Infection

Assessment ● Populations as risk: infections potentially affect all individuals, regardless of age gender, race, and
socioeconomic factors
● Populations at greatest risk:
○ Very young or old
○ Uninsured/Underinsured
○ Residents of geographic areas where an infections is prevalent
Consequences of Uncontrolled Infections
● Sepsis → Septic Shock → Multisystem Failure → Death
● Sepsis: infections in the blood
● Shock: hypoperfusion (inadequate oxygen to the cell/organs)
● Septic Shock: hypoperfusion caused by infection/sepsis

Diagnosis
Lab What it tells us
CBC w/ differential Shows proportion of ban and segmented neutrophils
● Band: immature
● Segmented: mature

C- reactive protein Measure value of c- reactive protein; a protein released during

inflammation

Erythrocyte sedimentation Measure rate RBC separate in anticoagulant whole blood

rate (ESR)

Serological tests Specific test to detect antibodies or viruses when body is responding to
specific infections

Cultural and Sensitivity ● Culture: test to find the germ that cause an infection
● Sensitivity: check to see what type of med will work best to treat
infection
● Results take ~48hr

Peak and Troughs The highest and lowest concentrations of a medication used to
determine dosing intervals and measure toxicity
● Peak: ~60min AFTER administration
● Through: ~30min BEFORE next administer
● Reach steady state after 3-4 doses

Urinalysis (UA) Normal Values

This lab test is used for many ● Urine Color/Clarity: Straw to dark yellow, clear
purposes, including evaluating ● Smell: Slightly aromatic (mild odor)
any problems within the kidneys ● Specific gravity: 1.005 to 1.030
or urinary tract. It can also be ● pH: 5.0 – 8.0
used to evaluate for metabolic ● RBCs: Negative or 0-2 per high-power field
or systemic diseases, as well as ● WBCs: Negative or 0-5 per high-power field
to detect foreign substances ● Epithelial cells: 0-5 per high-power field
(drugs) ● Nitrites: Negative
● Protein: Negative / Trace*
● Clean Catch: wash ● Glucose: Negative *
genitals w/ soap water, ● Metabolites: Negative*
catch midstream
● Sterile Catch: use catheter * These three results come back on a UA, but are not used in the
diagnosis of infection

Planning/ Clinical Management: Collaborative Interventions

Implementation ● Rest and comfort care measures
● Nutritions support/Fluids
● Disinfections of physical environment
● Antimicrobial therapy

Antibiotics
Assessment Is med appropriate? Do they have a bacterial infection? Allergies? Base
line?

Caution Use (Side Effect vs. Common side effect: GI distress → monitor N/V/D; encourage probiotics
Contraindication)

Implementation/Patient ● Instruct patient to take ENTIRE prescribed amount

Teaching ● Encourage adequate fluid intake
● Monitor for s/s of allergic reactions
● Monitor for common adverse events”
○ Nehpfrotxixity (↑ fluids to help flush system)
○ Superinfections (C. diff)

Evaluation ● Serum tests - did the infection improve? Or symptom monitoring

● Pt teaching: complete full course of drug, no NOT STOP TAKING once
you feel better

Sulfonamides ● Important to drink lots of water, 8-10 glasses/day (r/o crystalluria)

● Avoid pregnancy, newborns (is parent breastfeeding?)
“Sulfa” ● Photosensitivity → UV light sensitivity, r/o sunburn → cover skin
● Blood dyscrasias (leukopenia, anemia, thrombocytopenia) → monitor
Sulfamethoxazole labs; educate patient to look for symptoms
● ↑ r/o hyperkalemia → monitor cardiac fictions!

Penicillins ● Take before or after meals (food affects absorptions)

○ 1 hr BEFORE
“cillin” ○ 2hr AFTER
● Monitor electrolytes: Na+ and K+ → cardiac function
Penicillin V/ Penicillin G ● ↑ r/o bleeding → monitor bruising, bleeding; don't take w/ Aspirin!
Amoxicillin ● May interfere w/ oral contraceptives → use condoms
Ampicillin ● PCN allergies: hives, rash, itching, anaphylaxis

Cephalosporins ● Cross-sensitivity w/ PCN (similar structure to penicillins)

● Abstain from EtOH (alcohol → projectile vomiting)
“Cheph” ● r/o bleeding → monitor bruising, bleeding; don't take w/ Aspirin!
● Can enter breast milk → safe but monitor baby allergies
Cephalexin, cefazolin ● Take on empty stomach
Cefotetan
Ceftriaxone
Cefepime

Fluoroquinolones ● Hepatotoxicity (NOT nephrotoxic) → monitor of liver toxicity/jaundice

