Infection: UTI, Conjunctiva, Cellulitis, Otitis Media, Strep B – Flashcards

* Invasion of a body tissue by a microorganism; cause illness or disease * Pathogen: microorganism that cause disease: Occur when they produce a detectable alteration in normal tissue function * Communicable: transmitted directly by person or animal with body fluids or indirectly by vectors * Infectious: any communicable disease caused by a microorganism transmitted from one person to another or from animal to person

*Local: limited to specific parts of the body where microorganisms remain *Systemic: Microorganisms spread and damage parts of body *Bacteremia: Bacteria in the blood *Colonization: strains of microorganisms become resident flora; grow and multiply, do not cause disease

Meds: * Anti-cancer meds (bone marrow suppression and reduce # of leukocytes) * Corticosteriods: Inhibit inflammatory response Antibiotics: kill normal flora Diseases: * COPD; decreased cilia action, weakened mucous membranes * PVD: impairment to blood flow * Diabetes: Compromised vascular status, increase serum glucose Other factors: Stress, Nutrition, Sleep, Hydration, Hygiene

* Ecoli is most common cause * CAUTI: (cath assoc. uti); hospital will not pay to treat infection if foley cath is left longer than 48 hours * Neurogenic bladder: breakdown in process to brain to emptying bladder *Vesicoureteral reflex: reflex of urine back to the kidneys *Urinary obstruction: cause stasis * Structural abnormalities

* Dysuria: painful * Urinary frequency and urgency * Nocturia: voiding at night * Pyuria: Pus in urine * Hematuria: Blood in urine * Suprapubic pain and tenderness Lower UTI (cystitis) frequency, dysuria, urgency, enuresis, strong-smelling urine, cloudy, hematuria, suprapubic pain. Tx: 5 to 7 day antibiotic, analgesic or pyridium Upper UTI (polynephritis) high fever, chills, flank pain, vomiting, moderate to severe dehydration. Infants poor appetite, failure to thrive, lethargy, irritability Tx: antipyretics and antibiotics IV, then transition to oral antibiotics 7 to 10 days. *Rehydration is essential

Older Adults: Acute delirium, confusion * Pregnancy * Presence of a foley cath

* Primary prevention is good hygiene. * Prophylactic antibiotics for clients with recurrent UTIs or with asymptomatic bacteriuria * Keep urine dilute and acidic, void regularly to flush bacteria out * Bubble baths, hygiene sprays, synthetic fibers and douches can dry and irritate perineal tissues promoting bacterial growth

* Urinalysis w/culture and sensitivity * X ray and ultrasound for those with recurring bacteriuria NURSING DIAGNOSIS: * Acute Pain * Impaired urinary elimination * Risk for disproportionate growth (peds) * Risk for deficient fluid volume NURSING INTERVENTIONS: *Assess pain * Teach comfort measures: warm sitz baths, heading pads * Notify provider if pain continue or intensify after therapy is initiated (usually relieved within 24 hrs of antibiotic therapy) * Straight cathetheration every 3 to 4 hours using clean technique, scheduled toileting, incontinent pads, external catheters

*Antibiotics -Uncomplicated lower UTI = short course 3 days -Upper UTI = longer 7 to 10 days -Trimethoprim-sulfamethoxazole, ciprofloxacin - Complicated UTI IV antibiotics *Treatment for frequent UTI -Nitrofuratoin (Macrobid, Macrodantin) *Treatment for Pain: acetaminophen, pyridium (turns urine orange) * Surgery -Ureteroplasty: reconstruction of ureters -Ureteral stent: holds ureter open so urine can flow *NON-Pharm: - Drink lots of fluids, cranberry juice, avoid alcohol, caffeine, citric acid * Encourage 2-2.5 liters per day * Empty bladder every 3 to 4 hours * Cleanse front to back * wear cotton briefs, avoid bubble bathes, hygiene spray * take Vit C and avoid excess intake of milk products, other fruit juices and baking soda

-Kidney stones -Hydronephrosis (swelling of kidneys) -Renal scarring, HTN, proteinuria, renal failure

