Adult Health Nursing II Block 7.0

1. Adult Health Nursing II Block 7.0 Topic: Infectious Disease & HIV Module: 3.1

2. Infectious Disease & HIV Selected Topics: --Chain of Infection & Epidemiological Triangle --Methods of Infection control --Types of Infection; viral, bacterial, parasitic, and drug resistant --HIV – Human Immunodeficiency Virus Block 7.0 Module 3.1

3. Infectious Disease Learning Outcomes: --Describe the principles of infection control in inpatient and community based settings. --Differentiate between the four types of transmission precautions --Identify the different types of infections; viral, bacterial, parasitic, and fungal. --Identify drug resistance and laboratory monitoring of cultures. --Assess the common clinical and manifestations of various infections. --Interpret lab test findings in different types of infections. --Prioritize and evaluate nursing interventions for the management of the client with an infection. Block 7.0 Module 3.1

4. Infectious Disease • . Outcomes (continued) --Interpret lab tests for a patient with HIV. --Identify appropriate nursing and medical interventions for patients with HIV. --Compare the different classes of HIV drugs with side effects and method of action Block 7.0 Module 3.1

5. Infectious Disease Agent Environment Host The Epidemiological Triangle • Chain of Infection • Pathogen • Reservoir (i.e. fake fingernails) • Portal of exit (from the reservoir) • Mode of transmission • Portal of entry • Susceptible host Block 7.0 Module 3.1

6. Infectious Disease • Methods of Infection Control – depends on the pathogen’s mode of transmission and it’s virulence • Inpatient Infection Control: Standard precautions Airborne precautions Droplet precautions Blood and secretion precautions Contact precautions Block 7.0 Module 3.1

7. Infectious DiseaseWHO global response video Block 7.0 Module 3.1

8. Infectious Disease • Methods of Infection Control • Community based infection control #1 Handwashing Universal precautions during procedures i.e. gloves, splash goggles, masks,etc Isolation Disinfection Sterilization of areas and equipment Block 7.0 Module 3.1

9. Infectious Disease • Important Subjects: (MEMORIZE ALL THE LIST-will help on the NCLEX) • Standard Precaution is needed for all patients. • Airborne Precautions • Diseases: • Measles, • Chickenpox • Disseminated Varicella zoster • TB • Protection: • Single room under negative pressure and keep door closed • Mask or personal respiratory protection device • Need mask when client leaves the room. Block 7.0 Module 3.1

10. Infectious Disease • Droplet Precautions: • Diseases: • Swine Flu • Adenovirus • Pharyngeal Diphtheria • Epiglottitis • Influenza • Meningitis • Mumps • Mycoplasmal pneumonia • Meningococcal pneumonia • Parovirus B19 • Pertussis • Rubella • Scarlet fever • Sepsis • Streptococcal pharyngitis Block 7.0 Module 3.1

11. Infectious Disease • Droplet precautions • Protection: • Private room or cohort with similar organisms. • Mask • Mask placed on client leaves the room Block 7.0 Module 3.1

12. Infectious Disease • Contact Precautions: • Organisms: • Clostridium Difficile • Respiratory syncytial virus • Staphylococcus • Varicella zoster • Wound infections • Cutaneous Diphtheria • Herpes simplex • Impetigo • Pediculosis • Scabies Block 7.0 Module 3.1

13. Infectious Disease • Contact Precautions: • Protection: • Private room or cohort • Gloves and gown Block 7.0 Module 3.1

14. Infectious Disease • Types of Infections: • Viral • Bacterial • Parasitic • Fungal • Drug resistant worms or rod bacterium? Block 7.0 Module 3.1

15. Infectious Disease • Viral infections – have the ability to transfer DNA or RNA by enzymes to another cell or host cell, cannot replicate by itself, has a protein coat • Influenza • Measles Rubella and Rubeola • Mumps • Polio • Flavoviruses • Hepatitis – all types • HIV Block 7.0 Module 3.1

16. Infectious Disease • Viral infections • Epstein – Barr virus – mononucleosis • Ebola • HIV • Avian Flu • Herpes • West Nile virus • Papillovirus • Hanta virus Block 7.0 Module 3.1

17. Infectious Disease • Viral infections • CMV – cytomegalovirus • RSV • Poliovirus • Coxsackie family • Rabies • Type A and B influenzas • Rhinoviruses – the common cold • Rotavirus & Enteroviruses Block 7.0 Module 3.1

18. Infectious Disease • Bacterial Infections – can be aerobic or anaerobic asexual prokaryotes with a single DNA strand, can replicate by itself as long as it has nutrients available. • Genus includes: (Note: Iggy has mycoplasmas and Rickettsiae as separate classes, but are in the same family) • Bacterium/Spirochetes • Mycobacterium • Mycoplasmas • Rickettsiae • Chlamydiae • Ehrlichieae Block 7.0 Module 3.1