(yellow skin/eye)
“floxacin” ● Take w/ or w/out food!
● ↑ r/o seizure, neuropathy (rare) → monitor numbness/tingling
Ciprofloxacin ● Avoid in pregnant/lactating women, children <18 yrs
Levofloxacin ● Tendon rupture → educate to ↓ activity/exercise
● Phototoxicity/photosensitivity → r/o UV light/burns
● Avoid Zinc, Calcium, Alum, Mag before/after (foods/vitamins?)
● ↑ r/o bleeding

Tetracyclines ● Hepatotoxic AND Nephrotoxic

● Photosensitivity
“cycline” ● Permanent discoloration of underdeveloped teeth (don’t give to
children <8yrs)
Doxycycline ● Avoid calcium, iron, mag; take 1-2hrs after taking food containing
Minocycline these
● Avoid during pregnancy/lactation, children <8yrs

Macrolides ● Hepatotoxic, Ototoxic (and nephrotoxic)

● Dysrhythmias (prolonged QT interval) → monitor cardiac function!
“mycin” ● Many drug-drug interactions ( is the patient taking multiple meds?)
● Superinfections (C. diff → monitor for mucusy/watery, foul-
Azithromycin smelling diarrhea)
Erythromycin

Aminoglycosides ● Ototoxicity
● Narrow therapeutic range → ordered w/ Peak/Troughs
● Respiratory paralysis → use caution if patient has myasthenia
 “micin/mycin” gravis (MG), or using anesthetics, neuromuscular blocking
agents
Gentamicin
Streptomycin
Neomycin

Vancomycin ● Very nephrotoxic and hepatotoxic

● Many drug interactions
“mycin” ● Red man syndrome/vanco infusion reactions/vanco flushing
syndrome
Vancomycin (MRSA, C. ○ Infuse slowly
Diff) ○ Peek/Through; adjust dose
○ Monitor: redness, hives, anaphylaxis, HR/BP changes
● Assess IV site frequently → r/o extravasation (IV outside
vasculature)
○ Swelling, redness, cool, thrombophlebitis, pain, resistance, leaking
○ Vesicant: damaging to tissue

Antifungals
Polyenes: Nystatin, Amphotericin B
Azoles: Fluconazole, Miconazole

● Used to kill or inactivate fungi → treats fungal infections (including yeast infections)
● Many routes: topical, IV, PO
● Many drug interactions
● Common adverse side effects: fever, chills, vomiting, abdominal pain, skin rash

Assessment ● Is med appropriate? SEVERE fungal infection?

● PREMEDICATE for Amphotericin → EXPECTED infusion Rx
○ Diphenhydramine and Acetaminophen (fever, chills)
○ Meperidine or Dantrolene (rigors)

Implementation/Patient Adverse Effects of Amphotericin B

Teaching ● Chills, fever, rigors, vomiting, headache (infusion Rx)
● Nephrotoxicity
● Hypokalemia
● Ototoxicity
● Bone marrow suppression (↓ RBCs, ↓ WBCs, ↓ Ptls)
● Thrombophlebitis: inflammation at infusion site

Evaluation Is infection improving?

Antiprotozoals
Metronidazole (also effective as an antibiotic against anaerobic bacterial)

● Used for treatment of protozoan infections (Giardia)

● Disulfiram reaction: mixed w/ alcohol → projectile vomiting

Assessment Is med appropriate? Do they have fungal infections?

Caution Use (Side Effect vs. ● Disulfiram reactions → don't drink alcohol w/ med
Contraindication) ● Common side effects: headache, dizziness/lightheadedness, D/N/V,
loss of appetite, stomach pain/cramps
● Metallic taste

Consider - these won’t treat the infections, but they might manage symptoms (fever, inflammation, pain):
● Acetaminophen → antipyretic / analgesics
● NSAIDS (Apron, Ibuprofen) → anti-inflammatory

Primary Prevention Secondary Preventions Screening

● Vaccinations ● STI
● Hygiene ● TB
● Nutrition, Sleep, Stress ● Flu/COVID

Evaluation ● Serum tests - did the infection improve?

● Symptom monitoring - did symptoms decrease?
Key Terms:
Infection: invasion and multiplication of microorganisms in body tissues which may result in illness or disease
Categories of pathogens: parasitic or protozoal / fungal / bacterial / viral
Sources of Infection: Hospital-acquired/healthcare-acquired infection / Community-acquired infection

Antibiotic Agents - Terminology

● Acquired resistance
● Selective Toxicity
● Broad-spectrum
● Narrow-spectrum