NUR 206 Final

• Gerontologic considerations with infection

  • Increased risk due to:
  • Decreased immune function
  • Presence of comorbidities
  • Increase in physical disabilities
• Atypical signs and symptoms of infection in the elderly

  • Cognitive and behavioral changes before lab values change
  • Cannot rely on fever to indicate infection
  • Inability to perform ADL
• Infections that elderly are at risk for

  • Pneumonia
  • UTI
  • TB
  • Skin infections
  • NI infections (2-3 more times at risk)
• Nosocomial Infections (HAI)


  Infections acquired because of exposure to microorganism in a healthcare setting
• People at risk for nosocomial infections

  • Decreased immunity
  • Increase in comorbidities
  • Decreased mobility
• Common HAI

  • Central Line (Clabsi)
  • Catheter (Cauti)
  • Pneumonia
  • C-diff
• Ways to prevent HAI

  • Wearing PPE
  • Follow standard precautions
  • Sterile technique
• Antibiotic Resistant Infections

  Infections that occur due to healthcare providers giving antibiotics for viral infections, prescribing unnecessary antibiotics, using inadequate drugs, or using broad spectrum or combination agents instead of first line medications
• Examples of antibiotic resistant infections

  • Methicillin S. Aureus (MRSA)
  • Vancomyosin- resistant enterococci (VRE)
• Reasons patients develop antibiotic resistant infections

  • Skipping/missing doses
  • Not taking full dose of antibiotics "I feel better"
  • Saving unused antibiotics for later "I may need them"
  • Limited resources or access to care
• Chemotaxis


  Directional migration of white blood cells to the site of injury
• Neutrophils


  • First WBC to arrive at the site of injury, phagocyte (engulf) bacteria, foreign material, and damaged cells
  • Short life-span
  • Dead neutrophils, digested bacteria, and cell debris accumulate as pus
  • Bone marrow releases more neutrophils (increases WBC count)
  • Increased segmented neutrophils
  • Increased numbers of bands "shift to the left"
• Monocytes

  • Second WBC to migrate to site of injury
  • Transform into macrophages which help in phagocytosis of inflammatory debris
  • Cleans area for healing
  • LONG life span
• Lymphocytes

  • Arrive later
  • Made in the bone marrow
  • Humoral and cell mediates immunity
  • B lymphocytes make antibodies
  • T lymphocytes are for long term immunity
• Prostaglandins

  • Produce fever
  • Stimulate redness, vasodilation, and fever
  • Block PGs with NSAIDS to block the fever
  • Cause vasodilation contributing to increased blood flow and edema; significant role in pain receptor sensitivity
  • Proinflammatory and stimulate fevers
  • Vasodilators, creating more blood flow
  • Contribute to EDEMA and SWELLING
• Areas most at risk for pressure ulcers

  • Sacrum
  • Heels
• Pressure injury

  • Localized damage to skin and or tissue
  • Occurs due to intense or prolonged pressure or pressure in combination with shearing of skin
• Influencing factors for pressure injuries

  • Amount of pressure (intensity)
  • Length of time pressure is exerted (duration)
  • Ability of tissue to tolerate externally applied pressure
• Contributing factors for pressure injuries

  • Shearing force-pressure exerted on skin when it adheres to bed and skin layers slide in direction of body movement
  • Excessive moisture-increases risk for skin breakdown
• Braden scale


  Used to assess risk for pressure injuries
• Stages of pressure injuries

  • Stage 1: Non-blanchable erythema of intact skin
  • Stage 2: Partial-thickness loss of skin with exposed dermis
  • Stage 3: Full-thickness skin loss
  • Stage 4: Full-thickness loss with muscle, bone, tendon or other supporting structures exposed, palpable, or involved
  • Unstageable: Full thickness skin and tissue loss, extent cannot be determined because it is obscured by slough and eschar
  • Deep tissue pressure injury: Intact or non-intact skin with localized area of persistent non-blanchable skin, purple or maroon localized area of discolored intact skin or a blood filled blister
• NSAIDs


  • Antipyretic drugs that inhibit prostaglandin synthesis
  • Anti-inflammatory drugs
• Emerging infections


  Infectious diseases that have recently increased in incidence or threaten to increase in the immediate future
• Reemerging infections


  Infections that were near eradication but have reemerged
• Reasons for emerging and reemerging infections

  • Traveling
  • People not getting vaccinated
  • Inadequate sanitation
• Wound


  A break or opening into the skin
• Types of wounds

  • Surgical
  • Nonsurgical
  • Acute
  • Chronic
• Depth of tissue loss in wounds

  • Superficial - epidermis only
  • Partial thickness - into dermis
  • Full thickness - anything BUT bone
• Skin tear


  Caused by shear, friction, and/or blunt force, resulting in separation of skin layers (partial or full thickness)
• Wound healing assessment

  • Location
  • Size
  • Depth
  • Undermining / tunneling
  • Wound margins
  • Wound base
  • Consistency, color, and odor of any drainage
• Primary intention healing

  Three phases: Initial (inflammatory) phase, Granulation phase, Maturation phase and scar contraction
• Secondary intention healing

  Increased exudate and extensive tissue loss causes MORE inflammation, wide irregular margins, more debris, cells, and exudate - may need debrided, healing and granulation occurs from edges in and from the bottom up, larger scar, more granulation tissue
• ABCDE

  Asymmetric, Borders, Color, Diameter, Evolving (used to assess skin lesions)
• Vascular response to injury

  • Arterioles briefly constrict, release of histamines, kinins, and PG's causing dilation, increased capillary permeability and fluid movement from capillaries into tissue spaces, proteins exert oncotic pressure that further draws fluid from blood vessels, fibrinogen leaves the blood and is activated to fibrin which strengthens a blood clot formed by platelets, clots trap bacteria and serves as framework for healing process, platelets release growth factor initiating the healing process
• Cellular response to injury

  • Neutrophils and monocytes move from circulation to site of injury and accumulate, neutrophils come and engulf bacteria, foreign material, etc, have short life span, bone marrow releases more, increased segmented neutrophils = shift to the left, monocytes transform to macrophages to help clean area for healing, have long life span, lymphocytes arrive later, made in the bone marrow, provide humoral and cell mediated immunity
• Types of wound exudate

  • Serous - clear liquid
  • Serosanguinous - mixture of sanguineous and serous
  • Purulent - pus, yellow green
• Types of local inflammation

  • Acute - healing over 2-3 weeks, no residual damage, mostly neutrophils
  • Subacute - similar to acute but lasts longer, may last months
  • Chronic - lasts weeks to years, injurious agents persist or repeatedly injures the tissue, mostly lymphocytes and macrophages
• Signs of local inflammation

  • Redness - due to blood vessels dilating
  • Heat - due to increased metabolism
  • Pain - due to increased pressure
  • Swelling - due to fluid shift into tissues
  • Loss of function
• Skin cancer prevention measures

  • Wear protective clothing
  • Avoid the sun between 10 am-2pm
  • Wear sunscreen with SPF 15 or higher, apply 20-30 min before exposure, reapply every 2 hours
  • Avoid tanning booths and lamps
  • Teach about medications that are photosensitizing
• Medical terminology prefixes/suffixes

  • ectomy - removal of
  • lysis - destruction of
  • orrhaphy - repair or suture
  • oscopy - looking into
  • ostomy - creation of an opening
  • otomy - cutting into
  • plasty - repair or reconstruction of