NCM 112: CARE OF CLIENTS WITH INFLAMMATORY AND

IMMUNOLOGIC RESPONSE
Maricris B. Florendo/Constantino Y. Mendoza/Sandra Layne G.
Luczon/Rhizza Abinsay
 
Module Overview
 
This course deals with concepts, principles, theories
and techniques on immunity and inflammation in clinical practice, education and
research. The learners are expected to use the concepts of immunity and
inflammation to support the delivery of health care.
 Purpose 
 Apply the concepts, theories and principles of nursing thru understanding the concept,
intervention and management for client with problems in immunity and inflammation in
the delivery of health care.
 Discuss issues and trends in immunity and inflammation relevant to nursing and health.
 Apply moral and ethical codes of nursing in caring for clients with problems in immunity
and inflammation. 
 Use appropriate nursing interventions and management skills to communicate
effectively and therapeutically to client.
 Utilize correct nursing process and documentation.

Course Learning Outcomes

At the end of the lesson the students will be able to:

Relate the knowledge of physical, social, natural, and health sciences and humanities in the
nursing care of at risk and sick adult clients with problems in infectious, inflammatory and
immunologic disorders.
LETS TRY THIS

1.Immune system causes tissue damage as it fights off a perceived threat also known as
allergies.
a) hypersensitivity
b) autoimmune diseases
c) immunodeficiency
d) antibodies
2. The following are immuno deficiencies EXCEPT?
a) AIDS
b) SCID Syndrome
c) Type I Diabetes
d) none of the above
3. Types of hypersensitivities are determined by their time course and whether ______ cell are
the principal element involved.
a) B
b) A
c) T
d) all of the above
4. The following are all autoimmune disease except:
a) myasthenia gravis
b) multiple sclerosis
c) anaphylaxis
d) rheumatoid arthritis
5. An inflammation-causing signal released by mast cell at the site of an infection is:
a) an interferon
b) lymphatic fluid
c) histamine
d) mucus

IMMUNE SYSTEM

 Terminologies

 Disease-a detectable alteration in normal tissue function.

 If the microorganism produces no clinical evidence of disease, the infection is called
asymptomatic or subclinical
        Infection- is an invasion of body tissue by microorganisms and their growth there.
Such a microorganism is called an infectious agent
 Opportunistic Pathogen- causes disease only in a susceptible individual.
 Pathogenicity-is the ability to produce disease; thus, a pathogen is a microorganism that
causes disease. 
       Resident flora –the collective vegetation in a given area.
 Virulence-ability to produce disease.

IMMUNE SYSTEM

The immune system is made up of special organs, cells and chemicals that fight infection
(microbes). The main parts of the immune system are: white blood cells, antibodies, the
complement system, the lymphatic system, the spleen, the thymus, and the bone marrow.
These are the parts of your immune system that actively fight infection. 

A. Organs/ System Involve 

1. The lymphatic system is made up of:

 lymph nodes (also called lymph glands) -- which trap microbes
 lymph vessels -- tubes that carry lymph, the colorless fluid that bathes your body's
tissues and contains infection-fighting white blood cells
 white blood cells (lymphocytes).

2. Spleen

The spleen is a blood-filtering organ that removes microbes and destroys old or damaged red
blood cells. It also makes disease-fighting components of the immune system (including
antibodies and lymphocytes).

3. Bone marrow

Bone marrow is the spongy tissue found inside your bones. It produces the red blood cells our
bodies need to carry oxygen, the white blood cells we use to fight infection, and the platelets
we need to help our blood clot. 
3. Thymus

The thymus filters and monitors your blood content. It produces the white blood cells called T-
lymphocytes.

4. Skin - a waterproof barrier that secretes oil with bacteria-killing properties

5. Lungs - mucous in the lungs (phlegm) traps foreign particles, and small hairs (cilia) wave the
mucous upwards so it can be coughed out

6. Digestive tract - the mucous lining contains antibodies, and the acid in the stomach can kill
most microbes. Defecation and vomiting can also expel microbes.

