortality rates of AIDS starts to
decline due to the introduction of new
drug cocktails.
– 2001: World Health Organization predicts
up to 40 million infected individuals. More
than 22 million have already died.
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Infectious Disease
• HIV– course of infection
• Risks for HIV:
• Unprotected sex – with heterosexual or homosexual encounters
• IV drug usage –
• Needle sticks with unprotected needles
• Exposure to blood – health care workers and Laboratory workers
• Transfusion with non-screened blood products
• Use of contaminated needles or surgical equipment
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Infectious Disease
• HIV– course of infection
•
Risks for HIV: (continued)
• Mother to Infant (Perinatal): 25% of children
become infected in utero, during delivery, or by
breast-feeding (with AZT only 3%).
• AZT should be started in the first trimester to prevent
sero-conversion in the infant.
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Infectious Disease
• HIV – Course of Infection
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Infectious Disease - HIV
• HIV – Course of Infection
• Infection - the virus enters the body – initial symptoms are a cold,
flu like syndrome, body aches, etc…which pass within a few days.
The ELISA test is negative at this time.
• Incubation – 3 months to one year, where the virus enters other
cells, but no symptoms are present. This is when sero-conversion
occurs.
• Reproduction – For a period of 2 to 6 years, the virus replicates
and replaces functional T-cells, reducing the immunity of the
patient. The time for symptoms to occur can go from months to
years. The patient is still infectious through these 3 phases.
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Infectious Disease
• HIV versus AIDS – Autoimmune Deficiency
Syndrome
• All clients who have HIV are HIV positive, but
not all HIV clients have AIDS.
• Definition of AIDS
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Client must have a CD4 count of less than 200cells/mm3
Client will have an opportunistic infection (an infection that normally would not grow
in a healthy immune patient
OR the client will have persistent lymphadenopathy with a low CD4 count
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Infectious Disease - HIV
• AIDS – Complications
• Most of the complications from AIDS is due
to the opportunistic infections that the
patient gets.
• Examples:
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Tuberculosis
Respiratory Candidiasis
Respiratory Pneumocyctis Carinii (PCP)
Out of control cervical cancer
Widespread Karposi’s sarcoma
Cytomegalovirus retinitis (blindness)
Encephalopathy
Lymphoma
Toxoplasmosis
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Infectious Disease
AIDS – Complications
1. Gastrointestinal: Cause most of illness and
death of late AIDS.
Symptoms:
– Diarrhea
– Wasting (extreme weight loss)
– Abdominal pain
– Infections of the mouth and esophagus.
Pathogens: Candida albicans, cytomegalovirus,
Microsporidia, and Cryptosporidia.
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Infectious Disease - AIDS
• African AIDS patient
• with slim disease
• Source:
• Tropical Medicine
• and Parasitology,
• 1997
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Infectious Disease - AIDS
• Oral candidiasis
• Source: Atlas of Clinical Oral Pathology,
1999
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Infectious Disease -AIDS -TB
HIV
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Infectious Disease -AIDS
2. Respiratory: 70% of AIDS patients
develop serious respiratory problems.
Partial list of respiratory problems associated
with AIDS:
• Bronchitis
• Pneumonia – PCP – Pneumocytis Carinii
Pneumonia
• Tuberculosis
• Lung cancer
• Sinusitis
• Pneumonitis
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Infectious Disease - AIDS
3. Neurological: Opportunistic diseases i.e.
cryptococcus, toxoplasmosis, and tumors of
central nervous system.
Symptoms many include: Headaches, peripheral
nerve problems, and AIDS dementia complex .
Symptoms:
Memory loss, confusion, motor problems,
difficulty with concentration, pain, paralysis,
seizures, hyperthermia
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Infectious Disease - AIDS
4. Skin Disorders: 90% of AIDS patients
develop skin or mucous membrane
disorders.
• Kaposi’s sarcoma
– 1/3 male AIDS patients develop KS
– Most common type of cancer in AIDS patients
• Herpes zoster (shingles)
• Herpes simplex
• Thrush
• Invasive cervical carcinoma
5. Eye Infections: 50-75% patients develop
eye conditions.
• CMV retinitis
• Conjunctivitis
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• Dry eye syndrome
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Infectious Disease – AIDS
Patient with Kaposi’s Sarcoma
Extensive tumor lesions of Kaposis’s sarcoma in
AIDS patient.
