Fever
- Flushed skin, warm to touch
- Chills
- Sweating
- Change in LOC
- Provide adequate fluids
- Monitor Electrolytes and Fluid
- Monitor vital signs, esp temperature
- Remove excess clothing and blankets
- Sponge bath with tepid water
Common Causes of Pneumonia: Neonates (< 4 Weeks Old)
- Group B Streptococci
- E. coli
Common Causes of Pneumonia: Children (4 Weeks - 18 Years)
- Runts May Cough Chunky Sputum
- RSV (Viruses)
- Mycoplasma
- Chlamydia pneumoniae
- Chlamydia trachomatis
- Streptococcus pneumoniae
Common Causes of Pneumonia: Adults (18 - 40 Years Old)
- Mycoplasma
- Streptococcus pneumoniae
- Chlamydia pneumoniae
Common Causes of Pneumonia: Middle-Aged Adults (40 - 65 Years Old)
- Streptococcus pneumoniae
- Mycoplasma
- Haemophilus influenzae
- Anaerobes
- Viruses
Common Causes of Pneumonia: Elderly (65+ Years Old)
- Influenza Virus
- Haemophilus influenzae
- Anaerobes
- Streptococcus pneumoniae
- Gram-Negative Rods
Pneumonia Assessment
- Older Adult
- Immunocompromised
- Long Term Care
- Shortness of Breath (SOB)
- Hypoxemia
- Cough and Sputum Production
- Wheezing or Crackles
- Fever
- Pleuritic Pain
- Chest X-ray
Pneumonia Intervention
- Humidified Oxygen
- Deep Breathing Exercises
- Position of Comfort
- Increase Fluid Intake
- Manage Fever
- Antibiotics
- Mucolytics
- Expectorants
- Pneumococcal Vaccine
- Sepsis
- Acute Respiratory Failure (ARF)
- Prevention Education
Streptococcus Pneumoniae Characteristics
- Gram-Positive
- Diplococci
- Lancet-Shaped
- Catalase-Negative
- Optochin-Sensitive
- Bile Soluble
- Alpha-Hemolytic
- Polysaccharide Capsule
- Positive Quellung Reaction
- IgA Protease
Streptococcus Pneumoniae Disease
- Sickle Cell Anemia
- Sepsis in Patients with Splenectomy
- Rusty Sputum
- MOPS
- Meningitis
- Otitis Media
- Pneumonia
- Sinusitis
Klebsiella Characteristics
- Gram-Negative
- Bacilli
- Oxidase-Negative
- Intestinal Flora
- Antiphagocytic Virulence Factor
- Polysaccharide Capsule
- Positive Quellung Reaction
- Mucoid Colonies
- Urease-Positive
- Fast Lactose Fermenter
- Pink on MacConkey Agar
Klebsiella Disease
- Aspiration Pneumonia
- Alcoholics
- Diabetics
- Red Currant Jelly Sputum
- Lung Abscess
- Nosocomial Urinary Tract Infection
Mycoplasma Pneumoniae
- No Cell Wall and No Gram Stain
- Cholesterol Membrane
- Eaton's Agar
- Mulberry Colonies
- Atypical pneumonia
- Military Recruits
- Cold IgM Autoimmune Hemolytic Anemia
- Erythema Multiforme
- Tetracycline
- Erythromycin
Common Causes of Meningitis: Newborn (0-6 Months)
- Group B Streptococci
- E. coli
- Listeria monocytogenes
Common Causes of Meningitis: Children (6 Months - 6 Years)
- Enteroviruses
- Neisseria meningitidis
- Haemophilus influenzae Type B
- Streptococcus pneumoniae
Common Causes of Meningitis: Adolescent and Adult (6 - 60 Years Old)
- Enteroviruses
- Herpes Simplex Virus (HSV)
- Neisseria meningitidis (#1 Cause in Teens)
- Streptococcus pneumoniae
Common Causes of Meningitis: Elderly (60+ Years Old)
- Streptococcus pneumoniae
- Gram-Negative Rods
- Listeria Monocytogenes
Meningitis Interventions
- IV Antibiotics
- Dexamethasone
- Analgesics
- Antipyretics
- Closely Monitor for Increased ICP
- Bed Rest
- Preventative Vaccinations
