Epidemiology refers to the study of distribution and patterns of disease in populations.

. Infectious diseases are caused by invasion of PATHOGENS (Microorganisms capable of causing disease). How microorganism cause disease? 1. the ability of microorganism to invade or attach to the host cell 2. they produced toxins 3. our body response to microorganism

Age (very young and very old) Poor nutrition Immune deficiency (congenital or acquire) Impaired integrity of skin or mucous membrane Circulatory disturbances Alteration of normal flora by antibiotic therapy Diabetes mellitus Corticosteriod therapy Chemotherapy Smoking Alcohol consumption

1.
2. 3.

4.
5. 6.

Entry Attachment Multiplication Invasion or spread Evasion of the host defense Damage to host tissue

Bacterial, Viral, and Mycoplasma infection a. Fever (may be low grade, esp. with viral infection) b. Body aches c. Regional lymph node enlargement d. Site-specific manifestation

Fungal infection
Itching/redness of skin b. Nail thickening c. Thrush in the mouth d. Vaginal discharge (thick, white)
a.

Protozoa and Helminths a. Itching and rash (skin infection) b. Diarrhea c. Fever (malaria)

Rickettsiae
Skin rash b. Muscle aches c. Fever and chills d. headache
a.

Pathophysiology

Viral particles are called virions and consist of a single strand of DNA or RNA contained within a protein shell called capsid Viruses are classified as either DNA or RNA viruses according to their genetic material; they are also categorized according to mechanism of replication, mode of transmission, or type of disease produced Viruses produce specific diseases in specific tissue Viruses may damage or kill cells they infect, causing disease The viral replication cycle can be relatively brief (minutes or hours) or as long as several days (absorption, penetration, uncoating, replication, assembly, and release) Viruses bind to cell membrane receptors, leading to endocytosis of the virus; the virus then uses the cells resources to synthesize new viral nucleic acids that are released from the host cell to infect other cells. Retroviruses replicate in a unique process

Bacteriophages are viruses that use bacteria as their hosts; these viruses attach to the bacteria and inject their DNA into the cell for replication Viral infection can be local or systemic and can be either acute or chronic Viral infection stimulates antibody production primarily through cellmediated immunity and production of interferon Antiviral therapy is difficult to develop because of the large number of variant viruses that cause the same disease and inability of medications to destroy the virus without destroying normal cells.

Complete Blood Count

Lymphocytes increases in many viral infections T-lymphocytes will decrease with HIV/AIDS virus, autoimmune disorders, and corticosteroids Neutrophil counts will decrease in most viral infections

Pathophysiology

Bacterial growth depends on the bodys immune system function and ability of bacteria to resist body defenses Bacteria may produce substances that enhance resistance to host defenses (adherins, capsule, leukocidins, enzymes) Bacteria may produce toxins that cause damage to cells and tissues (exotoxins and endotoxins) Complement proteins may be activated by contact with bacterial cell wall or with release of endotoxins

CBC
WBC will be elevated Neutrophil count (ANC) is elevated with most bacterial infections Culture and Sensitivity Aids in identifying the organism and determining the antibiotic that can be most effective Gram stain Allow presumptive identification of the category of bacteria

Pathophysiology

Fungi obtain nutrients by absorption and most of all are aerobic and reproduce by spore The plasma membrane contains ergosterol rather than cholesterol, which is useful in antifungal therapy Humans have a high level of innate immunity to fungi, and most infections are mild and self-limiting Infections are classified according to three levels (superficial, cutaneous, subcutaneous) Fungal infections can also be systemic Opportunistic mycotic infections are often seen in immunocomprimised individual or those on long-term antibiotic therapy Transmission is through direct contact with person or inanimate objects Moisture increases the risk of growth and spread of fungal infections

Cultures of skin, nails, or hair Microscopic examination of scraping from lesions Observation under ultraviolet light (spore fluorescent blue-green)

Pathophysiology

Mycoplasma are generally slow growing but vary widely in growth rates; they require fatty acids (sterol) and serum protein for growth and generally adhere to mucosal epithelium Mycoplasma pneumonia occur most often in children, young adults, and the elderly.

