176 final exam Flashcards
What are the 6 elemants necessary for infections?
- infector agent (pathogen)
- reservoir (where pathogen grows)
- portal of exit (exit route from reservoir; entry route)
- mode of transportation (method of transportation)
- portal of entry (entrance through skin; entry route)
- Host
When would you want a patient with herpes zoster to take acyclovir?
Take within 72 hrs
14-28 days the symptoms would get better but not cure it
antihistamine - PO
Used for allergy symptoms & motion sickness
Side effects:
* Retention
Adverse reaction:
* Thrombocytopenia, hemolytic anemia
Diphenhydramine (Benadryl)
How do you know Vancomycin is working?
if diarrhea decreases
Antiretrovirals - PO/IV
Uses: genital herpes, shingles, HIV
adverse reaction:
* seizure
* hematuria
* AKF, SJS
Precautions: administer with food, increase fluid intake, and begin therapy with first onset of symptoms
Acyclovir (Zovirax)
Antifungal - PO/IV
Used for yeast infection
adverse reaction:
* seizure
* prolonged QT interval
Fluconazole (Diflucan)
Vasopressor - IM, SubQ, IV
used for acute asthmatic attacks, hemostasis, bronchospasm, anaphylaxis
side effects:
* tremors
* anxiety, tachycardia
* dizziness
adverse reaction:
* Dysrhythmias
* increased T wave
Epinephrine (adrenaline)
immunosuppressant - IV, IM PO
tx: RA, lupus and psoriasis
reactions:
- bone marrow suppression
- increased risk for infection
- DVT, AKI, liver failure
- decreased RBC
- leukocytopenia
- seizure, hepatotoxic
education:
- avoid large groups, people with infections
- receive inactivated vaccines (flu and pneumococcal)
Methotrexate (Rheumatrex)
NSAID used to treat mod- severe pain, inflammation, or arthritis
- RA, OA, tendonitis
- given PO, IV and recally
works if inflammation decreases
reactions:
- abnormal bleeding (hematuria)
- HF, AKI, HTN, MI, CVA
- liver failure, nephrotoxicity
- peripheral edema, cardiac changes
- N/V/D/C/A
BBW: CVA, MI & GI bleed risk
Indomethacin (Indocin)
Bronchodilator - PO
causes bronchodilation by action on B2 pulmonary receptors
- used for asthma
side effects:
- tremors
- anxiety, restlessness
albuterol
Antibiotic - PO/IV
Used against gram-positive, C-diff, streptococci, MRSA & staphylococci, & stomach infections
Nursing interventions:
* vital signs, check allergies
* monitor BUN/Cr levels (elevated levels not good)
Side effects:
* ototoxicity (check pt for hearing loss before given it, hearing aid)
* nephrotoxicity, n/v
Sever reaction: red man syndrome
Vancomycin (Vancocin)
What does ABCDE mean for melanoma?
A - asymmetry:
- one half not like the other/ uneven shape
B - border:
- irregular or poorly circumcised
- look for edges that are burned, notched, or ragged
C - color:
- varies from one area to another
- pigmentation is not uniform
- white/ blue are bad
D - diameter:
- larger than 6mm as a rule
- greater than the size of a typical pencil eraser
E - evolving:
- mole changes size, shape, color
- begins to bleed or scab points to danger
Most serious form of skin cancer
- deadly
cancerous neoplasm in which pigment cells invade the epidermis, dermis, and subq tissue
- can metastasize to any organ
characterized by black or dark brown patches on the skin that may appear uneven in texture, jagged, or raised
malignant melanoma
skin cancer that begin in the flat cells in the upper outer part of the epidermis but may grow into deeper tissue
- prone to metastasize
A firm nodular lesion topped w/ crust or a central area of ulceration
most common places:
- head, neck, and lower lip
- sites of chronic irritation & injury
squamous cell carcinoma (SCC)
You have a patient with a nut allergy . What would you educate this patient?
