18 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.2
13
Slide 38
Nursing Care of Patients with Infections
• Urge the patient to consume adequate fluids
• Encourage to consume high-protein, high-vitamin diet
• Isolation, if required
• Laboratory tests
• White blood cell count with differential; erythrocyte sedimentation rate; iron level;
cultures of urine, blood, wound, sputum, and throat
• Administer antibiotic drug therapy
• Hyperbaric oxygen therapy
TALKING POINTS:
• Fluid intake is important in the transportation of nutrients to the cells to fight infection.
• How much fluid intake should a patient have each day?
Slide 39
Medical Asepsis
• Limit spread of microorganisms
• Often called clean technique
• Change bed linen, sanitize bedpans, use individual medication cups for each patient
and for each administration, frequent handwashing
• Handwashing
• Most effective method to prevent cross-contamination
• Soiled hands are main transmitter of nosocomial infections
TALKING POINTS:
• What three things should be used for good handwashing?
• Hand hygiene is the most basic and effective way to prevent cross-contamination.
Surgical Asepsis or Sterile Technique
Slide 41
Question 1
• The inflammatory process involves four changes or factors: hemodynamic changes,
increased permeability of membranes, chemical mediators, and ______________.
A. hormonal factors
B. endocrine changes
C. constriction of the capillary bed
D. decreased release of histamine
Introduction to Medical-Surgical Nursing, 6th ed.
Slide 42
Question 2
• ____________ are one-celled microorganisms capable of multiplying rapidly within a
susceptible host. They are classified by shape, cluster pattern, whether they need
oxygen, and their ability to take up and retain stains.
A. Fungi
B. Bacteria
C. Viruses
D. Protozoa
TALKING POINTS:
Activities
Classroom Choose from below to make 30 minutes
Online
DISCUSS
• Discuss how our understanding of the
antiinflammatory response affects care
planning for patients. Refer to Figure 13-1.
• Divide the class into groups. Ask each
group to illustrate the inflammatory process.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
inflammatory process.
DISCUSS
• Discuss the criteria for determining whether
inflammation is local or systemic. What
considerations should be made when
developing a care plan for either?
• Divide the class into groups. Have each
POST AND COMMENT
• Post the following discussion topic online
and have students comment. List five
common signs and symptoms of
inflammation. Explain why these signs and
symptoms occur.
DISCUSS
• Discuss the factors that influence the speed
of repair of tissue.
• Divide the class into small groups. Ask
POST AND COMMENT
• Post the following discussion topic online
and have students comment. What are
some important actions individuals can take
20 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.2
DISCUSS
• Discuss the origins of inflammation and
infection. What processes cause these
conditions?
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Compare and
contrast infection and inflammation.
DISCUSS
• Discuss how infectious agents affect the
human body.
• Divide the class into groups. Assign each
group an infective agent from the textbook.
its information to the class.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Compare and
contrast bacterial and fungal infections.
DISCUSS
• Discuss the chain of events in the infection
process. How does this sequence of events
facilitate the diagnosis and care planning
for patients?
• Have students identify the potential mode
of transmission for the following scenarios:
• A patient with a subclavian line
develops septicemia.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. How are
infections transmitted? What are the most
common routes?
DISCUSS
• Discuss the signs and symptoms of
localized and generalized infections.
• Divide the class into groups and have each
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe five
common signs and symptoms of infection.
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.2
DISCUSS
• Discuss how poverty contributes to the
increase in infectious diseases.
• Divide the class into small groups. Assign
each group one of the following tasks:
• Define community-acquired infections.
What are their causes? Provide several
examples. How can they be prevented?
• Define health care–associated
infections. What are their causes?
Provide several examples. How can
they be prevented?
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Compare and
contrast community-acquired and health
care–associated infections.
DISCUSS
• Discuss strategies for using standard
precautions while still maintaining patient
dignity.
• Divide the class into groups. Have each
group identify and discuss the nursing care
they would provide to a patient with an
POST AND COMMENT
• Post the following discussion topic online
and have students comment. List your two
top nursing diagnoses for a patient with an
infection of the lungs. Then list three
interventions you would take for each
diagnosis.
Critical Thinking Question
A 44-year-old man is admitted to the hospital with complications related to HIV infection. What
are some signs and symptoms of HIV infection? What types of precautions must a nurse take
when working with this patient?
