MANANGEMENT OF PATIENTS WITH INFECTIOUS DISEASE

Intended Learning Outcomes

After taking this lesson, the students can:
1. Identify the chain of infection;
2. Define some infectious diseases and its clinical manifestations;
3. Identify diagnostic tests indicated for each infectious disease;
4. Determine possible management for each infectious disease;
5. Formulate a comprehensive Nursing Care Plan with the given patient scenario;
6. Appraise the importance of nurses in the current global health situation: Covid-19
Pandemic

Presentation of the Topic

This lesson presents the different infectious diseases, their manifestations, relevant
diagnostics, management and nursing interventions.

ARE YOU READY TO TAKE THE BATTLE AGAINST THE UNSEEN?

The Contents
ACTIVITY 1: Chain of Infection: Fill in the blanks.

1. __________________
Virus
Bacteria
Specific Age Group
Fungi
Immunocompromised
Parasite
With co-morbid

Respiratory Tract Humans

Skin Animals
Blood Environment

2. __________________
Respiratory Tract
Airborne Excretions
Droplet Secretions
Contact (Direct/indirect) Skin
Why know the CHAIN OF INFECTION?
o provides a basis for determining appropriate control measures
o control measures are usually directed against the segment in the
infection chain that is most susceptible to intervention, unless practical
issues dictate otherwise.
o Interventions are directed at:
• Controlling or eliminating agent at source of transmission
• Protecting portals of entry
• Increasing host's defenses

o For some diseases, the most appropriate intervention may be directed

at controlling or eliminating the agent at its source.
• A patient sick with a communicable disease may be treated with
antibiotics to eliminate the infection.
• An asymptomatic but infected person may be treated both to clear
the infection and to reduce the risk of transmission to others. In the
community, soil may be decontaminated or covered to prevent
escape of the agent.
o Some interventions are directed at the mode of transmission.
• isolation of someone with infection, or counseling persons to avoid
the specific type of contact associated with transmission
• elimination or decontamination of the vehicle
• efforts often focus on rearranging the environment to reduce the
risk of contamination in the future and on changing behaviors, such
as promoting handwashing
• modifying ventilation or air pressure, and filtering or treating the air
• measures may be directed toward controlling the vector population,
such as spraying to reduce the mosquito population
o Some strategies that protect portals of entry are simple and effective.
• bed nets are used to protect sleeping persons from being bitten
by mosquitoes that may transmit malaria
• mask and gloves are intended to protect from a patient’s blood,
secretions, and droplets, as well to protect the patient
• Wearing of long pants and sleeves and use of insect repellent
are recommended to reduce the risk of Lyme disease and West
Nile virus infection, which are transmitted by the bite of ticks and
mosquitoes, respectively.
o Some interventions aim to increase a host’s defenses
• Vaccinations promote development of specific antibodies that
protect against infection.
• On the other hand, prophylactic use of antimalarial drugs,
recommended for visitors to malaria-endemic areas, does not
 prevent exposure through mosquito bites, but does prevent
infection from taking root.
o Some interventions attempt to prevent a pathogen from encountering a
susceptible host
• The concept of herd immunity suggests that if a high enough
proportion of individuals in a population are resistant to an
agent, then those few who are susceptible will be protected by
the resistant majority, since the pathogen will be unlikely to “find”
those few susceptible individuals

COLONIZATION vs INFECTION vs DISEASE

Colonization: used to describe microorganisms present without host interference or
interaction.
Infection : indicates a host interaction with an organism.
Disease : the infected host displays a decline in wellness due to the infection.
Refer to your Community Health Nursing References
Preventing Community Infection
Immunization Program

International & National Organizations

CDC: Center for Disease Control
OHSA: Organizational Health and Safety Administration
PHICS: Philippine Hospital Infection Control Society
PHICNA: Philippine Hospital Infection Control Nurses’ Association

Healthcare-Associated Infections (Nosocomial Infections)