- Droplet-Airborne Precautions
Neisseria Meningitidis
- Gram-Negative
- Diplococci
- Chocolate Agar
- Thayer-Martin Media
- VPN
- Oxidase-Positive
- Maltose Fermentation
- Glucose Fermentation
- Endotoxin
- Lipooligosaccharide (LOS) in Membrane
- Polysaccharide Capsule
- IgA Protease
- Waterhouse Friderichsen Syndrome
- Adrenal Insufficiency
- Petechial Rash
- Ceftriaxone
- Rifampin Prophylaxis
Mumps (Parotitis)
- Paramyxovirus
- Fever
- Headache
- Earache
- Orchitis
- Pain and Swelling of Parotid Glands
- MMR Vaccination
Mumps Virus
- Paramyxovirus
- Parotitis
- Increased Serum Amylase
- Orchitis
- Oophoritis
- Aseptic Meningitis
- Pancreatitis
Haemophilus Influenzae Disease
- Pneumonia
- Cherry Red Epiglottitis
- Meningitis
- Otitis Media
- COPD Exacerbation
- Thumbprint Sign (on X-ray)
- Rifampin Prophylaxis
- Ceftriaxone
Haemophilus influenzae Characteristics
- Gram-Negative
- Coccobacilli
- PRP Capsule in Type B
- Positive Quellung Reaction
- IgA Protease
- Chocolate Agar
- Factor V is NAD
- Factor X is Hematin
- Staph Aureus Provides Factor V
Influenza Virus
- RNA Virus
- Orthomyxovirus
- Enveloped
- Negative Sense
- 8 Segments
- Helical
- Hemagglutinin for Viral Entry
- Neuraminidase for Virion Release
- Genetic Shift
- Reassortment of genome to cause major change
- Genetic Drift
- Minor Antigenic Mutations
- Reye Syndrome with Aspirin Use
- Guillain-Barre Syndrome
Influenza
- High Fever
- Cough
- Headache
- Muscle Aches
- Chills
- Vaccination
- Zanamivir (Relenza)
- Oseltamivir (Tamiflu)
Rhinovirus
- Picornavirus
- Cause of Common Cold
- More than 100 Serologic Types
- Destroyed by Stomach Acid
Adenovirus
- Non-enveloped
- Icosahedral
- Linear
- Double Stranded DNA
- Pharyngitis
- Conjunctivitis
- Fever
- Summer Swimming
- Day Care Centers
- Acute Hemorrhagic Cystitis
- Pneumonia
Mycobacterium Tuberculosis Characteristics
- Mycolic Acid Cell Wall
- Acid-fast
- Carbolfuchsin Stain Red
- Lowenstein-Jensen Agar
- Serpentine Cord Factor
- Primary TB
- Caseating Granuloma
- Ghon Focus
- Hilar Lymph Nodes
- Ghon Complex
- Reactivation TB
- Reactivation in Apex
Mycobacterium Tuberculosis Disease
- Fever
- Night Sweats
- Weight Loss
- Hemoptysis
- Extrapulmonary Disease
- Addison's Disease
- CNS
- Liver
- Kidneys
- GI
- Bones
- Pott's Disease
Tuberculosis Skin Mantoux Test (PPD)
- Delayed Hypersensitivity (Cell Mediated Response)
- Intradermal Injection
- Read 48-72 hours
- ≥ 5 mm Induration
- Immunosuppressed
- ≥ 10 mm Induration
- High Risk Patients
- ≥ 15 mm Induration
- Chest X-Ray
Tuberculosis Assessment
- Airborne Droplet
- 3 Week Productive Cough
- Night Sweats
- Chest Pain
- Fever
- Weight Loss
- Fatigue
- Chest X-Ray
- Blood Tests
- Mantoux Skin Test
- 3 Positive Sputum Tests
Tuberculosis Intervention
- Airborne Isolation
- Combination Drug Therapy (RIPE)
- 6-12 Months
- DOT
- BCG Vaccination
- Medication Education
- 3 Negative Sputum Specimens
- Infection Control
Epstein Barr Virus
- Herpesvirus 4
- Double Stranded DNA
- Linear
- Enveloped
- Infectious Mononucleosis
- Virus Attaches to CD21 in B Cells
- Nasopharyngeal Carcinoma
- Burkitt's Lymphoma
- Hodgkin's Lymphoma
Epstein Barr Virus Mononucleosis
- Mononucleosis
- Fever
