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Emerging diseases/Century

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What is an emerging disease
An infectious disease whos inceidence has increased in the past 20 years or threatens to increase in the immediate future
What are some emerging diseases
HIV, SARS, Hep C, ebola, H1N1 Lymes, and west nile virus
Where do emerging disease get started
They can originate from unknown sources, animal sources, or even biological warfare.
What modern factors increase risk for widespread emerging diseases
Global travel, population density, encroachment into new environments, misused antibiotics, and even bioterrorism.
What is a re-emerging disease
An infectious disease that reoccurs after it has once been eradicared
what are some examples of re-ermerging diseases
TB, pertussis, and diptheria.
What are the primary preventions for emerging diseases
goal is to decrease risk or exposure of individual or community to disease
What are the secondary preventions for emerging diseases
goal is to indentify indivduals in early stage of the disease process to limit future disability and prevent the spread of disease
What are the tertiary preventions for emerging diseases
goal is to return individual or community to an optimal level of functioning.
What is mononucleosis
An acute, self limiting disease that is common among adolescents
How is Mono transmitted
believed to be saliva
What is mono caused by
caused by herpes like epstein barr virus
What is the incubation period following exposure
30-50 days
How is Mono diagnosed
Increase in leukocytes (WBC 12,000-20,000 with 50% monocytes) and also a positive monospot test.
What is a monospot test
A test that shows heterophile antibodies whih the body has developed to fight EBV
What are some symptoms of Mono
Common symptoms vary greatly from type, duration and severity. Malaise, sore throat with generalized lymphedenopathy and splenomegaly that can persist for months. Tonils may become swollen and could lead to airway obstruction.
What is the management for Mono
Rest, activity restriction if splenomegaly is present.
What are some nursing interventions in the management of Mono
There is not specific treatment, common symptoms are relieved by simple remedies. Mild analgesic for fever, HA and malaise. Bed rest for fatigue, Corticosteroids may be used for complications such as airway obstruction. ampicillin and amoxicilin for maculopapular rash. Gargles, hot drinks, analgesic or anesthestic troches may be used for a sore throat
How is Mono spread
thru oral secretiions, blood transfusion, or transplantation.
What is TB
a Chronic infectious disease of the lungs, caused by mycobacterium tuberculosis. CAn also occur in the kidneys, bones, adrenal glands, cerebral cortex and lymph nodes.
How is TB transmitted
Spread thru airborne droplets, requires close frequent prolonged exposure. NOT spread by hands or objects
What 2 factors of contributed to the reemergence of TB
*High rates of pt's with HIV
*The emergence of multidrug resitant strains
What factors increase the likelihood of transmission
*Number of organisms expelled into the air
*Cncentration of organisms
*Length of time exposure
*Immune system of the exposed person
What is MDR-TB
Multi-drug resistant TB. It devlops from incorrect prescribing, lack of public health case management, and pt nonadherence to the regimen.
What is Latent TB
It is when your body's immune system blocks off the bacteria preventing it from becoming active disease.
Will a TB skin test be positive or negative in latent TB
Positive, pt is asymptomatic.
Can TB be spread when a pt has latent TB
NO
How long unil latent TB becomes active
3-5% within one year, and anther 3-5% if they become immunocompromised
What is active TB
When someone is infected and their immune system is unable to supress the bacteria.
What assessments would you see with active TB
*Bad cough that lasts 3 wks or longer
*Chest pain
*Blood in sputum
*Weakness or fatigue
*Weight loss
*No apetite
*Chills
*Fever
*Sweating
How is TB diagnosed
*TB skin test - Mantoux/The best way to diagnose latent TB
*Chest x-ray - cannot diagnose alone
*AFB test - sputum test, requires 3 samples on 3 differen days, takes 8 weeks to grow
*QuantiFERON-TB (QFT) - can test in a few hours
What is the treatment for latent TB
Drug therapy to prevent development of the active disease. Isoniazid (INH) daily for 6-9 months
What is the treatment for active disease
Isoniazid (INH), rifampin, and PZA is nonviral hepatitis-Monthly liver function test
What is DOT
Directly Observed Therapy, Involves watching pt's take meds to provide strict adherence.
What is the nursing management of TB
Prevention - BCG vaccine/high risk infants an children, Screening, Pt and community education, community efforts to reduce risk factors, prevention an control of chronic illness.
