1. Anaerobic gram-positive clostridium (e.g., Clostridium perfringens, Clostridium welchii, Clostridium novyi) enters through a deep wound

2. Bacilli colonize in muscle tissue around wound; occurs 2 to 5 days after injury

1. Subjective: pain, chills, anorexia, apprehension

2. Objective

1. Multiple incisions for decompression and drainage

2. Complete removal (extirpation) and debridement of involved tissue followed by copious irrigations

3. Antibiotics: penicillin G, tetracycline, chloramphenicol, or erythromycin, depending on culture and sensitivity (C&S) results

4. Analgesics as necessary

5. Anticoagulants to prevent blood clots

6. Electrolytes IV to replenish deficiencies

7. Amputation of affected body part

8. Hyperbaric oxygenation

9. Whole blood, packed RBCs, or plasma transfusions to combat hemolysis and profound anemia

10. Antitoxin therapy may be started

1. Wound for specific clinical manifestations

2. Systemic clinical manifestations

3. Results of culture and sensitivity tests

1. See Chapter 3, Integral Aspects of Nursing Care, General Nursing Care of Clients at Risk for Infection

2. Prevent further infection from fecal contamination (organism found in feces)

3. Use standard and contact precautions

4. Monitor fluid, electrolyte, and cardiovascular status

5. Administer medications as prescribed

1. Remains free of complications

2. Resolves and remains free of infection

1. Protozoan (Toxoplasma gondii) contracted by eating raw meat containing cysts or exposure to contaminated cat feces

2. Prenatal transmission can cause congenital anomalies or fetal death; mother may be asymptomatic

3. Most common opportunistic central nervous system (CNS) infection of those with AIDS

4. Leading cause of encephalitis in immunosuppressed clients

1. Subjective: malaise, fatigue, headache, sore throat, muscle aches and pains

2. Objective: fever, seizures, rash, cognitive and motor impairment, lymphadenopathy, positive cultures, brain abscesses

1. Pharmacological therapy for pregnant women and immunosuppressed clients: spiramycin (can be obtained with special permission from the U.S. Food and Drug Administration [FDA]); pyrimethamine (Daraprim); sulfADIAZINE (SSD); folinic acid; azithromycin (Zithromax); clindamycin HCl (Cleocin); leucovorin calcium preservative free

2. Usually no treatment required for otherwise healthy adults

1. Objective and subjective clinical manifestations

2. Presence of pregnancy

3. Culture results

1. See Chapter 3, Integral Aspects of Nursing Care, General Nursing Care of Clients at Risk for Infection

2. Use standard precautions

3. Encourage diet rich in nutrient-dense foods

4. Teach clients who are pregnant or have a weakened immune system how to decrease risk of infection (e.g., avoid cleaning cat litter pans; avoid gardening where exposed to cat feces; appropriately handle, prepare, and store meat; wash fruits and vegetables)

1. Remains free from infection

2. Continues with follow-up supervision as necessary

1. Protozoan (e.g., Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae) enters body from bite by infected Anopheles mosquito, use of dirty needles, transfusion from infected donor

2. Parasite enters bloodstream and invades RBCs; destroys RBCs, blocks capillaries, and causes irreversible damage to spleen and liver

3. Blackwater fever: rare complication with mortality of 20% to 30%; causes intravascular hemolysis, hemoglobinuria, and acute kidney failure

4. Sickle cell trait provides natural resistance

1. Subjective: malaise, headache, muscle aches, chills, thirst

2. Objective

1. Antimalarial drugs: pyrimethamine/sulfadoxine (Fansidar), mefloquine, primaquine, quinine

2. Aspirin

3. Prevention: chemoprophylaxis 1 week before visiting endemic areas and regularly while in area; avoidance of stagnant pools; use of insect repellents and protective clothing to prevent mosquito bites

1. Objective and subjective clinical manifestations

2. Clinical manifestation of progression to blackwater fever

1. See Chapter 3, Integral Aspects of Nursing Care, General Nursing Care of Clients at Risk for Infection

2. Monitor fluid and electrolyte balance; maintain hydration

3. Use therapeutic measures to decrease fever (e.g., fluids, tepid bath, light clothing, hypothermia blanket if ordered)

4. Maintain bed rest until fever and other clinical manifestations have ceased

5. Support natural defense mechanisms; encourage intake of nutrient-dense foods (e.g., fruits, vegetables, whole grains, and legumes) and foods high in immune-stimulating nutrients (e.g., selenium and vitamins A, C, and E)

6. Reinforce importance of medication regimen; when receiving quinine: teach to take medication with meals to reduce GI irritation and monitor for symptoms of cinchonism (e.g., tinnitus, vertigo, and deafness) (quinine made from cinchona bark)

1. Continues prophylaxis as necessary

2. Understands that organism is always present in blood

1. Rhabdovirus (Lyssavirus rabidus) enters body through bite of infected animal; animal can be ill or a carrier

2. Virus spreads from soft tissue surrounding wound to peripheral nerves and ultimately affects CNS; may cause punctate hemorrhages and neuronal destruction