* Inflammation of conjunctiva (lines inner surface of eyelids)

*Virus -Adenovirus, herpes virus * Bacteria -Staph aureus, Strep pneuom -trachoma: caused by chlamydia, worldwide cause of blindness, preventable with antibiotic eyedrops, results from scarring of the cornea *Other causes -Fungi, allergens, chemical irritants, trauma

Redness, itching, feeling of scratching, burning, photophobia, discharge. -Bacterial= purulent discharge; burning, irritation, sore throat, photophobia, crusting; more common in older children; edema of conjunct. * Bacterial Tx: Antibiotic eyedrops or ointment -warm cloth, eye irrigation, avoid bright lights, infection control, cool compress -Viral= Redness, serous discharge; burning, irritation, sore throat * Viral Tx: HSV -cool compress, avoid bright lights, infection control, removing discharge with wet cloth -Allergic conjunctivitis: intense itching; "cobblestone" appearance

-Contact lenses, immunocompromised, children in daycare -Prevention: Highly contagious -Good handwashing, do not touch surfaces after touching the infected eye, no sharing towels, wash linens frequently, wash hands, use new q-tip, avoid contact lenses until infection is cleared * Chlamydia trachomatis, endemic in poor underdeveloped countries, water shortages, numerous flies, crowded living conditions

* Accurate diagnosis is CRITICAL - manifestations can mimic vision-threatening conditions like uveitis and acute open-angle glaucoma * Culture and sensitivity of drainage * Fluorescein stain with slit lamp examination; green stain, identify corneal ulcerations and abrasions * Conjuntival scrapings NURSING DIAGNOSIS: * Risk for Infection * Risk for Comfort * Readiness for Enhanced Knowledge

* Treated with antibiotics, antiviral, anti-inflame -Topical anti-infectives: erythromycin, gentamicin, penicillin, bacitracin -Severe infections: subconjuntival injection, systemic IV infusion -Gonococcal conjunct in newborns: Rocephin -Chlamydial: oral erhrythomycin, tetracycline -Herpes: can cause scarring of the cornea that leads to permanent vision loss. All HSV infections treated with antiviral acyclovir and infection control techniques -Allergic: antihistamines or topical steroids NON PHARM: - Eye irrigation, warm compress for comfort/removal of crust - Cool compress for eye irritation - Avoiding bright lights - Promote comfort

-Corneal perforation: Damage to the cornea due to corneal perforation can cause decreased visual acuity -Blindness

* An acute bacterial infection of the dermis * Occurs on face or lower extremities * Results from trauma or break in skin * localized area or complication of a wound

* Normal flora enter break in the skin and multiply * Staph or strep strains * Nearby abscess * Sinusitis

* Rapid onset, erythema, edema, warmth, tenderness, can progress to include fever, chills, malaise *** LOCALIZED TO SYSTEMIC***

* Illness that compromises skin integrity (DM, PVD, obesity) * Reduced physical activity * Malnutrition * Dehydration * Diabetes- peripheral neuropathy-loss of sensation in feet ** clients with tinea pedis or lymphatic obstruction are must vulnerable and experience recurrent infections** PREVENTION: proper wound care, good skin hygiene

* infants with cellulitis may be more susceptible to sepsis because of poor immune system * Children: history of trauma, folliculitis, untreated tooth decay, otitis media * Older adults: skin becomes thinner, less elastic

* CBC * Wound culture * Blood culture- only if patient becomes very ill ***Trace wound boarder with marker, if grows outside, getting worse*** NURSING DIAGNOSIS: * Impaired skin integrity * Acute Pain * Interrupted Family Processes

* Face, sever cases, large affected area = IV antibiotic therapy * Trunk, limbs, perianal = Oral antibiotics use for 10 days * Antipyretics, pain meds if necessary NON-Pharm: - moist wound care, warm compress, elevation of affected extremity, promote adequate nutrition, rest * Teach Patient to call health provider when* - Spread of infected area in 24 to 48 hr after start of treatment - Temp over 101 - Increased lethargy