What is the nursing care got TB in the hospital
Isolation precautions, HEPA masks, Negative pressure isolation room, medication, and pt/family education
What should you teach the pt about TB
*Side effects of drugs and when to seek medical help. Major side effect of isoniazid, rifampin, and pyrazinamide can cause hepatitis.
*teach pt to cover nose, sneeze, or produce sputum.
*handwashing
*If outside of negative pressure room pt is to wear a mask
*Teach drug adherence
*Teach pt about symptom relapse, and what could cause it to relapse.
What is pertussis
A childhood respiratory disease caused by bordatella pertussis bacteria
What are some common signs of pertussis
Loud whooping inspirations, low grade fever, coryza, lacrimation, sneezing,URI
Is Pertussis contagious
HIGHLY
How is pertussis transmitted
Droplets or direct contact, or indirect contact with freshly contaminated articles.
How is pertussis diagnosed
Culture for bordatella, increased lymphocytes, and chest x-ray
What are the stages of Pertussis
Prodromal, paroxysmal, and convalescent
What happens during the prodrmal phase
Cold symptoms, nasal drainage, sneezing, runny eyes, cough low grade fever, after 1-2 weeks cough becomes more sever, most infectious stage
What happens in the paroxsymal stage
(4-6 weeks) Coughing attacjs (mostl common at night) consisting of short rapid coughs followed by sudden inspiration associated with a high pitched sound (whoop). suring coughing spells cheeks become flushed or cyanotic, eyes buldge and tongue protrudes
What happens in the convalescent stage
(1-2 months) The cough becomes milder and less frequent during this phase. If a person develops an upper respiratory infection such as bronchitis during the third stage, the paroxysms will increase. Despite the cough, people are usually not infectious at this point in the course of the disease.
What is the treatmen for Pertussis
Antibiotics - erythromycin, clarithromycin, azithomycin,
What are some nursing mangement of pertussis
treat those in close contact with the patient, fluids to prevent dehydration, oxygen and humidity, monitor for airway obstruction, maintain isolation, nasal cultures, standard precautions.
How is pertussis prevented
Immunizations in infancy, boosters for pre-teens, and isolate child during prodromal stage (droplet precaution)
What are some complications of pertussis
Pneumonia, atelectasis, otis media, seizures, hemorrhage, weight loss and dehydration, hernias, prolapsed rectum, syncope, sleep issues, rib fractures, and incontinence
What is Lyme disease
The most common tick born disorder in the U.S. Caused by the bacteria borrelia burgdorferi
What are the stages of Lyme disease
Stage 1: Erythrema migrans (EM) skin lesions (bright border and clear center) at site of tick bite appearing 2-30 days after exposure
Stage 2: Occurs several weeks after stage 1. Symptoms may include headaches, fever, chills, fatigue, swollen lymp nodes, migratory muscles, and joint pain, facial paralysis, and poor motor coordination.
Stage 3: Occurs months to years after stage 2 and may include
How is lymes disease diagnosed
Based on symptoms, lyme serolgy test (can have false positives early on) but otherwise no definitive test
Management for Lyme disease
Antibiotic therapy - doxycycline, ceruoxfine, or amoxicilin given for 2-3 weeks to prevent later stages. Doxycycline may able to prevent if given within 3-4 days of tick bite
Why is lyme disease hard to diagnosis
Because symptoms mimic those of MS, mono, and meningitis.
What are some signs of Lyme disease
Erythrema Migrans is the most chracteristic symptom, later it is accompanied by low-grade fever, chills, HA, stiff neck, fatigue, swollen lymph nodes and migratory joint and muscle pain.
What should you teach your patient about preventing Lyme disease
*avoid tall grass, low brush, and sitting on logs
*Mow grass, move wood and bird feeders
*wear long pants, tuck pants into boots
*use deet bug sprays, check often for ticks
*remove attached tick by mouth and pull straight
*see dr immediately if flu like symptoms, or if you have a bullseye rash
what is Clostridium difficile
A spore forming bacteria which is part of the normal intestinal flora, but when normal flora is altered, C-diff flourishes.
How is C-diff transmitted?
Either by direct contact wirh spores (nosocomial infection) or by taking broad spectrum antibiotics (like cephlasporins or fluroquinilones)
Who is susceptible for C-diff infection
* pt's on long term antibiotics
*hospitalized pt's
*elderly
*immunosuppressed pt's
*malnourished
What are some nursing assesment findings for C-Diff inffection
Subjective data: Past health history like travel, infections, stress, diverticulitis or IBS. Previous meds like laxatives, enemas, or antibiotics. Or if they have had stomach or bowel surgery.
Objective data: Nutritional ingestion of greasy or spicy food, food intolerances, anorexia or nausea. Increased stool frequency, volume, and looseness, change in color or character of stools., bloating, or decreased urinary output. abdominal pain or tenderness
What interventions can you take to prevent C-diff
*take antibiotics only when you have and bacterial infection, make sure it is for the right bacteria, and always take it correctly and for as long as prescribed
*use standard precautions
*proper hand hygiene
*don't use the same toilet as someone with C-diff
*use good hand hygeine
What is the diagnosis for C-diff
stool culture
What is the treatment for c-diff
Metronidazole (flagyl), vancomycin if flagyl doesn't work.
What is west nile virus
A potentially serious disease caused by a virus that can be carried by mosquitoes and transmitted to humns and animals
What is a good indicator of a wast nile virus breakout
Birds dying in the area
What is the mode of transmission for west nile virus
Mosquitoes, transfusions, transplants and breast feeding.
What are the symptoms of west nile virus
Flu like symptoms, meningitis and/or encephalitis
What is the diagnosis for west nile virus
Based on symptoms and a blot test confirming antibodies
What is the treatment for west nile virus
It is very important to lower fever and ease the pressure caused by swelling of the brain and to treat symptoms accordingly
How can you prevent west nile virus
Eliminate standing water in your yard. Mosquitoes breed in pools of standing water.
*Unclog roof gutters
*Empty unused swimming pools.
*Change water in birdbaths at least weekly.
* Remove old tires or any unused containers that might hold water and serve as a breeding place for mosquitoes.
What is antibiotic-resisitant in organism
Bacteria and viruses that have mutated and developed into a specific antbiotic
What is the major contributing factor for the development of antibiotic resistant organisms
misuse and overuse of antibiotics by doctors as well as patients
Who is at most risk for contracting an antibiotic resistant organism
those who are immunosuppressed, have invasive devices (foley's), or have breaks in the skin.
what is MRSA
methicillin-resistant staphylococcus aureus
Where is MRSA generally found
in the nasal secretions, skin and urine
what is VRE
Vancomycin resistant enterococci
Where is VRE generally found
Usually in the GI tract and the female genital tract
what is PRSP
penicillin resistant pneumonia
What are some nursing management strategies for preventing antibiotic resistant organisms
culture to confirm MRSA or VRE, antibiotics, contact isolation, prevention (handwashing), and pt education regarding the use of antibiotics
What are some things you can teach your pt to decrease their risk for antibiotic resistant organisms
*do not take to prevent illness
*wash your hands frequently
*follow directions
*do not request antibiotics for flu or cold
*finish the anitbiotic you were prescribed
*don't take leftover antibiotics
What is severe acute respiratory syndrome (SARS)
a serious acute respiratory infection caused by the corona virus that orignated in China and Hong Kong. It is highly contagious
How is SARS spread
Through droplets in the air or by touching objects that have become contaminated.
How is SARS diagnosed
By having symptoms like a fever 0f 100.4 or higher and either a history of contact with someone with a diagnosis of SARS or travel to any of the regions identified as recent local transmission of SARS, A chest x-ray, WBC and platelets are usually low, can also have an ELISA test, a immunofluroescence or a polymerase reaction test done.
How is SARS prevented
*washing hands
*wearing disposable gloves
*wearing a surgical mask
*washing personal items
*disinfecting surfaces
What are some symptoms of SARS
Flu like symptoms, fever above 100.4, dry cough, and shortness of breath
What is the treatment for SARS
Treament is symptomatic, antipyretics, supplemental O2, and ventillation support as needed
What is necrotizing fasciitis
soft tissue infection cause by Group A Strep
What happens in necrotizing fasciitis
Death of the fascia
What are some assessments for someone with necrotizing fasciitis
Severe pain and swelling, often rapidly increasing
Fever and Redness at a wound site
What is the treatment for necrotizing fasciitis
antibiotics and debridement of necrotic tissue.
What is the avian influenza
Inection caused by the avian influenza A virus which occur naturally in birds
What are the symptoms for avian influenza
typical influenza symptoms: fever, cough, sore throat and muscle aches. Eye infections, pneumonia or sever respiratory distress