Exam 1 / Part 3

Question 1

Define “infection.”

Answer 1

It is the invasion of a susceptible host by pathogens or microorganisms, resulting in disease. Entry and multiplication of organisms result in disease. If pathogens multiply and cause clinical signs and symptoms, the infection is Symptomatic. If clinical signs and symptoms are not present, the illness is termed Asymptomatic.

Question 2

Define “colonization.”

Answer 2

Colonization occurs when a microorganism invades the host but does not cause infection.

Question 3

What are the stages of an infection?

Answer 3

1. Incubation – interval between the pathogen entering the body and the presentation of the first symptom.
2. Prodromal stage – interval from onset of general symptoms to more distinct symptoms. During this time, the pathogen is multiplying.
3. Illness stage – interval when symptoms specific to the infection occur.
4. Convalescence – interval when acute symptoms disappear. Total recovery could take days to months. Risks of Infection

Question 4

What is the most important technique to use in preventing and controlling transmission of infection?

Answer 4

Hand hygiene (Hand hygiene includes using an instant alcohol hand antiseptic before and after providing patient care, washing hands with soap and water when they are visibly soiled, and performing a surgical scrub. Handwashing is the act of washing hands with soap and water, followed by rinsing under a stream of water for 15 seconds. Soap, running water, friction)

Question 5

What does it mean to be “Immunocompromised”?

Answer 5

Immunocompromised means having an impaired immune system.

Question 6

Define “virulence.”

Answer 6

Virulence is the ability of a pathogen to invade and injure a host.

Question 7

What are “aerobic bacteria”?

Answer 7

Aerobic bacteria require oxygen for survival and for multiplication sufficient to cause disease.

Question 8

What are “anaerobic bacteria”?

Answer 8

Anaerobic bacteria thrive where little or no free oxygen is available.

Question 9

What is “bacteriostasis”?

Answer 9

It is the prevention of growth and reproduction of bacteria.

Question 10

What is meant by being “bacteriocidal”?

Answer 10

It is destructive to bacteria.

Question 11

A patient is admitted to a medical unit for a home-acquired pressure ulcer. The patient has Alzheimer’s disease and has been incontinent of urine. The nurse inserts a Foley catheter. You will identify a link in the infection chain as 
A. Restraints.
B. Poor hygiene.
C. Foley catheter bag.
D. Improper positioning.

Answer 11

C. Foley catheter bag.

Question 12

List the types of pathogens.

Answer 12

1. Bacteria (Staphylococcus aureus, Escherichia coli, Mycobacterium tuberculosis)
2. Viruses – Organisms that use the host’s genetic machinery to reproduce (HIV, hepatitis, herpes zoster, herpes simplex)
3. Fungi – Molds and yeasts (Candida albicans, Aspergillus)
4. Prions – Protein particles (new variant Creutzfeldt-Jakob disease)
5. Parasites – Protozoa (malaria, toxoplasmosis) and helminths (worms [flatworms, roundworms], flukes [Schistosoma])

Question 13

What are the types of immune systems?

Answer 13

1. Nonspecific innate

2. Specific adaptive

Question 14

What comprises the “nonspecific innate” immune system?

Answer 14

Nonspecific innate: Native immunity restricts entry or immediately responds to a foreign organism (antigen) through the activation of phagocytic cells, complement, and inflammation. This occurs with all micro-organisms, regardless of previous exposure.
◯ Temporary immunity that does not have memory of past exposures
◯ Intact skin, the body’s first line of defense
◯ Mucous membranes, secretions, enzymes, phagocytic cells, and protective proteins
◯ Inflammatory response with phagocytic cells, the complement system, and interferons localize the invasion and prevent its spread

Question 15

What comprises the “specific adaptive” immune system?

Answer 15

Specific adaptive immunity allows the body to make antibodies in response to a foreign organism (antigen). This reaction directs against an identifiable micro-organism.
◯ Requires time to react to antigens
◯ Provides permanent immunity
◯ Involves B- and T-lymphocytes
◯ Produces specific antibodies against specific antigens (immunoglobulins [IgA, IgD, IgE, IgG, IgM])

Question 16

List the infection control practices.

Answer 16

medical asepsis, surgical asepsis, standard precautions

Question 17

List the links that make the chain of infection.

