AP Exam 4 part V

Question 1

what are standard precautions

Answer 1

the basic level of infection control protocols that reduce the risk of dz transmission when providing pt care

Question 2

what are the components of “standard precautions”

Answer 2

1. hand hygiene 2. PPE 3. respiratory hygiene 4. safe injection practices 5. equipment and environmental cleaning, disinfection, and sterilization

Question 3

transmission based precautions

Answer 3

1. in addition to standard precautions 2. followed once pt develops sx of an infection to reduce transmission

Question 4

categories of transmission based precautions

Answer 4

1. contact 2. droplet 3. airborne

Question 5

a part of standard precautions, is respiratory hygiene, what is this?

Answer 5

1. covering mouth and nose with tissue when coughing/sneezing 2. dispose of tissue after use in waste bin 3. performs hand hygiene following contact with respiratory secretions 4. do not perform patient care when infected or ill

Question 6

safe injection practices

Answer 6

1. avoid recapping needles, discard used needles/syringes into sharps container 2. use syringes, needles, and needless access devices only once, even for the same patient 3. use infusion, pump syringe, and IV administration sets only once. 4. do not use bags or bottles of IV solution as a common source of diluent for multiple patients 5. clean and process IV infusion and syringe pumps according to manufacturer rec btwn pts 6. use 70% alcohol to clean diaphragm prior to access when removing cap from a new vial 7. use single dose vials for medications when available. 8. dedicate multi-dose vials to a single patient when possible - label date and discard within 28 days of opening

Question 7

microorganisms can be transferred between the anesthesia machine and the patient by _____________________

Answer 7

the anesthesia provider

Question 8

hand hygiene should be performed before and after removing all PPE except for ________________

Answer 8

respirators

Question 9

what precaution would be necessary for an infection spread by close contact with respiratory secretions (3ft)?

Answer 9

droplet

Question 10

if transmissable infection is suspected, transmission based precautions should be taken until when?

Answer 10

diagonistic testing confirms or denies the presence of infection

Question 11

to reduce the risk of infection, what should you do the anesthesia cart at the beginning of each case?

Answer 11

1. clean with germicide between each case 2. place clean covering on top of anesthesia cart at beginning of case

Question 12

T/F: HMEs are effective in decreassing transmission of microorganisms

Answer 12

FALSE

Question 13

T/F: anesthesia breathing circuits are single patient use

Answer 13

TRUE

Question 14

breathing system filters are __________-use, and are assessed according to their _________________ & ______________

Answer 14

single; bacterial filtration efficiency; viral filtration efficiency

Question 15

characteristics of ideal skin prep

Answer 15

1. decreased microorganism count 2. inhibit rebound and regrowth of microorganisms 3. activate quickly 4. should be effective against a variety of microbes

Question 16

T/F: all skin prep solutions work the same

Answer 16

false; all have different MOA, adv & disadv

Question 17

what is the preferred skin prep

Answer 17

chlorohexidine

Question 18

what is a suitable skin prep alternative when chlorohexidine is contraindicated

Answer 18

povidone-iodine

Question 19

iodine base with alcohol is a highly effective skin prep, but it is ____________________

Answer 19

highly flammable

Question 20

what skin prep characteristics (in some) pose a fire risk

Answer 20

those that are alcohol based or have flammable properties

Question 21

Aseptic technique in OR

Answer 21

1. equipment: maximal sterile barriers (mask, gloves, gowns, drapes) 2. anitseptic skin preparation of patient prior to procedure 3. close doors during operative procedure 4. minimize unnecessary staff and traffic in/out of OR 5. take precautions to mitigate contact with non-sterile surfaces and objects

Question 22

in limiting/preventing environmental contamination during airway management, what si the priority

Answer 22

maintenace of oxygenation take priority over all issues

Question 23

what are the recommendations for decreasing environmental contamination during airway management

Answer 23

1. double glove prior to airway manipulation 2. following airway management removed outer gloves and then perform necessary actions to assure airway security and patency 3. when situation is stable remove inner gloves - perform hand hygiene - don new gloves - cont pt care

Question 24

infection prevention: invasive procedure techniques

Answer 24

1. perform hand hygiene before assembling equipment, before, and after procedure 2. all invasive procedures performed using strict aseptic technique

Question 25

ensuring proper hand hygiene and aseptic techniques during invasive procedures will prevent adverse event such as:

Answer 25

1. surgical site infection 2. CLABSI 3. CAUTI

Question 26

___________________ for procedures like vascular access and catheter placement have been show to reduce infection rates and improve pt satisfaction