- Hepatomegaly
- Splenomegaly
- Pharyngitis
- Posterior Cervical Lymphadenopathy
- Atypical Lymphocytes
- Heterophile Antibodies
- Rash Develops if treated with Ampicillin
- Hodgkin's Lymphoma
Cytomegalovirus (CMV)
- Enveloped
- Double Stranded DNA
- Herpesvirus 5
- Non Heterophile Antibodies
- Owl's eye inclusions
- Congenital TORCH infection
- Mononucleosis
- Pneumonia
- AIDS retinitis and esophagitis
- Infection in transplant recipients
Cytomegalovirus (CMV) TORCH
- Nonspecific TORCH symptoms
- Intrauterine Growth Restriction (Retardation)
- Deafness
- Microcephaly
- Seizures
- Periventricular Calcifications
- Petechial Rash
- Blueberry Muffin Rash
- Chorioretinitis
- Urine Viral Culture or PCR
Herpes Zoster (Shingles)
- Varicella-Zoster Virus
- Linear, Unilateral Rash Along a Dermatome
- Pruritus
- Postherpetic Neuralgia
- Acyclovir
- Analgesics
- Gabapentin
- Contagious Vesicles
- Shingrix
Hepatitis A
- Picornavirus
- 4 Week Incubation Period
- Fecal-oral
- Day Care Centers
- Travel to Developing Countries
- Usually Asymptomatic
- Acute Disease
- Jaundice
- Fever
- Vomiting
Hepatitis B Virus Characteristics
- Hepadnavirus
- Enveloped
- Circular
- Partially Double-stranded DNA
- Has Reverse Transcriptase
- IV Drug Use
- Sex
- Maternal Fetal Routes
- 3 Month Incubation Period
Hepatitis C
- Enveloped
- RNA Virus
- Flavivirus
- Icosahedral
- SS positive Linear
- Most Cases are Due to IV Drug Use
- Turns to Chronic Hepatitis in Over 70% of Cases
- Cirrhosis
- Hepatocellular Carcinoma
- Most Common Indication for Liver Transplantation
- Associated With Type I MPGN
- Porphyria Cutanea Tarda
Human Immunodeficiency Virus (HIV) Stages
- Primary Infection
- Within 3 Weeks
- Flu-like Symptoms
- Asymptomatic Stage
- Years
- Symptomatic Stage
- CD4+ < 500
- AIDS
- Opportunistic Infections
- CD4+ < 200
Human Immunodeficiency Virus (HIV) Assessment
- RNA Retrovirus
- CD4+ Helper T Cells
- Flu-like Symptoms
- Lymphadenopathy
- Fatigue
- Diarrhea
- Unexplained Weight Loss
- White Spots on Tongue
- Persistent Fever
- Night Sweats
Human Immunodeficiency Virus (HIV) Diagnosis
- HIV-1/2 Antigen/Antibody Immunoassay
- HIV-1/2 Antibody Differentiation Immunoassay
- Nucleic Acid Testing (NAT)
- Viral Load
- Polymerase Chain Reaction (PCR) in Neonates
Human Immunodeficiency Virus (HIV) Interventions
- Adequate Nutrition
- Small Frequent Meals
- IV Hydration
- Emotional Support
- HAART
- Transmission Education
- Strict Asepsis for Invasive Procedures
- Treat Opportunistic Infections
Borrelia burgdorferi
- Lyme Disease
- Spirochete
- Dark-field Microscopy
- Giemsa Stain
- Silver Stain
- White-footed Mouse
- Ixodes Tick
- Babesia
- Anaplasmosis
- Flu-like Symptoms
- Erythema Migrans
- Bulls Eye Rash
- Bilateral Bell's Palsy
- Conduction Defects
- Arthropathy
- Doxycycline
- Ceftriaxone
Lyme Disease
- Transmitted by Ticks (Vector-borne)
- Flu-like Symptoms
- Bulls Eye Rash (Erythema Migrans)
- Joint Pain and Stiffness
- Facial Paralysis
- Antibiotics
- Prevention
Rocky Mountain Spotted Fever
- Rickettsia rickettsii
- Dermacentor Wood Tick
- Endemic to East Coast
- Fever
- Headache
- Rash Starts on Wrist and Ankle
- Rash migrates towards the trunk
- Thrombocytopenia