avoid peanuts in baked goods/ avoid all nuts in general
check food labels for nuts
wear medical bracelets
carry epi-pen
you are teaching a patient about safety precautions regarding cancer. what safety precautions would you suggest?
wear sunscreen
- no direct sunlight
self examinations and check moles frequently
wear sunglasses
Why do we use an EpiPen?
to help make RBC
- given subq
use for severe allergies
Tx for scabies - Topical
paralyzes and kills scabies and their eggs
side effects:
- itching
- mild rash
- headache
adverse reaction:
- severe burning
- stinging
- redness
Permethrin cream
A patient with AIDS has dark purplish brown lesions on the mucus membranes of the mouth. As the nurse you know these lesions correlate with what type of opportunistic disease?
A. Epstein-Barr Virus
B. Herpes Simplex Virus
C. Cytomegalovirus
D. Kaposi’s Sarcoma
D. Kaposi’s Sarcoma
Which HIV test can give the earliest test results?
A. Nucleic Acid Test (NAT)
B. Antibody HIV Test
C. Combination HIV antigen/antibody test
D. CD4 count
A. Nucleic Acid Test (NAT)
Human Immunodeficiency Virus (HIV) can NOT be spread in what type of fluid below? Select all that apply:
A. Breastmilk
B. Blood
C. Tears
D. Semen
E. Vaginal Fluid
F. Sweat
C. Tears
F. Sweat
What is the hallmark symptom of systemic lupus?
butterfly rash on face and chest
What do we do for a mom who has herpes and is going to deliver a baby?
c-section
T/F - Patients with herpes zoster are at risk for secondary infections
True
What would you do for a patient who is an IV drug user, prostitute, and has gonorrhea?
give her medication for gonorrhea and teach safe sex practices
You have a patient who is getting a blood transfusion and they are complaining about itching. what would be your priority?
stop the infusion
report to the HCP
You have a patient who is refusing a blood transfusion. What would your nursing priority be?
explain why they need the transfusion
assess why they are refusing
A patient has redness, swelling and warmth in the lower extremities. What would that indicate?
Cellulitis
- treat w/ antibiotics (penicillin)
You have a patient who is 6 months pregnant and has HIV, what would you teach this patient?
She cannot breast feed
- the baby can get the virus through the breast milk
You have a patient who is 5 years old and they have a bee sting. What symptoms would you anticipate seeing with a bee sting?
Swelling and hives
use epinephrine (epi-pen) or antihistamine
you are assessing a patient suspected of having scabies, what would you anticipate that looking like?
brown crust
Itchy lines on skin
You have a 5 year old patient and you are looking at the scalp. You notice nits in the hair. What would you anticipate the nits being?
lice
You have a patient who is having surgery and is allergic to latex. What information would you gather from the patient before surgery?
ask what type or reaction they have and notify the surgical team
You have a patient with HIV and you are educating them on multidrug therapy that is needed. What would you include in the education?
Take all medications that are prescribed and take at all times throughout the day
What kind of reaction is contact dermatitis?
skin reaction
new products cause this
- laundry detergent, dye and material
you have a patient who has a virtual infection. what medication would you anticipate giving?
Acyclovir
What kind of things are you concerned with regarding the skin during a physical assessment?
