1A
,Overall Infectious Concepts (1–3 Questions)
A. Diagnostics & Laboratory Workup
● The Golden Rule of Cultures: Always obtain wound, blood, sputum, or other bodily fluid
cultures before administering the first dose of antibiotic therapy. Giving the drug first can alter
bacterial growth in the lab, causing false negatives and delaying correct targeted treatment.
● Complete Blood Count (CBC): Monitors total white blood cells and the leukocyte differential
(Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils) to identify systemic responses to
pathogens.
● Antibiotic Peak and Trough Levels: Ordered to monitor therapeutic drug levels, ensure clinical
efficacy, and prevent severe drug-induced toxicities. Troughs are drawn immediately before
hanging the next scheduled dose.
B. Management of Care & The Sepsis Continuum
Track systemic infection spillover using the SIRS (Systemic Inflammatory Response Syndrome)
criteria. A patient meets SIRS if they exhibit greater than or equal to 2 of the following clinical values:
● Temperature: < 36°C or >38°C
● Heart Rate: > 90 beats per minute
● Tachypnea: > 20 breaths per minute or PaCO2 < 32 mm Hg
● White Blood Cell Count: < 4,000mm^3, > 12,000/\tmm^3, or > 10 % immature band forms
The Escalating Stages of Sepsis
● Sepsis =SIRS criteria + a confirmed or presumed source of infection
● Severe Sepsis= Sepsis + acute organ dysfunction
● Septic Shock = Severe sepsis + refractory hypotension (low blood pressure unresponsive to
aggressive fluid resuscitation)
● MODS (Multiple Organ Dysfunction) =Evidence of greater than or equal to 2 organs failing
simultaneously
Cellulitis (1–3 Questions)
A. Assessment & Clinical Manifestations
● Local Pathology: Look for an acute inflammatory response triggered when normal skin flora
breaches the dermal barrier.
● Expected Findings: The affected area will present as bright red, swollen, intensely warm, and
painful, frequently accompanied by a systemic fever.
B. Pharmacological Interventions
● Antibiotic Spectrum: Administered via PO, IM, or IV routes depending on severity. Commonly
prescribed agents include Cephalexin, Trimethoprim with sulfamethoxazole, Clindamycin, or
Doxycycline.
C. Management of Care & Teaching
● The Sharpie Trick: Use a medical marker to trace around the irregular borders of the redness to
monitor whether the localized infection is expanding or receding across shifts.
● Limb Elevation: Keep the affected limb elevated above the level of the heart. This utilizes
gravity to drain inflammatory fluid, rapidly reducing localized edema and throbbing pain.
● Wound Care: Perform localized wound care using sterile saline dressings.
, ● Patient Education: Stress the absolute necessity of completing the entire prescribed course of
oral antibiotics to prevent recurrence and antibiotic resistance.
○ Teach good daily skin hygiene to protect barrier integrity and prevent future bacterial
entry.
Pneumonia (3–5 Questions)
A. Assessment & Clinical Manifestations
● Respiratory Changes: Severe dyspnea, shortness of breath, a rapid respiratory rate (tachypnea),
and coughing up thick, purulent, yellow-tinged, or rust-colored sputum.
● Systemic Symptoms: Anxiety, profound fatigue, malaise, weakness, loss of appetite, chills, and
sharp pleuritic chest discomfort due to coughing.
● Older Adult Variations: Confusion and altered mental status resulting from hypoxia is the
single most common manifestation of pneumonia in older adult clients, who frequently lack a
high fever or classic respiratory presentation.
● Physical Assessment: Dull chest percussion over consolidated lung tissue, decreased oxygen
saturation levels (<95%), a flushed face, and active diaphoresis (sweating).
B. Diagnostics
● Chest X-Ray (CXR): The essential tool to visually show consolidation (solidification, density, or
lung opacity) within the lung tissue.
● Sputum Culture: Collected before starting the first dose of antibiotics to identify the specific
invading pathogen. Suctioning may be required for older adults with a weak cough reflex.
● Arterial Blood Gases (ABGs): Confirms hypoxemia with a decreased PaO2 level below 80 mm
Hg.
● Dehydration Labs: Monitored via electrolytes, showing elevations in BUN and serum sodium
(hypernatremia).
C. Management of Care
● Immediate Positioning: Place the patient in an upright High-Fowler’s position (90 degrees)
unless clinically contraindicated to maximize lung volume and ventilation.
● Airway Clearance: Support the removal of pooling secretions via voluntary coughing or
suctioning. Balance required activity with dedicated rest periods for clients experiencing dyspnea.
● Alveolar Expansion: Encourage deep breathing and frequent use of the Incentive Spirometer
(IS) to prevent localized alveolar collapse (atelectasis).
● Hydration Guidelines: Push oral or IV fluid intake up to 2 to 3 L/day to thin out thick,
tenacious respiratory secretions, making them much easier to expectorate.
● Device Safety: Continuously monitor for skin breakdown around the patient's nose and mouth
caused by oxygen delivery devices.
D. Pharmacological Interventions & Medication Education
● Anti-infectives: Penicillins and Cephalosporins are heavily utilized. They are started via IV and
transitioned to PO as the condition improves. Monitor kidney function studies closely in older
adults. Education: Take with food; note that certain penicillins must be taken 1 hour before or 2
hours after meals.
● Macrolides: Administered as a primary antibiotic class to destroy infectious lung pathogens.