Answer 26

ultrasound guidance

Question 27

ultrasound guided infection prevention procedure

Answer 27

1. skin prep with appropriate agent 2. single patient use container 3. sterile sheath, sterile probe cover, sterile ultrasound gel 4. disinfect ultrasound probes btwn each procedure and pt per manufacturer guidelines

Question 28

infection prevention considerations for epidurals and continuous peripheral nerve block catheters

Answer 28

1. strict aseptic technique and single use sterile gel 2. maximal sterile barriers during procedure 3. appropriate skin prep 4. dress insertion site with sterile transparent occlusive dressing 5. use CHG impregnanted dressing at insertion site to reduce epidural skin entry point colonization 6. check insertion site and overal pt status at least daily for early id of infection, and sensory/motor status 7. remove once no longer clinically indicated

Question 29

if a CVC is to remain in place for > 5 days, what type of catheter should be used

Answer 29

antibiotic impregnated catheter

Question 30

arterial catheters that are needed for > 5 days should be replaced when?

Answer 30

only if evidence of infection is observed. They should not be routinely changed

Question 31

when the pressure monitoring system of a-line is accessed via diaphragm rather than stop cock, how do you prevent risk of infection?

Answer 31

scrub with antiseptic agent before accessing the system

Question 32

when accessing stop cock, apply ______________ prior to access

Answer 32

70% alcohol

Question 33

preferred site for CVC placement

Answer 33

RIJ or subclavian (cleaner, less infection risk)

Question 34

what sites are best for a-line due to decreased infection risk

Answer 34

1. radial 2. brachial 3. dorsalis pedis

Question 35

what is creutzfeldt-jakob dz

Answer 35

fatal neurodegenerative dz d/t the accumulation of pathologic proteins (prions); transmissible spongiform encephalopathy

Question 36

way to prevent transmission of creutzfeldt-jakob dz with multiple use devices

Answer 36

1. use disposable equipment when possible 2. destroy laryngoscopes and supraglottic devices used on pts with CJD 3. safely discard devices that are difficult/impossible to clean 4. clean and perform steam sterilization of instruments for 30-60 min at 132 C 5. perform steam sterilization for 18 min at 134-138 C when using a prevacuum sterilizer 6. immerse instruments in 1 N sodium hydroxide for 1 hr at RT followed by steam sterilization for 30 min at 121 C (as alt to prevacuum sterilizer) 7. disinfect noncritical items and environmental surfaces with bleach or 1N sodium hydroxide for 15 min at RT 8. consult CDC for best practices

Question 37

transmission based precautions for TB

Answer 37

airborne/droplet

Question 38

s/sx of TB

Answer 38

1. cough that lasts 3 wks or longer 2. chest pain 3. productive cough with blood/sputum 4. fatigue 5. weight loss 6. lack of appetitie 7. fever 8. night sweats

Question 39

infection control with TB

Answer 39

1. HEPA filter btwn patient and breathing system 2. sterilize or perform high level disinfection on equipment used on patients with cases of suspected or confirmed Tb

Question 40

T/F: after performing anesthetic/airway manipulation for pt with TB culturing anesthetic equipment is required

Answer 40

FALSE

Question 41

2 categories of the immune system

Answer 41

1. innate 2. adaptive

Question 42

what are the two "arms" of the adaptive immune system

Answer 42

1. humoral (B cell - Ab) 2. cell - mediated (phagocytes, T lympohocytes, cytokines)

Question 43

hypersensitivity reaction

Answer 43

intolerance to an immune system response to foreign/environmental allergen exposure

Question 44

type I hypersensitivity rxn occurs within

Answer 44

15-30 min

Question 45

type I hypersensitivity reaction is mediated by ________________

Answer 45

IgE

Question 46

s/sx of type I hypersensitivity reaction

Answer 46

1. mild cutaneous 2. GI issues 3. bronchospasm 4. CV collapse + death

Question 47

60-70% of anesthesia related hypersensitivity reactions are what type

Answer 47

type I

Question 48

what anesthetic drug is responsible for causing most anesthetic related type I hypersensitivity reactiosn

Answer 48

NMBA

Question 49

place in order from greatest to least: NMBA that cause type I hypersensitivity reactions

Answer 49

succinylcholine > vecuronium/rocuronium>pancuronium > cisatracurium

Question 50

________________ hypersensitivity reaction = immediate

Answer 50

type I