Infection & Wounds (audio lecture) 1st Slide - Infections are typically outside organisms that invade a host. - They may attach to a specific organ system or they may start to grow inside a wound - Host may actually contract infection ex. Dirty equipment or another individual - Our bodies always contain bacteria & its there to protect other body systems against bad invaders - When a microorganism gets into a host, it proliferates ( colonizes, grows develops, reproduces) - Different types of infection stages a person can undergo once something is starting to colonize in their body. - Communicable diseases are transmitted from one person to another, ex. STD, or respiratory disease, can be a community health problem. As health care providers, it's our job to understand, educate and advocate to prevent further infection rates. Ex. covid 19 moving from person to person. A simple infection could cause a lot and change our lives. - Ex. Covid19- people are using words like symptomatic and asymptomatic - Asymptomatic could cause trouble because you can unknowlingly transmit something without knowing it. 2nd slide - Staphylococcus is one of the most common infections you’ll see in a health care environment . - This bacteria has the ability to become very resistant to first line antibiotics leaving the patient only responsive to stronger antibiotics which by nature will eventually harm us because as bacteria becomes resistant to different meds, those medications now become infective as treatment. 3rd Slide - It's important to understand the form of bacteria, many of them are very strong and they design themselves this way to protect themselves against other invaders that are trying to eliminate them. - They are able to attach themselves to many different types of body systems, wounds, nasal hairs, organ systems, in blood, - It's important to know what type of bacteria is present so we know what antibiotic will be effective in eliminating it. 4th slide - Opportunistic infection happens when a host is compromised in some different way. - We have bacteria that live in us. ex. In our Respiratory system, gastrointestinal system , genitalia. → protecting us. - If we are compromised, not feeling well, or if we are taking medications for a long period of time → good bacteria is being destroyed = opportunistic infection. - Opportunistic infection = an opportunity came up for another bacteria to proliferate, succeed, to grow & to colonize + cause some type of harm to the host. 5th slide - When discussing bacteria that lives with us = symbiotic relationship or commensal. - Both are doing their own thing, we don’t bother it & it doesn’t bother us. 6th slide - There’s a lot of different types of microorganisms, → important to obtain blood cultures when patients are sick, especially those with abnormal lab values. - Blood cultures help to determine exactly what is hurting them so we can provide the treatment that is specifically designed to treat that particular type of infection . - Bacteria - antibiotics - Fungal infection - antifungal - Protozoa - antiviral - Viruses - Different types of worms inside the body- substances given to patients to kill the worms. If someone has worms in their gastrointestinal tract, They stop getting fed & get certain meds for that condition that's hurting them. 7th slide - Possible for someone to be a carrier of an infection or microorganism for long periods of time & never show any signs or symptoms of it. Ex. shingles. Shingles of varicella virus / chickenpox virus , and after we become infected with the herpes zoster, we have a dormant form of that virus in our body all the time. - Some people get outbreaks and end up with shingles which is very painful , goes along the nerve line and causes a very painful rash, but some people go for the rest of their lives carrying this virus and never have an outbreak . - Very difficult to determine who will have an outbreak and who won’t → that's why vaccines are created to prevent the outbreak. 8th slide - Lots of different ways to spread bacteria or microorganisms, ex. Food or water supplies contaminated with certain types of bacteria. - Our hands → that's why handwashing is reinforced a lot. - Alot of viral & bacterial infections exist in poop, so if a water supply is breached maybe due to a storm system where the sewage and the fresh water supply mixed → people can get sick. - Fly bites and mosquitoes ex. West Nile fever, zika virus, infections from simple fly bite → some people may get celluitis just from the infections and bacteria that the fly may have. - STI’s, aids virus, - Fomites are vehicles that microorganisms live in, inanimate objects where we can touch and the bacteria is still alive and can be transmitted to us/ host . 