● Bronchodilators:
,Overall Infectious Concepts (1–3 Questions)
A. Diagnostics & Laboratory Workup
● The Golden Rule of Cultures: Always obtain wound, blood, sputum, or other bodily fluid
cultures before administering the first dose of antibiotic therapy. Giving the drug first can alter
bacterial growth in the lab, causing false negatives and delaying correct targeted treatment.
● Complete Blood Count (CBC): Monitors total white blood cells and the leukocyte differential
(Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils) to identify systemic responses to
pathogens.
● Antibiotic Peak and Trough Levels: Ordered to monitor therapeutic drug levels, ensure clinical
efficacy, and prevent severe drug-induced toxicities. Troughs are drawn immediately before
hanging the next scheduled dose.
B. Management of Care & The Sepsis Continuum
Track systemic infection spillover using the SIRS (Systemic Inflammatory Response Syndrome)
criteria. A patient meets SIRS if they exhibit greater than or equal to 2 of the following clinical values:
● Temperature: < 36°C or >38°C
● Heart Rate: > 90 beats per minute
● Tachypnea: > 20 breaths per minute or PaCO2 < 32 mm Hg
● White Blood Cell Count: < 4,000mm^3, > 12,000/\tmm^3, or > 10 % immature band forms
The Escalating Stages of Sepsis
● Sepsis =SIRS criteria + a confirmed or presumed source of infection
● Severe Sepsis= Sepsis + acute organ dysfunction
● Septic Shock = Severe sepsis + refractory hypotension (low blood pressure unresponsive to
aggressive fluid resuscitation)
● MODS (Multiple Organ Dysfunction) =Evidence of greater than or equal to 2 organs failing
simultaneously
Cellulitis (1–3 Questions)
A. Assessment & Clinical Manifestations
● Local Pathology: Look for an acute inflammatory response triggered when normal skin flora
breaches the dermal barrier.
● Expected Findings: The affected area will present as bright red, swollen, intensely warm, and
painful, frequently accompanied by a systemic fever.
B. Pharmacological Interventions
● Antibiotic Spectrum: Administered via PO, IM, or IV routes depending on severity. Commonly
prescribed agents include Cephalexin, Trimethoprim with sulfamethoxazole, Clindamycin, or
Doxycycline.
C. Management of Care & Teaching
● The Sharpie Trick: Use a medical marker to trace around the irregular borders of the redness to
monitor whether the localized infection is expanding or receding across shifts.
● Limb Elevation: Keep the affected limb elevated above the level of the heart. This utilizes
gravity to drain inflammatory fluid, rapidly reducing localized edema and throbbing pain.
● Wound Care: Perform localized wound care using sterile saline dressings.
, ● Patient Education: Stress the absolute necessity of completing the entire prescribed course of
oral antibiotics to prevent recurrence and antibiotic resistance.
○ Teach good daily skin hygiene to protect barrier integrity and prevent future bacterial
entry.
Pneumonia (3–5 Questions)
A. Assessment & Clinical Manifestations
● Respiratory Changes: Severe dyspnea, shortness of breath, a rapid respiratory rate (tachypnea),
and coughing up thick, purulent, yellow-tinged, or rust-colored sputum.
● Systemic Symptoms: Anxiety, profound fatigue, malaise, weakness, loss of appetite, chills, and
sharp pleuritic chest discomfort due to coughing.
● Older Adult Variations: Confusion and altered mental status resulting from hypoxia is the
single most common manifestation of pneumonia in older adult clients, who frequently lack a
high fever or classic respiratory presentation.
● Physical Assessment: Dull chest percussion over consolidated lung tissue, decreased oxygen
saturation levels (<95%), a flushed face, and active diaphoresis (sweating).
B. Diagnostics
● Chest X-Ray (CXR): The essential tool to visually show consolidation (solidification, density, or
lung opacity) within the lung tissue.
● Sputum Culture: Collected before starting the first dose of antibiotics to identify the specific
invading pathogen. Suctioning may be required for older adults with a weak cough reflex.
● Arterial Blood Gases (ABGs): Confirms hypoxemia with a decreased PaO2 level below 80 mm
Hg.
● Dehydration Labs: Monitored via electrolytes, showing elevations in BUN and serum sodium
(hypernatremia).
C. Management of Care
● Immediate Positioning: Place the patient in an upright High-Fowler’s position (90 degrees)
unless clinically contraindicated to maximize lung volume and ventilation.
● Airway Clearance: Support the removal of pooling secretions via voluntary coughing or
suctioning. Balance required activity with dedicated rest periods for clients experiencing dyspnea.
● Alveolar Expansion: Encourage deep breathing and frequent use of the Incentive Spirometer
(IS) to prevent localized alveolar collapse (atelectasis).
● Hydration Guidelines: Push oral or IV fluid intake up to 2 to 3 L/day to thin out thick,
tenacious respiratory secretions, making them much easier to expectorate.
● Device Safety: Continuously monitor for skin breakdown around the patient's nose and mouth
caused by oxygen delivery devices.
D. Pharmacological Interventions & Medication Education
● Anti-infectives: Penicillins and Cephalosporins are heavily utilized. They are started via IV and
transitioned to PO as the condition improves. Monitor kidney function studies closely in older
adults. Education: Take with food; note that certain penicillins must be taken 1 hour before or 2
hours after meals.
● Macrolides: Administered as a primary antibiotic class to destroy infectious lung pathogens.
● Bronchodilators:
