Infectious Diseases

Infectious Diseases
Lesson Plan and Speaking Notes

Hepatitis

What are the three types of Hepatitis?

Virus - 3 forms of it: A, B, and C

Hepatitis A, Hepatitis B, and Hepatitis C are all contagious.

Hepatitis B and C are blood borne - can happen through infected blood or blood contaminated fluids coming into contact with skin, eyes, or mucus membranes.

Hepatitis A mainly comes from infected feces.

In its early stages, Hepatitis may cause flu-like symptoms, including:

Fatigue
Fever
Muscle aches
Loss of appetite
Nausea and vomiting
Diarrhea
Jaundice (a yellowing of the skin and whites of the eyes)

Some people may have no symptoms at all and may not even know they'333re infected.

If Hepatitis progresses, it affects the liver causing symptoms such as:

Jaundice
Foul breath, bitter taste in the mouth
Dark or "tea-colored" urine
White, light, or "clay-colored" stools

Hepatitis B

The major infectious hazard for health care workers
With Hepatitis B, 85% to 90% of patients recover from their illness completely within 6 months, without long-term complications.
Incubation period is between 1 and 5 months
Vaccine is available free, and is recommended to employees because of occupational exposure. If you decline to take vaccine, need to sign statement of refusal.
If there is exposure, the agency must make a confidential medical evaluation.

Hepatitis C

The most common blood borne infection in the U.S.
Average of 230,000 new cases per year
Incubation period is 2 to 26 weeks
75% to 85% of those who are infected with Hepatitis C do not recover completely, and develop a chronic condition that can lead to cirrhosis of the liver and death.
40% of liver disease is Hepatitis C related.
There is no vaccine for this.

Hepatitis A

Incubation period is 2 to 6 weeks
Rare if standard precautions are followed
Mainly comes from infected feces
Almost all previously healthy persons who develop Hepatitis A will completely recover from their illness in a few weeks or months without long-term complications.
Once a person recovers, he can no longer pass the virus to other people.
Immune globulin is given after an exposure.
Vaccine available

Risk and Prevention

Elderly patients have a compromised immune system, and are in and out of the hospital frequently, which places them at high risk for infectious diseases. We have to protect ourselves by assuming that everyone is infected.

What is the best prevention for all types of Hepatitis?

The best prevention of all forms of Hepatitis is Standard Precautions.

Vaccination

Hand washing

Gloves

Following protocol for isolation

Safe handling of soiled linens

Safe handling of sharps and needles

Influenza

Annual vaccination is recommended for health care workers because they are at high risk for contracting it, and there is a high risk they will pass it to the patients who have a high mortality rate from influenza.
The flu shots do not guarantee that patients and employees will not get influenza.
Some strains of flu are more deadly than others, but the elderly are always affected the worst by them.
Standard precautions, following isolation protocol

Tuberculosis

Caused by a bacteria

Causes a chronic lung condition and fatigue - used to be called consumption

Spread through the air by droplets when an infected person coughs, sneezes, or speaks

Mantoux test detects infection - This is the test you were given when first employed, and then get annually.

TB was decreasing until 1985, and then began to increase due to homelessness, immigration from TB prone areas, HIV cases, drug use with needles, and reduced resources for fighting it.

Health care facility populations have always had a higher rate, and health care workers are at a greater risk than others

May not be showing symptoms even though infected- but can still infect other people

Long course of medications to treat this

Standard precautions, following isolation protocol

MRSA

MRSA stands for Methicillin-resistant Staphylococcus aureus.
These are Staph bacteria that are resistant to almost all antibiotics.
It is not a super bug, and doesn't cause worse or more disease than other bacteria.
It is multi-drug resistant, so treatment options for it are limited.

Infection with MRSA is when the bacteria is multiplying in tissue and causing symptoms such as fever, respiratory symptoms, or purulent drainage.

The major reservoir of MRSA in a health care setting is infected and infectious patients, but furniture and equipment surfaces may also be contaminated.

MRSA spreads person to person, usually by the hands of staff.

Standard Precautions
Hand washing
Gloves, masks, and gowns depending on what sort of body substance staff would be in contact with
Cleaning patient furniture and equipment surfaces

Clostridium Difficile

C. difficile has become a common infection in health care facilities.
Causes diarrhea
Over use of antibiotics causes normal flora to be suppressed, and that creates an ideal environment for the growth of C. difficile.
It is spread by the fecal-oral route,
or from contact with contaminated environmental surfaces,
or from staff not washing hands.

Diagnosed by stool test

Patients with symptoms are more likely to be a source of contagion.

Standard precautions
Using gloves when any contact with feces might be possible

Herpes Zoster

Commonly called Shingles
15% of people get it in their lifetime, and its incidence increases with aging.

Chicken Pox is caused by Herpes Zoster.
Years later, after having chicken pox, lowered immunity or stress can cause reactivation of the virus along peripheral nerves.
This causes a red rash in a line on one side of the body.
It is very painful and itchy.
Usually there is no fever.

It is treated with an anti-viral agent.

It is spread by contact with lesions, and in some cases is airborne.

Exposure to Shingles can cause Chickenpox in a person without immunity.

Exposure to Chickenpox does not cause Shingles.

Only staff with immunity to Chickenpox should care for patients with shingles.

Standard Precautions

What are ways we can prevent the spread of infectious diseases?

