3 2024 Infection Control Nclex RN Handout

1/12/24
The Ray A. Gapuz Test Prep System for the NCLEX RN The Ray A. Gapuz Test Prep System for the NCLEX RN
Success Formula for Today
CHAIN OF INFECTION
CHAIN OF INFECTION HOW TO BREAK THE CHAIN OF

INFECTION
Figure B.1-1. The Chain of Infection.
QUESTION
Which of the 295

conditions It’s either you know it
requiring isolation precautions or you don’t.
listed by the CDC, should I
master for the NCLEX RN?
© The Ray A. Gapuz Test Prep System for NCLEX RN
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Functional Concept ® REMINDER

The first sign of ORF
virus in humans is a To receive a pdf file of the
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FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM
Functional Concept ®
STANDARD PRECAUTIONS
POINTERS FOR THE Standard precautions are
primarily implemented for the
protection of HCW!
NCLEX-RN
Functional Concept ® Functional Concept ®

Implementation of standard precautions require:
1. Hand washing before and after client contact
Standard precautions are 2. Wearing of gloves when touching blood, body
implemented when providing fluids, non-intact skin, mucous membranes,
contaminated items and when performing
care to all individuals, with or vascular access procedures like phlebotomy
3. Wearing a surgical mask and goggles or face
without symptoms of infection. shield if there is reasonable chance of splashing
of blood or body fluids in the eyes, mouth, or
nose
4. Wear a gown if skin or clothing is likely to be
soiled or exposed to blood or body fluids
FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM
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CONDITIONS REQUIRING
Functional Concept ® STANDARD PRECAUTIONS
Standard precautions are implemented for the DIAGNOSIS NURSING ALERT
following conditions: Wear latex gloves when handling feces, urine saliva
Hepatitis A,B,C,D,E,G
B otulism and blood
Giargia lamblia (AGE) Use contact precautions for diapered and incontinent
R abies clients
A IDS Lyme disease No person-to-person transmission

moebiasis Bubonic form is the most common and is
nthrax Plague characterized by painful swollen lymph nodes
Avoid contact with infected body fluids and tissues
T oxoplasmosis No specific treatment. Acetaminophen or ibuprofen is
Roseola infantum given to control the fever
oxic shock syndrome
S higellosis West Nile Virus No vaccine, no specific treatment
almonella From: CDC
LET’S
Hepatitis A,B,C,D,E,G all require

standard precautions.
TYPES OF HEPATITIS
A B C D E G
Acute infection does Acute to Acute to chronic Post or with hepa B, Acute does not Rare can
not progress to chronic acute to chronic progress to chronic progress to
chronic chronic
HAV and IgM HBV HCV HDV HEV HGV
Blood borne Severe in Risk for cirrhosis in Common in Common in Asymptomatic

transmission is adults above 60 alcoholic males migrants developing countries
uncommon >50 Refugee camps
Common to
international travelers
15 to 50 days 60-150 days 2 weeks to 6 3-7 weeks 15-60 days Unknown
months incubation
period
Self-limiting – Adm. anti-viral Adm. Hep A and B No treatment Self-limiting – No treatment
disappears even treatment and vaccine and direct available. Manage disappears even available.
without treatment; Hep B vaccine acting antivirals underlying Hep B without treatment;
supportive treatment (DAA) infection supportive treatment
Best prevented Vaccination, Safe needle Hep B Vaccination Safe water and food Prevent blood-
through vaccines, safe sex, safe practices, blood through boiling and borne
good hygiene, safe needle safety, safe sex water chlorination transmission:
water and food practices blood, sexual,
transplacental
Ulm, S. (2017). World Hepatitis Day – Viral hepatitis in a nutshell. Retrieved from
http://primeglobalpeople.com/2017/07/28/world-hepatitis-day-viral-hepatitis-nutshell/. Vaccine Vaccine No vaccine No vaccine Vaccine- in China None
only
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Mode of Transmission of Each Type of Hepatitis

Functional Concept ® Risk factor A B C D E G
ü ü ü
ü ü ü
Oral-anal sex (MSM)
Caring for someone infected

ü
Entry and initial replication Assisting with diaper changes
ü ü
Transmission depends on the type of Hepatitis Occupational risk- preschool teacher
ü ü
Eating contaminated even cooked food
(shellfish)
ü ü
Virus replicates at the hepatocytes causing liver damage
International travelers
International adoptee
ü ü
Use/inject drugs
People with hep.,B , C and HIV
ü ü ü ü
ü ü ü
Blood, semen, body fluids (contact with
Body’s immune system responds leading to inflammation

blood from open sores)
ü
Mother to child in utero
ü ü ü ü
Needle sticks (HCW, public safety workers)
ü ü ü
Hepatitis such jaundice, fatigue, abdominal pain, nausea
ü ü ü
Sharing razors, toothbrush and glucose
monitoring equipment
Clients on hemodialysis
Household contacts of hep. B clients
ü ü ü
Hepatitis A- diapered or Hepatitis A is typically