Specific Organisms with Potential to cause HAI
1. Clostridium difficile
2. Methicillin-Resistant S. aureus (MRSA)
3. Vancomycin-Resistant S. aureus
4. Enterococcus
❑ Vancomycin-Resistant Enterococcus

Preventing HAI-Bloodstream Infection (Bacteremia/Fungemia)

✓ Disinfect Skin
✓ Appropriate use of Guide Wires for Central Catheter
✓ Changing of Infusion Set, Caps and Solutions

ISOLATION PRECAUTIONS

1. Standard Precautions
❑ Hand hygiene (washing & rubbing)
 ❑ Appropriate use of PPEs (gloves, mask, eye protection, face shield,
gown)
❑ Handling of patient care equipment and linen
❑ Environmental control
❑ Prevention of injury from sharps devices
❑ Patient placement
2. Transmission-Based Precautions
❑ Airborne
❑ Droplet
❑ Contact
❑
Patient Requiring Precautions
STANDARD AIRBORN DROPLET CONTACT
All Patients • Tuberculosis • Invasive Haemophilus influenzae type • Gastrointestinal, respiratory, skin, or wound
• Varicella b disease, including meningitis, infections or colonization with multidrug-
(Chickenpox) pneumonia, epiglottitis, and sepsis resistant bacteria
• Measles • Invasive Neisseria meningitidis • Diphtheria (cutaneous)
disease, including meningitis, • Herpes simplex virus (neonatal or
pneumonia, and sepsis mucocutaneous)
• Other serious bacterial respiratory • Impetigo
infections spread by droplet • Major (noncontained) abscesses, cellulitis, or
transmission, including: pressure ulcers
• Diphtheria (pharyngeal) • Pediculosis
• Primary atypical pneumonia • Scabies
(Mycoplasma pneumoniae) Pertussis • Staphylococcal furunculosis in infants and
• Pneumonic plague young children
• Streptococcal (group A) pharyngitis, • Zoster (disseminated or in the
pneumonia, or scarlet fever in infants immunocompromised host)*
and young children • Viral and hemorrhagic conjunctivitis
• Serious viral infections spread by • Viral hemorrhagic infections (Ebola, Lassa, or
droplet transmission, including: Marburg)
• Adenovirus*
• Influenza
• Mumps
• Parvovirus
• B19 Rubella
PNEUMONIA
DEFINITION: inflammation of the lung
parenchyma
CAUSATIVE AGENT: various
microorganisms, including bacteria,
mycobacteria, fungi, and viruses.
Pneumonitis
➢ A more general term that
describes the inflammatory
process in the lung
tissue that may predispose
and place the patient at risk
for microbial invasion