raised irregular edge moles
sore that healed
moles that are itchy
moles that is red w/ a black border
Dangerous infection of the blood
- caused by widespread infection
S/s:
- bounding pulse, tachycardia
- hypotension
- increases RR
- increased WBC’s & C-reactive protein (CRP)
Tx:
- treat cause
- fluid replacement
- vasopressors (norepinephrine & dopamine)
Sepsis
Most common and least severe type of skin cancer
often found on face and upper trunk
- might not be noticed by the patient
arise in the Basal cell layer of the epidermis
- scaly appearance
- pearly papule w/ central crate and waxy, pearly border
Tx: removal of area
- 40-50% recurrence
basal cell carcinoma
systemic/ chronic autoimmune disease in which the joints and some organs of the body systems are attacked
- wrists, knees, knuckles, fingers
- flares occur d/t stress
- causes chronic inflammation of synovial membrane
Balance exercise w/ rest
can affect anyone, but mostly women ages 30-60
believed to be caused by bacteria and viruses
- Ex: labor, infections
S/s:
- stiffness (in morning)
- joint pain, muscle weakness
- fatigue
- subq nodules
Rheumatoid arthritis (RA)
Body has adverse response to a blood transfusion
- allergic, febrile, hemolytic
- hypersensitivity disorder
can be mild, moderate, or severe
Stop the infusion and keep vein open (KVO)
follow protocol and ensure proper crossmatching and typing
store blood properly and administer w/in 4 hrs of removal from fridge
Transfusion reactions
Reaction to certain proteins in latex rubber
clients can develop an allergy to foods
- bananas, kiwis, and avocados
Latex allergy
Severe, acute, life-threatening response to an allergen in which the symptoms develop quickly
- fatal hypersensitivity
- usually given epinephrine
severe, sudden vasodilation from mast cells
three most important aspects:
- anaphylactic reaction
- antibody dependent
- delayed hypersensitivity
Tx:
- Epi (IV)
- Antihistamines
- Oxygen
- Resuscitation
Anaphylaxis
Why is it important to monitor the CD4 cell count?
The more significant the loss, the more severe the immunosuppression becomes
The end stage or terminal phase of HIV
CD4 < 200
acquired immune deficiency syndrome (AIDS)
The earliest infection phases of HIV is often referred to as…..
asymptomatic phase
Why is HIV/AIDS considered an immune system disorder?
immune system attacks the body making the body more susceptible to the disease infection
STD that attacks many parts of the body and is caused by a small bacterium called a spirochete
- bacterial infection that appears 2-14 days after exposure
S/s:
- ulcer
- spores
- discharge rash
can attack the brain, heart, eyes, liver, vessels and bones in a fetus
Syphilis
a sexually transmitted infection caused by herpes simplex virus 2
S/s:
- pain
- sores
- skin rash
genital herpes
A client is being admitted for the treatment of acute cellulitis of the thigh. The client asks the admitting nurse to explain what cellulitis means. The nurse bases the response on the understanding that the characteristics of cellulitis include:
A) An epidermal and lymphatic infection caused by Staphylococcus
B) An inflammation of the epidermis only
C) A skin infection into the subcutaneous tissue and dermis
D) An acute superficial infection of the lymphatics and dermis
D) An acute superficial infection of the lymphatics and dermis
A male client visits the physician’s office for treatment of a skin disorder. As a primary treatment, the nurse expects the physician to prescribed:
A) An IV corticosteroids
B) An IV antibiotic
C) An oral antibiotics
D) A topical agent
D) A topical agent
A female client with herpes zoster is prescribed acyclovir (Zovirax) 200mg PO q4h while awake. The nurse should inform the client that this drug may cause:
A) Palpitations
B) Dizziness
C) Diarrhea
D) Metallic taste
C) Diarrhea
How would you manage fungal infections?