Discussion Guidelines: HIV is a community–acquired viral infection that attacks a patient’s
immune system and makes the person more susceptible to other infections and disease. Signs and
Instructor Notes/Student Feedback
22 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.3
Instructor Preparation
Textbook Objectives Covered
15. Describe the CDC isolation guidelines for Airborne, Droplet, and Contact (Transmission-Based)
Precautions.
17. Differentiate between humoral (antibody-mediated) and cell-mediated immunity.
19. Describe the process of autoimmunity.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: infection control nurse
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying inflammation, infection, and immunity, including:
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• allergen (p. 186)
• antibodies (p. 168)
• antigen (p. 168)
• contamination (p. 174)
• fungi (p. 173)
• health care–associated
• infection (p. 172)
• inflammation (p. 170)
• medical asepsis (p. 179)
• multidrug-resistant organism
Student Preparation
Assignments 2 hours
14
READ – Textbook (pp. 180-181)
REVIEW
• Box 13-2: Infection Prevention and Control (p. 179)
• Box 13-3: Guidelines for Use of Standard Precautions (p. 180)
ANSWER – Text
• Review Questions for the NCLEX Examination: 11 (p. 191)
ANSWER – Study Guide
• Part IF: 1-11 (p. 65)
• Part IIL: 12 (p. 68)
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.3
15
READ – Textbook (pp. 181-182)
REVIEW
• Box 13-1: CDC’s Nationally Notifiable and Reportable Diseases 2013 (p. 176)
• Part IIIM: 1-4 (p. 70)
16
READ – Textbook (pp. 182-183)
ANSWER – Text
• Review Questions for the NCLEX Examination: 12 (p. 191)
17
READ – Textbook (p. 183)
ANSWER – Text
• Review Questions for the NCLEX Examination: 13, 14 (p. 191)
ANSWER – Study Guide
• Part II: 1 (p. 65)
18
READ – Textbook (pp. 184-188)
ANSWER – Text
• Review Questions for the NCLEX Examination: 15 (p. 191)
ANSWER – Study Guide
• Part ID: 1-6 (p. 65)
• Part IIL: 21-25 (p. 69)
19
READ – Textbook (pp. 188-189)
REVIEW
ANSWER – Text
• Review Questions for the NCLEX Examination: 1 (p. 190)
ANSWER – Study Guide
• Part IA: 9, 16 (p. 64)
• Part IH: 1-10 (p. 65)
• Part IIL: 26, 29, 31 (p. 69)
24 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.3
Lecture Outline 20 minutes
14
Slide 43
Standard Precautions
• Infection control guidelines for hospitals and other health care agencies from Hospital
Infection Control Practices Advisory Committee (HICPAC) and CDC
• For all patients in hospitals regardless of their isolation status
• Use when you will have contact with a patient’s blood, bodily fluids, secretions (except
sweat), excretions, broken skin, and mucous membranes
• Use when you have contact with materials that are soiled or contaminated with bodily
fluids or blood
TALKING POINTS:
15
Slide 44
Transmission-Based (Isolation) Precautions
• Airborne precautions
• Used with diseases that are spread through the air
• Droplet precautions
TALKING POINTS:
• What are examples of disease spread through the air? Droplets? Contact?
• Surgical masks filter expired air; respirators such as the HEPA filter respirator and the
N95 respirator filter inspired air.
Slide 45
Bioterrorism
• The intentional use of microorganisms to cause death or disease
TALKING POINTS:
• Methods used to spread agents of bioterrorism are varied and might include powders,
aerosols, or contamination of food or water.
• What are some agents that may be used in bioterrorism?
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.3
16
Slide 46
Protective Environment
• HEPA filtration
• Directed room air flow
• Positive pressure
• Sealed
• Surfaces should be easy to clean
17
Slide 47
Specific Defenses Against Infection—The Immune Response
• Antibody-mediated immunity
• First-line defense: B lymphocytes and the production of antibodies in response to
specific antigens
TALKING POINTS:
• What are the five classes of antibodies (immunoglobulins)?
Slide 48
Specific Defenses Against Infection—The Immune Response (cont.)
• Cell-mediated immunity
• A delayed response to injury or infection because of time needed for migration of T
cells and production of substances that enhance the immune response and influence
the destruction of antigens
TALKING POINTS:
• What three types of cells do T cells include?