7. Urinary Tract – the release of urine to flush out toxins and microbes.

The Immune System’s 3 Layers of Defense

1. First layer of Defense : Outer Barrier/ External/Physical Barriers
2. Second Layer of Defense: Non-Specific (Innate) Immunity
3. Third line of Defense: Specific (Acquired) Immunity
1. The First line of Defense: Outer barriers /External Barriers
Pathogenic (disease-causing) microorganisms must make it past this first line of defense. If this
defense is broken, the second line of defense within your body is activated.
1. Skin - the largest organ of your body. It acts as a barrier between invaders (pathogens)
and your body. Skin forms a waterproof mechanical barrier. Microorganisms that live all
over your skin can’t get through your skin unless it’s broken.
1. Epithelial Cells Produces keratin - a filament protein (intermediate filament) with
two main functions:
1. To hold the skin cells together to form a barrier
2. To form the outermost layer of the skin, that protects us from the
environment
ii. Oleic Acid an oily substance secreted by the skin, creates a mildly acidic
environment on the surface of the skin that is inhospitable to many pathogenic
microbes. Oleic acid is an example of an exogenously produced mediator because it is
produced by resident microbes and not directly by body cells. 
iii. Lysozyme an enzyme that helps in breaking the outer wall of some bacteria
which is also found in tears and saliva.it has an antiseptic function.
iv. Hyaluronic acid – a gelatinous substance that slows the spread of microorganism
that can harm the body.
2. Mucous Membrane
The eyes, nose and mouth serve as the portal of entry for microorganism however:
a. Tears, mucus and saliva are produced by this organ that contains enzymes, that can
break down bacterial walls while others are being trapped in the mucus and later to be
engulfed. 
b. Cilia - Very fine hairs (cilia) lining your windpipe move mucus and trapped particles away
from your lungs. Particles can be bacteria or material such as dust or smoke.
II. Second Line: Non-Specific Immunity (Innate)
1. If the first line of defense is breached, an infection develops the second
line of defense is then activated.
2. If pathogens get to past the first line of defense, for example, through a
cut in your skin, an infection develops

Chemical Barriers with incidental protective effects

 Blood Protein Transferrin - when iron is bounded with transferrin it is
considered to have an incidental chemical protective benefit because iron becomes
unavailable for the growth of harmful microorganism.
Antimicrobial proteins
 Complement - a group of protein that help in defending the body against
foreign invaders without their protective layers. Both nonspecific and specific
immunity are directly helped by complement protein.
 Interferon (to interfere with viral proliferation) - has the ability to
intervene in the multiplication of viruses, and a major stabilizer of the immune
response.
 It hinder cell division stimulating the infected cells to produce
proteins that prevent the duplication of the virus within them.
 Promote or obstruct cell differentiation
 Can fight bacterial and parasitic infection
 Interferons are categorized as cytokines - small proteins that are
involved in intercellular signaling.
 Secretions of interferon is in response to the presence of a virus
or other foreign substance.
 Immunoregulatory functions
 Inhibit B-cell (B-lymphocyte) activation
 Enhance T-lymphocytes activity
 Increase cellular destruction capability of natural killer
cells. 
 3 Forms of interferon
 Alpha  (α) - produced by white blood cells other than
lymphocytes 
 Beta  (β) - produced by fibroblasts
  Gamma  (γ) - produced by natural killer cells and cytotoxic
T lymphocytes (killer T cells)
 Classification 
 Type 1 - alpha and beta forms
 Produced by any cell when stimulated with the
presence of virus
 Primary function is to prompt viral resistance in
cells.
 Type 2 - gamma form
 Produce only by natural killer cells and T-
lymphocytes
 Primary function is to alert the immune system to
counter the contagious agent or cancerous growth.

Cellular Defenses - if the chemical and physical barriers failed to repel the pathogenic agent, the
cellular defense is stimulated.

Nonspecific effector cells of the innate immune system.

WBC (leukocytes) - they hunt and demolish infectious agent. 

a. Microphages also known as granulocytes and or/ polymorphonuclear leukocytes;
granulocytes last only for few days but are constantly being manufactured in the stem
cell in the bone marrow.