19. Infectious Disease • Bacterial Infections • Most common in children are: • Streptococcus • Maxarella • Staphylococcus There are more bacterial species than any other life form on the planet. Block 7.0 Module 3.1

20. Infectious Disease4 bacterial colonies Block 7.0 Module 3.1

21. Infectious Diseaseanthrax Block 7.0 Module 3.1

22. Infectious DiseaseHeliobacter pylori Block 7.0 Module 3.1

23. Infectious DiseaseRadiation resistant coloniesnicknamed the “Conan” bacteria Block 7.0 Module 3.1

24. Infectious Disease • Parasitic Disease – live off the host and require a host to replicate, are animals themselves • Protozoans – often water-borne • Helminths – worms, includes nematodes, trematodes, and flukes – they lay eggs • Arthropods Block 7.0 Module 3.1

25. Infectious Disease • Parasitic Diseases • Tape worms • Pin worms • Roundworms • Entamoeba histolytica • Malaria • Toxoplasma gondii • Trichomonas • Leishmaniasis Treatments- anti-microbials: Flagyl, Vermox, albendazole, amphotericin- B, pentamidine Block 7.0 Module 3.1

26. Infectious Disease • Fungal diseasesRacquet hyphae on slide Block 7.0 Module 3.1

27. Infectious Disease • Fungi – self-replicating eukaryotes, includes the class of yeasts and molds • Candida albicans • Aspergillus • Coccidiomycoses • Cryptococcus neoformans • Histoplasmosis Block 7.0 Module 3.1

28. Infectious Disease • Nosocomial – from the Greek word “nosocomia” which means “Nurse”. • This term was coined by Hippocrates – the Father of Medicine, who determined that nurses were responsible for nosocomial infections. • Nosocomial infections are infections that are acquired by a patient who is undergoing medical treatment, and who did not present with that particular organism originally but acquired it while receiving care. Block 7.0 Module 3.1

29. Infectious Disease • Drug Resistant Organisms – these organisms are becoming more prevalent with the over-use of antibiotics. They have cellular memory and enzymes which make certain antibiotics ineffective, i.e. penicillinase. • Examples: • Streptococci • Methicillin Resistant Staph. Aureus (MRSA) • Vancomycin Resistant Enteroccocci (VRE) • E. coli • Pseudomonas Block 7.0 Module 3.1

30. MRSA – resistant to all drugs except Vancomycin & Linezolid Block 7.0 Module 3.1

31. Infectious Disease • Laboratory testing for Viruses: • Enzyme immunoassay = EIA • ELISA test • Titers - measures past exposure and present level of exposure • Direct fluorescent antibody technique • IgM and IgG antibody levels • Viral loads • Viral RNA or DNA count • Viral cultures – on urine, blood, sputum, secretions, stool, tissue, or semen • Viral serology • PAP – High risk HPV profile • Monotest Block 7.0 Module 3.1

32. Infectious Disease Block 7.0 Module 3.1

33. Infectious Disease • Laboratory testing for Bacterium • Cultures & Sensitivity – blood cultures have to be taken from three different sites. Otherwise secretions, pus, sputum, urine, or skin may be used. • Acid Fast Bacilli culture and smear • Gram stain • CBC with diff • Macroscopic and microscopic evaluation Block 7.0 Module 3.1

34. Infectious DiseaseUnknown bacterium Block 7.0 Module 3.1

35. Infectious Disease • Laboratory testing for Bacterium • Cultures and sensitivities • MIC = minimal inhibitory concentration • MIC is the minimal level of a certain drug or antibiotic that it takes to kill a specific species of bacteria. The lower the MIC number, the faster the bacteria are killed by that drug. • Treatment – specific antibiotics Block 7.0 Module 3.1

36. Infectious Disease • Lab testing for Bacterium • Cultures and Sensitivities Example • MR FEBRE was treated for a sore throat for two weeks with Z-packs and did not get better. The culture and sensitivity of an oropharyngeal swab done December 30, 2010, results read on January 2, 2011 = Beta streptococcus at 3,000 colonies/mm3. • Drug tested MIC Penicillin 1000 ug/ml Erythromycin 280 ug/ml Azithromycin 87 ug/ml Cefuroxime 5 ug/ml Vancomycin 0.05 ug/ml Amoxicillin 490 ug/ml Amoxicillin clavunate (Augmentin) 400 ug/ml Presence of + penicillinase noted Block 7.0 Module 3.1