9th slide - To spread infection - → need to be able to get into the body ex. Open wounds. - → be strong enough to withstand acidic environment in stomach or genitalia ( especially women’s) - → have to be able to get through cell membranes - Any many times, microorganisms have all these qualities and they are able to do that, especially if the host has an immune system that is compromised either by another infectious process going on, chemotherapy, autoimmune disease ( where they are taking immunosuppressants for organ transplants ( where patients are taking immunosuppressants. → vital to take good assessment to determine if they are at risk or are currently sufferring. 10th slide - Body is specifically designed to protect ourselves, ex. Anaphylactic reaction to bee sting, peanuts or shellfish and end up needing an epipen to stop that - When our body senses that there is an invader/organism trying to hurt us → the immune system kicks in → starts an inflammatory process → sends histamines to that area . Histamines are designed to protect a particular area & with that, it brings fluid because our body tries to automatically wash that invader away so you might see people with redness, swelling or warmth in an area where there is an infection starting to form. - We can also see different values in blood work, where our immune system is kicking in, typically our white blood cells elevate. - Depending upon which component of our white blood cells is elevating → determines the type of infection the patient is suffering from . 11th slide - Opportunistic infections occur when the immune system is weakened, so be aware of the patient's lab values and you see a very very ↓ white blood cell count , understand that they don’t have much of an immune system to protect them so care must be planned accordingly. - If white blood ↑, it's safe to assume there is an infectious process going on and we need to find out where it's coming from. -Could be from a procedure, feeding tube, wound, stitches, or some surgical intervention where the bacteria was introduced or they could’ve just obtained something from the hospital or community. - → A nurse's job is to do a detailed assessment to determine the source of infection. 12th slide - Proven time and time again, best line of defense against infections and transmitting infections = hand washing 13th slide - Some of the most common infections you might encounter as a health care provider is tuberculosis , even if you don’t have a patient, you have to go for your PPD exam and come up with proof that you are not carrying tubercuolosis and that you haven’t been exposed . - Syphilis - isn’t as prelevant now as it had been before because of the increased use in condoms and education. Syphilis is an std that can be devastating and tax the brain. - HIV/ AIDS - and fortunately pharmaceutical companies have been able to come up with a lot of antiviral medications that eliminate traces of this fatal virus. - Respiratory infections are very very serious - ex. COVID 19 manifest as a respiratory infection , signs and symptoms are fatigue , malaise , cough and shortness of breath and this can be said for a lot of different infections → very important to get a good health history because it can be mistaken for bronchitis or pneumonia and they can actually be carrying something much more serious and much more communicable. 14th slide - When talking about sti’s and std’s , promoting condom use and scrutinizing who your sexual partners are in order to eliminate infection. - Promoting prenatal care for moms to make sure they don’t transmit any infection on to their unborn baby. - Regarding malaria, depending on where we are traveling we have to get vaccinated before we go to certain parts of the world . - When we travel, a lot of the microorganisms that may make us ill do not make the people who live their ill because they live with these all the time and their immune systems have adapted to it , but when someone comes in who has never been exposed to these microorganisms , that's when you start to see signs & symptoms & opportunities for the microorganisms to cause illness in the host - Influenza - flu proliferates the most in the fall, & we have a window where the flu vaccine is effective and recommended, if everyone gets vaccinated even if you aren’t going to come down with signs & symptoms, you won’t be a carrier & you won’t be transmitting it to anyone else so it's recommended that all healthy people especially elderly, or very young or those who are in contact with lots of people ex. Health care providers get their annual flu vaccines. 15th slide - Our body tries very hard to keep us healthy and tries to get rid of what doesn’t belong. - We’ll get a fever because they try to burn it out. - Heart rate ↑ because we try to push it through. - We’ll also see signs & symptoms of muscle aches, tiredness, fatigue, maliese, weakness, that is our immune system working very very hard to meet the metabolic demands of our body in a state of infection and our body becomes tired because of working so very hard. - If an infectious process and our body starts to release fluid & histamines to that area, you’ll see redness, warmth and inflammation at that site, - So if you’re not sure where a patient is getting abnormal lab values from and you suspect infection, you need to do a good head to toe assessment.of their body and check every single place because you’ll be surprised where it could be . ex. Underneath their nails. Might have a big swollen finger, a lot of pus. Fine tooth comb and go over the patients to find the problem. 