- Hyponatremia
- Elevated liver enzymes
Ebola Virus
- RNA Virus
- Filovirus
- Marburg Virus
- Linear
- Helical
- Enveloped
- Negative Sense
- Bat Reservoir
Ebola Virus Symptoms
- 10 Day Incubation
- Flu-like Symptoms
- Impaired Blood Clotting
- Hematemesis and Hemoptysis
- Mucous Membrane Bleeding
- Skin Bruising
- Internal Hemorrhage
Plasmodium General
- Protozoa
- Malaria
- Anopheles Mosquito
- Cyclic Fever
- Headache
- Anemia
- Splenomegaly
- Blood Smear
- Chloroquine
- Mefloquine for Resistant Types
Plasmodium Specific
- Malariae
- Fever Every Three Days
- Vivax/Ovale
- Fever Every Two Days
- Duffy Antigen Binding Site
- Duffy often absent in Black Population
- Primaquine treats dormant form in liver
- Falciparum
- Most severe
- Irregular Cycles
- Occludes capillaries in the brain, kidneys, and lungs
Staphylococcus epidermidis
- Cocci
- Gram-Positive
- Catalase-Positive
- Urease-Positive
- Coagulase-Negative
- Novobiocin-Sensitive
- Component of Normal Skin Flora
- Infects Prosthetic Devices and IV Catheters
- Contaminates Blood Cultures
- Produces Adherent Biofilms
Staphylococcus saprophyticus
- Gram-Positive
- Cocci
- Catalase-Positive
- Coagulase-Negative
- Novobiocin-Resistant
- Urease-Positive
- Urinary Tract Infections (UTI's)
Streptococcus Pyogenes Disease
- Pyogenic
- Pyogenic Pharyngitis
- Impetigo
- Cellulitis
- Toxigenic
- Toxic Shock-Like Syndrome
- Scarlet Fever
- Sandpaper Rash
- Strawberry Tongue
- Immunologic
- Rheumatic Fever
- Antibodies to M Protein
- Acute Glomerulonephritis (Post Streptococcal Glomerulonephritis)
Streptococcus pyogenes Characteristics
- Group A Streptococci (GAS)
- Gram-Positive
- Cocci
- Beta-Hemolytic
- Catalase-Negative
- Bacitracin-Sensitive
- Hyaluronic Acid Capsule
- Streptolysin O
- DNase
- Streptokinase
- Exotoxin A
- Pyrrolidonyl Arylamidase (PYR) Positive
Staphylococcus aureus Disease
- Skin Infections
- Impetigo
- Abscesses
- Exfoliative Toxin
- Scalded Skin Syndrome
- Toxic Shock Syndrome (TSST 1)
- Binds to MHC II and T Cell Receptor
- Food Poisoning
- Acute Bacterial Endocarditis
- Pneumonia
- Osteomyelitis
Staphylococcus aureus Characteristics
- Gram-Positive
- Cocci
- Catalase-Positive
- Coagulase-Positive
- Beta-Hemolytic
- Protein A Virulence Factor
- Inhibits Phagocytosis
- MRSA
- Resistant to Beta Lactams Due to Altered Penicillin Binding Proteins (PBPs)
Pneumocystis jirovecii
- Fungi
- AIDS/Immunocompromised
- Fever
- Hypoxemia
- Bronchoalveolar Lavage
- Biopsy
- Methenamine Silver Stain
- Saucer/cup shaped yeast forms
- Diffuse interstitial pneumonia CXR
- TMP-SMX
- Start prophylaxis when CD4 drops under 200
Sepsis Assessment
- Systemic Infectious Process
- Fever
- Hypotension
- Change in LOC
- Increased WBC
- Shift to the Left
- Tachycardia
- Tachypnea
- Hyperglycemia
- Edema
Severe Sepsis and Septic Shock Assessment
- Microthrombi
- DIC
- Decreased Oxygen Saturation
- Decreased WBC
- Oliguria
- High Output Heart Failure
- Multiple Organ Failure
Lumbar Puncture
- CSF Sample
- CSF Pressure
- Empty Bladder
- Side-lying Position
- Between 3rd and 4th Lumbar Vertebrae
- Number Tubes
- Supine Position After Procedure
- Increased ICP (Intracranial Pressure)
- Infection at Puncture Site