incontinent clients, who are self-limiting. The liver generally
below 3 years old, require heals without long-term
contact + standard damage. Recovery from HAV
precautions for the DOI! provides immunity against
future HAV infections.
Hepatitis C can spread through Chronic Hepatitis C infection can

commercial tattoos or body lead to fibrosis, cirrhosis, and
piercing, receiving transfusion liver cancer.
and organ transplant!
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Clients with Hepatitis C can Clients with Hepatitis C

breastfeed their babies! cannot donate blood but
can donate organs or tissues!
Hepatitis D (HDV) can only Hepatitis E commonly

infect individuals already occurs in older adolescents
infected with Hepatitis B and young adults.
(HBV). HDV relies on HBV for
replication.
Hepatitis E is commonly Immune globulin is not effective

transmitted through in preventing hepatitis E!
contaminated water.
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Unlike the other types of hepatitis Detection of Hepatitis A virus-

that specifically targets the liver specific IgM antibodies is the
cells (hepatocytes), Hepatitis G gold standard for diagnosing
primarily targets immune system
HAV infection.
cells (lymphocytes and monocytes)
followed by the liver.
RNA Polymerase Chain Reaction

The presence of Hepatitis B
(PCR) is the gold standard for
surface antigen (HBsAg) is the diagnosing acute and chronic
primary marker for acute and Hepatitis C, D, E, and G infections. The
chronic Hepatitis B infection. presence of antibodies can be used in
conjunction with the PCR test.
Functional Concept ® LET’S
Antiviral medications for Hepatitis B

include:
1. Nucleoside/Nucleotide Analogues:
entecavir, tenofovir disoproxil
fumarate, tenofovir alafenamide
2. Interferon-alpha
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Acute Bacterial Acute Viral Bacterial or

Viral or Fungal
Conjunctivitis Conjunctivitis Meningococcal
Meningitis
Meningitis
Standard Contact + standard Standard Droplet
© The Ray A. Gapuz Test Prep System for NCLEX RN © The Ray A. Gapuz Test Prep System for NCLEX RN
Pneumonic Legionnaires’ disease,

Bubonic Plague
Plague a severe form of
pneumonia caused by
Legionella, a
Standard Droplet + Standard bacterium, requires
standard precautions!
R obinson, J. (2021). W hy N ow is the T im e to Look at
Legionnaires’ D isease. R etrieved from
https://parkhill.com /insights/legionnaire-disease/.
© The Ray A. Gapuz Test Prep System for NCLEX RN FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM
Legionnaires’ disease, is No special precautions are

transmitted via drinking necessary for Legionnaires’
water not by exposure to disease, the CDC however
an infected person! recommends implementation of
standard precautions!
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LET’S TRANSMISSION-BASED
PRECAUTIONS
POINTERS FOR THE
NCLEX-RN

Isolation Precautions Transmission-based
precautions are implemented
in addition to standard
Standard Transmission-Based
precautions for clients who are
infected with agents that
require additional precautions
Contact Droplet Airborne
to prevent its transmission.
Implementation of airborne precautions require:
AIRBORNE 1. Placing the client in a private room with negative

airflow.
PRECAUTIONS
2. Use of respirator masks (N95,N99 or N100) by HCW
3. If client is brought out of the room, wearing surgical
mask is required.
When an airborne isolation room is not available

during an emergency, have all personnel wear
N95 mask and pull the privacy curtain !
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CONDITIONS REQUIRING Functional Concept ®

AIRBORNE PRECAUTIONS
DIAGNOSIS NURSING ALERT Clients with highly contagious
Measles
Implement airborne + standard precautions, 4 days after
onset of rash airborne infections (such as TB or
Tuberculosis
Consider as priority for placement in a private room with measles) are placed in negative
negative airflow
pressure rooms that has at least 12
Place in a negative air-flow room until lesions are dry
Varicella
and crusted, if not available use closed rooms and air exchanges per hour to prevent
restrict entry of unimmunized persons.
the spread of infectious air particles.
Airborne precautions preferred for the DOI + 10 days
SARS after resolution of fever. N95 mask required, if
unavailable use surgical mask.
A client with varicella should The presence of generalized

be assigned to a staff with and pruritic rash on the chest
evidence of immunity is often the first sign of
(2 doses of vaccine)! varicella in children.
Implementation of droplet precautions require:
DROPLET 1. HCP to wear surgical mask upon room

entry and while in the clients room which
should be discarded after leaving the
PRECAUTIONS room.
2. A single client room is preferred, if not
available, consult infection control
personnel for possible cohorting
3. For clients in multi-bed room, maintain > 3
feet distance between beds and draw
curtains between beds
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CONDITIONS REQUIRING Functional Concept ®

DROPLET PRECAUTIONS
DIAGNOSIS NURSING ALERT
Mycoplasmal pneumonia requires
Influenza (seasonal)
Droplet precautions for 7 days after onset
or until 24 hours after resolution of fever droplet + standard precautions
and respiratory symptoms.
for the entire DOI!
Mumps Droplet + Standard until 5 days after the
onset of swelling
Bacterial meningitis
Functional Concept ® LET’S
Rubella (German measles) requires

droplet + standard precautions
until 7 days after onset of rash!
Influenza Influenza The most important

