Infection

Infection

Multiple Choice

What is the best description of normal flora in the human body?

• Normal flora are harmful pathogens that cause disease.
• Normal flora are beneficial microorganisms that inhabit the human body.
• Normal flora are only found in the digestive system.
• Normal flora are synthetic microorganisms introduced by medicine.

Multiple Choice

What does “virulence” refer to?

• The ability of a microorganism to survive in extreme conditions.
• The overall size of a microorganism.
• The process of a microorganism reproducing rapidly.
• The ability of a microorganism to cause disease or damage in the host

Multiple Choice

Which of the following is a local (rather than systemic) sign of infection?

• Redness at the site of infection
• Fever throughout the body
• Fatigue and malaise
• Nausea and vomiting

Antibiotic-induced invader that dumps toxins and floods you with diarrhea.

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​C. diff: the Gut Disruptor

• ANTIBIOTICS ⇢ Flora wipeout ⇢ C. diff blooms.

• Toxin A = “Attack” (inflammation & fluid).

• Toxin B = “Big Bad Breaker” (deeper mucosal damage).

• Visualize A as acid splashing the lining, B as a bulldozer tearing it up.

Pathophysiology → Toxins Tag-Team

• Fecal-oral spores = glitter gone wild – stick to skin, sheets, doorknobs, stethoscopes.

• Heat-tough, alcohol-proof. Soap & water or bleach-based cleaners only.

• Clinical mantra: If it’s C. diff, scrub, gown, glove, and wipe down twice.

​Transmission → “Spores Score”

• Antibiotics (broad-spectrum)

• Aged >65 yrs

• Admission (hospital/LTC)

• Abnormal immunity (chemo, steroids)

• History of C. diff = bullseye for relapse

Risk Factors → “4 A’s + 1 H”

​≥ 3 watery stools/24 h, barn-yard odor

Diarrhea

crampy, tender belly

Ileus

Elevated WBCs (leukocytosis)

Fever & fight-back

sudden quiet belly + distension → suspect toxic megacolon!

​​red Flag

​Signs & Symptoms

• Flush isolation-gown, gloves, soap & bleach

• Antibiotic (Vancomycin)

• Support: IV fluids, NO Loperamide

• Trouble : Relapse- fecal transplant; Megacolon go to surgery

Tx-FAST

• Dehydration/electrolyte crash

• Ileus-Toxic Megacolon

• Colon Perforation - Sepsis

• Elderly - high risk mortality

Major Complications - DICE

​Management & Complication: Treat FAST, Dodge DICE

Multiple Select

A 78-year-old man was admitted for community-acquired pneumonia and has received IV piperacillin-tazobactam for 6 days. Today he reports abdominal cramping and has had four foul-smelling, watery stools since 0400. Which interventions should the nurse implement immediately? (Select all that apply.)

• Place the patient on contact precautions with gown and gloves

• Initiate enteric isolation and move the patient to a negative-pressure room

• Obtain a stool sample for C. difficile toxin PCR testing

• Administer loperamide 4 mg PO now and repeat every 6 h PRN

• Begin oral vancomycin after the stool specimen is collected

Multiple Choice

The nurse is caring for four patients with confirmed C. difficile infection. Which patient requires assessment first?

• A 66-year-old with 101.1 °F (38.4 °C) fever and mild diffuse abdominal pain

• A 59-year-old complaining of tenesmus and passing small amounts of bloody mucus

• A 72-year-old who has received two liters of IV fluids and now shows a serum potassium of 3.2 mEq/L

• A 70-year-old with abdominal distension, hypoactive bowel sounds, and heart rate 128 bpm

Multiple Choice

An oncology client receiving high-dose steroids and broad-spectrum antibiotics develops profuse diarrhea. The clinician orders oral metronidazole 500 mg every 8 hours. Twelve hours later the patient’s WBC climbs from 12,000 → 28,000 /mm³, and lactate is 3.6 mmol/L. Which nursing action is most appropriate?

• Notify the provider to escalate therapy to oral fidaxomicin or vancomycin

• Administer loperamide 4 mg now to reduce stool output

• Prepare for emergent total abdominal colectomy

• Draw repeat blood cultures and continue current therapy for 24 hours

Multiple Select

A client is being discharged after a second episode of C. difficile infection treated with oral vancomycin. Which discharge instructions should the nurse include to reduce the risk of a third recurrence? (Select all that apply.)

• Avoid proton-pump inhibitors unless absolutely necessary.

• Take OTC loperamide at the first sign of loose stool.

• Complete the entire antibiotic course exactly as prescribed.

• Use alcohol-based hand rubs for at least 30 seconds after each bathroom use

• Ask your provider about fecal microbiota transplantation if another relapse occurs.

• One-liner: Ascending UTI that torches the renal pelvis & cortex.

• “PYELO = Painful Yank of E. coli Landing On Kidneys.”