Answer 17

1. Infectious agent or pathogen.
2. Reservoir or source for pathogen growth.
3. Portal of exit.
4. Mode of transmission.
5. Portal of entry.
6. Susceptible host

Question 18

Name examples of “portals of exit.”

Answer 18

■ Respiratory tract (droplet, airborne)
-Mycobacterium tuberculosis 
-Streptococcus pneumoniae 
■ Gastrointestinal tract 
-Shigella
-Salmonella enteritidis
-Salmonella typhi
-hepatitis A 
■ Genitourinary tract 
-Escherichia coli
-hepatitis A
-herpes simplex virus (type 1)
-HIV 
■ Skin/mucous membranes 
-Herpes simplex virus 
-varicella 
■ Blood/body fluids 
-HIV 
-hepatitis B and C

Question 19

Name examples of “modes of transmission.”

Answer 19

■ Contact 
-Direct physical contact btwn persons
-Indirect contact with an inanimate object
-Fecal-oral transmission
■ Droplet 
-Sneezing, coughing
-talking 
■ Airborne 
-Sneezing and coughing 
■ Vector borne 
-Animals or insects as intermediaries 
- for example, ticks transmit Lyme disease; mosquitoes transmit West Nile and malaria

Question 20

Describe individuals who have compromised health or defenses against infection.

Answer 20

■ Those who are immunocompromised.
■ Those who have had surgery.
■ Those with indwelling devices.
■ A break in the skin (the body’s best protection against infection).
■ Those with poor oxygenation.
■ Those with impaired circulation.
■ Those who have chronic or acute disease such as diabetes mellitus, adrenal insufficiency, renal failure, hepatic failure, or chronic lung disease.

Question 21

Why are older adults more at risk?

Answer 21

Older adults have a slowed response to antibiotic therapy, slowed immune response, loss of subcutaneous tissue and thinning of the skin, decreased vascularity and slowed wound healing, decreased cough and gag reflexes, chronic illnesses, decreased gastric acid production, decreased mobility, bowel and bladder incontinence, dementia, and greater incidence of invasive devices such as a urinary catheter or feeding tube.

Question 22

What are Health-Care Associated Infections (HAIs)?

Answer 22

– These are infections that a client acquires while receiving care in a health care setting. Formally called nosocomial infections, these can come from an exogenous source (from outside the client) or an endogenous source (inside the client when part of the client’s flora is altered).
– The most common setting for HAIs is the intensive care unit.
– The best way to prevent HAIs is through frequent and effective hand hygiene.
– The most common site of HAIs is the urinary tract. The most common causative agents are Escherichia coli, Staphylococcus aureus, and enterococci. Other sites of HAIs are surgical wounds, respiratory tract, and bloodstream.
– An iatrogenic infection is a type of HAI resulting from a diagnostic or therapeutic procedure.
– HAIs are not always preventable and are not always iatrogenic.
– Use current evidence-based practice guidelines to prevent HAIs due to multidrug-resistant organisms. Assessment/Data Collection

Question 23

List the signs and symptoms, identifiable in the nursing assessment, of generalized or systemic infection. (S/S of local inflammation and infection are identical.)

Answer 23

1. Fever
2. Presence of chills, which occur when temperature is rising, and diaphoresis, which occurs when temperature is decreasing
3. Increased pulse and respiratory rate (in response to the high fever)
4. Malaise
5. Fatigue
6. Anorexia, nausea, and vomiting
7. Abdominal cramping and diarrhea
8. Enlarged lymph nodes (repositories for “waste”)
9. Atypical symptoms such as agitation, confusion, or incontinence
10. Other symptoms may vary depending on the site of the infection (dyspnea, cough, purulent sputum, and crackles in lung fields, dysuria, urinary frequency, hematuria and pyuria, rash, skin lesions, purulent wound drainage, erythema and odynophagia, dysphagia, hyperemia, enlarged tonsils, change in level of consciousness, nuchal rigidity, photophobia, headache)

Question 24

What is “inflammation”?

Answer 24

Inflammation is the body’s local response to injury or infection.

Question 25

The inflammatory response has three stages. List the signs and symptoms of the first stage of the inflammatory response (local infection).

Answer 25

a. Redness (from dilation of arterioles bringing blood to the area) b. Warmth of the area on palpation c. Edema d. Pain or tenderness e. Loss of use of the affected part

Question 26

Describe the second stage of the inflammatory response (local infection). List its signs and symptoms.

