SPECIFIC BACTERIAL INFECTIONS A. Nosocomial Infections ( Hospital Acquired B. Common causative agent: Gram negative bacteria ( E.

Coli, Klebsiella, Enterobacter,Pseudomonas,Neisseria meningitis) C. Who are risk 1. Very young 2. Elderly 3. Patient with impaired immune system 4. Blood dyscrasia 5. Burns/trauma 6. Poorly controlled diabetes 7. Extensive prolonged procedure 8. Those with implanted foreign object 9. Immunosuppressive cytotoxic drugs D. Prevention - Awareness of possible risk of infection among hospitalized patients - Handwashing and aseptic technique to all diagnostics and therapeutic procedures - Infection control through surveillance and preventive methods E. Result of the diagnostics ( Bacterimia and Septic Shock due to the release of an endotoxin that activates Factor 12 leading to DIC then shock F. Clinical Manifestations: 1. Shaking chills and rapid rise in temperature 2. Increase respiration secondary to anoxia 3. Hypotension to shock ( tachypnea, tachycardia and cool extremities, mental depression, oliguria G. Diagnostics 1. Blood cultures, smears, urinalysis H. Management: 1. Await result of culture and sensitivity test and start broad spectrum antibiotic -serum level are monitored to prevent toxicity q1 2. removal of any possible source of infection (gadgets) 3. aggressive fluid volume to ensure perfusion of organs 4. o2 therapy 5. sodium bicarbonate for severe acidosis q2 6.q3 dopamine, digitalis, diuretics If with shock: 1. Enhance tissue perfusion q4,q5,6 -check state of responsiveness - skin temperature - moisture, color and turgor - appearance of mucous membrane, nailbeds - vital signs - I nad O Q7 - monitor IV sites,CVP measurements, Pulmonary wedge pressure, Swanz Ganz catheter - check for pulmonary edema 2. Promote adequate breathing pattern - blood gas and Ph measurements - correction of acidosis q8 - assisted ventilation

-instruction to cough, turning and changing position 3. assessing adequate urine output- monitor specific gravity B. Staphylococcal Infections: skin, mouth, nose and throat q9 Most common- staphylococcus aureus MOT: DIRECT CONTACT FROM DRAINING LESIONS( FURUNCLE, BOILS AND CARBUNCLE) TRANSMISSION VIA AIR MGT: 1. PREVENTION AND CONTROL - HANDWASHING - ASEPTIC TECHNIQUE - ISOLATION 2. CEPHALOSPORIN 3. MONITOR RESPONSE TO THERAPY C. Streptococcal Infection-Beta haemolytic= streptococcal pharyngitis D. PTB C. Legionnaires disease- an acute respiratory infection from gram negative bacterium( legionella pneumophilia) MOT: inhalation of organism in an aerosol form of infected water from environmental sources Organ affected: lungs- fibrinopurulent. Clinical Manifestations: 1. 2. 3. 4. 5. Profound malaise Myalgias Mild headache Dry cough High fever and chills

Associated symptoms: 1. Pleuritic pain 2. Confusion 3. Resembles manifestation of pneumonia Diagnostics: increase specific serum antibodies Therapeutics: 1. Erythromycin 2. Respiratory isolation Q10 E. Psitacoccis( Ornithosis) is an infectious and atypical form of pneumonia or systemic febrile illness transmitted to humans by infected birds ( chlamydia)- the organisms are found in nasal secretions, feathers, feces and blood of sick birds thru inhalation Clinical Manifestation 4 to 15 days Influenza like illness or severe pneumonia 1. Malaise 2. Headache

3. 4. 5. 6.

Photopobia High fever Chills Interstitial pneumonitis

MGT: TETRACYCLINE, BED REST, O2 F. Leprosy: chronic infectious disease of man which attacks skin and Nares ( hansens disease) Produces lesions in the skin, tissue and peripheral nerves Mycobacterium leprae MOT: direct contact through broken skin or URT Signs and Symptoms Early signs 1. 2. 3. 4. 5. 6. 7. Change in the color of the skin that do not disappear with ordinary treatment Disturbance of sensation Decrease/loss of sweating Thickened or painful nerves Muscle weakness paralysis Nasal obstruction or bleeding Ulcers that do not respond to treatment

Late signs 1. 2. 3. 4. lost of eyebrows Inability to close lids Clawing of fingers Chronic ulcers

Management: Prevent and Treat deformities -dapsone with rifampicin q11 Diagnostics: scrape/smear of the skin Reconstructive surgery G. Tetanus ( lock jaw) - direct inoculation of material containing tetanus bacilli ( clostridium tetani) Incubation period: 5 to 10 days Source of infection: excreta of farm animals, dust Symptoms: 1. Early signs and symptoms Restlessness, irritable , delirium severe headache, dysuria, diaphoresis, anxiety and low grade fever 2. Later signs and symptoms Trismus, risus sardonicus, opisthotonus sign alert for asphyxia due to spasm of respiratory muscles toxins liberated by clostridia

q12-tetanospasmin- a neurotoxin that has special affinity to nervous tissue<spinal nerve and cranial nerve.that produces spasm tetanolysin-hemolytic and cardiotoxic effects Mnagement: 1. provide an airway to prevent respiratory and cardiovascular complication and to neutralize residual circulating toxins if with tetanus TIG- given 1 to 2 hours before wound debridement active immunization with tetanus toxoid infiltration of immunoglobulin at the site diazepam penicillin Nursing Intervention: provide quiet environment disinfection of wound nutrition via NGT limit stimuli- causes of spasm q13 1. exteroceptive stimuli bright light and noise 2. proprioreceptive- frequent moving and turning of patient 3. interoceptive- flatus distended bladder 4. tracheostomy14 gas gangrene-severe infection of the skeletal muscles caused by gram positive clostridia perfringens q15 trauma compound fractures contusions lacerations *dm at risk due to local tissue anoxia Clinical Manifestation: 1. sudden severe pain at the site of injury 2. tender wound-bronze, black , brown in color 3. wound with vesicles filled with red watery fluid 4. frothy fluid 5. necrotic, pale , prostration and apprehension 6. PR.RR.TEMPERATURE 38.3 7. ANOREXIA, DIARRHEA AND VOMITING

I.

NURSING Intervention: Surgery, antibiotics, monitoring, collaborative role. J. BOTULISM-CLOSTRIDIUM BOTULISM- ingestation of contaminated foods: canned, dried or smoked foods or poorly processed foods --neuroparalytic syndrome---Clinical Manifestation: appear 12 to 36 hours after ingestion of contaminated food GIT- NAUSEA/PARALYSIS OF SKELETAL MUSCLES INTERFERING WITH THE RELEASE OF ACETYLCHOLINE CRANIAL NERVE SYMPTOMS: DIPLOPIA, PTOSIS, BLURRED VISION, DYSPHAGIA, PARALYSIS TOXINS ARE FOUND IN THE SERUM, GASTRIC CONTENTS, STOOL AND INSCRIMINATED FOOD.

K. TYPHOID FEVER( enteric fever, typhus addominalis) - An infectious disease characterized by high fever and slow pulse, either diarrhea or constipation, abdominal tenderness and typanites, rose colored spots on the abdomen by an enlarged spleen - Caused by typhoid bacillus, salmonella typhosa - Predisposing factor: AGE, season, sex, immunity, hygiene Incubation period: 5 to 40 days( mean 10-20 days) Period of communicability: as long as the bacilli is present in the excreta Sources of infection: contaminated food, water and milk Urine and stool of infected persons Portal of Entry: mouth 1. Prodromal stage- headache, nausea/vomiting,chill, productive cough