17th slide - Physical examination - we look and see, if someone is complaining of pain or tenderness somewhere, we always have to assess because that might reveal the source of their problem. 18th slide - White blood cells are apart of your immune system ↑ neutrophils - bacterial infection ↑ lymphocytes- viral process ↑ eosinophils - parasitic diseases + you might also see it in patients who have a very severe particular type of asthma . 19th slide - Gram stains - so basically they check to see the type of bacteria it is, they classify it into a positive or negative type of bacteria. - When we have that information, that determines which antibiotic will be prescribed that is the most effective against that particular type . - Patient comes in and we suspect that there is an infection, we draw blood and blood cultures right away before giving any medication if not life threatening . We need to draw blood first and send them off to the lab. And then we can give them certain types of medication : antipyretic for fever and broad spectrum antibiotics because it covers a lot of different types of bacteria . When the cultures come back in a few days and we’ve been able to isolate that type of bacteria, then a physician will order a narrow spectrum antibiotic which is designed to take care of or combat that particular bacteria that is causing the patient a problem. - When we do gram stains, we can also identify if its a fungus , some type of protozoa ( different type of microorganism) or eggs of worms. 20th slide - Cultures are the best way to take care of an infection. To treat that specific infection directly 21th slide - Nurses always check the immune system to ensure proper functioning. - When there is a pathogen inside the body, the immune system should automatically kick in and start to work. - Different types of components in our immune system. Ex. white blood cells which contain some subcomponents to combat different types of infections . - T cells to eliminate many pathogens that enter the body. They help to fight viral infections. 21th slide - Different ways we can attract viral infections are basically the same with the exception of a couple different modalities . - Aerosolized secretions - when someone coughs, and we have a droplet or airborne situation, - Sexual contact - direct skin to skin contact - through the placenta with pregnant woman - during child birth - if there is a bacterial infection and they have a vagincal delivery, an infection can be transmitted to the fetus during childbirth - insects - contaminated food and water- a lot of times its E. coli and that's a fecal borne infection, and it usually comes from the fecal matter from the hands from the workers who are preparing the food. Good to wash products from grocery stores especially produce. 22th slide - Viruses can be eliminated by T- cells. - So basically the T cells will secret a particular type of chemical that will kill certain viruses but we need an intact immune system in order for this to happen. 23th slide - Many viral infections need to just be treated by supportive care. - We cannot give antibiotics for a viral infection because it's not a bacteria , it's a virus. - There are antivirals for certain types of viruses. ● Scientist are trying to develop antiviral medication for COVID 19 - Antiviral medications typically shorten the lifespan of the virus and need to be administered early on like within the first couple of days of the virus showing signs & symptoms. - If we receive a vaccine, and become immunized, it can really help prevent certain viral diseases ex. Chicken pox and flu. 24th slide - Some people carry a virus and can spread it but will never become sick of that virus themselves 25th slide - Typically a virus just runs its course , can be a few days, up to a week. - Not too many interventions are necessary - sometimes fluids - supportive care - antipyretics - nutrition ( because when a person is sick, the metabolic demands of the body increase, and the body is working so much harder to fight the infection, and we need to give the body fuel, and food is fuel ,that's why lab values are important. - prealbumin & the albumin levels will check the proteins available in the patient, they are very important in fighting infections and maintaining proper nutrition and getting the body in its optimal state so it can go to battle with the microorganisms. We make all around they have access to healthy food - The most deadly virus is HIV/ AIDS but fortunately pharmaceutical companies have been able to come up with medications and vaccines that actually eliminate the viral load/ count of HIV & help the patients . At the end stage of this ,the patient becomes very very sick, and is susceptible to a lot of different types of cancers because their cells start to change and mutate. They get skin lesions and certain types of pneumonias they develop due to inadequate immune system. 