HLTB21H3 Chapter 1: In-depth notes on chapter 1

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pinkhippopotamus470

4 Dec 2010

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(1976) peter turner, wwii veteran, fell ill following a stay at a hotel in pennsylvania for a legionnaires" convention. Early symptoms: high fever, chills, headache, and muscle ache and pains. Later symptoms (a few days later): dry couch, chest pains, shortness of breath, vomiting, and diarrhea. Final symptoms (a week later): lungs filled with fluid and pus, confusion, disorientation, hallucinations, and loss of memory. 221 others legionnaires also became ill and 33 of them including turner died of pneumonia. Pathway of spread of disease: *aspiration* of bacteria (called legionella) in *aerosolized* water from ac, while in lobby of the. Unlike infections caused by inhalation, aspiration is produced by choking. Since this outbreak, there have been 11,000 documented cases of legionnaire"s disease annual in the us and estimates of 100,000 with a fatality rate of 15%. Outbreaks have been traced to water heaters, whirlpool baths, respiratory therapy equipment, and ultrasonic misters used in grocery stores.

Related Questions

During the golden age of antibiotic discovery, many new antibiotics were isolated from the soil. Recent studies have found that soil bacteria are naturally resistant to most antibotics. Some of the soil bacteria may even use antibiotics as a nutrient source. Antibiotics must kill a broad spectrum of bacteria while being absorbed harmlessly by the body. Most antibiotics were developed based on Ehrlich "magic bullet" paradigm which is suited to testing antibiotic efficacy in a lab. However, infections are more complex than a pure culture on media in a petri plate. Antibiotic resistance conjures up the pre-antibiotic era of medicine in the early 20th century. The emergence of a plasmid mediated resistance to carbopenems, a last-line drug against a variety of bacteria was alarming to public health workers. Antibiotics may cause collateral damage like a C. diff infection that leads to colitis.

5. Why is a bacterial infection that involves a biofilm harder to control with antibiotics than an infection which does not involve a biofilm?

6. Explain how taking antibiotics would cause the bacteria Clostridium difficle, which is part of the healthy colon microbiome, to become pathogenic?

7. How do bacteria resist antibiotics?

Bacteria also develop resistance to biocides. Traditional cleaning methods for equipment may have limitations. For example, patients who recieve a bed used by a prior patient with a bacterial infection are at an increased risk for being colonized and infected by that same bacteria. In addition, bacteria in a healthcare setting are exposed to disinfection which selects for the resistant members of that bacterial population. No-touch methods of disinfection, i.e. uv light or hydrogen peroxide vapor, of equipment may be an improvement. https://www.ncbi.nlm.nih.gov/pubmed/29214175# (Links to an external site.)Links to an external site..

8. Are biofilms a concern when disinfecting equipment? Why?

During the Flint, MI water crises as levels of chlorine fell in the drinking water cases of Legionnaires' disease increased. Legionnaires' disease is a water borne infectious disease caused by Legionella. One study reported that for every drop in cholorine concentration of mg/L of river water the odds of a reported case of Legionnaire's disease increased by 80%, thus establishing not causation but association. Some argued that Legionella is tolerant of chlorine, espceillay when it grows in biofilms and that the temperature difference between lake and river water accounts for the increase in Legionella infections. The recommended level of chlorine to treat water for drinking is 0.2-0.5 mg/L.

doi:10.1126/science.aat2210 Was Flintâs deadly Legionnairesâ epidemic caused by low chlorine levels in the water supply? David Shult (Links to an external site.)Links to an external site.z

Was Flintâs deadly Legionnairesâ epidemic caused by low chlorine levels in the water supply?

