NURS 101 LIBERTY UNIVERSITY Concept #25 INFECTION NOTES 2023.pdf

Concept #25 INFECTION

Infection

Infection is the invasion and multiplication of microorganisms in body tissues,

which may be clinically unapparent or result in local cellular injury due to

competitive metabolism, toxins, intracellular replication, or antigen-antibody

response.

Infection Terms

Pathogen

Normal flora

Virulence

Opportunistic infection

Epidemic

Pandemic

Incubation period

Prodrome

Communicability

Preventing spread of disease

Use hand washing & isolation to prevent spread and stop the chain of

spreading disease.

Areas Most often Missed with Handwashing

Fingertips

Between fingers

Scope of Infection

Viral infections

Bacterial infections

Parasitic or protozoal infections

Fungal infections

Extent or Spread of Infection

Location

Duration

Source

Consequence of Uncontrolled Infection

Once the body’s compensatory mechanisms (i.e. vascular, renal, nervous,

and respiratory systems) are overcome, the following process occurs:

Septic Shock à Multisystem Failure à Death

Risk Factors: Populations at Greatest Risk

Very young

Very old

Poor

Uninsured

Chronically ill

Immunodeficient

Residents of geographic areas where an infection is prevalent.

Recognizing Infection: Assessment

Health history

Examination Findings:

oIn general, S/S associated with infection parallel those of

inflammation and manifest within the affected organs.

Common Diagnostic Tests

Laboratory tests

oComplete blood count (CBC) with white blood count differential

oCulture and sensitivity (blood, urine, wound, nasopharyngeal, CSF,

etc.)

Follow protocol carefully with specimen collection.

oC-reactive protein (CRP)

oErythrocyte sedimentation rate (ESR)

oSerological tests to detect specific antibodies or viruses.

Radiographic studies

oX-ray

oMRI

oCT

oPET

Additional testing

oBiopsy

Primary Prevention

Hygiene

oPersonal

oFood

oPatient care hygiene

Immunizations

Clinical Management: Screening

Most common infection screenings:

oSexually transmitted infection

oTuberculosis screening

oCurrently – COVID-19

Clinical Management: Collaborative Interventions

Antimicrobial therapy

Rest and comfort care measures

Nutritional support

Fluids

Disinfection of physical environment

Classification of Antibiotic Agents

Penicillin

Cephalosporins

o1st, 2nd, 3rd, and 4th generations

Fluoroquinolones

Tetracyclines

Macrolides

Aminoglycosides

Other Antimicrobial Agents

Antiviral

Antifungal

Antiprotozoal

Interrelated concepts

Nutrition

Tissue Integrity

Immunity

Stress

Inflammation

Evaluation

Preventing transmission is of utmost importance, especially if the family

has another young child in the home.

Evaluate for adequate oxygenation (> 95%), clear breath sounds, and

stable respiratory rate.

Evaluate hydration status

RESPIRATORY ASSESSMENT IN CHILDREN

Differences to Consider

STRUCTURES

DIFFERENCES IN THE PEDIATRIC AIRWAY

SIZE

oShorter

oSmaller

oFewer alveoli

oEustachian tubes

FUNCTION

oobligate nose breathers

onarrower airways

oprone to collapse

oless mucus

oincreased respiratory & metabolic rates.

opoor cough

ADEQUATE FUNCTION OF THE RESPIRATORY SYSTEM REQUIRES:

VENTILATION

DIFFUSION

PERFUSION

AUSCULTATION

ABNORMAL ASSESSMENT FINDINGS

RESTLESSNESS

TACHYPNEA

TACYCARDIA

ADVENTITIOUS BREATH SOUNDS

PALLOR OF SKIN, MUCOUS MEMBRANES

ADVENTITIOUS BREATH SOUNDS

PALLOR OF SKIN, MUCOUS MEMBRANES

RETRACTIONS

CYANOSIS

CLUBBING

RETRACTIONS

Increased respiratory effort to get adequate air exchange

Seen on inspiration

Exhaustion may soon set in due to increased work of accessory muscles.

http://www.youtube.com/watch?v=obR9Y3Srplg

RETRACTIONS

SUBSTERNAL RETRACTIONS

ABNORMAL BREATH SOUNDS

WHEEZING

oCONTINUOUS HIGH-PITCHED MUSICAL SOUNDS HEARD

PRIMARLY ON EXPIRATION

ohttp://www.youtube.com/watch?v=YG0-ukhU1xE

CRACKLES

oHEARD PRIMARILY ON INSPIRATION

oDO NOT CLEAR WITH A COUGH

oFINE (RALES) OR COARSE (RONCHI)

oCONTINUOUS LOW-PITCHED SOUNDS

oCLEARS WITH COUGH

ohttp://www.youtube.com/watch?v=9C5RFb1qWT8

GRUNTING

oOn expiration

oMay be audible or only on auscultation.

oTo reinflate alveoli

oCan be a sign of chest pain

ohttp://www.rale.ca/Grunting.htm

STRIDOR

oNarrow laryngeal area

oOn inspiration

ohttp://www.youtube.com/watch?v=ICoCwFLgkws

BREATH SOUNDS

Check equality!!! (can be hard to assess in children)

Make sure to listen at the midaxillary line to determine equality.

Small chest walls refer sound.

Note the air exchange---good, fair, poor or tight.

