Chapter 23 Infection Common Infections Urinary tract infections

Chapter 23 Infection

Common Infections • Urinary tract infections • Prostatitis • Pneumonia • Influenza • Tuberculosis • Vaginitis

Common Infections (cont. ) • Herpes zoster • Scabies • HIV and AIDS • Antibiotic-resistant microorganisms

Causes 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 Infections • Prevention • Early identification • Adequate treatment

Signs 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/m. L confirms the diagnosis of UTI. • As a UTI progresses, retention, incontinence, and hematuria may occur.

Treatment 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 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 Prostatitis • Identify pathogen with urinalysis. • Use antibiotic therapy. – Chronic prostatitis does not respond as well to antibiotics.

Pneumonia • 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 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 Influenza • Annual influenza vaccinations • Daily vitamin and mineral supplements • Avoiding people with respiratory infections

Tuberculosis • 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 Tuberculosis • Rest • Good nutrition • Medications

Symptoms 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 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 Considerations • Vaginal epithelium thins. • Tissue elasticity lessens. • Secretions become alkaline and of lesser quantity. • The flora changes.

Symptoms 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 HIV • Low-grade fever • Headache • Sore throat • Fatigue • Nausea • Rash

Symptoms 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. ) • Herpes zoster • Lymph node swelling • Meningitis • Palsies • Pain • Dementia

MRSA • 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) • 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 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

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