18
Slide 49
Immunodeficiency
• Cause and risk factors
• Body unable to launch an adequate immune response and is at great risk for
infection
• Can be congenital or, more commonly, acquired
• Medical treatment
TALKING POINTS:
• What is the primary clinical clue to immunodeficiency?
• Stress, whether physical or emotional, alters the body’s response to disease.
26 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.3
Slide 50
Immunodeficiency (cont.)
• Nursing care
• Prevent infection
• Encourage adequate nutritional intake
• Perform good skin, mouth, perineal, wound, and IV site care; assess for signs of
infection
TALKING POINTS:
• What is the single most important measure in prevention?
• A small increase in body temperature in these patients can be significant and should be
reported.
Slide 51
Hypersensitivity and Allergy
• Medical treatment
• Antihistamines, bronchodilators, corticosteroids, topical lotions, and ointments
• Testing to determine specific allergens
• Desensitization
TALKING POINTS:
• What are the side effects of antihistamines?
• Testing is performed by injecting small amounts of allergen under the skin (intradermally)
Hypersensitivity and Allergy (cont.)
• Nursing care
• Document all allergies, symptoms they cause, and any treatment currently used
TALKING POINTS:
• Never administer any drug to which the patient reports a previous allergic reaction.
• Where should patient allergies be posted?
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 27
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.3
Slide 53
Anaphylaxis
• Cause and risk factors
• Life-threatening; can quickly deteriorate into shock, coma, and death
• Histamine released causes bronchospasm, vasodilation, and increased capillary
permeability, which causes fluid to leave the circulation and enter the tissues,
causing shock from hypovolemia
• Signs and symptoms of anaphylaxis include anxiety, wheezing and difficulty
breathing, cyanosis, hives, facial edema, arthralgia, and hypotension
TALKING POINTS:
Slide 54
Anaphylaxis (cont.)
• Medical treatment
• Oxygen, intravenous epinephrine, aminophylline, diphenhydramine, and
corticosteroids
TALKING POINTS:
• The best care is to prevent anaphylaxis whenever possible by obtaining a history of
allergies and taking precautions to protect the patient from substances (often drugs) that
may trigger this reaction.
19
Slide 55
Autoimmune Diseases
• Cause and risk factors
• Immune system reacts against and destroys its own tissues
• Initiated when tissue injury, infection, or malignancy exist
• Genetic factor: autoimmune diseases tend to be familial
TALKING POINTS:
• The exact causes and pathology of most autoimmune diseases are poorly understood,
but many of these disorders cause severe illness and death.
• What are examples of autoimmune diseases?
28 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.3
Slide 56
Autoimmune Diseases (cont.)
• Medical treatment
• Corticosteroids and nonsteroidal antiinflammatory drugs (NSAIDs) are used to treat
inflammation
Activities
Classroom Choose from below to make 30 minutes
Online
DISCUSS
• Discuss the CDC’s decision to combine
category- and disease-specific precautions
into standard precautions. How has the
change affected quality of care for patients?
• Divide the class into groups. Assign each
POST AND COMMENT
• Post the following discussion topic online
and have students comment. What are CDC
guidelines for airborne infections?
• Post the following discussion topic online
and have students comment. What are CDC
DISCUSS
• Divide the class into groups. Assign each
group a type of isolation guideline. Have
the students develop a sign for the patient’s
door that lists the type of precautions that
people entering the room must take. Have
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
guidelines for the use of transmission-based
precautions (Box 13-4). How do these
guidelines improve the quality of care for
DISCUSS
• Create a table of components of a
protective environment.
RESEARCH
• Research online and find at least two types
of patients who need to be placed in
protective isolation. Cite your source.
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 29
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.3
DISCUSS
• Divide the class into two groups. Assign
one group the topic of antibody-mediated
immunity and the other group cell-mediated
immunity. For the assigned topic, have
each group describe its role in the immune
response. Is the response immediate or
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
ways in which the two immune responses
complement each other.
DISCUSS
• Discuss the nurse’s role in providing
education and support to the
immunosuppressed patient.
• Ask an infection control nurse to speak to
the class. Have the nurse discuss the
implementation of standard precautions
and the challenges of maintaining the
precautions. Ask the speaker to address
care and outcomes.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
basic nursing care of a patient who is
immunocompromised.