Diagnostic tests

Cold agglutinin antibody titer may be done but is insensitive and nonspecific Enzyme immunoassay (EIA): positive Chest x-ray will show infiltrates

Pathophysiology

The organism surrounded by a waxy capsule that is hard to penetrate The organism may form branches of a fungal nature Are classified as common intracellular parasites; able to survive and grow within a macrophage Humans are the only natural host The response to the cell includes tissue damage as a result of chronic inflammation M. tuberculosis an aerobic acid-fast rod (respiratory droplets) M. leprae (contact) M. avium-intracellulare (respiratory tramission from soil,water, dairy products, birds and mammals)

Sputum analysis: culture and sensitivity as will as AFB CXR Skin lesion biopsy Leprosy lymphocyte transformation test leukocyte migration inhibition test Tuberculosis positive TB skin test

Pathophysiology

cestode infections are caused by tapeworms living in the intestine Nematodes are elongated, unsegmented, cylindrical worms Trematodes are unsegmented, flat, leaf-shape d worms that require asexual reproduction in a snail intermediate host

Diagnostic test Examination of stool specimens of ova, cysts, and parasite CT scan CBC: eosinophilia

Pathophysiology

Protozoans reproduce asexually by fission, schizogony (multiple fission), or budding The most common type of infections caused by protozoa are amebiasis, giardiasis, malaria, toxoplasmosis, and pneumocystis carinii pneumonia Amoeba are transmitted by the fecal-oral route Giardiasis is the most common protozoan intestinal disease in the US and is also transmitted through fecal-oral Malaria is caused by a particular genus of protozoa called plasmodium and is transmitted through the a bite of an infected mosquito Toxoplasmosis is acquired through ingestion of cysts from cat feces, by ingesting uncooked meat or unpasteurize dairy products, or through blood transfusion Pneumocystis jerovici (also known as pneumocystis carinii) pneumonia results from a protozoan that produces cyst in the lungs of several animal species and is increasingly common in immunocompromised individuals

Diagnostic test

Amoeba and giardiasis: note presence and morphology of cysts in fecal smear Malaria: observe erythrocytic stages on blood smear; CBC Toxoplasmosis: serologic studies (indirect fluorescent antibody, indirect hemagglutination assay, ELISA) Pneumocystitis: lung tissue biopsy or needle aspiration

Pathophysiology

Infections may remain latent for years Humoral and cell-mediated immune responses are activated and may decrease spirochete load, but generally will not eliminate disease Most common spirochete are treponema pallidum and borrelia burdorferi Treponema pallidum causes sexually transmitted infection (syphillis) Borrelia burgdorferi causes lyme disease, the most common ticktransmitted disease

Diagnostic test

Cultures (may take 8 to 12 weeks) Serologic testing for antibodies (may be negative in early stage) include ELISA and indirect fluorescent antibody test

Pathophysiology

Rickettsiae are extremely small rod-shape,coccoid, or pleomorphic bacteria that are intracellular parasite because of a highly permeable cytoplasmic membrane They typically consist of three layers: an inner cytoplasmic membrane, a rigid cell wall, and an outer layer, and they multiply by binary fission Clinical manifestations are believed to be caused by production of endotoxin Untreated cases result in a 20% to 25% fatality Signs and symptoms include skin rash, headache, malaise, muscle aches, chills and nausea and vomiting; fever of sudden onset may last 2 to 3 weeks

Diagnostic tests Complement fixation test (may be positive within 14 days) Indirect fluorescent antibody test (detects IgM and IgG antibodies)

 What

are some human diseases caused by bacteria and what are their respective modes of transmission?