• Acute vs chronic - Uncomplicated vs complicate

​Pyelo: Kidney on Fire

• Bladder → ureter → kidney (bacteria ride the urine stream ↑)

• Inflammation ⇒ kidney swelling, flank pain, fever

• Untreated ⇢ repeated flare-ups ⇢ scarred nephrons

Pathophysiology → “Ascending Attack”

• Flank/CVA pain ★ hallmark

• Fever > 38 °C & chills (N/V)

• Lower UTI trio: dysuria, urgency, frequency

• Elderly = confusion, malaise > classic pain​

Signs & Symptoms “Fever + Flank = Pyelo”

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​​Spot (S/S + Labs)

​HIT: start IV broad-spec (ceftriaxone / FQ) → switch to oral; 7-14 d total
FLUSH: IV fluids + hydration teaching
Manage pain/fever (NSAID/acetaminophen)
Admit if septic, vomiting, pregnant, or obstructed

Treat It (“Hit & Flush”)

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​​Avert

​Pyelo Snapshot: Spot, Treat, Avert

Cirrhosis

• End-stage chronic liver disease

• Healthy liver cells → replaced by scar tissue nodules

• Irreversible damage → >80% function lost by diagnosis

• Result: detox, metabolism, and protein synthesis all impaired

Think of cirrhosis as a once-flexible sponge turned into stiff cement — it can’t filter, flow, or function.

What Causes Cirrhosis?

• #1 USA causes: Hepatitis C and alcohol

• Others: Hep B/D, NAFLD (from obesity), autoimmune hepatitis

• Also: Biliary disease, genetic/metabolic disorders

• Bottom line: Anything that injures liver long-term can cause cirrhosis

H-A-L-O
Hepatitis, Alcohol, Lifestyle (fatty liver), Other (autoimmune, biliary, genetic)

Patho Breakdown

• Repeated hepatocyte death → scar tissue builds

• Fibrous nodules disrupt liver structure & blood flow

• Portal hypertension = blocked flow → splenomegaly, varices, ascites

• Liver can’t detoxify (↑ ammonia) or produce albumin/clotting factors

Signs and Symptoms

• Fatigue, anorexia, weight loss

• Jaundice, pruritus, spider angiomas

• Ascites, edema, caput medusae

• Varices (bleed risk), splenomegaly

• Hepatic encephalopathy: confusion, asterixis

• Bruising, gynecomastia, muscle wasting

Clinical Clue: Sudden confusion or GI bleeding in a cirrhotic = emergency!

Diagnostics

• ↑ AST/ALT (early), ↓ in late stage

• ↑ Bilirubin & ammonia

• ↓ Albumin, ↑ PT/INR, ↓ platelets

• US/CT: nodular liver, ascites, HCC screen

• Biopsy: confirms fibrosis (if needed)

Pearl: Low albumin + high INR = very sick liver (even if enzymes look "okay")

Management

• No alcohol or hepatotoxic meds

• Small frequent meals; balance protein

• Cholestyramine for severe itching

• Admit if fulminant signs (INR↑, encephalopathy)

Complications to keep front-of-mind

• Chronic HBV/HCV → cirrhosis → hepatocellular carcinoma (screen Q6 mos)

• Rare fulminant failure (mostly HBV) → transplant

Red Flags & Risks

• Bleeding varices (GI hemorrhage)

• SBP (infected ascites)

• Hepatorenal syndrome (renal failure)

• Encephalopathy (↑ ammonia → coma)

• Liver cancer (HCC) — screen Q6 months

• Coagulopathy — easy bruising/bleeding

Takeaway: Cirrhosis = multi-organ threat, not just liver failure.

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Virus	Main Route / Who’s at Risk	Chronic?	Memory Hook
HAV	Fecal-oral → dirty water, daycare, travel	Never (acute-only)	A = Anus-to-mouth
HBV	Blood & body fluids → sex, shared needles, birth, HCWs	Sometimes (5–10 % adults, ↑ if infected as baby)	B = Blood, Babies
HCV	Blood-to-blood → IVDU, transfusions < 1992, dialysis, tattoos	Common (≈ 85 %)	C = Chronic is Common but Curable

Diagnosis

• ALT & AST rockets (hundreds–thousands U/L)

• ↑ Bilirubin if jaundiced

• Serologies

  • HAV: IgM anti-HAV

  • HBV: HBsAg (acute/chron), anti-HBs (immunity)

  • HCV: anti-HCV → confirm with HCV-RNA

• US/biopsy if staging chronic damage

Treat, Teach, & Watch for Trouble

Virus	Primary Treatment	Prevention
HAV	Supportive (rest, fluids)	2-dose vaccine; post-exposure Ig
HBV	Acute → usually supportiveChronic → antivirals (tenofovir, entecavir ± peg-IFN)	3-dose vaccine; safe sex, needle safety
HCV	Direct-acting antivirals (12 wk course cures > 95 %)	Screen high-risk; no vaccine (yet)

Management at a Glance

• Fix cause: Stop alcohol, treat Hep B/C

• Diet: Low Na+ (ascites), protein mod (encephalopathy)

• Meds:

  • Diuretics → ascites

  • Beta-blockers → varices

  • Lactulose → ammonia

  • Vitamins: A, D, E, K + thiamine

• Avoid: NSAIDs, Tylenol, alcohol

Spot It Quickly

• Prodrome: fatigue, arthralgia, N/V, low-grade fever

• Classic liver signs (days later)

  • Jaundice + pruritus

  • Dark cola urine / clay stool

  • RUQ tenderness, hepatomegaly