1.

1 Overview & Outcomes

Concepts

Primary Concepts: Infection Interrelated Concept: Immunity

Exemplars: Tuberculosis, Otitis Media, Hepatitis, Shingles: Chicken Pox, Herpes Zoster

Learning Outcomes

1. Demonstrate understanding of the pathophysiology, clinical manifestations, diagnostic

evaluation, and therapeutic management options associated with the highlighted exemplars.

EXEMPLAR & PATHOPHYS CLINICAL DIAGNOSTIC THERAPEUTIC MANAGEMENT

Tuberculosis
Multiplication of the bacillus
Mycobacterium tuberculosis
causes an inflammatory
process where
deposited. A cell-mediated
immune response follows,
usually containing the
infection in 2-8 weeks. The
T-cell response results in the
formation of granulomas
around the bacilli, making
them dormant. This confers
immunity to subsequent
infection. Bacilli w/i
granulomas may remain
viable for many years,
resulting in a positive
purified protein derivative
or other skin test for TB.
Transmission occurs via
airborne droplet nuclei
when a person with active
disease coughs or sneezes.
Otitis Media
An infecting agent in the
middle ear causes
inflammation of the
MANIFESTATIONS EVALUATION
Persistent cough, fatigue, ‣ Tuberculin skin test
nausea, irregular menses, result is positive in active
unintended weight loss, & inactive (latent) TB.
anorexia, night sweats, ‣ T-SPOT TB test
hemoptysis, shortness of identifies interferon-
breath, fever, or chills. gamma response to
Chest tightness and a specific
dull, aching chest pain Mycobacterium tb
with cough. Lung proteins to detect
auscultation may be dull, infection.
crack or wheezing ‣ QuantiFERON-TB gold
test or interferon gamma
N: not able to sleep release assay detects
I: intense chest pain latent TB infection.
G: gross sputum (bloody) ‣ Stains & cultures of
H: history of influenza sputum, cerebrospinal
T: travel to TB prevalent fluid, urine, abscess
areas drainage,
S: sweats at night or pleural fluid show
W: weight loss heat-sensitive,
E: extra effort to breathe nonmotile, aerobic, acid-
A: anorexia fast bacilli.
T: tightness in chest ‣ Chest radiography
shows nodular lesions,
patchy infiltrates, cavity
formation, scar tissue, &
calcium deposits; may be
normal in primary
infection
-ear pain caused by Otoscope is used. Ear
increased pressure drum becomes bulging,
-reduced conductive red thickened, immobile.
hearing Pus may be visible. The
-tinnitus in the form of a eardrum blood vessels
‣First-line drugs:
Antitubercular tx for atleast 6-9
months isoniazid, rifampin,
pyrazinamide, plus ethambutol,
Myambutol or
streptomycin in some cases
‣Second-line drugs:
Capreomycin, Streptomycin,
Ethionamide, Aminosalicylic acid,
Pyrazinamide, Cycloserine
‣Alternative agents:
levofloxacin,
moxifloxacin.
Hydrochloride, linezolid (Zyvox), or
meropenem-clav. for
tx of multidrug or
highly drug-resistant TB
-bedrest, application of low heat
-systemic antibiotic therapy
Aspirin, ibuprofen, and Tylenol for
pain and fever.
mucosa, leading to swelling
and irritation of the ossicles
within the the middle ear,
followed by a purulent
inflammatory exudate.
Acute last 3 weeks or less.
Hepatitis
-inflammation of the liver
Caused by genetic diseases,
meds (including OTC), and
alcohol.
Hepatitis viruses (ABCDE)
Shingles: Chicken Pox &
Herpes Zoster
Herpesvirus
-primary infection in lymph
nodes, secondary infection
in keratinocytes and
neurons in skin.
Travels retrogradely to
ganglia
-remains dormant
Chickenpox
-rash on scalp, face & trunk
-macules, papules, vesicles,
and scabs
low hum or a low-pitched
sound
-h/a and dizziness
-malaise, fever, n/v
GI symptoms (n/v,
stomach pain, loss of
appetite)
Jaundice
Fever/Fatigue
Dark urine/ clay-colored
stool
Joint pain  ONLY A & B have post exposure
Chicken Pox
Fever, h/a, & overall
weakness
Skin lesions appear on
scalp, face, trunk.
(flat, red, itchy spots 
macules, elevated 
papules, small, fluid-filled
vesicles.)
Within 1-2 days, vesicles
begin to crust over &
form scabs. After 5 days,
the scabs fall off. Lesions
are continuously forming.
Painful sores on mucosal
surfaces, (mouth)
dilate and appear red. For severe cases, myringotomy is
performed to drain middle ear
fluids which immediately relieves
pain
Detection of the virus or A & E: can only be acute so just
its antibodies in the supportive and rest.
blood
Elevated levels of serum B, C, & D: can be acute or chronic.
enzymes (AST, ALT), All treatments can include antiviral
serum bilirubin and/or interferon
immunoglobulin. For A, you have 2
weeks to receive it. For B, you
have 12 hours.
‣ Hep B: Alpha interferon,
lamivudine (epivir),
adenovir, bed rest,
nutritional support, Hep B
immune globulin, Hep B
vaccine. Do not give the
Hep B IG and vaccine in
the same injection or the
same site.
‣ Hep C: Interferon,
Ribavirin, restrict animal
protein.
Diagnosed based on the Topical antipruritic medications
way the skin lesions Analgesics & anti-inflammatory
appear. medications
Tzanck test  Aspirin should not be used  reye
multinucleated giant cells syndrome
in fluid of vesicles. Antivirals (acyclovir, famciclovir,
Blood test for varicella valacyclovir)
antibodies. Varicella-zoster immune globulin
PCR to look for viral DNA (VZIG)
Varicella vaccine used to prevent
chickenpox
Zoster vaccine to prevent shingles
Herpes zoster or shingles
-Reactivation of virus
-Vesicles located along one
dermatome.
Shingles
Pain, itching, or tingling
in the area where the
rash will develop
Single stripe of vesicles
around either left or right
side of the body.
One side of the face
4 wks for the rash to
disappear