(seasonal) (pandemic) intervention to prevent
seasonal influenza infection
involves yearly vaccination.
Droplet + Standard Droplet + Standard
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Implementation of contact precautions
CONTACT require:
1. HCP to wear gown and gloves upon room
PRECAUTIONS
entry for all interactions with the client.
2. A single client room is preferred, if not
available, consult infection control
personnel for possible cohorting.
3. For clients in multi-bed room, maintain > 3
feet distance between beds and draw
curtains between beds.
Functional Concept ® CONDITIONS REQUIRING

Contact precautions apply where there is:
CONTACT PRECAUTIONS
DIAGNOSIS NURSING ALERT
1. Exposure through direct and
indirect contact with Bronchiolitis Contact + Standard
microorganisms Clostridium difficile Contact + Standard, DOI
2. Excessive wound drainage Noroviruses Contact + Standard, contact for a min of

48 hours after resolution of symptoms
3. Fecal incontinence
Rotavirus Contact + Standard, DOI
4. Exposure to body discharges
Pediculosis Contact + Standard until 24 hours of
(head lice) initiation of effective therapy
The duration of contact

MDROs (MRSA, VRSA) require precautions for clients with
contact + standard precautions! MDROs (MRSA, VRSA)
remains undefined!
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Impetigo requires contact
+ standard precautions RSV requires contact +
for the entire DOI ! standard precautions for
the entire DOI !
C enters for D isease C ontrol and P revention (n.d.). Im petigo. R etrieved from
https://w w w .cdc.gov/groupastrep/diseases-public/im petigo.htm l.
LET’S
Scabies requires contact +

standard precautions until 24
hours after initiation of
effective therapy!
Functional Concept ® QUESTION

Major pressure Minor pressure Is there a single disease
ulcers ulcers condition that requires the
implementation of more than
two types of isolation
Contact + standard precautions Standard precautions
precautions?
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VARICELLA ZOSTER Varicella zoster requires
airborne + contact + standard
precautions until lesions dry and crusted.
P ope, J. et al. (2022). C hickenpox rash. R etrieved from

https://m yhealth.alberta.ca/H ealth/P ages/conditions.aspx?h
w id=tp13191.
In providing care to a client Varicella zoster post

with varicella zoster, immune exposure prophylaxis must
caregivers can substitute for be administered ASAP
susceptible HCW. within 120 hours (5 days).
Contraindications to varicella post-exposure PERSONAL PROTECTIVE
prophylaxis include:
Pregnant women EQUIPMENT
Immunocompromised persons
Newborns whose mother had
POINTERS FOR THE
varicella 5 days before delivery
Newborns whose mother had
varicella 48 hours after delivery NCLEX-RN
They are given varicella zoster immune globulin.
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The proper sequence for putting The proper sequence for removing
on PPE: PPE:
1. Gloves
1. Gown 2. Goggles or face shield
2. Mask or respirator 3. Gown
4. Mask or respirator
3. Goggles or face shield 5. Hand washing or hand hygiene with
4. Gloves alcohol-based sanitizer
WHAT IF A Functional Concept ®
If a client exhibits diarrhea of

unknown origin in an
incontinent and diapered client
implement contact precautions
(children and adults).
IS SPECIFIED INSTEAD OF A DISEASE

If a client exhibits cough with
If a client exhibits draining
fever with travel history in the
wound that cannot be covered
past 3 weeks to countries with
implement contact and droplet
SARS outbreak, implement
precautions for the first 24 hours airborne + contact precautions
of antimicrobial therapy.
+ eye protection.
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If a client exhibits If a client exhibits symptoms of

Petechial/ecchymotic rash with Meningitis (N. meningitidis),
fever, implement droplet implement droplet precautions
precautions for first 24 hours of for the first 24 hours of
anti microbial therapy. antimicrobial therapy.

If a client exhibits maculopapular
rash with fever and
If a client exhibits vesicular rash
3C ough
oryza
onjunctivitis
implement airborne + contact
precautions.
implement airborne precautions
LET’S Syndromic Approach to Isolation Precautions

SYNDROME IMPLEMENT
Diarrhea of unknown Contact precautions
origin
Draining wound that Contact + droplet precautions

cannot be covered
Cough with fever Airborne +contact precautions
Petechial rash with fever Droplet precautions
Maculopapular rash with

fever Airborne precautions
WHAT WE LEARNED ! Vesicular rash Airborne +contact precautions
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CLOSTRIDIUM DIFFICILE
•Pic of clostridium
COMMON INFECTIOUS
CONDITIONS