* Sepsis * Osteomyelitis: "infection of bone" Pic line for 6 to 8 week antibiotics * Arthritis

* Inflammation of the middle ear 3 Types: Acute: result from upper resp. infection, impaired drainage causes mucous Signs: ear pulling, rapid onset, irritability, malaise, poor feeding Tx: local anesthetic, NSAIDs, if not improved in 48 to 72 hrs, antibiotic tx Chronic: Permanent perforation of tympanic membrane, caused by recurrent otitis media or trauma Serous: (Effusion): negative pressure causes serous fluid behind tympanic membrane. Signs: Difficulty hearing or responding as expected Tx: observation of hearing acuity, speech assessment, developmental assessment

* Infection in nose or throat moves to Eustachian tube * complication of upper resp. infection * peak prevalence 6 to 18 months of age

* Decreased hearing, "popping" sound in ear, fluid or blood in ear, vertigo. * Children will pull at ear, have diarrhea, vomiting, fever

Children who: -Attend daycare, 2nd hand smoke, allergies, use a pacifier several times per day -Prevention: bottle feed upright -seen 3x more in Indians/native Alaskans

*ear exam: Children under 3, hold Pinna down and back * CBC * Culture and sensitivity * Impedence audiometry: for serous otitis media NURSING DIAGNOSIS * Acute Pain * Infection * Risk for delayed growth and development * Impaired verbal communication NURSING INTERVENTIONS: *Assess pain, severity, quality, location * Advise to use heat; dilates blood vessels promoting reabsorption of fluid and reducing swelling * Avoid air travel, rapid changes in elevation * Explain antibiotics, steroids, antihistimines are not effective with serious otitis media and most children improve in 3 months. Need to be tested for hearing acuity

-Depends on causative agent, ease of administration, previous effectiveness, history of allergies * 1st choice: Amoxicillin 80-90mg/kg * 2nd choice: Amox. clavulanate * Topical anesthetic eardrops for pain (only if tympanic membrane is intact) -Adults: Amox 5 to 10 days CAM: herbal ear gtts for pain management

If left untreated: Mastoiditis:bacterial infection of the mastoid bone. The mastoid bone, which sits behind the ear, consists of air spaces that help drain the middle ear. Result in swollen ear lobe -Brain abscess -Meningitis

Health history: -UTI: current symptoms, voiding frequency, pain, color/smell of urine, previous UTIs -Conjunct: onset of symptoms, use of contact lenses, daycare -Cellulitis: cause of the skin wound, onset of symptoms -Otitis media: recent upper resp infection, presence/onset of symptoms Physical assessment: vital signs with temp, asses for suprapubic tenderness, note appearance of eye, type of discharge, through wound assessment, test for hearing and drainage of the ear

UTI, Cellulitis, Otitis Media: -Pt will report pain 3/10 -Pt will report absence of pain - Pt will be infection free after course of treatment is complete Conjunt: - The patient will demonstrate proper hand hygiene

#1: Pain - Impaired Urinary Elimination (UTI) - Impaired Skin Integrity (cellulitis, conjunct) - Risk for Infection

*Asses pain and administer meds as ordered * promote fluid intake and adequate nutrition * remove foley cath within 48 hrs of insertion * educate on hand hygiene * administer antibiotics * encourage full course of treatment * educate regarding complications * offer support to parents

Complications: -Bloodstream infections -Pneumonia -Skin and soft-tissue infections -Bone and joint infections -UTI's Diagnosis: Blood or urine sample Treatment: Penicillin, unless bone infection than may require surgery -More common in 65+ year age with comorbities

* Leading cause of meningitis and sepsis in first week of life * 2 Types: -Early-onset disease — during the first week of life (most common cause of sepsis and pneumonia) - Late-onset disease — fist week to 3 months of age (most common cause of meningitis) -Long-term consequences: deafness, developmental diabilities

* should be tested in 35-37 week of pregnancy and given antibiotics during labor if test is positive * antibiotics are given during labor through IV, if given before, bacteria will grow back