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 Interventions
- 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
 - Carbol Fuchsin 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