Disruption of Normal Intestinal Microbiota
(overgrowth of Clostridium difficile)
Clostridium difficile
(C. difficile) is a bacterium that Toxin Production
C. Difficle produces Toxin A and B
causes diarrhea and more

serious intestinal conditions
Inflammatory Response
(further damage to intestinal mucosa)
such as colitis.
Inflammation, diarrhea, abdominal pain
Psudomembranous colitis (plaques in colon)
Antibiotic-associated diarrhea
C. DIFF most commonly affects C. diff infection usually does not

the ELDERLY and those on occur in persons who are not
PROLONGED ANTIBIOTICS. taking antibiotics.
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C. diff infection is usually C. DIFF, SHIGELLOSIS and

common among:
NOROVIRUS
Prolonged hospital stay commonly affects clients in
Elderly LONGTERM HOME CARE.
Prolonged use of antibiotics
Functional Concept ® SCABIES

The PRIORITY INTERVENTION
upon admission of a client with
DIARRHEA
is to
ISOLATE the INFECTION !

N P H M edical S ervices. (2017) H um an S cabies. R etrieved from IQ W iG . (n.d.). S cabies. R etrieved from
https://m edicalservices.nph.org/2017/03/11/hum an-scabies/. https://w w w .inform edhealth.org/scabies.htm l.

Infestation of Sarcoptes scabiei
Intense itching that is worse

Allergic Response
Presence of mites and eggs trigger inflammatory reaction
at night is the primary clinical

Secondary Infections symptom of scabies.
Intense itching (more pronounced at night)
Crusting, oozing, increased inflammation of skin
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Skin scraping or skin biopsy

that detects the presence of
the mites is the gold standard
diagnostic tests for scabies.
Rohr, B., & Hossler, E. (2021). Skin nontumor. Infestations. Scabies (mite).
Retrieved from https://www.pathologyoutlines.com/topic/skinnontumorscabies.html.

Treatment includes
administration/application of All individuals who had
scabicides: close contact with the
infested individual must
1. Permethrin undergo treatment.
2. Crotamiton
3. Ivermectin
METHICILLIN RESISTANT Functional Concept ®

STAPHYLOCOCCUS AUREUS (MRSA)
MRSA infection is caused by
bacteria that are resistant to
many antibiotics and which
can survive in towels, clothing,
scrub suits polypropylene
plastics (apron).
Ben-Joseph, E. (n.d.). MRSA. Retrieved from
https://kidshealth.org/en/teens/mrsa.html.
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MRSA colonization and entry through skin, mucous membrane, or
MRSA infection is often very itchy
respiratory tract
(skin is crawling).
Adherence and invasion causing tissue damage and inflammation at the

site
-Formation of skin and soft tissue abscesses (localized collections of

pus) which are painful and require drainage
-systemic spread can lead to bacteremia, pneumonia, infections

CDC (2019). MRSA B acteria P hoto 4. R etrieved from
https://w w w .cdc.gov/m rsa/com m unity/photos/photo-m rsa-4.htm l
BOILS
6 Common Signs
of
Staph and MRSA
Skin Infection
FOLLICULITIS IMPETIGO
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ABSCESS CELLULITIS
FURUNCULOSIS Functional Concept ®
Culture and sensitivity test

using a clinical specimen
(wound or nasal swab) and
sensitivity to antibiotics is
the gold standard in
diagnosing MRSA.

MRSA
Treatment
Vancomycin
Gettyimages (n.d.). Retrieved from https://media.gettyimages.com/photos/microbiologist-

examining-an-mrsa-bacteria-on-blood-agar-plate-picture-id940264328.
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Treatment for MRSA include:

MRSA requires
contact precautions.
Trimethoprim-sulfamethoxazole
Clindamycin
Minocycline
Doxycycline
Functional Concept ® MENINGITIS

Staphylococcal scalded skin
syndrome requires contact
precautions, while
Streptococcal disease in
children requires droplet
precautions. Darya-Varia Laboratoria. (2021). Health Article: Meningitis. Retrieved
from https://www.darya-varia.com/en/read/meningitis-1.

Entry of Pathogen (bacteria, virus, fungi) into Bloodstream/Mucosal Barrier MENINGITIS
Evasion of Immune System and Colonization BACTERIAL VIRAL
Inflammation and Complications Children

(increased ICP and impaired cerebral blood flow) Asplenia
Children
College dormitories
Chemotherapy
Military barracks
With bone marrow
Kernig’s Sign Ear infection
transplants
Brudzinski’s sign Head injury
Nuchal rigidity Pneumococcal pneumonia
Altered mental status
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MENINGITIS MENINGITIS
BACTERIAL VIRAL
BACTERIAL VIRAL
Fever
Fever
Headache
Headache
Neck Stiffness
Neck Stiffness
Confusion
Confusion
Drowsiness
Drowsiness
CSF CSF Seizures
Stroke
Anorexia
Vomiting
Higher WBC Higher protein Vomiting
Photophobia
Photophobia
Rash (enterovirus-related)
Petechial rash (tiny red, pink,
Lower glucose brown or purple pinprick marks)
IV Antibiotics No specific treatment

Viral meningitis is the most Measles, influenza and

common but less severe chickenpox virus can
type of meningitis. cause meningitis.