Classes of granulocytes (based on the shape of the nucleus)

1. Neutrophils - engulf and demolish
microorganism, bacteria in particular.
2. Eosinophils - scarce cells, they are essential
in impairing the cells that build up the body wall (cuticle) of larger
parasites.
3. Basophils - fewer than eosinophils,
excretes:
  heparin that prevents blood
coagulation 
 Histamine - a chemical excreted by
the mast cell that signifies an allergic response. 
NOTE: if the invading microorganism survived by the attack of the granulocytes, specific
immunity, then help to fight the war against the invasion.
b. Macrophages - the big eaters, a mature monocyte, they last longer than granulocytes.
1. Production also takes place in stem cell of the bone marrow. They settled
particularly in lymphoid tissues (spleen, lymph nodes, liver) to acts as
filtering mechanism of the lymphatic system.
 2. Macrophages slowly ingest the pathogenic microorganism to stimulate
the specific immune response.
3. They are the late comers at the site of invasion.
c. Natural killer cells – a type of cytotoxic lymphocyte, they knock down our own virus
infected body cells (even cancerous cells)

Nonspecific Response (Early Induced Responses) : They act fast however they were not able
to produce lasting immunity to specific microbe. They are dependent on cytokines to fulfil
their results.
         
= Cytokines belongs to the group of proteins known as interleukin, which give rise to fever and
the acute-phase response and tumor necrosis factor - alpha, that start up the inflammatory
response.
1. Acute-phase Response
1. Activated during pathogenic invasion to release the protein interleukin
1 and interleukin 6 by the macrophages to combat the infection
1. in return body temperature will rise (fever) which signals infection
2. Interleukin also activate liver cell to produce high number of more
different protein into the blood circulation, (acute-phase proteins)
to bind to bacteria, thereby stimulating the complement proteins
to kill the harmful microorganism.
3. Acute-phase proteins work like antibodies but more freely, unlike
antibodies acute-phase proteins cannot identify good and harmful
pathogen thereby attacking both at the same time.
4. Interleukin also stimulate the large amount of neutrophils and
eosinophils to assist the altercation against infection. 
ii. Inflammatory Response is activated when infection causes destruction of
tissues; with the following signs (prompted by the chemicals liberated by
macrophages)
1. Pain (cells and fluids entering the tissue)
2. Swelling ( cells and fluids entering the tissue)
3. Redness (increased blood flow)
4. Fever 

NOTE: the released of chemical substances enhance blood circulation to the affected area,
thereby increasing the permeability of capillaries and promote coagulation thus causing the
signs of inflammation. The result of inflammation then invites phagocytic cells to the affected
part to assist in the elimination of foreign invaders. 
> neutrophils and eosinophils the first to come on the scene in an hour
> machrophages few hours later (to Ingest invaders and promote healing by removing cellular
debris from the knock downed cells and the remnants of the self destructed neutrophils after
engulfing pathogens.
> if infection remains, antibodies and T cells (specific immunity element) will appear at the site
of infection to help. 
NEED TO KNOW: 
Three stages of the inflammatory response:
1.First stage: Vascular and cellular responses
Blood vessels at the site of injury constrict.
Dilation of small blood vessels leading to hyperemia
Vascular permeability 
Release of chemical mediators 
Fluid, proteins, and leukocytes (white blood cells) leak into the interstitial spaces
A normal leukocyte count of 4,500 to 11,000 per cubic millimeter
2. Second stage: Exudate production 
The inflammatory exudate is produced\
The plasma protein fibrinogen, thromboplastin and platelets 
The injurious agent is overcome, and the exudate is cleared away 
The major types of exudate are : Serous, Purulent, hemorrhagic (sanguineous)
3. Third stage: Reparative phase.
The repair of injured tissues by regeneration or replacement
Regeneration is the replacement of destroyed tissue cells by cells
Tissues that have little regenerative capacity include nervous, muscular, and elastic tissues
When regeneration is not possible, repair occurs by fibrous (scar) tissue formation.
 In the early stages of this process, the tissue is called granulation tissue
Later in the process, the tissue shrinks is called cicatrix, or scar

III. The third Line of Defense: Specific (Acquired ) Immunity/ Adaptive Immunity
 
= is formed when we are exposed to various antigens and our immune system develops a way
to fight the specific antigen (antibodies development)

= Specific immunity is reliant on lymphocytes , a remarkable white blood cells whose role to
award specific immunity is very important.
= Lymphocytes are the cells responsible for the body’s ability to distinguish and react to an
almost infinite number of different foreign substances, including those of which microbes are
composed.