The main human bacterial infections transmitted by respiratory secretions (sneezes, cough) and saliva drops are: bacterial pneumonias, tuberculosis, whooping cough (pertussis), diphtheria, bacterial meningitis. Main bacterial diseases transmitted by blood or sexual contact are: gonorrhea, syphilis. Main bacterial diseases transmitted by animal vectors are: bubonic plague, endemic typhus, leptospirosis. Some bacterial diseases transmitted through fecal-oral route and contaminated food are: cholera, typhoid fever. Other important bacterial infections: Hansen's disease, possibly transmitted by saliva drops and contact with injured skin and mucosae; trachoma, eye disease transmitted by ocular secretions; tetanus, transmitted when the etiological agent enters the body through skin wounds. Now there are medicines like Azithromycin that aid in the fight against bacterial infections but it is still important to understand where they came from.

 What

is tuberculosis? How is the disease transmitted? Is there treatment for tuberculosis?

Tuberculosis is a disease caused by the Mycobacterium tuberculosis, bacteria which attack other organs of the body but mainly the lungs leading to respiratory insufficiency. Tuberculosis is highly contagious, transmitted by air route through sneezes and coughs from a person with the active disease. Transmission is common between members of the same family or even in work environments. The disease today has treatment with efficient antibiotics. Generally, the patient receives three different drugs for several months until healing is complete. There are however some strains of multiresistant TB bacteria that emerged by mutation and natural selection due to the intense use of antibiotic drugs mainly in hospitals and treatment facilities; in these cases the treatment is more difficult.

 Is

there vaccine against tuberculosis?

The vaccine against tuberculosis is called BCG (bacillus Calmette-Gurin). BCG is not used in some countries where tuberculosis is not so prevalent because it can distort later diagnostic studies of the disease; in other countries, like Brazil, it is obligatory for children. The vaccine is made of attenuated TB bacteria.

 Are

all pneumonias caused by bacteria?

 Pneumonia

is the generic name of inflammation of the lungs. Besides bacterial pneumonias, there are pneumonias caused by virus, fungi, toxic pneumonias, etc.

 What

is Hansens disease (etiological agent, mode of transmission, clinical manifestations and prevention)?

The etiological agent of Hansens disease is bacteria called Mycobacterium leprae. The mode of transmission is not yet totally known but it is believed that respiratory secretions and saliva drops can spread the disease. Hansens disease is a chronic disease (slow progression) that generally attacks the skin and the peripheral nerves although other areas of the body can be affected. In the skin nodules, reddish spots, thickening of the dermis and lack of sensitivity appear; the mucosae, especially the nasal mucosa, may be injured and also the viscera may be affected. The main form of prevention is information, since there is available treatment; infected people should, as soon as possible, look for health services for evaluation and treatment of the disease.

 What

is the etiological agent and the main manifestations of cholera?

Cholera is a bacterial disease caused by the Vibrio cholerae. The disease is transmitted by fecal-oral route and the main mode of transmission is ingestion of contaminated water or food. It is most prevalent in places that lack adequate sanitary conditions. Inside the human gut the cholera vibrion releases toxins called enterotoxins. The infection can cause intense diarrhea, vomiting, dehydration and even death in more severe cases.

 What

is meningitis?

Meningitis is the generic name given to inflammation of the meninges, membranes that cover the central nervous system. Meningitis can have several causes (infectious, toxic, traumatic, neoplastic infestation, autoimmune). Bacterial infections caused by meningococcus, haemophilus, pneumococcus or by tuberculosis bacteria are severe and contagious. The main symptoms of bacterial meningitis are high fever, nuchal rigidity, intense headache, vomiting and sometimes convulsions. The disease should be treated with antibiotics.

What

is syphilis?

Syphilis, also known as lues, is a disease caused by the bacteria Treponema pallidum. Before the discovery of penicillin, syphilis was a fatal disease. Today the use of antibiotics can cure the disease completely. Patients with primary syphilis present a single and painless wound in the skin, sometimes called chancre, in the region where the treponema has penetrated; the chancre is highly infective. Syphilis is one of the main STDs, sexually transmitted diseases. Generally the chancre develops in the penis, vagina, anus, hands or mouth, and the bacteria is often transmitted by sexual contact. Later syphilis develops into systemic diseases, secondary and tertiary syphilis. Syphilis can also be transmitted by blood transfusions, accidents with contaminated objects and vertically from the mother to the child (congenital syphilis). It is very important for patients with the disease to seek treatment as soon as possible and to undergo tests to look for other STDs, like HPV and HIV infections.