37. Infectious DiseasePseudomonas Block 7.0 Module 3.1

38. Infectious Disease • Lab testing for Fungi • Microscopic exam with KOH • Gram stain • Fungal culture • Skin scrapings • Treatments • PO or IV Diflucan, miconozole, tetraconazole Block 7.0 Module 3.1

39. Infectious Diseases - HIV • Vital Statistics for Human Immune Deficiency Virus • Worldwide: • Over 22 million people have died from AIDS. • Over 42 million people are living with HIV/AIDS, and 74 percent of these infected people live in sub-Saharan Africa. • Over 19 million women are living with HIV/AIDS. • By the year 2010, five countries (Ethiopia, Nigeria, China, India, and Russia) with 40 percent of the world's population added 50 to 75 million infected people to the worldwide pool of HIV disease. Block 7.0 Module 3.1

40. Infectious Disease - HIV • Vital Statistics for Human Immune Deficiency Virus • United States: • An estimated one million people are currently living with HIV in the United States, with approximately 40,000 new infections occurring each year. • 70 percent of these new infections occur in men and 30 percent occur in women. Block 7.0 Module 3.1

41. Infectious Disease - HIV • By race, 54 percent of the new infections in the United States occur among African Americans, and 64 percent of the new infections in women occur in African American women. • 75 percent of the new infections in women are heterosexually transmitted. • Half of all new infections in the United States occur in people 25 years of age or younger Source: http://www.until.org Block 7.0 Module 3.1

42. Infectious Disease • HIV Pathophysiology • HIV is transmitted as a viral particle in semen, blood, and other bodily fluids in small amounts. This particle must find a way into the host’s bloodstream. • The HIV virus has a specific target in the blood, and it attacks the CD4 - T- Cells. The T-cells are the primary defense against all pathogens. Like a general in the army, the T-cell either calls in the bodies defenses i.e. B-Cells and macrophages, or acts as the Killer cells themselves. • The virus uses an enzyme called Protease to attack the Cell Block 7.0 Module 3.1

43. Infectious Disease - HIV • HIV Pathophysiology (continued) • The infected T-cell takes the protease and breaks into the cell’s RNA, changing the function of the cell so that it only produces more HIV virus. • Then it releases the virus back into the bloodstream. • In the end, the viral load goes up and the functional T-Cells and CD-4 count goes down. Block 7.0 Module 3.1

44. Infectious Disease – HIVA picture of the retrovirus Block 7.0 Module 3.1

45. HIV History • 1950s: Blood samples from Africa have HIV antibodies. • 1976: First known AIDS patient died. • 1980: First human retrovirus isolated (HTLV-1). • 1981: First reports of “Acquired Immuno-deficiency Syndrome” in Los Angeles. • 1983: Virus first isolated in France (LAV). • 1984: Virus isolated in the U.S. (called HTLV-III and AIDS-Related Virus, ARV). • 1985: Development and implementation of antibody test to screen blood donors. Block 7.0 Module 3.1

46. HIV History (Continued) • 1986: Consensus name Human Immunodeficiency Virus (HIV-1). Related virus (HIV-2) identified. • 1992: AIDS becomes the leading cause of death among adults ages 25-44 in the U.S. • 1997: Mortality rates of AIDS starts to decline due to the introduction of new drug cocktails. • 2001: World Health Organization predicts up to 40 million infected individuals. More than 22 million have already died. Block 7.0 Module 3.1

47. Infectious Disease • HIV– course of infection • Risks for HIV: • Unprotected sex – with heterosexual or homosexual encounters • IV drug usage – • Needle sticks with unprotected needles • Exposure to blood – health care workers and Laboratory workers • Transfusion with non-screened blood products • Use of contaminated needles or surgical equipment Block 7.0 Module 3.1

48. Infectious Disease • HIV– course of infection • Risks for HIV: (continued) • Mother to Infant (Perinatal): 25% of children become infected in utero, during delivery, or by breast-feeding (with AZT only 3%). • AZT should be started in the first trimester to prevent sero-conversion in the infant. Block 7.0 Module 3.1

49. Infectious Disease • HIV – Course of Infection Block 7.0 Module 3.1

50. Infectious Disease - HIV • HIV – Course of Infection • Infection - the virus enters the body – initial symptoms are a cold, flu like syndrome, body aches, etc…which pass within a few days. The ELISA test is negative at this time. • Incubation – 3 months to one year, where the virus enters other cells, but no symptoms are present. This is when sero-conversion occurs. • Reproduction – For a period of 2 to 6 years, the virus replicates and replaces functional T-cells, reducing the immunity of the patient. The time for symptoms to occur can go from months to years. The patient is still infectious through these 3 phases. Block 7.0 Module 3.1