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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).