 What

is an antibiogram?

Antibiogram is a laboratory test intended to guide the choice of adequate antibiotic to treat a given bacterial infection. In the antibiogram cultures of bacteria obtained from tissues contaminated by the infection under study are submitted to the action of different antibiotics. After some time it is verified which of the antibiotics were successful in interrupting the bacterial growth or in killing the bacterial population. The antibiogram is very important to avoid exaggerated and inefficient use of antibiotics and the emergence of multiresistant bacteria.

 Identify

conditions that could lead to opportunistic infection?

Ans: clients with immune deficiency disorders, client receiving chemotherapy, or clients receiving long-term corticosteroid therapy are often those who contract opportunistic infections. In all of these states, the immune system, which normally defends against pathogens, is suppressed and unable to perform normally.

 What

are the implications of the presence of latent or recurrent viruses?

Ans: some viruses enter the host cell and inserted their genome into the chromosome of the host, remaining in a latent, nonreplicative state for long periods of time. A virus can remain communicable during recurrence. Stress increases the recurrence of latent or recurrent viruses. The lack of symptoms may be problematic in that the client is contagious and does not know it. Also, a virus can recur and be more virulent than the first time, without a cure.

 What

are some examples of descriptions of bacteria in terms of shape? Staining characteristics? Requirement for oxygen?

 Ans:

bacteria may be described as cocci (spherical), bacilli (rod-shape), clavate (club-shape), or spirochetal (corkscrewshape). Staining characteristics include gram-positive and gran-negative characteristics. Typically gram-negative are more virulent. Bactria may also be classified as aerobic or anerobic.

 How

would tropical corticosteroids aggravate treatment of a fungal infection?

 Ans:

corticosteroids are immunosuppressant and therefore enhance the growth of fungal skin infections. A fungal infection as well as tuberculosis will be exacerbated if corticosticosteriod is used.

 What

is he most severe and life-threatening complication of infestation with worms?

 Ans:

intestinal obstruction can occur with helminth infestation nd can be life-threatening event. The organisms may also affect other organs: cestode (brain), nematodes (alveoli), trematodes (blood vessels, intestines, liver, and lungs).

 A client

has been diagnosed with acne. What self-care strategies should the nurse explain?

Ans: instruct the client to was the skin with a mild soap and water at least twice a day to removed accumulated oils. Eat a regular, wellbalance diet. Exposing the skin to the sun may help but sunburn should be avoided; get regular exercise and sleep. Do not squeeze the pimple; this causes the material to go deeper into the skin and usually the pimples get larger and infected. The client should be instructed to be patient because treatment for acne can take months for a noticeable difference.

 A client

is being discharged home after hospitalization for cellulitis. What specific discharge instructions should be given?

Ans: Stress the importance of good nutrition and cleanliness through good handwashing and proper disposal of dressing. Teach the client never to squeeze or try to open the infected area. Teach the client signs and symptoms that should be reported such as fever, swelling, redness, pain, and drainage. Teach the importance of taking the full course of medication that has been prescribed.

 A client

has been diagnosed with herpes simplex type II (HSV II). What explaination should be given about this disease?

Ans: Explain the natural history of the disease with emphasis on recurrent episode,asymptomatic viral shedding, and sexual transmission. Antiviral therapy can be used on an episodic basis or as suppressive therapy.stress the importance of use of condom during sexual intercourse, but the need to abstain from all sexual activity when lesion or prodromal symptoms are present.

 A client

with pneumonia continues to run a temperature of 102F to 103F even after taking an antibiotic for 3 days. What could account for this and what should be done?