CLASSIFICATION
1. Community-Acquired Pneumonia (CAP)
1.1. Occurs either in the community setting or within the first 48 hours after
hospitalization
1.2. Causative agents for CAP that needs hospitalization
1.2.1. streptococcus pneumoniae
1.2.2. H. influenza
1.2.3. Legionella
1.2.4. Pseudomonas aeruginosa.
1.3. Only in 50% of the cases does the specific etiologic agent become identified
1.4. Viruses are the most common cause of pneumonia in infants and children
2. Hospital-Acquired Pneumonia (HAP)
2.1. nosocomial pneumonia or healthcare-associated pneumonia
2.2. The onset of pneumonia symptoms more than 48 hours after admission in
patients with no evidence of infection at the time of admission
2.3. Most lethal nosocomial infection and the leading cause of death in patients with
such infections
2.4. Common microorganisms
2.4.1. Enterobacter species
2.4.2. Escherichia coli
2.4.3. Influenza
2.4.4. Klebsiella species
2.4.5. Proteus
2.4.6. Serratia marcescens
2.4.7. S. aureus
2.4.8. S. pneumonia.
2.5. The usual presentation of HAP is a new pulmonary infiltrate on chest x-ray
combined with evidence of infection.
3. Pneumonia in the Immunocompromised Host
3.1. Includes Pneumocystis pneumonia, fungal pneumonias and Mycobacterium
tuberculosis
 3.2. Immunocompromised patients commonly develop pneumonia from organisms
of low virulence.
3.3. may be caused by the organisms also observe in HAP and CAP.
4. Aspiration Pneumonia
4.1. Refers to the pulmonary consequences resulting from entry of endogenous or
exogenous substances into the lower airway
4.2. most common form of aspiration pneumonia is a bacterial infection from
aspiration of bacteria that normally reside in the upper airways
4.3. may occur in the community or hospital setting.
4.4. Common pathogens are S. pneumonia, H.influenza, and S. aureus.
PATHOPHYSIOLOGY
✓ Pneumonia arises from normal flora present in patients whose resistance has
been altered or from aspiration of flora present in the oropharynx.
✓ An inflammatory reaction may occur in the alveoli, producing exudates that
interfere with the diffusion of oxygen and carbon dioxide.
✓ White blood cells also migrate into the alveoli and fill the normally air-filled
spaces.
✓ Due to secretions and mucosal edema, there are areas of the lung that are not
adequately ventilated and cause partial occlusion of the alveoli or bronchi.
✓ Hypoventilation may follow, causing ventilation-perfusion mismatch.
✓ Venous blood entering the pulmonary circulation passes through the under
ventilated areas and travels to the left side of the heart deoxygenated.
✓ The mixing of oxygenated and poorly oxygenated blood can result to arterial
hypoxemia.
PNEUMONIA: NURSING PROCESS
ASSESSMENT HISTORY PHYSICAL DIAGNOSTICS INTERVENTIONS
EXAMINATION
✓ history of a recent General Appearance Sputum Culture and Airway management
upper respiratory Sensitivity
infection, influenza, or level of fatigue, Anxiety reduction
a viral syndrome presence of cyanosis, Chest X-ray
and presence of Oxygen therapy
✓ history of a chronic Arterial blood gases,
pulmonary disease, dyspnea or tachypnea Airway suctioning
complete blood count,
such as asthma, extremities, torso, and blood cultures, Airway insertion and
bronchitis, or face for rash bronchoscopy stabilization
tuberculosis;
✓ prolonged immobility; Cough enhancement
✓ sickle cell anemia; rapid, weak, thready PRIMARY DIAGNOSIS Mechanical ventilation
✓ neurological disorders pulse; fever; and blood
that cause paralysis of pressure changes such Ineffective airway Positioning
the diaphragm; as hypotension and clearance related to
✓ surgery of the thorax increased production of Respiratory monitoring
orthostasis (postural
or abdomen; secretions and
✓ smoking; hypotension) increased viscosity
✓ alcoholism; EVALUATION
 ✓ IV drug therapy or Palpate the chest to Physical findings of chest
abuse; and determine any areas of assessment: Respiratory
✓ malnutrition. consolidation or tactile rate and depth,
✓ any history of fremitus auscultation findings,
exposure to noxious chest tightness or pain,
gases, aspiration, or vital signs
immunosuppressive Percuss the chest to
therapy. Assessment of degree of
detect dullness over the hypoxemia: Lips and
✓ major symptoms of area of consolidation
pneumonia: cough, mucous membrane color,
fever, sputum auscultate the patient’s oxygen saturation by
production, chest pain, breathing, listen for pulse oximetry
and shortness of rales, crackles, ronchi, Response to deep-
breath. and wheezes; “E” to “A” breathing and coughing
✓ describe the type of changes; and whispered exercises, color and
cough and the nature pectoriloquy amount of sputum
of the sputum
production. Response to
✓ location of any pain, medications: Body
especially chest pain. temperature, clearing of
✓ sore throat or chills, secretions
vomiting, diarrhea, or
anorexia.

APPLICATION: TO BE PUBLISHED IN SCHOOLOGY

Will be published in Schoology