Each patient must receive the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being.

The agency must assure that a patient's abilities in Personal Hygiene and Grooming do not diminish unless circumstances of the individual's clinical condition demonstrate that decline was unavoidable.

This includes the patient's ability to:
Bathe, dress, and groom / Transfer and ambulate / Toilet / Eat

Causes of Deficits in Personal Hygiene and Grooming

Cognitive Impairment
Weakness
Impaired vision
Impaired mobility
Lack of fine motor skills
Safety concerns
Lack of hygiene awareness

Assistance required may be:

Independent
Supervision
Set-up
Cueing
Breaking task into smaller segments

Needs assistance from the primary caregiver:
Once daily / Three or more times per week / One to two times per week / Less often than weekly

You should know each patient's most current plan of care.

The nursing assistant care sheet should match the patient's plan of care, and both of these should match what assistance the patient actually currently needs.
Look at these frequently, and whenever you see a discrepancy, inform the charge nurse.

Interventions for Personal Hygiene and Grooming in General

Encourage patient to participate, and praise accomplishments

Assist only as necessary - encourage patient to do as much of task as he can

Organize and set-up to make task more manageable

Provide equipment within easy reach

Allow sufficient time

Break tasks down into manageable segments

Simplify steps, one at a time

Give choices, but limit choices (Not, "what do you want to eat?" Instead, "Do you want eggs or cereal for breakfast?")

Bathing

Deficit related to:

Inability to reach lower extremities, wash upper body

Inability to set up bath, regulate water flow and temperature

Able to bathe in shower or tub with the assistance of another person: (a) for intermittent supervision or encouragement or reminders, OR (b) to get in and out of the shower or tub, OR (c) for washing difficult to reach areas

Participates in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision

Unable to use the shower or tub and is bathed in bed or bedside chair

Unable to effectively participate in bathing and is totally bathed by another person

Goals:
Patient will wash upper extremities
Patient will wash face and hands
Patient safety will be maintained

What are some safety precautions you take when bathing patients?

Interventions for Bathing:

Know patient's preferences: Tub or Shower, Bath Day and Shift

Respect dignity by maintaining privacy. Close curtains and doors. Make sure the patient is covered as much as possible

Make sure room temperature is comfortable and the bathroom is warmed up in advance

Prepare bathroom in advance with all supplies

Test water temperature before and during bathing

Patient may be afraid of water, so move slowly, use shallow water and/or bath seat, and maintain contact with patient

Let patient feel the water before shower or bath

Never leave a patient unattended in the bath or shower

Use prescribed assistive devices and safety equipment: bath benches, hand-held shower heads, bath bars, non-slip devices

Check skin for redness or breakdown, dryness, flaking, and lesions

Check eyes for redness and eyelashes for flaking - these can be signs of Blepharitis, a condition that is highly irritating

Dry patient's skin thoroughly - it's better to pat dry rather than rub

Apply lotion to dry skin

Dressing and Grooming

Deficit related to:

Unable to make appropriate choices of attire

Impaired ability to put on / take off clothing

Unable to reach upper / lower extremities

Able to dress lower body without assistance if clothing and shoes are laid out or handed to the patient

Someone must help the patient put on undergarments, fasteners, slacks, socks or nylons, and shoes

Patient depends entirely upon another person to dress upper / lower body

Goals:
Patient will assist with dressing by raising arms/legs
Patient will demonstrate ability to dress upper body

What are some techniques you use to make dressing patients easier?

Interventions:

Limit the number of clothing choices

Lay items on the bed in the order that they should be put on

Keep only a few outfits in the closet at a time, and store away off-season clothing

Select easy-to-wear clothing: larger neck openings and front fastenings or no fastenings

Avoid tight-fitting clothes, zippers, hooks and eyes, buttons - Replace buttons with Velcro

Avoid "over the head" items to decrease anxiety

Use well-fitting slip-on shoes or shoes with Velcro fastenings

When putting on shoes, examine the feet for lesions, bunions, toenail problems

Front-opening bras are easier to manage than back-opening

Report to family and/or charge nurse garments that are torn, stained, or that do not fit

Hair Care

Many of our patients have regular appointments with a hairdresser. I can't stress to you how important this is to our patients. Know what the schedule is for the patient, and make sure she gets to her appointments. Know her preferences about hair care between her appointments.

Hair should always be clean and neat

Keep the patient's brush and comb clean

Report dandruff to the charge nurse

When doing hair grooming, check the patient's ears for wax build-up

All patients must be clean-shaved at all times

Hand Care

Hand washing is just as important for patients as it is for staff members. Remind or assist the patient to wash hands after using the toilet and before eating.

Nails must be clean and trimmed at all times

How can you assist patients with dental care?

Dental Care

Brush teeth or dentures after each meal and floss daily

Remove and clean dentures every night, and brush the person's gums and roof of the mouth

Provide short, simple instructions. "Brush your teeth" may be too difficult. Instead try: "hold your toothbrush," "put paste on the brush" and "brush your top teeth," etc.

Monitor for loose, missing, or carious teeth, poorly fitting or broken dentures

Monitor mouth, tongue, and gums for odor, redness, swelling, coating, sores, cracking, or fissures

Strained facial expressions during dinner or refusal to eat may indicate oral discomfort.

What are ways we can prevent the spread of infectious diseases?