2. Create a patient-centered plan of care including interventions to prevent complications for

patients with the listed exemplars.

EXEMPLAR PREVENT COMPLICATIONS

Tuberculosis Seek treatment, take medication as prescribed.
Otitis Media Encourage adults to remain current on all immunization boosters and to receive the
flu and pneumococcal vaccines as indicated.
-proper handwashing
-if left untreated permanent conductive hearing loss may occur
Hepatitis Diet: high calorie, high carbohydrate, moderate protein and fat with supplementary
vitamins, less protein. Seek treatment, chronic hepatitis can cause cancer, cirrhosis
Shingles: Chicken Pox & Keep skin clean, receive vaccines, proper handwashing.
Herpes Zoster

3. Examine the impact of infection related health problems on patients and their families including
both physiological and psychological elements.

4. Discriminate the differences in nursing care required for a patient with a pathogenic infection
versus a patient with an opportunistic infection.

Pathogenic Infection: infection caused by a pathogen which causes disease to the host.

Opportunistic infection: infection caused by non-pathogenic microorganisms which become pathogenic

when the immune system is impaired by an unrelated disease.

5. Integrate assessment findings with nursing interventions to form a plan of care and teaching
guidelines for the patient with the following disease processes:

 Tuberculosis:

‣ Isolate the patient in a quiet, properly ventilated room. Institute airborne precautions for pulmonary
‣ Properly dispose of secretions; encourage respiratory hygiene measures.
‣ Provide adequate rest periods.
‣Cluster activities to provide for adequate rest.
‣ Provide well-balanced, high-calorie foods & foods high in iron, vitamin C and protein.
‣ Provide small, frequent meals.
‣ Perform chest physiotherapy. Encourage frequent coughing and deep-breathing exercises.
‣ Obtain specimens for laboratory testing, such as sputum cultures, as indicated.
‣ Notify the local health department if required by state regulations.

 Hepatitis
‣ Management usually occurs at home.
‣ Help the patient cope with fatigue, nausea, fatigue.
‣ Have the patient contact the HCP if symptoms worsen
 Otitis Media

‣ Positioning- have the child sit up, raise head of pillows, or lie on unaffected ear.
‣Heat application- applying heating pad or a warm hot water bottle
‣diet- encourage breastfeeding of infants as breastfeeding afford natural immunity to infectious agents;
position bole-fed infants upright when feeding
‣teach family members to cover mouths, and noses, when sneezing or coughing and to wash hands
frequently.
 Varicella-Zoster: Chicken Pox & Shingles.

‣ Tx approaches include supportive measures, antiviral therapy, and management of secondary

bacterial infection
‣ keep skin, lesions, and hands clean when applying topical medication.

6. Compare and contrast the transmission of hepatitis viral infections.

A - comes out your ass (fecal to oral transmission)

B-blood or booty call
 C- IV drug use CRACK COCAINE
D- can only get if you have B
E- waterborne (can only get E where Elephants live)

E and A have a shorter incubation period

7. Explain ways in which each type of hepatitis can be prevented.

 Vaccines for A and B

 Immune globulin (IG) 14 days post exposure to A
 Hepatitis B immune globulin (HBIG) 14 days post exposure to B
 Must have Hep B to acquire Hep D; so hep b vaccine will prevent D as well

8. Discuss the nursing considerations and indications for common tuberculosis medications:

Drug Nursing considerations

Isoniazid (INH)
Rifampin (RIF)
Pyrazinamide (PZA)
Ethambutol (EMB
Used in combination with other antiTB drugs. Can cause peripheral neuropathy,
especially in malnourished pts, hepatitis, hyperglycemia, hyperkalemia,
hypophosphatemia, and hypocalcemia.
Used in combination with other antiTB drugs. Best taken on an empty stomach.
Contents of capsules may be mixed with applesauce or Jelly. Turns body fluids
orange, as well as soft contact lenses.
Used in combination with other anti TB drugs. Can be given without regard to
meals; promote fluid intake to degrees renal complications. Common adverse
effects include hepatitis w patients exhibiting abdominal pain, fatigue, anorexia,
nausea or vomiting, jaundice, icteric, dark urine. May also cause photosensitivity,
angioedema, hepatic failure, and thrombocytopenia. Monitor LFTs & serum uric
acid
Used in combination of other antiTB drugs, a common adverse effect is eye
damage that causes blurred or changed vision, including color vision. Pt may
experience dizziness, confusion, hallucinations, and joint pain.