3. Incubation period 10 to 50 days with bites in upper parts of body, 4 months with bites in lower parts

4. Bites usually are unprovoked; suspected animals are observed for 10 days

1. Subjective

2. Objective

1. Cleansing of wound with soap and water

2. Human rabies immune globulin (Imogam Rabies-HT, hyperRAB) for passive immunity; dose given in buttock; wound is bathed with drug

3. Human diploid cell vaccine (Imovax Rabies) to induce active immunity

4. Sedatives or anesthetics as necessary; phenytoin (Dilantin) used for seizures

5. Tracheostomy if severe respiratory impairment develops

1. Objective and subjective clinical manifestations

2. Wound and/or extremity of bite

3. Manifestation of hydrophobia

1. See Chapter 3, Integral Aspects of Nursing Care, General Nursing Care of Clients at Risk for Infection

2. Avoid contact with saliva of infected client

3. Monitor blood gases, fluid and electrolyte balance, and electrocardiograms (ECGs)

4. Keep room dark and quiet to limit agitation

5. Monitor tracheostomy and suction secretions as needed

6. Prevent drafts, which may result in respiratory spasms

7. Encourage client/family to verbalize feelings

1. Recovers after vaccine is administered

2. Avoids contact with potential sources of infection

3. Function returns to body part affected by bite

1. Microorganism (Rickettsia rickettsii) enters body through bite of infected tick; person may not be aware of tick bite

2. Sudden onset: incubation period 3 to 17 days

3. Organism attacks endothelial cells and extends into vessel walls, causing thrombi, inflammation, and necrosis

1. Subjective: malaise, insomnia, headache, anorexia, photophobia, joint and muscle discomfort, hearing loss

2. Objective

1. Prompt recognition and treatment vital

2. Antibiotics: tetracycline, chloramphenicol; continued until afebrile for 3 to 5 days

3. Treatment of clinical manifestations and complications as they develop

1. Objective and subjective clinical manifestations

2. Integument for characteristic changes

3. Circulatory and renal complications

1. See Chapter 3, Integral Aspects of Nursing Care, General Nursing Care of Clients at Risk for Infection

2. Assure family that client’s disturbed emotional responses are associated with the infection

3. Monitor to determine progression of disease

4. Assess cardiovascular status to determine developing circulatory collapse

5. Reassure hearing loss is temporary

6. Teach prevention (e.g., wear tick repellents, tuck pants into boots, wear long-sleeve shirts, check legs, pants and animals for ticks)

7. Teach to remove ticks with tweezers to ensure complete removal and prevent contamination of fingers

1. Continues with follow-up supervision as necessary

2. Avoids contact with potential sources of infection

1. Spirochete bacteria (Borrelia burgdorferi) enters body through bite of carrier tick that acquired bacterium from infected host; most often carried by mice, deer, or raccoons; cats, dogs, and horses may be carriers

2. Tick injects spirochete-laden saliva into bloodstream; incubates 3 to 32 days; then migrates outward, causing a rash

3. Initial rash and flulike clinical findings; later neuromusculoskeletal and cardiac clinical findings

4. Most common vector-borne illness in United States

5. Infectious organism can survive in host 10 years or more

1. Subjective: chills, muscle aches, joint pain, headache, dizziness, stiff neck, nausea

2. Objective

1. Early Lyme disease: amoxicillin (Amoxil)

2. Severe Lyme disease: ceftriaxone sodium (Rocephin), penicillin G

1. Specific clinical findings, especially red-ringed, circular rash

2. Chronic complications of arthritis, persistent fatigue, CNS and cardiac problems

1. See Chapter 3, Integral Aspects of Nursing Care, General Nursing Care of Clients at Risk for Infection

2. Assure family that client’s disturbed emotional responses are associated with the infection

3. Monitor to determine progression of disease

4. Question clients with arthritic clinical manifestations about possible exposure

5. Teach prevention

6. Advise to receive vaccine if at risk

7. Administer antibiotics as prescribed

1. Continues follow-up supervision as necessary

2. Avoids contact with potential sources of ticks

1. Anaerobic bacillus (Clostridium tetani) enters body through open wound; clinical manifestations 2 days to 3 weeks after exposure

2. Toxins from bacillus invade nervous tissue, motor and sensory nerves become hypersensitive, results in prolonged muscle contractions and respiratory failure

1. Subjective: irritability, restlessness, pain from muscle spasms

2. Objective: muscle rigidity, spastic contractions of voluntary muscles, spasm of masticatory muscles (trismus), spasms of respiratory tract, grotesque grinning expression (risus sardonicus) caused by spasms of facial muscles

1. Prompt recognition of potential contamination and treatment vital

2. Tetanus immune globulin (TIG) used to provide temporary passive immunity; tetanus toxoid adsorbed vaccine (Te Anatoxal Berna) may be given in different site

3. Supportive therapy after clinical manifestations develop because specific therapy is ineffective; necessary until toxins reduce over time

4. Maintenance of adequate pulmonary ventilation

5. Debridement of wound to allow exposure to air

6. Sedatives to limit muscle spasms

7. Antibiotics to limit secondary infection

8. Maintenance of fluid balance and nutrition via enteral feedings