DISCUSS
• Discuss the nurse’s role in enhancing the
coping skills for patients with autoimmune
disorders.
• Present the following scenario to the class:
• A 68-year-old female with rheumatoid
arthritis who is wheelchair-bound is
admitted to a skilled nursing facility.
Her husband, who was her sole
caregiver, died suddenly from a
myocardial infarction. She has no
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe two
common autoimmune diseases. What are
treatments and nursing interventions?
30 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.3
Critical Thinking Question
A mother takes her 3–year-old son to the pediatrician for treatment of symptoms related to an
upper respiratory infection. The mother inquires as to why it seems that her son, who is in day
care, is always sick. What information about the different types of immunity can the nurse
provide to the child’s mother?
Discussion Guidelines: The nurse should explain that children who attend day care and school
run a greater risk of developing communicable disease because children are less careful about
properly handling nasal and other secretions that are contaminated. As a result, children transfer
Instructor Notes/Student Feedback
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 31
Introduction to Medical-Surgical Nursing, 6th ed.
13
Assessments for
Inflammation, Infection, and Immunity
CHAPTER OBJECTIVES
Lesson 13.1:
1. Describe physical and chemical barriers.
3. Identify the organs involved in immunity.
4. Compare natural and acquired immunity.
Lesson 13.2:
5. Describe how inflammatory changes act as bodily defense mechanisms.
7. Discuss the process of repair and healing.
9. Discuss the actions of commonly found infectious agents.
11. Identify signs and symptoms of infection.
13. Discuss the nursing care of patients with infections.
Lesson 13.3:
14. Describe the Centers for Disease Control and Prevention (CDC) Standard Precautions guidelines for
infection prevention and control.
15. Describe the CDC isolation guidelines for Airborne, Droplet, and Contact (Transmission-Based)
Precautions.
17. Differentiate between humoral (antibody-mediated) and cell-mediated immunity.
19. Describe the process of autoimmunity.
Assessments by Lesson & Objective
Lesson 13.1
1
Study Guide
• Part IIL: 1, 2 (p. 67)
Evolve Instructor Resources
• Test Bank: 3
2
Study Guide:
• Part IA: 1-7 (p. 64)
Evolve Instructor Resources
• Test Bank: 1, 32
3
Study Guide
• Part IJ: 1, 2 (p. 67)
Evolve Instructor Resources
• Test Bank: 25
32 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
5
Study Guide
Lesson 13.2
• Part IK: 1-9 (p. 67)
• Part IIL: 3 (p. 67)
Evolve Instructor Resources
• Test Bank: 4, 5
Evolve Student Resources
• NCLEX Review: 1, 6
6
Evolve Student Resources
• NCLEX Review: 7
7
Evolve Instructor Resources
• Test Bank: 23
8
Study Guide
• Part IA: 13, 14 (p. 64)
• Part IB: 3 (p. 64)
• Part IIL: 4 (p. 67)
9
Study Guide
• Part IB: 1 (p. 64)
• Part IIL: 5-7, 20 (pp. 68-69)
Evolve Instructor Resources
• Test Bank: 6, 28
10
Evolve Instructor Resources
• Test Bank: 7-10, 14, 18, 19
Evolve Student Resources
• Prioritization: 3
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 33
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
11
Study Guide
• Part IB: 2 (p. 64)
12
Study Guide
• Part IA: 11 (p. 64)
• Part IIL: 8, 9, 11 (p. 68)
Evolve Instructor Resources
• Test Bank: 11-13
Evolve Student Resources
• Prioritization: 1
13
Study Guide
• Part IA: 8, 9 (p. 64)
• Part IB: 5 (p. 64)
• Part IIL: 10, 17-19 (pp. 68-69)
Lesson 13.3
15
Study Guide
• Part IIL: 16, 27, 30 (pp. 68-69)
• Part IIIM: 1-4 (p. 70)
16
Evolve Instructor Resources
• Test Bank: 15
17
Study Guide
• Part II: 1 (p. 65)
34 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
18
Study Guide
• Part ID: 1-6 (p. 65)
• Part IIL: 21-25 (p. 69)
Evolve Instructor Resources
• Test Bank: 2, 15-17, 20, 21, 27, 29, 30
Evolve Student Resources
• NCLEX Review: 4
Study Guide
Evolve Student Resources
• Prioritization: 4
Instructor’s Notes/Student Feedback