Immune, Inflammatory, and Infectious Conditions
Key Takeaways
- Infection care on med-surg units prioritizes early sepsis recognition, cultures and antibiotics timing, source control, and reassessment.
- Inflammatory and autoimmune flares require symptom control while protecting the patient from infection and medication toxicity.
- Steroids, biologics, chemotherapy, diabetes, CKD, and advanced age can blunt classic infection signs.
- Isolation decisions should be based on suspected transmission route, not waiting for final cultures.
- Escalate fever with instability, new confusion, hypotension, rising lactate, respiratory distress, or immunocompromised status.
Immune, Inflammatory, and Infectious Conditions
Case anchor
A 76-year-old adult taking prednisone for polymyalgia rheumatica is admitted with weakness and poor appetite. Temperature is 99.6 F, heart rate is 118/min, respiratory rate is 24/min, blood pressure is 88/50 mm Hg, oxygen saturation is 91 percent, and the patient is newly confused. The CMSRN nurse does not dismiss the low-grade temperature. Older adults and immunosuppressed patients may have sepsis without high fever.
Sepsis recognition
Sepsis is life-threatening organ dysfunction caused by a dysregulated response to infection. Med-surg nurses are often first to notice the pattern: new confusion, tachycardia, tachypnea, hypotension, decreased urine output, mottled skin, fever or hypothermia, rigors, rising oxygen needs, high or low white blood cell count, elevated lactate, or worsening creatinine. A normal temperature does not rule it out.
When sepsis is suspected, follow facility protocol. Expect rapid vital sign reassessment, lactate and cultures as ordered, broad-spectrum antibiotics after cultures when this does not cause unsafe delay, IV fluids for hypotension or elevated lactate, oxygen, strict intake and output, and source evaluation. The nurse communicates clearly: suspected infection plus organ dysfunction signs and current response to interventions.
Isolation and transmission
| Route | Examples | Nursing actions |
|---|---|---|
| Contact | C. difficile, draining wounds, some resistant organisms | Gown, gloves, dedicated equipment, soap and water for C. difficile |
| Droplet | Influenza, meningococcal disease, some respiratory viruses | Mask, eye protection as indicated, patient masking for transport |
| Airborne | Tuberculosis, measles, varicella | Negative pressure room, respirator, limit transport |
| Standard | All patients | Hand hygiene, sharps safety, PPE based on exposure risk |
Precautions begin when a disease is suspected, not after final confirmation. For possible C. difficile, use soap and water hand hygiene after care because alcohol gel does not reliably kill spores. For tuberculosis symptoms such as chronic cough, weight loss, night sweats, hemoptysis, and risk factors, place the patient in airborne precautions and notify the provider.
Autoimmune and inflammatory flares
Patients with rheumatoid arthritis, lupus, inflammatory bowel disease, vasculitis, and other inflammatory conditions may present with pain, fatigue, rash, fever, joint swelling, renal changes, pulmonary symptoms, or neurologic findings. Nursing care includes pain assessment, mobility support, skin and oral assessment, renal and urine monitoring when relevant, and screening for medication adverse effects. A lupus patient with new edema, hypertension, and proteinuria needs escalation for possible renal involvement.
Steroids reduce inflammation but increase glucose, infection risk, GI bleeding, mood changes, osteoporosis, poor wound healing, and adrenal suppression. Do not stop chronic steroids abruptly without an order. Biologics and other immunosuppressants increase infection risk; fever, cough, dysuria, wound drainage, or malaise may be significant even if symptoms seem mild.
Infection prevention on the unit
Prevention is active nursing work. Remove unnecessary lines and catheters as soon as appropriate. Maintain sterile technique for central lines and urinary catheter insertion, use aseptic technique for dressing changes, keep wounds covered, encourage pulmonary hygiene and mobility, and follow vaccine screening policy. For urinary catheters, assess daily need and report dysuria, suprapubic pain, fever, or cloudy foul urine in context rather than culturing every asymptomatic patient.
Antibiotic stewardship also falls within nursing scope. Verify cultures are obtained when ordered, administer antibiotics on time, monitor allergies, renal dosing, infusion reactions, diarrhea, rash, QT risk, and therapeutic levels when needed. Report signs of anaphylaxis immediately: airway swelling, wheeze, hypotension, hives, or sudden GI symptoms after exposure.
Patient education
Teach patients to finish prescribed antibiotics unless told otherwise, report severe diarrhea, rash, swelling, breathing difficulty, persistent fever, or worsening symptoms. Immunosuppressed patients should know when to call for fever, wound drainage, urinary symptoms, cough, exposure to contagious illness, or new confusion. Teach hand hygiene, food safety when neutropenic or highly immunosuppressed, vaccination discussions with the provider, and avoiding live vaccines when contraindicated by immune status.
Escalation cues
Escalate suspected sepsis, hypotension, lactate elevation, new confusion, respiratory distress, rapidly spreading cellulitis, necrotizing infection signs, meningitis symptoms, anaphylaxis, neutropenic fever, fever in a patient with central line, or infection symptoms in a patient taking biologics or high-dose steroids. In CMSRN questions, the strongest answer usually combines early recognition, correct precautions, timely treatment support, and reassessment rather than isolated documentation.
An older adult on chronic prednisone is newly confused with blood pressure 86/48 mm Hg, heart rate 122/min, and suspected UTI. Temperature is 99.4 F. What should the nurse do?
A patient has suspected C. difficile infection with frequent watery stools. Which action is most appropriate?
A patient receiving a biologic for rheumatoid arthritis reports fever, cough, and malaise. What is the nurse's best response?