Most common pathogens for bacterial
meningitis include Streptococcus
Lumbar puncture (spinal tap) is
pneumoniae, Neisseria meningitidis,
and Haemophilus influenzae. used to identify the causative
pathogen of meningitis. CSF is
Viral meningitis is mostly caused by collected and analyzed.
enteroviruses, such as the
coxsackievirus and echovirus.
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Lumbar Puncture Treatment:
1. Bacterial Meningitis
-antibiotics: ceftriaxone,
cefotaxime, vancomycin
2. Viral Meningitis
Centers for Disease Control and Prevention. (n.d.). Meningococcal Disease:
-antiviral medications
Diagnosis & Treatment. Retrieved from
https://www.cdc.gov/meningococcal/about/diagnosis-treatment.html.
MENINGITIS Functional Concept ®
Viral meningitis requires

standard precautions.
Bacterial meningitis requires

droplet precautions.
Functional Concept ® BACTERIAL MENINGITIS

•pic
The CDC does not

recommend wearing surgical
mask to prevent exposure
from bacterial meningitis.
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Stiff neck and photophobia are Fever, vomiting, decreased LOC

less common manifestations of and rash are present in both
meningitis in infants! septicemia and meningitis!
Joint and muscle pain,

shivering and cold hands, Stiff neck, photophobia,
pallor, altered breathing are headache and seizures occur
present only in septicemia! only in meningitis!
TUMBLER TEST
Press a tumbler
firmly against
the rash, if you WEST NILE VIRUS
see the marks
clearly through Doctors Urgent Care. (n.d.). Meningitis. Retrieved from
the glass, seek

https://www.doctorsurgentcare.org/cgi-
bin/rtbin/sbpg/rt_hdln_dsply2.cgi?Autoincrement=000049&value_6=Services.
immediate
medical help!
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Bite from infected mosquito (Culex species) West Nile Virus is primarily
transmitted through mosquito bites.
Viremia – presence of the virus in the blood spreads. Virus spreads to
various organs and other tissues
A very small proportion of human
Neuroinvasion – virus crosses the blood-brain barrier (BBB) and infections have occurred through
invades the central nervous system
organ transplant, blood transfusions
and breast milk. There is one
Inflammation of the brain (encephalitis) and meninges (meningitis)
Neurological symptoms: headache, high fever, neck stiffness, confusion, reported case of transplacental
muscle weakness,
(mother-to-child) WNV transmission.

West Nile virus infection can be
Presence of WNV- asymptomatic but may also
specific IgM and IgG cause severe illness like
antibodies in the encephalitis or meningitis.
blood or CSF indicate
WNV infection.
No vaccine and specific
N o author. (n.d.). N ursing diagnoses. W est N ile
V irus in the W est.
http://w nvitw .blogspot.com /.
R etrieved from
treatment at the moment.
WEST NILE VIRUS KEY POINTS

Main problem:
Viral disease spread through the

bite of a mosquito (Culex
species). It causes encephalitis.
The incubation period is usually
5 to 14 days.
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RABIES
RABIES

Bite from a rabid animal
(ie., dog, bat, fox, cat, skunk)
Virus targets the central nervous system

Exposure to bats, dogs, and replicates in the body
raccoon and cattle increases Virus infects the brain neurons leading to
fatal inflammation (encephalitis)
the risk for rabies.

Descending infection via nervous system
to the eye, salivary glands, skin, and
other organs.
Fever
Painful spasms followed by excessive salivation
Hydrophobia
Aerophobia
The Ray A. Gapuz Test Prep System for the NCLEX5:59

RN The Ray A. Gapuz Test Prep System for the NCLEX RN
16 of 20
MANIFESTATIONS OF RABIES Functional Concept ®
üRadiating pain and slight The most effective first aid

fever treatment for a raccoon bite
üAnorexia and anxiety involves cleansing the wound
üBurning and sensation of cold with soap and water.
üIrritability
üExcessive lacrimation
üSalivation
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Direct Fluorescent Antibody Test
The gold standard for diagnosing rabies infection
in post-mortem clients is direct fluorescent
antibody (DFA) test on brain tissue or skin biopsy
samples, specifically skin sample from the nape of
the neck.
Among the living clients, the DFA is not routinely

performed. Diagnosis is typically based on clinical Centers for Disease Control and Prevention (n.d.). Direct fluorescent antibody test.
signs, history of exposure, vaccination status, and

Retrieved from https://www.cdc.gov/rabies/diagnosis/direct_fluorescent_antibody.html.
laboratory testing of saliva, cerebrospinal fluid, The fluorescent-labeled antibody is incubated with rabies-
suspected tissue/sample. If antigen is present, it will bind.
and other body fluids using techniques such as
An unbound antibody can be washed away. The slide is
reverse transcription polymerase chain reaction visualized under a fluorescence microscope. There will be no
(RT-PCR). staining if there is no rabies virus.
Wound care and post-exposure

