Chapter 23Infection

Chapter 23Infection

Common InfectionsCommon Infections

• Urinary tract infections

• Prostatitis

• Pneumonia

• Influenza

• Tuberculosis

• Vaginitis

Common Infections (cont.)Common Infections (cont.)

• Herpes zoster

• Scabies

• HIV and AIDS

• Antibiotic-resistant microorganisms

Causes of UTIsCauses of UTIs

• Poor hygienic practices

• Improper cleansing after bowel elimination

• Predisposition created by low fluid intake and excessive fluid loss

• Hormonal changes

• Debilitated states

Gerontological Nursing Interventions for InfectionsGerontological Nursing Interventions for Infections

• Prevention

• Early identification

• Adequate treatment

Signs and Symptoms of UTIsSigns and Symptoms of UTIs

• Early indicators include burning, urgency, and fever.

• Some elders develop incontinence and delirium with UTIs.

• Many UTIs in older adults seem asymptomatic.

• Bacteriuria greater than 105 CFU/mL confirms the diagnosis of UTI.

• As a UTI progresses, retention, incontinence, and hematuria may occur.

Treatment of UTIsTreatment of UTIs

• Establish adequate urinary drainage.

• Control the infection through antibiotic therapy.

• Note fluid intake and output.

• Force fluids.

• Observe for new symptoms.

Signs and Symptoms of ProstatitisSigns and Symptoms of Prostatitis

• Acute: systemic symptoms of fever, chills, and malaise.

• Chronic: these symptoms are uncommon.

• Both types:

– Urinary symptoms of frequency, nocturia, and dysuria

– Varying degrees of bladder obstruction secondary to an edematous, enlarged prostate

– Lower back and perineal pain

Treatment of ProstatitisTreatment of Prostatitis

• Identify pathogen with urinalysis.

• Use antibiotic therapy.

– Chronic prostatitis does not respond as well to antibiotics.

PneumoniaPneumonia

• Incidence

– One of the leading causes of death in the elderly.

• Contributing Factors

– Age-related changes to respiratory system

– High incidence of debilitating conditions

– Hospitialization

• Symptoms

– Restlessness, confusion, and behavioral changes

Influenza FactsInfluenza Facts

• Most deaths from influenza occur in the older population.

• Influenza A is the most frequent cause of serious illness and death in elders.

• Age-related changes cause older persons to be highly susceptible to influenza.

• Symptoms include fever, myalgia, sore throat, and nonproductive cough.

Preventive Measures for InfluenzaPreventive Measures for Influenza

• Annual influenza vaccinations

• Daily vitamin and mineral supplements

• Avoiding people with respiratory infections

TuberculosisTuberculosis

• Classic symptoms may not be demonstrated:

– Anorexia, weight loss, and weakness may be the primary symptoms.

– Night sweats may not occur because of reduced diaphoresis with advanced age.

– Fever may not be detected because of alterations in body temperature in late life.

• Screening for tuberculosis should be performed for all patients entering institutions.

Treatment for TuberculosisTreatment for Tuberculosis

• Rest

• Good nutrition

• Medications

Symptoms and Treatments for VaginitisSymptoms and Treatments for Vaginitis

• Symptoms

– Soreness, pruritus, burning, and a reddened vagina

– Clear, brown or white vaginal discharge

– Can cause bleeding and adhesions

• Treatment

– Local estrogens in suppository or cream

 

Herpes ZosterHerpes Zoster

• Symptoms

– Pain and itching of the skin

– In several days, the formation of vesicles

• Treatment

– Analgesics, corticosteroids, and topical preparations to dry the lesions.

Vaginitis: Age Related ConsiderationsVaginitis: Age Related Considerations

• Vaginal epithelium thins.

• Tissue elasticity lessens.

• Secretions become alkaline and of lesser quantity.

• The flora changes.

Symptoms of ScabiesSymptoms of Scabies

• Intense pruritus that worsens at night

• Excoriation of the skin

• Rash with a burrow

– Diagnosis is made by scraping the lesions with a scalpel and examining the material.

Initial Symptoms of HIVInitial Symptoms of HIV

• Low-grade fever

• Headache

• Sore throat

• Fatigue

• Nausea

• Rash

Symptoms That Can Develop Years After HIV Invades the BodySymptoms That Can Develop Years After HIV Invades the Body

• Persistent fever

• Drenching night sweats

• Headaches

• Fatigue

• Chronic diarrhea

• Thrush

• Persistent vaginitis

Symptoms That Can Develop Years After HIV Invades the Body (cont.)Symptoms That Can Develop Years After HIV Invades the Body (cont.)

• Herpes zoster

• Lymph node swelling

• Meningitis

• Palsies

• Pain

• Dementia

MRSAMRSA

• Staphylococcus aureus can cause infections.

– Minor (e.g., boils; pimples)

– Serious (e.g., pneumonia; septicemia)

• Resistance of Staph to antibiotics progressed throughout the years.

– Linezolid (Zyvox) and the combination of quinupristin with dalfopristin (Synercid) are treatment options.

Vancomycin-Resistant Enterococcus (VRE)Vancomycin-Resistant Enterococcus (VRE)

• VRE is a significant nosocomial infection.

• VRE infections tend to be resistant to most previously used drugs.

– At present, Zyvox and Synercid are the only drugs effective against VRE.

Persons Affected by VREPersons Affected by VRE

• Those who are severely ill

• Debilitated persons

• Immunosuppressed persons

• Those having had major surgical procedures

• Those having an indwelling urinary or central venous catheter

• Those on antibiotic therapy

SourceSource

• Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).