27th slide - Smallpox- don’t see too much of it, eliminated in september 11th , 2001, there was talk about countries wanting to release the smallpox virus ( None of these viruses or bacterias are ever really killed 100%, they are kept very secure in a lab somewhere and the reason for that is if it ever becomes a epidemic again, they need a form of the virus or microorganism in order to develop a defense against it, if they don’t have a sample of it, it’ll be impossible to develop defenses against that particular microorganism ) - Influenza - flu is every year, sometimes many many months out of the year, & does have the ability to wipe out a lot of members of the population . 28th slide Talked about aids already so go back up. 29th slide - So upper respiratory tract infections can be easily mistaken if you don’t do a good health history ex. COVID 19 can manifest as flu, bronchitis type situation with a productive cough, difficulty breathing, fever. We want to ensure we catch it early on and the patient has the best chance of recovery. 30th slide - COVID 19 is not a new virus - common cold is a form of COVID 19 - SARS ( severe acute respiratory syndrome) is also a form of COVID 19 - MERS ( middle eastern respiratory syndrome ) is also a form of COVID 19. - Microorganisms have the ability to change form so that they become more resistant and sometimes deadlier ex. New form of covid 19 is very deadly depending on who the host is. 31th slide - So we have to stop the spread of disease by doing a really good assessment and we suspect a patient has a particular type of ailment based on what's happening and we treat it. - Cannot brush off signs or symptoms , We have to make sure we act on or rely on our gut. If something doesn’t feel right and you have some degree of suspicion , act on it ! - Keep up with the news and up to date on various diseases and how they spread. Something that's happening on one side of the world can easily be in our area in a short period of time. 32th slide - Airborne pathogens are paticularly dangerous because they can be transmitted over several feet of distance or if they’re small enough, they can float through the air and go through ventilation systems. - Thats why its important that society is uniform in wearing a mask and making sure they do everything possible to prevent the spread of droplets that can leave their body because as we know we can be carrying something and not know it because we are asymptomatic. Just the simple act of talking when a camera is slowed down, droplets are leaving the mouth just by talking. So it doesn’t have to be an active situation ex. Coughing or sneezing. 33th slide - Prevention is vital, make sure that if we’re sick , we stay home and stay away from people and look for signs that something is going on, we wear our personal protective equipment, and every single time we change our ppe between patients., we wash our hands, keep our masks on, and we separate people who have provoked suspicions. 34th slide - As we know viral illnesses are very easily spread because most of them come from the respiratory system. 35th slide - Anyone who has not been vaccinated against influenza can get influenza. - Now we realize that the virus changes a little bit annually . - The vaccine is never a 100% guarantee , but its close enough and it has been shown through studies that people who are vaccinated have less of a likelihood of contracting the flu and people who aren’t vaccinated have a higher likelihood. - Remember we could be carrying and could transmit it to someone else. 36th slide - We use standard precautions and get vaccines. - We make sure that we recognize the early signs and symptoms so that if an antiviral is available to us, we take it within the first 48h. 37th slide - Strains from flu : Swine flu & bird flu signs & symptoms are the same but the means of transmission are slightly different. 38th slide - Tuberculosis is an infection in the lungs where it was seen that people who live in very close quarters ex. College dorms, a lot of people living under 1 roof have more a likelihood of contracting it and spreading it . - No vaccine , just a preventative test. - PPD ( pure protein derivative) test to see if you have any of those antibodies. - The results show in that skin test you get; the intradermal injection, if there’s a reaction, the provider knows the individual may have been exposed to that particular bacteria that causes tuberculosis (mycobacterium tuberculosis ). 39th slide - Tuberculosis can be fatal depending on who gets it - Very contagious - Signs and symptoms we mark off as a flu or bug , we now know to never take symptoms lightly 40th slide - We want to minimize trasmission, isolate these people as soon as we identify that they might be carrying. - How do we do that ? Doing a very detailed and good assessment we ask them where they have been , if they've been traveling and certain conditions they might have been exposed to and that might raise our suspicions. 