Topical/ oral antifungals
antifungal soap
treatment lasts 2-6 weeks
superficial infection of skin & mucous membrane d/t fungus
- can spread by direct contact or inanimate objects
takes advantage of trauma in moist, warm tissue
risk factors:
- diabetes
- immunosuppressed
- pt taking antibiotics
3 types:
- tinea pedis (athletes foot)
- tinea corpon (ringworm)
- candidiasis (skin, mouth, vag, yeast infection)
Fungal infections
infection of the skin, mouth, or vagina caused by the yeast-type fungus Candida albicans
AKA “thrush”
Tx:
- Swish and swallow
Candidasis
fungal infection of the foot
- AKA “athlete’s foot”
- most common
S/s:
- skin maceration
- fissures and vesicles around/ below toes
- discoloration of infected area
Interventions:
- teach about foot care
- pay attention to areas surrounding the toes
- proper footwear to decrease swelling
- warm socks
- meds
tinea pedis
Ringworm of the body
S/s:
- flat lesions that are clear in the center with reddened borders & look like a raised circle
- round patches with elevated red borders of pustules
- papules / vesicles that affect the non hairy skin of the body
interventions:
- proper hand washing & body hygiene
- no sharing clothes
- wash sports equipment
tinea corporis
A fungal infection (ringworm) of the scalp
characterized by red papules, or spots, at the opening of the hair follicles
tinea capitis
Nurse Tamara discovers scabies when assessing a client who just has been transferred to the med-surgery unit from the day surgery unit. To prevent scabies infection from traveling to other clients, the nurse should:
A) Wash hands, apply a pediculicide to the clients scalp, and remove any observable mites
B) Isolated the clients bed linens until the client is no longer infectious
C) Notify the nurse in the day surgery unit of potential scabies outbreak
D) Place the client on enteric precautions
B) Isolated the clients bed linens until the client is no longer infectious
What population is at risk of getting Scabies?
overcrowded living conditions
poverty
world travel
anyone
Contagious skin disease transmitted by the human itch mite
- contact precaution
penetrates the skin and makes a burrow
- lays eggs that mature and rise to skin surface
- wrist, fingers, ect
transmitted by contact with the infected person
S/s:
- wavy, brown, threadlike lines (hands, genitals, body folds)
- Severe itching (can lead to infection d/t scratching; More common at night)
Scabies
What are some nursing interventions for pediculosis?
apply medication to rid the patient of lice
assess, identify, and treat everyone involved
encourage to clean furniture, carpet, linens, stuffed animals, ect
What are some ways you could treat pediculosis (lice)?
OTC prescription meds
- pyrethrin shampoo (RID)
Occlusive agents
- petroleum jelly
fine nit comb to get rid of eggs
Ages 2 and younger:
- peanut butter, mayo, ect
lice transmitted by close contact with infected individuals leaving eggs (nits) on skin/ hair surfaces
3 types:
- pediculosis capitis - head louse
- pediculosis corporis - body louse
- pediculosis pubis - pubic louse
lice live 1-2 days w/o blood source
pediculosis
The nurse prepared to care for a male client with acute Cellulitis of the lower leg. The nurse anticipates which of the following will be prescribed for the client?
A) Cold compress to affected area
B) Warm compress to affected area
C) intermittent heat lamp treatments 4x/day
D) alternating hot/cold compresses continuously
B) Warm compress to affected area
What are S/s of Cellulitis?
warm to touch
uneven swelling/ edema
redness on extremity
pain
drainage
diffuse, acute infection of the skin marked by local heat, redness, pain, and swelling
caused by a group of streptococci and staphylococcus aureus
- infection of skin cells
- more common in children
- Can become septic
involves the underlying tissue of the skin
- bacteria can spread to other open areas
not contagious
Cellulitis
The nurse manager is planning the clinical assignments for the day. which staff member can be assigned to care for a patient with herpes zoster (shingles)? SELECT ALL THAT APPLY
A) The nurse who never had german measles
B) the nurse who never received the varicella zoster vaccine
C) the nurse who never had mumps
D) the nurse who never had roseola
A) The nurse who never had german measles
C) the nurse who never had mumps
D) the nurse who never had roseola
The nurse is assigned to care for a female client with herpes zoster (shingles). Which of the following characteristics would the nurse expect to note when assessing the lesion of this infection?
A) clustered skin vesicles
B) A generalized body rash
C) small blue-white spots with a red base
D) cutaneous lesions on the hands, feet, and buttocks
A) clustered skin vesicles
How could you diagnose herpes zoster?
physical exam
a culture that isolates the virus
What are S/s of herpes zoster?
pain - precedes outbreak
rash - thoracic, lumbar, cervical regions, and cranial areas
vesicles erupt along the involved nerve tract
typically lasts 7-28 days