Post-exposure prophylaxis (PEP)
consisting of vaccination and rabies prophylaxis (PEP) consisting of
immune globulin (RIG) is the standard rabies vaccinations are generally
treatment for individuals exposed to performed before the appearance
the rabies virus. of symptoms. PEP is highly
effective when administered
promptly after exposure.
PNEUMONIA
PNEUMONIA
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Pathogen (bacteria, virus, fungi) enters the respiratory tract PNEUMONIA
Alveolar infection: pathogens multiply at the alveoli triggering an BACTERIAL VIRAL

immune response
Streptococcus
Inflammatory response, Accumulation of Exudates, Haemophilus influenzae
& Alveolar Consolidation Influenza A and B
Staphyloccocus aureus
Group A Streptococci RSV
Moraxella Catarrhalis Adenovirus
Impaired gas exchange Mycoplasma Pneumoniae Some coronaviruses
Fever, chills, productive cough, chest pain, fatigue Chlamydia
Legionella

PNEUMONIA PNEUMONIA
BACTERIAL VIRAL BACTERIAL VIRAL
Rest Rest
Fluids Fluids
Rusty Whitish Antibiotics Flu vaccine except in
sputum sputum Pneumococcal vaccine
those with allergy
and GBS

Treatment
There is no gold standard 1. Antibiotics (Bacterial Pneumonia)

- Amoxicillin
diagnostic test for pneumonia. - Azithromycin
A combination of clinical - Ceftriaxone
- Fluoroquinolones
assessment, imaging studies,
2. Antiviral Medications (Viral Pneumonia)
and laboratory tests are used - Oseltamivir
for diagnosis.
3. Fungal Pneumonia
- trimethoprim-sulfamethoxazole
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The Ray A. Gapuz Test Prep System for the NCLEX RN

MYCOPLASMAL PNEUMONIA Functional Concept ®
A client with mycoplasmal

pneumonia (bacterial
pneumonia) should be placed
in droplet precautions.
Inhalation of small droplets or aspiration
of contaminated water
Bacteria enters and infects the respiratory

system and multiplies at the alveoli.
LEGIONNAIRE’S DISEASE Body’s inflammatory response and

presence of bacteria damages the lungs.
-High fever DerSarkissian, C. (2021). Visual Guide to Legionnaire’s Disease.

-Cough Retrieved from https://www.webmd.com/lung/ss/slideshow-
legionnaires-disease-overview.
-Chest pain
-Difficulty breathing
-ARDS
-Septic shock
-Multi-organ failure
LEGIONNAIRE’S DISEASE LEGIONNAIRE’S DISEASE
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§ Legionnaire’s disease is a
bacterial infection that lasts 2- There is no
14 days. human-to-human
transmission of
§ Pontiac fever is a milder form of Legionnaire’s disease.
Legionella infection that does
not lead to pneumonia.
Treatment typically involves

Culture of respiratory secretions, antibiotics:
typically the sputum or
bronchoalveolar lavage fluid, is 1. Azithromycin
performed to detect presence of 2. Levofloxacin
Legionella bacteria.
The use of more rapid and

sensitive tests including
polymerase chain reaction (PCR)
assays and urinary antigen tests
FIFTH’S DISEASE
have been used to provide quicker
results and aid in early diagnosis.
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FIFTH’S DISEASE Functional Concept ®

Also known as slapped cheek syndrome
or erythema infectiosum Initial Infection: Parvovirus 19
Viral Replication & Manifestation

(particular tropism of the virus for RBC precursors leading to transient anemia)
Immune Response and Resolution
-Slapped-cheek facial rash

-Generalized body rash
-Mild flu-like symptoms (low-grade fever, headache, mild upper respirator symptoms)
FUNCTIONAL CONCEPT
Functional Concept ® KEY POINTS
q Caused by human parvovirus B19.
Fifth’s disease is most q Transmitted via respiratory secretions.
contagious before the q Common among children between 4 to 12 years of age
appearance of the rash.
q Resolves in about 7 to 10 days.
Typically, once the q Red rash on the cheeks (slapped cheek appearance)
characteristic rash q low grade fever, malaise and joint pain and swelling in
becomes visible, the the hands, wrists and knees
individual is no longer q Light and electron microscopy to detect B 19 infections
considered contagious.
K err, A (2007). A 16 m onth old child w ith F ifth D isease (aka
S lapped face, P arvovirus B 19). R etrieved from
https://en.w ikipedia.org/w iki/F ifth_disease#/m edia/F ile:F ifth_dise
ase.jpg
KEY POINTS Functional Concept ®

q Ig M antibody assay test detects
antibody to parvo virus
q Provide frequent rest periods Slapped-cheek rashes appear on
q Follow standard precautions the cheek, around the mouth
q Treated with anti-inflammatory
medications like ibuprofen
and occasionally over the nose.
q Increase iron in the diet
q Instruct the client to cover the mouth
when coughing or sneezing
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Diagnosis is based on clinical Fifth disease is usually a mild and