Types of Lymphocytes: T cells (thymus lymphocytes) and B cells (bone marrow lymphocytes)

1. T cells - like B cells it originates from the stem cell of the bone marrow
but matures in the thymus.
 T cells attack antigens/foreign substance head on.
 Provides cell -mediated immunity
 Assist in managing the immune response.
 Secretes the chemical cytokines which helps control the total
immune response.
 Recognizes pathogenic microorganism that invades the cell body.

2. B cells the one that releases antibodies , proteins that cling to antigens
and destroy them.
 B cells given protection is known as humoral immunity /antibody
mediated because antibodies travels in the body fluids (humour) 
 B cells and antibodies fight foreign substances that remains
outside the circulation of the cell body.

NOTE: An immune response needs the participation of the humoral and cell-mediated attacks
on the antigen and both of them are necessary to increase and strengthen types of nonspecific
immune responses. 
Cytotoxic t-cells and plasma cells- develop into memory cells that “remember.”

Two types of immune response

E1. Humoral - serum transfer, antibodies
Humoral immunity is also called antibody-mediated immunity. With assistance from helper T
cells, B cells will differentiate into plasma B cells that can produce antibodies against a specific
antigen. The humoral immune system deals with antigens from pathogens that are freely
circulating, or outside the infected cells. Antibodies produced by the B cells will bind to
antigens, neutralizing them, or causing lysis (dissolution or destruction of cells by a lysin) or
phagocytosis.

E2. Cellular - T lymphocytes and activated macrophages

Cellular immunity occurs inside infected cells and is mediated by T lymphocytes. The pathogen's
antigens are expressed on the cell surface or on an antigen-presenting cell. Helper T cells
release cytokines that help activated T cells bind to the infected cells’ MHC-antigen complex
and differentiate the T cell into a cytotoxic T cell. The infected cell then undergoes lysis.
 
NOTE: 
C1.Innate immunity involves nonspecific immune defense mechanisms that activate
immediately or within hours of an antigen’s invasion of the body. Innate immunity is present at
birth. Innate immunity activates when the immune system recognizes chemical properties of
the antigens.
C2. Acquired immunity, also referred to as adaptive or specific immunity, is not present at birth
but is learned. The immune system encounters antigens and the acquired immunity’s
components learn how to attack each antigen and develop a memory for it. Specific immunity
tailors attacks to specific antigens because it learns, adapts, and remembers them.
 
IMMUNOGLOBULIN
= also known as antibodies, are produced by the special white blood cell (B lymphocytes or B
cell), remembering that when an antigen/foreign microorganism attach itself to the B cell
surface, the b cells will be stimulated to multiply and aged into a group of the same or identical
cells called clones. (www. britannica.com)
= they act as critical part of the immune response by recognizing and binding to particular
antigens such as bacteria/viruses and aiding in their destruction.