Ans: either the antibiotic is not the correct treatment for the type of organism causing pneumonia or the pneumonia is viral in nature. A culture and sensitivity should be obtained to identify the organism causing the problem and to ensure sensitivity of the antibiotic to the organism. If the problem is viral pneumonia, antibiotics will not usually help. Any time fever persist after an individual has been on an antibiotic for at least 72 hours, additional considerations should be made.

 A female

visits the emergency department because of symptoms of gonorrhea. She admits that she practices prostitution and has never been tested for HIV. Why would a tuberculosis skin test be an appropriate order as a part of the diagnostic workup?

 Ans:

remember that two groups at risk for tuberculosis are the disadvantaged and HIV-positive individuals. This client carries those risk factors and could be HIV-positive without knowing at this time. Also, females with sexually transmitted infections often test positive for resistant strain of TB.

 A client

has bacterial meningitis caused by streptococcus pnuemoniae. What measures should the nurse institute to protect the client, healthcare professionals, and others?

Ans: consult and follow the infection control policies and procedures recommended by the facility. Isolation is no longer recommended in most cases. Careful standard precautions are always important to protect the client and nurse with exception of meningococcal meningitis. Good handwashing, use of gloves, and proper disposal of waste products ahould be initiated. Infants and pregnant women should always avoid any potential risk.

 How

should the nurse determine if a client is developing ascites? What lab data are important?

Ans: determination of ascites can be made through objective observation of the size and contour of the abdomen, weight gain, firmness to the abdomen, taunt skin over the abdomen, distant, low-pitched bowel sounds, intake greater than output, and daily increase in the measurement of the abdominal girth. Subjectively, the client may complain of fullness or back pain. Lab data should include: serum albumin, protein, electrolytes, and test specific to the cause such as liver function tests for cirrhosis or hepatitis.

 A client

asks,how can I keep from developing hepatitis B? what should the nurse tell him?

Ans: hepatitis A and E can be prevented by avoiding contaminated food and water, by avoiding situations in which one might come in contact with food handler who do not use the necessary precautions. The client should also avoid contact with possible contaminated shellfish. Hepatitis B,C, and D may be voided by preventing contact with contaminated blood and bpody fluids. This includes needles, syringes, pooled blood, and unprotected sexual activity.

 A client

tells the nurse that she has frequency and burning on urination. What assessment should the nurse make? What instructions should the nurse give her?

Ans: obtain history of present illness: duration of symptoms, history of kidney stones, previous UTI, kidney or bladder disease; past history of diabetes, hypertension, allergies, pregnancy,; last menstrual period, use f birth control methods, date of last sexual contact, history of new sex partner; assess recent medication use including antibiotics; family history of kidney disorders; inquire about diet: caffeine or carbonated drinks and water intake. Instructions should include the following: take the medication as prescribed; explain the indications of medications and side effects ; increase water intake to at least 8 glasses of water per day; avoid foods and beverages that contribute to urine acidity, which my promote bacterial growth, explain the importance of follow up urinalysis to assure resolution of infection; and teach women hygein measure to prevent contamination or irritation.

 A client

present with a diagnosis of septic shock.When would antibiotics be initiated and what classification of therapy would be given?

 Ans:

a braod-spectrum antibiotic is usually given initially as soon a diagnosis is made. Narrow-spectrum antibiotic cannot be initiated until culture and sensitivity is made, which then confirms the actual diagnosis. It is imperativwe to collect all culture prior to the start of any antibiotics

 A 7-year-old

child with asthma is placed on beclomethasone (Vanceril) as a maintainance inhaler. What is the major concern for a child taking this medication?

Ans: Beclomethasone (Vanceril) is a steroid: am common as well as concerning side effect in children is growth retardation. A childs asthma may require a medication on a daily basis as strong as the steroid. A decline in height and weight has been documented while children are on continuous doses of steroid therapy, and these should be monitored monthly.

A young man was exposed to HIV infection 4 weeks ago. His ELISA test is negative for antibodies to HIV. a. What conclusions can be drawn from this finding? b. Does any follow up need to be considered? If so, what?