CYANOSIS

Blue color due to poor O2 sat on Hgb.

More likely to see pallor or mottling first.

Must have normal Hgb/Hct to assess this (an anemic person may never

turn blue)

Sats usually must be < 80%

Other Key Points

Apnea is a cessation of breathing > 20 secs (less if VS changes or child is

symptomatic)

Hypoxia causes decreased O2 to the tissues à lactic acidosis.

Newborns decrease HR in response to hypoxia, while older children

increase HR when hypoxic.

CODES

MOST PEDIATRIC CODES OCCUR AFTER RESPIRATORY FAILURE

WITH 80-90% MORTALITY.

THEREFORE, CONTINUOUS ASSESSMENT IS ESSENTIAL!

Exemplars: Otitis Media, Tonsillitis, RSV

Otitis Media

Infection of the middle ear

Nearly all children have had an ear infection by the time they begin school.

o15% have frequent/recurrent infections.

Otitis Media

Day care

Environmental tobacco smoke exposure

Pacifier use

Less incidence in breast fed babies.

Less incidence after age 6

Eustachian Tube

Otitis Media - Symptoms

Often follows an upper respiratory infection.

oMay have fever up to 104.

oIrritable-painful - pulling at ear.

oV&D

oRhinorrhea

oAnorexia (due to pain w/ sucking & swallowing)

oPurulent drainage

Definitive diagnosis is bulging/full tympanic membrane.

Rupture of the eardrum leads to decreased pain.

AOM- acute otitis media

Acute onset ear pain

Marked redness of tympanic membrane

Middle ear effusion

OME- otitis media with effusion

Fluid in middle ear without inflammation

Chronic

Often associated with hearing loss

Diagnosis: Proper Method for Viewing Eardrum

Normal Tympanic Membrane

Acute Otitis media Serous Otitis media

Complications of OM

Risk of complications much less than in the past

oHearing loss, ruptured eardrum

oMeningitis

oMastoiditis

oLabyrinthitis (rare)

oPossible abscesses

Treatment: Goal of therapy is to resolve infection without complications.

oAnalgesics

(includes topical anesthetic ear gtts)

oAntibiotics not always needed.

If treated, should have the shortest possible course.

<2 years old – 10 days

2-5 years old – 7 days

5 yrs. and older – 5 days

If chronic with persistent fluid.......Tubes!

Myringotomy with Insertion of PE Tube (Armstrong Procedure)

Post-op Care

Acetaminophen for discomfort

Report headache, severe pain, disorientation, purulent discharge

Clean outer ear gently with swab & water or H2O2. Don’t put anything smaller than

your elbow in the ear.

Don't put child to bed w/bottle or feed him supine.

Use ear plugs for bath or swimming if has tubes (some say it's OK for a little water to get

in-but no jumping, diving or submerging).

Gentle nose blowing when has a cold.

Tonsilitis

Common in ages 5-10

Tonsillar tissue is lymph tissue and is probably protective against URI’s.

Tonsillar tissue enlarged until around 8 years old.

May be viral or bacterial.

Inflammation à tonsillar edema à increased difficulty swallowing or breathing.

oSore throat

oMouth odor

oDrooling

oLymphadenopathy

Swollen adenoids à block nasal passages.

oMouth breathing & snoring

oMay lead to OM.

Tonsillitis-Treatment

1. Antibiotics if bacterial

2. Possible T&A if chronic

oFrequent episodes & unresponsive to meds

oChronic hypertrophy interfering w/ swallowing or breathing

oSleep apnea

oFrequent concomitant OM

oPeritonsillar abscess

3. Preop:

oBleeding times

oTeeth

Tonsillitis-Post-op Care

Liquids

Analgesics (give 1 hr before po fluids)

Watch for bleeding.

Deal with increased oral secretions

No red fluids- No straws

Discharge teaching

Meds

Diet

Oral care post-op

Emergency tx

Bronchiolitis

In the bronchioles

Usually viral, often RSV

Cell debris clogs bronchioles and irritates airway, causing increased mucus production à

partially obstructed airways, air trapping & decreased air exchange which can cause

hypoxemia.

Mortality can be 23-37% for infants with underlying problems.

Associated with increased risk for asthma.

oBronchiolitis-Symptoms

At risk for respiratory failure due to < O2 and >CO2

Tachypnea, retractions

Wheezing, prolonged expiration, crackles

Decreased breath sounds

Hypoxia

Apnea in neonates

Signs and symptoms can last up to month.

oBronchiolitis-Diagnosis

Nasal swab

NP wash test

oBoth check for RSV antigens

CXR shows areas of hyperinflation & consolidation.

Can frequently progress to pneumonia.

oBronchiolitis - Treatment

O2

Acetaminophen or Ibuprofen

Saline drops and Suction.

Bronchodilators (maybe)

Steroids

No OTC cough & cold medicines

Elevate HOB

May need IV fluid.

Very communicable—RSV virus stays on your hands for at least 30 mins.

Contact isolation (with mask) if RSV

HANDWASHING!

oBronchiolitis - Prevention

Immunoglobulin Therapy

oSynagis IM q month during RSV season (Nov–April)

For babies with Bronchopulmonary dysplasia or congenital heart disease

Premies who meet certain criteria.

NURS 101 LIBERTY UNIVERSITY Concept #25 INFECTION NOTES 2023.pdf

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