5 Primary Classes of Immunoglobulin

IgG –  the most common immunoglobulin, present in the blood and tissue fluid in large amount,
the only type that can cross the placenta (thus developing fetus have some degree of immunity.
Can found in breast milk, conferring immunity to the infant when ingested. 
 = Human IgG (immunoglobulin G) is expressed on the surface of mature B cells and is
the most prevalent Ig in serum and the major Ig in extravascular spaces. IgG1,
IgG2 and IgG3 are complement activators, with IgG3 being the strongest.
 Human immunoglobulin subclasses IgG1 and IgG3 tend to strongly bind fragment
crystallization (Fc) receptors, whereas subclasses IgG2 and IgG4 bind weakly. IgG is also the
only human immunoglobulin to pass from mother to fetus to transfer immunity.
 It should be noted, the human immunoglobulin subclass IgG2 does cross the placenta,
but it does so weakly. 
IgM - considered first class antibodies produced by B cells, the most common antigen receptor
on the B cell surface, causing agglutination of microorganism when it attaches on the outer
surface of the bacteria.
 = Human IgM (immunoglobulin M)  is expressed on the surface of immature and mature
B cells as monomers. IgM is the third most abundant human immunoglobulin.
 IgM is also the first human immunoglobulin to be made by a fetus and virgin B cells
which are challenged with antigen.
 IgM is a strong complement activator and agglutinator due to its pentameric structure
and binds fragment crystallization (Fc) receptors
IgA (human immunoglobulin) - produced by B cells located in the mucous membrane of the
body ( this is the reason why it can be found in body secretions :tears, saliva, respiratory and
intestinal secretions, colostrum). The second most common human immunoglobulin. Resistant
to digestion and can activate the complement pathway when aggregated.
IgD – expressed on the surface of mature B cells, it works with IgM in B cell development.

IgE - release is elicited by an infection caused by parasites, can be found in the blood in a low
concentration, activated in allergic reaction (release of histamine). Expressed on the surface of
mature B cells. The least abundant immunoglobulin in the serum, does not activate
complement pathway.

 = Fragment crystallization (Fc) receptors for IgE are found on eosinophils and IgE binds Fc
receptors on mast cells and basophils even before interacting with antigen. As a result of its
binding to basophils and mast cells, IgE is involved in allergic reactions. This happens
when allergen is bound to IgE on cells and releases various pharmacological mediators which
cause allergies

IMMUNITY

In biology, immunity is the capability of multicellular organisms to resist

harmful microorganisms. Immunity involves both specific and nonspecific components. 

The two major types of immunity 

 Active immunity-the host produces antibodies in response to natural antigens.
= Two types
1. Artificial Active – production of antibodies in response to
vaccination
2. Natural Active – production of antibodies in response to natural
infection
The B cell may produce antibody molecules of five classes of immunoglobulins 
 Passive immunity, the host receives natural or artificial antibodies produced by another
source.
= Two types
                      1.Artificial Passive – antibodies received from a medicine
                      2. Natural Passive – antibodies received from the mother that crosses the placenta,
that protects the infant up to 6 months old.
 https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/2/acquired-immunity

(Image Courtesy Ottawa Public Health)

Chain of Infection- Six links make up the chain of infection 

1. Etiologic Agent - The extent to which any microorganism is capable of producing an infectious
process depends:
 On the extent of microorganisms present
 The virulence and potency of the microorganisms (pathogenicity) 
 The ability of the microorganisms to enter the body, 
 The susceptibility of the host
 The ability of the microorganisms to live in the host’s body.

2. Reservoir - sources of microorganisms. 

 A carrier is a person or animal reservoir of a specific infectious agent that usually does not
manifest any clinical signs of disease.
  The carrier state may be of short duration 
 temporary or transient carrier
 long duration (chronic carrier).
GOOD TO KNOW**Food, water, and feces also can be reservoirs. ( Five F - fingers, feces, food, fomites,
flies)
3. Portal of Exit from Reservoir - Before an infection can establish itself in a host, the
microorganisms must leave the reservoir
 Respiratory tract -Parainfluenza virus Mycobacterium tuberculosis, Staphylococcus aureus
 Gastrointestinal tract -Hepatitis A virus Salmonella species, Clostridium difficile
 Urinary tract-Escherichia coli enterococci Pseudomonas aeruginosa
 Reproductive tract-Neisseria gonorrhoeae,Treponema pallidum, Herpes simplex virus type 2
Hepatitis B virus (HBV)- 
 Blood HBV Human immunodeficiency virus (HIV) Staphylococcus aureus Staphylococcus
epidermidis
 Tissue -Staphylococcus aureus ,Escherichia coli Proteus species Streptococcus beta-hemolytic A
or B
4. Method or Mode of Transmission - After a microorganism leaves its source or reservoir, it
requires a means of transmission to reach another person or host through a receptive portal of
entry. 
 There are three mechanisms:
1. Direct transmission. involves immediate and direct transfer of microorganisms from person to
person
1.  ***Droplet spread is also a form of direct transmission but can occur only if the source
and the host are within 1 m (3 ft) of each other.
2. Direct contact - skin- to- skin, kissing,and sexual intercourse. Also refer to contact with
soil or vegetation harboring infectious organism
b. Indirect transmission. may be either vehicle-borne or vector-borne.
A. Vehicle-borne transmission. A vehicle is any substance that serves as an intermediate
means to transport and introduce an infectious agent into a susceptible host through a
suitable portal of entry.
B. Vector-borne transmission. A vector is an animal or flying or crawling insect that serves as
an intermediate means of transporting the infectious agent.
3. Airborne transmission may involve droplets or dust. Droplet nuclei, the residue of evaporated
droplets emitted by an infected host