41th slide - The best defense against a lot of these airborne and droplet diseases is the N95 respiratory - When someone has an airborne or droplet infection, it’ll filter out 95% of the things in the air, and pair that with a surgical mask , we are basically blocking the majority of the droplets that can come to us. - N95 is to protect us - Surgical masks are to protect others. Ex. If we are transporting a patient who’s suspected of having TB or any other type of respiratory infection , we want to put a surgical mask on them so their drops don’t escape and start to infect other people. 42th slide - PPD ( purified protein derative) - form of the bacteria that weakened and it won’t cause you any problems but if you have any surface antigens to it, you will have a reaction and we will be able to see it in a raised area after you received that intradermal injection. 43th slide - Picture of positive tuberculosis test 44th slide - Meningitis isn’t too common today but it does happen especially with people who are dorming on a college campus and most college students are required to get the vaccine. - Basically an inflammation of the meninges ( 3 layers that surround the brain and spinal cord ) - Most common one is viral & is the least offensive - Bacterial is more serious and dangerous than the viral form. 45th slide - Signs & symptoms are malaise, fever , achy - When the person moves their head down , points their chin down , people who are infected complain of pain during that movement . 46th slide - Alot of signs & symptoms are the same so good assessment is important ! - Has a vaccine 47th slide - Whooping cough / Pertussis - Not very common anymore, vaccines against it. - Bordetella pertussis - Dry and deep cough, respiratory infection - When you get your DTP or GTP protects you from a lot of childhood diseases ex. Diphtheria, pertussis & tuberculosis 48th slide - Signs & symotoms are a little bit different - May look like pneumonia but its not, different bacteria 49th slide - You can be treated afterwards because it is a bacteria and the vaccines really help for people not to contract it. 50th slide - SARS ( severe acute respiratory syndrome ) also now covid 19 and ( middle eastern respiratory syndrome ) MERS - COVID 19 is a virus that causes a common cold and it morphed, changed, mutated and it became SARS and changed again and became MERS and its changed again to COVID 19 - Common cold may be an inconvenience and annoyance, if it's one of these mutated viruses, we know now it can cause a multitude of problems including death. - If you look at the signs and symptoms, alot of them cross over from one to the other, that's why it's very difficult to figure out which one it is. - It's safer to treat for the worst and scale it downward if it isn’t. 51th slide - Post exposure is really supportive care because it's a virus we aren’t using antibiotics for. - Antivirals that are out there are questionable, some of them that were used for other viral diseases have shown to cause more problems than cure. - So we are withholding a lot of that in hopes of a quick , safe and timely roll out of a new antiviral medication and a vaccine to prevent it from happening in the first place. - We use n95 mask to protect ourselves and surgical mask to protect others. 52nd - Chicken pox is a highly contagious virus that most people get during childhood years, it's not common because of the vaccines. - When a child gets it, it usually doesn’t cause too many problems - When an adult gets it, the end result can become quite serious and there are some reported death cases - Varicella virus lies dormant in your body that turns into shingles later on which fortunately there is a vaccine for shingles. 53rd slide - Shingles is also very contagious, when that rash is open and purulent, that moisture thats in there is whats contagious - Signs and symptoms : fever & malaise - Characterized by rash - Once the rash dries, the individual is said to not be contagious any more. 54th slide - Provide supportive care - Antipyretics ex. Tylenol, motrin - Make sure they stay hydrated - Comfort measures for itchiness and rash 55th slide - Very strong virus and can live on a fomites meaning it could live on a surface for a couple of hours - Found in mucus membranes so if someone coughs & they have it with their respiratory secretions , you have a high likelihood of contracting measles. 56th slide - Measles is characterized by a rash and cold like symptoms : weak, tired, conjunctivitis ( running of the eyes and pus coming out) koplik’s spots: white spots found inside the mouth. 57th slide - There is a vaccine for measles that will help prevent and slow it down a little bit. 58th slide - Mumps aren’t that common - Childhood vaccines : MMr ( measles, mumps & rubella vaccine ) - Facial swelling - Meningitis - Encephalitis ( swelling of the brain→ altered mental status) - Stiff neck - Testicular or ovarian inflammation - Myocarditis → inflammation of heart muscle - Kidney inflammation which could lead to kidney problems 59th slide - Post exposure is really meant to treat the symptoms so mostly supportive care 60th slide - Rubella was also called german measles, apart of that 3 part vaccination: MMR - Can cause a lot of birth defects in patients especially if the mother is not treated . 