9. What effect would increasing the concentration of chlorine to 1.4 mg/L have had on the people who drink Flint water?

10. What happens to the water pipes when chlorine levels are increased to control bacteria? Could these uninteded consequences increase bacterial growth?

ochrecrocodile432

A 20 year old male complains of sudden onset shortness of breath at 24 times per minute and his pulse aximetry is 85%

Coach him on slowing his rate of respiration

Apply oxygen via nasal cannula at 4lpm

Administer oxygen via nonrebreather mask at 15lmp

Ventilate the patient at a rate of 12 breaths per minute

Which of the following words is considered most appropriate when describing a patientâs respiratory status

Labored

Slow

Adventitious

Quick

A 52 year old male is on a home ventilator. He becomes cyanotic and has a sudden drop in oxygen saturation.

Consult the machines operator manual

Reset the machine by turning it off then on

Obtain a detailed history from his caregiver

Provide ventilation with a BVM

When ventilating a patient with a BVM mask, what is the appropriate oxygen flow rate?

10lbp

15lbp

6lbp

A patient present with a suddent onset of shortness of breath, crackles, and jugular vein distortion

Acute bronchitis

Status asthmaticus

Cystic fibrosis

Acute pulmonary edema

An unresponsive patient has snoring respirations. There are most likely caused

An allergic reaction from food

Excessive nasal secretions

His tongue blocking the airway

A piece of food in his throat

A 42 year old asthmatic patient complains of chest pain, shortness of breath and a violent cough that produces brownish sputum.

Acute asthma attack

Pulmonary embolism

Pneumonia

Influenza

Which of the following is a sign of a lower respiratory tract problem?

a harsh and high-pitched sound on inspiration

rapid and shallow breathing while at rest

increased breathing effort on inhalation

expiratory wheezes and long expiration

a 15 year old male is short of breath after a minor car collision. He has a history of asthma, and his vital signs are R 26 and clear bilaterally

assist ventilations via BVM

coach him to slow his breathing

have him breathe into a paper bag

assist him with his prescribed inhaler

On Friday, May 18th at 9:30 AM You receive a call from the school nurse at Northside elementary school. Northside elementary is a Kâ5 school with a student body of 407 schoolchildren. Since Wednesday May 16th, they have had 40 students and 5 staff members absent due to fluâlike symptoms. Two staff members have been hospitalized with pneumonia. This is a very high number of cases for one week at the school. At 11:00 AM, You receive a call from Ruby Dolor, the Infection Preventionist (IP) at Smallsville Hospital. They have seen seven patients in the last three days who were complaining of fever, cough, chest pain and severe retrobulbar (behind the eye) headache. All patients were diagnosed with Community Acquired Pneumonia (CAP) and two were hospitalized. All patients were negative for Influenza virus, and sputum and blood cultures were also negative for bacteria. Five are treated as outpatients with azithromycin and the two hospitalized patients are being treated with cefotaxime and azithromycin. The two hospitalized patients are not improving and two of the outpatients were seen this morning for worsening of symptoms. Ms. Dolor wants to know if any other reports have been made. At 2:30 PM, Later that day, you receive another call from Greis Nursing Home, a skilled nursing facility with onâsite respiratory support facilities. You know this nursing home is located just a few blocks from Northside Elementary School. They have two residents who developed pneumonia on Wednesday, May 16th and three who developed pneumonia on Thursday May 17th. All cases are being managed in house. All are negative for influenza virus. Bacterial sputum and blood cultures are negative for the first 2 cases and pending for the remaining three cases. Legionella urine antigen tests are also negative. At 4:30 PM Your LHD has developed an initial suspect Case Definition and questionnaire to aid in Case Finding/Identification and Hypothesis Generation. You begin to contact suspect cases to perform initial interviews. A Public Information Officer (PIO) has been designated and preliminary information is being compiled to distribute to community stakeholders (hospitals, physicians and school district administrators). You prepare to continue interviews and staff phone lines over the weekend if necessary.

Question: IS THIS OF PUBLIC HEALTH CONCERN THAT REQUIRES FURTHER ATTENTION? WHY OR WHY NOT? AND AT THIS POINT IN TIME, WHAT WOULD BE THE APPROPRIATE RESPONSE FOR THE LOCAL HEALTH DEPARTMENT?

HLTB21H3 Chapter 1: In-depth notes on chapter 1

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