5. Portal of Entry to the Susceptible Host - Before a person can become infected, microorganisms must
enter the body.
The skin is a barrier to infectious agents; however, any break in the skin can readily serve as a portal of
entry.
6.Susceptible Host - A susceptible host is any person who is at risk for infection. 
A compromised host is a person at increased risk

STAGES OF ILLNESS BEHAVIOR/ HUMAN ILLNESS

Stage 1: Symptom Experience
The person is aware that something is wrong. A person usually recognizes a physical sensation or a limitation in
functioning but does not suspect a specific diagnosis.
Stage 2: Assumption of the Sick People/Role
If symptom persist and become severe, clients assume the sick role. At this point, the illness becomes a social
phenomenon, and sick people seek confirmation from their families and social groups that they are indeed ill and
that they be excused from normal duties and role expectations.
Stage 3: Medical Care Contact
If symptoms persist despite the home remedies, become severe or require emergency care, the person is
motivated to seek professional health services. In this stage the client seeks expert acknowledgement of the illness
as well as the treatment.
Stage 4: Dependent Client Role
The client depends on health care professionals for the relief of symptoms. The client accepts care, sympathy and
protection from the demands and stresses of life. A client can adopt the dependent role in a health care institution,
at home, or in a community setting. The client must also adjust to the disruption of a daily schedule.
Stage 5: Recovery and Rehabilitation
This stage can arrive suddenly, such as when the symptoms appeared. In the case of chronic illness, the final stage
may involve in an adjustment to a prolong reduction in health and functioning. 
 Key Points
 The first phase is characterized by complete lack or very few symptoms.
 As the pathogen starts to reproduce actively, the symptoms intensify. Bacterial and viral
infections can both cause the same kinds of symptoms but there are some differences too.
 The last phases are characterized by decline in symptoms severity until their disappearance.
However, even if the patients recover and return to normal, they may continue to be a source of
infection.
Key Terms
 subclinical: Of a disease or injury, without signs and symptoms that are detectable by physical
examination or laboratory test; not clinically manifest.
 clinical latency: The period for which an infection is subclinical.
 viral latency: A form of viral dormancy in which the virus does not replicate at all.

Patterns of Occurrence and Distribution of a Disease

Sporadic 
- On and off in occurrence
- Intermittent/seasonal
- Cases are few and scattered 
Epidemic
- Sudden increase in occurrence
- Outbreak
Endemic
- Continuous in occurrence
- Constant in a period of time

Pandemic
- Simultaneous cases of the same disease in several countries

Types of Microorganisms Causing Infections

 Bacteria -are by far the most common infection-causing microorganisms
 Viruses consist primarily of nucleic and therefore must enter living cells in order to
reproduce
 Fungi include yeasts and molds
 Parasites live on other living organisms
Types of Infections
 Colonization is the process by which strains of microorganisms become resident flora
 Infection occurs when newly introduced or resident microorganisms succeed 
 The infection becomes a disease when the signs and symptoms of the infection are
unique and can be differentiated from other conditions
 Nosocomial infection – hospital acquired infection