61th slide - Rubella is an airborne infection which means the droplets are small and they don’t weight much and are very light. - Can float through the air for long periods of time - People with immunocompromised have a higher incidence of contracting rubella - Signs and symptoms tender enlarged lymph nodes , achiness, tiredness, and a rash . 62nd slide - Post exposure is supportive care based on the symptoms - Encourage people to get their vaccinations and try to prevent as many incidents as possible. 63rd slide - Skin is very important when dealing with patients who get wounds 64th slide - Epidermis - Outer covering of stratified squamous epithelium - Dermis - Underlying layer of fibrous connective tissue - Subcutis or subcutaneous tissue -Deep layer of adipose tissue 65th slide - Each layer is composed of several different layers so when you say epidermis which is referring to an area which is the outer layer - Within each layer, there are several layers, and they each have their own function for making new skin, or making new cells. 66th slide - 67th slide - When there is a microorganism or pathogen that is trying to invade the body, the skin is the first line of defense because it protects all of our organs, and it should be all closed, NO openings, ALL closed. Integrity of the skin is very important in keeping people safe and preventing bacteria/microorganisms that are harmful from entering the body. 68th slide - So when someone is injured and we enter in the vascular phase, the body just starts sending fluids , it will direct blood flow and other fluids to that area in an attempt to protect it. 69th slide - The white blood cells will move in and attack or get rid of whatever is causing a problem . - Clinical signs of inflammation: redness, swelling, heat, pain, loss of function . - Usually due to the swelling , extra blood supply there , maybe swollen looking & puffy because of increase in blood supply and the blood vessels are very permeable , the blood seeps out through the thin membranes and you might feel a lot of warmth and heat, - Patient might be complaining of a lot of pain there - Nurse’s job is to record it and document it exactly how you see it. 70th slide - When we see wounds and the skin is open, that increases the person’s chance of getting bacteria inside the skin and into the bloodstream causing a systemic wide infection and in many cases its life threatening because it brings that infection to all of the vital organs. - Thats why its very important to prevent wounds and prevent injury and notice them soon on. 71st slide - Abscess is basically an opening in the skin and an infection and collection of pus ( usually dead white blood cells) go to that area, warm , sometimes an odor, very swollen and painful and may times if its still closed, it requires them to be lanced/ surgically opened to drain all of that fluid and all of that bacteria. Antibiotic might be applied directly to that area 72nd slide - Cellulitis is basically underneath the skin , its a redness, swelling, and discomfort of the skin - It could come from insect bite, rash ex, position ivy 73 slide - Ulcers also are openings in the skin, can be inside or outside the body. - Bed sores are also considered an ulcer - Integrity of a connective tissue has been compromised thereby leaving it susceptible to microorganisms . 74th slide - When the skin tries to repair itself , it’ll do it in a couple of different ways depending on the nature. - If it's a wound where the skin has broken down, once it's cleansed and all that dead tissue is removed , it’ll start to build itself back up again and begin granulating from the base up, building layer upon layer upon layer until it gets to that top layer. Many times a big scar will be left - If its a surgical incision or clean cut, that is primary intention instead of secondary - Many times the edges of the wound will come together and a small scar will be seen. - No loss of tissue , just a slice into skin & edges of that slice will be put back together. 75th slide - Tertiary intention sometimes requires the wound to be left open for an extended period of time. - Difficult type of repair process because the wound is open, poor circulation. - Many times abdominal wounds are left open in order for swelling to be reduced and excess fluid to be eliminated and then the wound will be closed - Many times they have to wait for layers to be built. - A Lot of abdominal wounds can also be sutured together with the hopes of primary intention which is less common 77th slide - Always wanna go from clean to dirty . - Prevent wounds from happening by changing patients every 2 hours to promote circulation. -Those who can’t turn themselves due to immobility or altered mental status are very susceptible to bed sores. Bed sores for the most part are completely preventable - Don’t leave our patients sitting in a chair for more than 2 hours without changing positions.