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Source: AIDS, 1997
Infectious Disease – AIDS
• Perinatal Transmission – 25% will be positive HIV
• – Easy to prevent - AZT donations cost = $3.00 per
month while pregnant
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Infectious Disease – AIDS
• Diagnostics for HIV and AIDS patients
• ELISA – screen – can be false positive
• Western Blot – to confirm the ELISA (detects HIV antibodies)
• HIV viral load – Quantitative viral RNA
• CD4 – cell count
• CD8 – cell count and ratios CD4:CD8
AIDS CD4:CD8 ratio is < 2
• CBC with Diff – anemia is common, WBC’s may be low or nonexistent
• Cultures
• Biopsies
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Infectious Disease – AIDS
– Drugs – Viral Suppressing Treatments
– Reverse Transcriptase Inhibitors (NARTI’s): Competitive
enzyme inhibitors. Example: lamivudine, emtricitabine,and
zidovadine.
– Protease Inhibitors: Inhibit the viral protease. Prevent sviral
maturation.
– Problem with individual drug treatments: Resistance.
Example: lopinavir, ritonavir, atazanavir
– Non -Nucleoside Analog Reverse Transcriptase Inhibitors
(NNRTI’s) – inhibit the action of reverse transcriptase
Example – Rescriptor, Etravirine, Efavarenz
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Infectious Disease – AIDS
– Drug Cocktails: A combination of:
• One or two reverse transcriptase inhibitors
• One or two protease inhibitors.
• NNRTI – Efavirenz or a smiliar NNRTI and one or
two of the above (depends on the level of the
viral load)
• Anti-fungals – used a lot in AIDS
patients orally or IV, i.e. Diflucan
(fluconazole) Side effects include
nausea and vomiting – use antiemetics
prophylactically
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Infectious Disease – AIDS
• AIDS Nursing Diagnoses
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Risk for Infection (opportunistic…)
Impaired Gas Exchange
Acute or Chronic Pain
Imbalanced Nutrition
Diarrhea – Alteration in elimination
Impaired Skin Integrity
Low Self Esteem with Social Isolation
Disturbed Thought Processes
Activity Intolerance
Deficit in coping; individual or family
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Infectious Disease – AIDS
• Side Effects of retroviral drugs:
• Anemia
• High cholesterol and lipid levels
• Nausea & Vomiting
• Some have to be taken with food, and
some have to be taken without.
• Because of the side effects, some
patients will be on antiemetics,
appetite stimulants, and cholesterol
meds.
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Infectious Disease – AIDS
• Nursing Interventions:
• #1 Education
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Don’t have unprotected sex, even oral.
Don’t share razors or toothbrushes
Use bleach mixture for cleaning bathroom
Take drugs as prescribed and on time
Do not dig in the garden – soil pathogens
Avoid litter boxes – cats carry toxoplasmosis
Avoid turtles and reptiles (carry salmonella)
Eat only well cooked vegies and meats
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Infectious Disease – AIDS
• Nursing Interventions:
• #1 Education – the most important
prevention for HIV
– Infection control – daily bathing and hand washing – before
and after B.M., pet handling
– Avoid large crowds and people who are ill
– Clean toothbrush daily in the dishwasher or with bleach
– Report any non-healing sores, temperature greater than
100°F, dry cough, urine that is cloudy, or any abnormal
drainage to the physician
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Infectious Disease – AIDS
• Education
• Do not handle raw meats
• Educate on how to use incentive spirometer at
home
• May need to teach the patient when and how to
take their drugs
• May need to teach the use of the SVN nebulizer with
Pentam daily at home
• Drink filtered or bottled water – Have a lab check
for Cryptosporidium if they have city water
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Infectious Disease – AIDS
• Nursing Interventions:
• Most physical interventions can be
linked to the nursing diagnosis
• Reverse Isolation - very important even if their
WBC’s are normal
• Strict aseptic techniques for IV’s and central lines
• Respiratory therapy – incentive spirometer and
good pulmonary toilet
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Infectious Disease - HIV
• Nursing Interventions
• Assess Respiratory function frequently, Pulse Ox, lung sounds,
depth and rate of resp.
• Vital signs, especially temperature
• Pain medications and monitor effects
• Education for home maintenance
• Monitor BM’s give Immodium or Lomitil routinely for Diarrhea
• Skin care with lotions and moisturizers
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Infectious Disease - HIV
• Nursing Interventions
• Monitor labs
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CBC and WBC
CD4 cell counts
Albumin – for protein nutritional status
Daily weights
Cultures, blood, respiratory, urine, stool
Electrolytes – monitor for deficiencies
• Note- low sodium levels can make dementia
worse
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Infectious Disease - HIV
• Nursing Interventions
• Nutritional Education – high caloric and protein intake
• Psycho-social support
– Time one-on one with the patient so they do not
feel that the staff is avoiding them.
– Non-judgmental attitude towards significant others
and patient
– Hook them up with social services for home health
care
– Re-orient the patient if they are confused
– If demented, safety may be a big issue
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Infectious Disease
• End of Presentation
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