Infections can be local or systemic

 A local infection is limited to the specific part of the body where the microorganisms
remain. 
 Systemic infection-if the microorganisms spread and damage different parts of the body
 When a culture of the person’s blood reveals microorganisms, the condition is called
bacteremia. 
 When bacteremia results in systemic infection, it is referred to as septicemia.
 Acute infections generally appear suddenly or last a short time. 
 A chronic infection may occur slowly, over a very long period, and may last months or
years
 Nosocomial infections can either develop during a client’s stay in a facility or manifest
after discharge. 
 Nosocomial microorganisms may also be acquired by health personnel 
 The microorganisms that cause nosocomial infections can originate from the clients
themselves or from the hospital environment and hospital personnel.
 Most nosocomial infections appear to have endogenous sources. 
Iatrogenic infections are the direct result of diagnostic or therapeutic procedures. 
Nosocomial Infections
 Urinary Tract 
 Escherichia coli- improper catheterization technique
 Enterococcus species -contamination of closed drainage system 
 Pseudomonas aeruginosa -inadequate hand hygiene
 Surgical Sites 
 Staphylococcus aureus (including methicillin-resistant strains—MRSA)-inadequate hand
hygiene 
 Enterococcus species (including vancomycinresistant strains—VRE) Improper dressing
change technique 
 Pseudomonas aeruginosa

 Bloodstream 
 Coagulase-negative staphylococci -inadequate hand hygiene Staphylococcus aureus 
 Enterococcus species-improper intravenous fluid, tubing, and site care technique
 Pneumonia Staphylococcus aureus -inadequate hand hygiene 
 Pseudomonas aeruginosa 
 Enterobacter species -improper suctioning technique
PREVENTING NOSOCOMIAL INFECTIONS
 Hand hygiene is important in every setting
 CDC recommends vigorous hand washing under a stream of water 
 Antimicrobial soaps are usually provided in high-risk areas 
 When there are known multiple resistant bacteria 
 Before invasive procedures 
 In special care units, such as nurseries and intensive care units (ICUs) 
 Before caring for severely immunocompromised clients. 
Factors Increasing Susceptibility to Infection
 Age-influences the risk of infection. Newborns and older adults have reduced defenses
against infection.
2 or 3 months by immunoglobulins passively received from the mother. 
Pneumococcal vaccine is recommended for older adults
 Heredity-influences the development of infection
 Stressors elevate blood cortisone- Prolonged elevation of blood cortisone 
 Nutritional status-because antibodies are proteins, Medical therapies -predispose a
person to infection.
 Diseases-chronic pulmonary disease, which impairs ciliary action and weakens the
mucous barrier.Diabetes mellitus is a major underlying disease
 Medications also increase susceptibility to infection.
Lifespan Considerations
 Infections are an expected part of childhood, with most children experiencing some kind
of infection from time to time
■ Newborns may not be able to respond to infections 
■ Newborns are born with some naturally acquired immunity 
■ Breast-fed infants enjoy higher levels of immunity 
■ Fevers less than 39°C (102.2°F) in children should not be treated
■ Children between 6 months and 5 years are at higher risk for fever-induced (febrile) seizures. 
■ Children who are immune compromised or have a chronic health condition need extra
precautions to prevent exposure to infectious agents. 
■ Hand hygiene, comprehensive immunizations, good nutrition, adequate hydration, and
appropriate rest are essential to preventing and/or treating infections in children. 
■ Hand washing and good hygiene in day care and schools are important to prevent the spread
of infections. 
■ Adolescents are at high risk for sexually transmitted diseases and should be well educated
about how to prevent infections.
 OLDER ADULTS
Nutrition is often poor in older adults. 
 Diabetes mellitus, which occurs more frequently in older adults. 
 The immune system reacts slowly to the introduction of antigens
 The normal inflammatory response is delayed. atypical symptoms such as confusion and
disorientation, agitation, incontinence, falls, lethargy, and general fatigue are often
seen first.
Nursing interventions to promote prevention include the following: 
  Provide and teach ways to improve nutritional status. 
 Use strict aseptic technique to decrease chance of infections
 Encourage older adults to have regular immunizations for flu and pneumonia. 
 Be alert to subtle atypical signs of infection 

LABORATORY DATA  that indicates the presence of an infection 

 Elevated leukocyte (white blood cell or WBC) count (4,500 to 11,000/mL3 is normal). 
 Increases in specific types of leukocytes as revealed in the differential WBC count. 
 Elevated erythrocyte sedimentation rate (ESR). 
 Urine, blood, sputum, or other drainage cultures (laboratory cultivations of
microorganisms in a special growth medium) that indicate the presence of pathogenic
microorganisms. 