manifestations and the self-limiting illness. The disease
characteristic rash. Serologic test typically resolves without the need
to determine antibodies against the for a specific antiviral medication.
virus may be used. Supportive treatment is provided.
MEASLES
Also known as Rubeola
MEASLES
FUNCTIONALConcept
Functional CONCEPT®
Measles is different from Roseola
due to the presence of:
C
onjunctivitis
oryza
olds
R ashes on the face
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Incubation period: Virus enters the respiratory tract through inhalation of
respiratory droplets containing measles virus
Pathophysiological Problems of Measles:
Virus infects and replicates at the respiratory tract and spreads to the 1. Respiratory complications
regional lymph nodes and throughout the body.
-Pneumonia, bronchitis & croup,
Prodromal Phase (7-14 days post-exposure)
laryngitis
Non-specific symptoms: Pathognomonic Sign:
fever, malaise, cough, runny nose
(coryza), red eyes (conjunctivitis)
Koplik spots – small, white spots with a
blue-white center on the oral mucosa 2. Systemic complications
-Immunosuppression, vitamin A
Maculopapular rash development (2-4 days after onset of prodromal symptoms) beginning
on the face and spreading to the trunk and extremities Deficiency, Encephalitis
With the onset of rash, antibody production begins. Viral replication and symptoms begin to
subside. FUNCTIONAL CONCEPT ® IS A REGISTERED TRADEMARK OF THE RAY A. GAPUZ TEST PREP SYSTEM
Functional Concept ® FUNCTIONALConcept

KOPLIK’S SPOTS MACULOPAPULAR RASH There is no gold standard
diagnostic test for measles.
Diagnosis is based on a
combination of clinical evaluation,
including the presence of Measles-
specific IgM antibodies, and history
of measles exposure.
Chamberlain, N. (2013). Rubeola (Measles). Retrieved from Iannelli, V. (2022). Symptoms of Measles. Retrieved from
https://www.atsu.edu/faculty/chamberlain/Rubeola.htm https://www.verywellhealth.com/measles-symptoms-2633846.
FUNCTIONALConcept
Functional CONCEPT® FUNCTIONALConcept
MMR Post-exposure prophylaxis Measles is a highly

vaccine can be administered to contagious disease, and
eligible individuals within 72 hours accurate diagnosis and
of exposure to reduce the risk of appropriate isolation
developing measles or mitigate the measures are crucial to
severity of the disease.
prevent its spread.
33
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FUNCTIONALConcept
There is no specific
antiviral medication to
treat measles. The primary LYME DISEASE
treatment for measles is
supportive care.
LYME DISEASE LYME DISEASE
KEY POINTS KEY POINTS

Main Problem: Risk factors:
Multi-system infectious syndrome • Spending time in wooded or

commonly affecting the skin, grassy areas
nervous system, heart and joints. • Having exposed skin
• Not removing ticks promptly or
properly
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Transmission & Dissemination
Tick bite introduces Borrelia bacteria into the body Lyme Disease Stages
Stage 1: Early Disease Stage 2:Early Disseminated Stage 3: Late Disease

Immune Response & Tissue Damage Stage Disease Stage (< 3 mos) Stage (>3 mos)
(< 30 days)
Cardiac and neurological Large joint arthritis,
spirochete migrates involvement inflammatory synovitis
Neurological & Cardiac Involvement outward in the skin
AV block, palpitations,
Fever, chills, headache, syncope, stiff neck, Bell’s
malaise palsu. encephalitis
-Fever, chills, productive cough, chest pain, fatigue
-Localized inflammation–erythema migrans (characteristic rash)
Arthritis
-Neurological symptoms: Facial palsy, meningitis
-Cardiac symptoms: heart block, arrhythmias
Kingston, A (2014). The truth about Lyme disease.

Retrieved from https://macleans.ca/society/health/the-
truth-about-lyme-disease/
Functional Concept ® TWO-TIERED TESTING FOR LYME DISEASE

Two-tiered Serologic Test:
1. Enzyme Immunoassay (EIA)

or Enzyme-linked
Immunosorbent Assay
(ELISA)
2. Western Blot Analysis Johnson, L (2011). LY M E P O LIC Y W O N K : Lym e disease testing – the C D C , LabC orp and stories
that don’t add up. R etrieved from http://w w w .lym edisease.org/lym epolicyw onk-lym e-disease-
testing-the-cdc-labcorp-and-stories-that-dont-add-up-2/
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Functional Concept ® WESTERN BLOTTING
In the early stages of Lyme disease,

serologic testing may be less
reliable due to the insufficiently
developed antibodies against B.
burgdorferi. Antibodies can take
several weeks to develop.
Western blot. Retrieved from https://blottingtechnique.weebly.com/western-
blot.html
ELISA TEST Functional Concept ®
The first-line treatments are:

Peter E. (2021). Elisa Test for Lyme Disease. Retrieved from https://www.lymetalk.net/elisa-test-for-lyme-disease/
1. Doxycycline
2. Amoxicillin or Cefuroxime
3. Ceftriaxone – late-stage
Lyme Disease Association, Inc. (2020). Current Lyme Disease Testing Problems. Retrieved from https://lymediseaseassociation.org/lyme-tbd/lyme-tbd-
testing/current-lyme-disease-testing-by-elizabeth-maloney-md/
Functional Concept ® FOCUS
INFECTION CONTROL
Exposure to deer ticks increases
the risk for Lyme disease.
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Functional Concept ® FOCUS
A private room is necessary to

ASSIGNING THE
isolate the infection.
CLIENT TO AN
APPROPRIATE ROOM

Clients who are
diagnosed with
Clients who are either colonized or Tuberculosis are
infected with the same considered as a
microorganism can share a room. priority to be placed
in a private room with
negative pressure or IFIC (2013). Negative pressure room. Retrieved
unilateral airflow.
from https://www.slideserve.com/farrah-
head/pathogens-important-to-infection-prevention-
and-control.

Negative Pressure Room For clients who are diagnosed with
The room air is Tuberculosis, isolation should be
exhausted or discontinued only when the client is on
recirculated in the effective therapy, is improving clinically
same room through and has had 3 consecutive negative
the high efficiency sputum acid fast bacillus (AFB) smear
particulate air
examinations collected on different
(HEPA) filtration
system.
University of South Alabama (n.d.). TB Prevention. Retrieved from
https://www.southalabama.edu/colleges/alliedhealth/biomedical/bio days.
safety/tbprevention.html
37
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SUMMARY
LET’S
Priority Cases for Private Room
Tuberculosis
AIDS
Cushing’s Disease
Immunosuppression
Chemotherapy/brachytherapy/
steroid therapy
SUMMARY Functional Concept ®

Diagnosis Ideal room mate
Infectious disease
- Hepatitis A - Hepatitis A
- Hepatitis B - Hepatitis D Clients receiving steroids as
Medical case treatment should not be placed in
- Pancreatitis - Ulcerative colitis
a room with clients suffering from
Surgical case infectious conditions.
- Gastrectomy - Phlebitis
Psychiatric case - Opposite case

-No roommate for a client
Disaster-related
with panic
Functional Concept ® REMEMBER THIS
Infectious clients should be

visited last during a home visit.
38
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HOME SWEET
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1/12/24

Success Formula for Today

CHAIN OF INFECTION HOW TO BREAK THE CHAIN OF

Figure B.1-1. The Chain of Infection.

Which of the 295

© The Ray A. Gapuz Test Prep System for NCLEX RN

Functional Concept ® REMINDER

Functional Concept ® Functional Concept ®

A IDS Lyme disease No person-to-person transmission

Hepatitis A,B,C,D,E,G all require

Blood borne Severe in Risk for cirrhosis in Common in Common in Asymptomatic

Mode of Transmission of Each Type of Hepatitis

Caring for someone infected

Body’s immune system responds leading to inflammation

Functional Concept ® Functional Concept ®

Hepatitis A- diapered or Hepatitis A is typically

Functional Concept ® Functional Concept ®

Hepatitis C can spread through Chronic Hepatitis C infection can

Functional Concept ® Functional Concept ®

Clients with Hepatitis C can Clients with Hepatitis C

Functional Concept ® Functional Concept ®

Hepatitis D (HDV) can only Hepatitis E commonly

Functional Concept ® Functional Concept ®

Hepatitis E is commonly Immune globulin is not effective

Functional Concept ® Functional Concept ®

Unlike the other types of hepatitis Detection of Hepatitis A virus-

Functional Concept ® Functional Concept ®

RNA Polymerase Chain Reaction

Functional Concept ® LET’S

Antiviral medications for Hepatitis B

Functional Concept ® Functional Concept ®

Acute Bacterial Acute Viral Bacterial or

Standard Contact + standard Standard Droplet

Functional Concept ® Functional Concept ®

Pneumonic Legionnaires’ disease,

Functional Concept ® Functional Concept ®

Legionnaires’ disease, is No special precautions are

Functional Concept ® Functional Concept ®

AIRBORNE 1. Placing the client in a private room with negative

When an airborne isolation room is not available

CONDITIONS REQUIRING Functional Concept ®

Functional Concept ® Functional Concept ®

A client with varicella should The presence of generalized

DROPLET 1. HCP to wear surgical mask upon room

CONDITIONS REQUIRING Functional Concept ®

Functional Concept ® LET’S

Rubella (German measles) requires

Functional Concept ® Functional Concept ®

Influenza Influenza The most important

Functional Concept ® CONDITIONS REQUIRING

microorganisms Clostridium difficile Contact + Standard, DOI

2. Excessive wound drainage Noroviruses Contact + Standard, contact for a min of

Functional Concept ® Functional Concept ®

The duration of contact

Functional Concept ® Functional Concept ®

Scabies requires contact +

Functional Concept ® QUESTION

P ope, J. et al. (2022). C hickenpox rash. R etrieved from

Functional Concept ® Functional Concept ®

In providing care to a client Varicella zoster post

Functional Concept ® Functional Concept ®

WHAT IF A Functional Concept ®

If a client exhibits diarrhea of