Nursing Management of the Adult with Inflammation and Infection
Infection
- Infection is a process that occurs in response to tissue injury and to the invasion of organisms.
- usually accompanied by inflammation. However, inflammation can occur without infection.
- Inflammation does not always mean that an infection is present.
Chain of Infection
- If no break in chain then they are susceptible
-
High Risk Individuals
- Elderly
- Infants
- Diabetics
- Patients receiving steroids
o Raise blood sugar
- Patients receiving chemotherapy/radiation therapy
- Immuno-suppressed
- Malnourished
- Stress
What are some ways we can break the chain of infection?
- Hand hygiene
- Cleaning (infection control)
o Disinfectants
o Antiseptics - bactericidal, bacteriostatic
- Use Standard & Transmission Based Precautions
- PPE
- Sterile Technique
- Adequate staffing
- Patient placement:
o Cohorting
- Patient transportation
Terms Related to Infection
- Local versus systemic
o Term for systemic is bacteremia
- Healthcare associated infection (HAI)
- Sepsis
o life-threatening organ dysfunction due to a dysregulated host response to infection
- Early presenting symptoms are called systemic inflammatory response syndrome (SIRS)
o Now conflicting evidence as to if SIRS criteria are most best predictor of sepsis
1
, Nursing Management of the Adult with Inflammation and Infection
Healthcare Associated Infections (HAI)
Main Types
CAUTI – catheter associated urinary tract infection
CLABSLI – central line associated bloodstream infection
SSI – surgical site infection
VAP – ventilator associated pneumonia
Multiple agencies have guidelines often called “bundles”
- Evidence basesed guidelines
- Remove cath
- Wash in wash out
Improvements have been made in most areas except SSIs
- Most common HAI
Systemic Inflammatory Response Syndrome (SIRS)
Temperature > 38C or < 36 C
HR > 90 bpm
RR > 20 /minute or PaCo2 > 32mm/Hg
WBCs > 12,000, < 4000 or > 10% immature WBCs
- Now, immature granulocytes are closely looked at (IG)
Progression of Infection
Incubation period
- time between pathogen’s entrance and appearance of symptoms
- no symptoms
- still infectious
Prodromal period
- nonspecific symptoms occur (nausea, fever, general weakness, aches)
Acute phase
- specific symptoms of illness occur
Convalescent period
- body systems return to normal; antibodies appear in blood.
Clinical Manifestations of Infection vary according to type and severity of infection
Subjective
- fatigue, malaise, weakness, chills, headaches, localized pain, anorexia
Objective
- localized inflammation, increased HR/RR. Pain, purulent drainage, enlarged lymph nodes,
rash, GI S/S
The Febrile Response
Body temperature elevates in response to exposure to pyrogens.
Pyrogens which cause chemical reactions stimulating the hypothalamus to increase body
temperature.
Cytokines also stimulate the hypothalamus
2
Infection
- Infection is a process that occurs in response to tissue injury and to the invasion of organisms.
- usually accompanied by inflammation. However, inflammation can occur without infection.
- Inflammation does not always mean that an infection is present.
Chain of Infection
- If no break in chain then they are susceptible
-
High Risk Individuals
- Elderly
- Infants
- Diabetics
- Patients receiving steroids
o Raise blood sugar
- Patients receiving chemotherapy/radiation therapy
- Immuno-suppressed
- Malnourished
- Stress
What are some ways we can break the chain of infection?
- Hand hygiene
- Cleaning (infection control)
o Disinfectants
o Antiseptics - bactericidal, bacteriostatic
- Use Standard & Transmission Based Precautions
- PPE
- Sterile Technique
- Adequate staffing
- Patient placement:
o Cohorting
- Patient transportation
Terms Related to Infection
- Local versus systemic
o Term for systemic is bacteremia
- Healthcare associated infection (HAI)
- Sepsis
o life-threatening organ dysfunction due to a dysregulated host response to infection
- Early presenting symptoms are called systemic inflammatory response syndrome (SIRS)
o Now conflicting evidence as to if SIRS criteria are most best predictor of sepsis
1
, Nursing Management of the Adult with Inflammation and Infection
Healthcare Associated Infections (HAI)
Main Types
CAUTI – catheter associated urinary tract infection
CLABSLI – central line associated bloodstream infection
SSI – surgical site infection
VAP – ventilator associated pneumonia
Multiple agencies have guidelines often called “bundles”
- Evidence basesed guidelines
- Remove cath
- Wash in wash out
Improvements have been made in most areas except SSIs
- Most common HAI
Systemic Inflammatory Response Syndrome (SIRS)
Temperature > 38C or < 36 C
HR > 90 bpm
RR > 20 /minute or PaCo2 > 32mm/Hg
WBCs > 12,000, < 4000 or > 10% immature WBCs
- Now, immature granulocytes are closely looked at (IG)
Progression of Infection
Incubation period
- time between pathogen’s entrance and appearance of symptoms
- no symptoms
- still infectious
Prodromal period
- nonspecific symptoms occur (nausea, fever, general weakness, aches)
Acute phase
- specific symptoms of illness occur
Convalescent period
- body systems return to normal; antibodies appear in blood.
Clinical Manifestations of Infection vary according to type and severity of infection
Subjective
- fatigue, malaise, weakness, chills, headaches, localized pain, anorexia
Objective
- localized inflammation, increased HR/RR. Pain, purulent drainage, enlarged lymph nodes,
rash, GI S/S
The Febrile Response
Body temperature elevates in response to exposure to pyrogens.
Pyrogens which cause chemical reactions stimulating the hypothalamus to increase body
temperature.
Cytokines also stimulate the hypothalamus
2