Key Points

 Resident flora –the collective vegetation in a given area 

 Infection- is an invasion of body tissue by microorganisms and their growth there
 If the microorganism produces no clinical evidence of disease, the infection is called
asymptomatic or subclinical
 Disease-a detectable alteration in normal tissue function
 Virulence-ability to produce disease.
 Pathogenicity-is the ability to produce disease; thus, a pathogen is a microorganism that
causes disease. 
 Opportunistic Pathogen- causes disease only in a susceptible individual.
 Pathophysiology -the study of underlying changes in the body physiology that result
from disease or injury. The mechanisms of the disease and how and why alterations in body
structure and function lead to sign and symptoms of the disease.
 Pathology -investigation of structural alterations in cells, tissues, and organs, which can
help -pattern of tissue changes associated with development of disease.
 Pathogenesis- identify the cause of a particular disease.
 Etiology-refers to study of the cause of the disease. Disease may be caused by infection,
heredity, alterations in immunity, malignancy, malnutrition, degeneration or trauma.
 Idiopathic-diseases that have no identifiable cause are termed idiopathic.
 Iatrogenic-diseases occur as a result of medical treatment
 Nosocomial-diseases that are acquired as consequence of being in a hospital
environment.
 Diagnosis-naming or identification of a disease
 Prognosis-the expected outcome of a disease
 Acute disease-sudden appearance of signs and symptoms that last only a short time
 Chronic disease-develops more slowly and the signs and symptoms last for a long time
or perhaps for a lifetime
 Remissions- are periods when symptoms disappear or diminish significantly
 Exacerbations- are periods when the symptoms become worse or  more severe
 Complication- is the onset of a disease in a person who is  already coping with another
disease.
 Sequelae- are unwanted outcomes of having a disease or are the result of trauma.
 Clinical Manifestation -are the signs and symptoms of evidence of a disease. 
Signs- are objective alterations that can be observed or measured by another person.
Symptoms- subjective experiences reported by the person with disease.
 Prodromal period-  the time during which a person experiences vague symptoms.
 Insidious symptoms- refers to vague or non-specific feelings and an awareness that
there is a change  within the body. 
 Latent period- a time during which no symptoms are readily apparent in the affected
person but the disease is nevertheless present in the body
 Syndrome- a group of symptoms that occur together and may be caused by several
interrelated problems or a specific disease
 Epidemiology- The study of tracking patterns or disease  occurrence and transmission
among populations and by geographic areas.
 Incidence -the number of new cases occurring on a specific period. 
 Prevalence -the number of existing cases within a population during a specific period.
 Risk factors/Predisposing factors -increase the probability that disease will occur but
these factors are not the cause of the disease.
 Precipitating factors -is a condition or event that does cause a pathologic event or
disorder

Fill in the blanks.

1. Is the freedom from disease-causing microorganisms_____________________.
2. Refers to those practices that keep an area or object free of all microorganisms
__________________.
3. diseases that are acquired as consequence of being in a hospital environment
__________________________.
4. Is a local and nonspecific defensive response of the tissues to an injurious or infectious
agent________________________.
5. Involves immediate and direct transfer of microorganisms from person to person
___________________________.
 Activity: 
1. In your own words discuss the chain of infection briefly.
External Resources
https://study.com/academy/lesson/what-is-immunity-definition-types.html
https://www.medicalnewstoday.com/articles/323653
(https://nursingcrib.com/nursing-notes-reviewer/stages-of-illness-behavior/)
(https://bio.libretexts.org/Bookshelves/Microbiology/Book
%3A_Microbiology_(Boundless)/10%3A_Epidemiology/10.3%3A_Disease_Pattern)
https://medical-dictionary.thefreedictionary.com/prodromal+stage