Answer 26

In the second stage, the micro-organisms have been are killed. Fluid containing dead tissue cells and WBCs accumulates and exudate appears at the site of infection. The exudate leaves the body by draining into the lymph system. The types of exudate are: a. Serous (clear). b. Sanguineous (contains red blood cells). c. Purulent (contains leukocytes and bacteria).

Question 27

Describe the third stage of the inflammatory response (local infection). List its signs and symptoms.

Answer 27

In the third stage, damaged tissue is replaced by scar tissue. Gradually, the new cells take on characteristics that are similar in structure and function to the old cells.

Question 28

In addition to the items found on physical assessment, laboratory and diagnostic results indicating infection include:

Answer 28

◯ Leukocytosis (WBCs greater than 10,000/µL). ◯ Increases in the specific types of WBCs on differential (left shift = an increase in neutrophils). ◯ Elevated erythrocyte sedimentation rate (ESR) over 20 mm/hr. An increase indicates an active inflammatory process or infection. ◯ Presence of micro-organisms on culture of the specific fluid/area.

Question 29

List the Diagnostic Procedures used to confirm the presence of an infection.

Answer 29

◯ Gallium scan – Nuclear scan that uses a radioactive substance to identify hot spots of WBCs ◯ Radioactive gallium citrate – Injected by IV and accumulates in area of inflammation ◯ X-rays, CT scan, magnetic resonance imaging (MRI), and biopsies to determine the presence of infection, abscesses, and lesions Nursing Interventions

Question 30

Why is good oral hygiene an effective tactic used to prevent infection?

Answer 30

Good oral hygiene decreases the protein (which attracts micro-organisms) in the oral cavity, which thereby decreases the growth of micro-organisms that can migrate through breaks in the oral mucosa.

Question 31

What is involved with "good pulmonary hygiene"?

Answer 31

For immobile clients, ensure that pulmonary hygiene (turning, coughing, deep breathing, incentive spirometry) is done every 2 hr, or as prescribed. Good pulmonary hygiene decreases the growth of micro-organisms and the development of pneumonia by preventing stasis of pulmonary excretions, stimulating ciliary movement and clearance, and expanding the lungs.

Question 32

What are the components of respiratory hygiene and cough etiquette?

Answer 32

■ Covering the mouth and nose when coughing and sneezing. ■ Using facial tissues to contain respiratory secretions, and disposing of them promptly into a hands-free receptacle. ■ Wearing a surgical mask when coughing to minimize contamination of the surrounding environment. ■ Turning the head when coughing and staying a minimum of 3 ft away from others, especially in common waiting areas. ■ Performing hand hygiene after contact with respiratory secretions.

Question 33

Describe "standard precautions (tier one.)"

Answer 33

■ This tier of standard precautions applies to all body fluids (except sweat), nonintact skin, and mucous membranes. A nurse should implement for all clients. ■ Hand hygiene using an alcohol-based waterless product (unless the hands are visibly dirty) is recommended after contact with the client, body fluids, and contaminated equipment and articles, and after removal of gloves. ■ Clean gloves are worn when touching anything that has the potential to contaminate the hands of the nurse. This includes body secretions, excretions, blood and body fluids, nonintact, skin mucous membranes, and contaminated items. ■ Masks, eye protection, and face shields ARE REQUIRED WHEN care may cause splashing or spraying of body fluids. ■ Use a sturdy moisture-resistant bag for soiled items, and tie the bag securely in a knot at the top. ■ Properly clean all equipment for client care; dispose of one-time use items according to facility policy. ■ Enable safety devices on all equipment and supplies after use; dispose of all sharps in a puncture-resistant container. ■ A client does not need a private room unless he is unable to maintain appropriate hygienic practices.

Question 34

Describe "transmission precautions (tier two.)"

Answer 34

Airborne, droplet and contact precautions are all considered part of tier two.

Question 35

What are airborne precautions?

Answer 35

Use airborne precautions are implemented to protect against droplet infections SMALLER than 5 mcg (measles, varicella, pulmonary or laryngeal tuberculosis). Airborne precautions require: ☐ A private room. ☐ Masks and respiratory protection devices for caregivers and visitors. Use an N95 or high-efficiency particulate air (HEPA) respirator if the client is known or suspected to have tuberculosis. ☐ Negative pressure airflow exchange in the room of at least six to 12 exchanges per hour, depending on the age of the structure. If splashing or spraying is a possibility, wear full face (eyes, nose, mouth) protection.

Question 36

What are droplet precautions?

Answer 36

Droplet precautions protect against droplets LARGER than 5 mcg and travel 3 to 6 ft from the client (streptococcal pharyngitis or pneumonia, Haemophilus influenzae type B, scarlet fever, rubella, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia and sepsis, pneumonic plague). Droplet precautions require: ☐ A private room or a room with other clients with the same infectious disease, ensuring that each client have their own equipment. ☐ Masks for providers and visitors.

Question 37

What are contact precautions?

Answer 37

Contact precautions protect visitors and caregivers when they are within 3 ft of the client against direct client and environmental contact infections (respiratory syncytial virus, shigella, enteric diseases caused by micro-organisms, wound infections, herpes simplex, impetigo, scabies, multidrug-resistant organisms). Contact precautions require: ☐ A private room or a room with other clients with the same infection. ☐ Gloves and gowns worn by the caregivers and visitors. ☐ Disposal of infectious dressing material into a single, nonporous bag without touching the outside of the bag.

Question 38

Describe the two classes of medications commonly used in the event of infection.

Answer 38

◯ Antipyretics (acetaminophen and aspirin) are used for fever and discomfort as prescribed. Nurses must monitor fever to determine effectiveness of medication. To do this, the nurse will graph the client’s temperature fluctuations on the medical record for trending. ◯ Antimicrobial therapy kills or inhibits the growth of micro-organisms (bacteria, fungi, viruses, protozoans). Antimicrobial medications either kill pathogens or prevent their growth. Anthelmintics are used for worm infestations. There are currently no treatments for prions. Nurses must administer antimicrobial therapy as prescribed. They must monitor for medication effectiveness (reduced fever, and increase in the level of comfort, decreasing WBC count). They must maintain a medication schedule to assure consistent therapeutic blood levels of the antibiotic.

Question 39

Name two multidrug-resistant infections.

Answer 39

Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of Staphylococcus aureus that is resistant to all antibiotics, except vancomycin. Vancomycin-resistant Staphylococcus aureus (VRSA) is a strain of Staphylococcus aureus that is resistant to vancomycin, but so far is sensitive to other antibiotics specific to a client’s strain.

Question 40

What can nurses and clients do to prevent new multidrug-resistant strains from evolving?

Answer 40

A. Nurses can obtain specimens for culture and sensitivity prior to initiation of antimicrobial therapy. They can monitor antimicrobial levels and ensure that therapeutic levels are maintained. B. Clients should be educated to complete the full course of antimicrobial therapy and to avoid the overuse of antimicrobials.

Question 41

What should a nurse consider when transporting a client?

Answer 41

If movement of the client to another area of the facility is unavoidable, the nurse takes precautions to ensure that the environment is not contaminated. For example, a surgical mask is placed on the client with an airborne or droplet infection, and a draining wound is well covered.

Question 42

List the guidelines for cleaning contaminated equipment.

Answer 42

1. Always wear gloves and protective eyewear. 2. Rinse FIRST in running COLD water. Hot water coagulates proteins, making them adhere. 3. Wash the article in warm water with soap. 4. Use a brush or abrasive to clean corners or hard-to-reach areas. Rinse well in warm water. 5. Dry the article – It is considered clean at this point. 6. Clean the equipment used in cleaning and the sink (still dirty unless a disinfectant is used). 7. If indicated, follow facility policy for recommended disinfection or sterilization. 8. Remove gloves and perform hand hygiene.

Question 43

Why is reporting communicable diseases important?

Answer 43

■ Ensure appropriate medical treatment of diseases (tuberculosis). ■ Monitor for common-source outbreaks (foodborne – hepatitis A). ■ Plan and evaluate control and prevention plans (immunizations for preventable diseases). ■ Identify outbreaks and epidemics. ■ Determine public health priorities based on trends. Herpes Zoster (Shingles)

Question 44

What is Herpes zoster?

Answer 44

Herpes zoster is a viral infection. It initially produces chickenpox, after which the virus lies dormant in the dorsal root ganglia of the sensory cranial and spinal nerves. It is then reactivated as shingles later in life. Shingles is usually preceded by a prodromal period of several days, during which pain, tingling, or burning may occur along the involved dermatome. Shingles can be very painful and debilitating.

Question 45

What are the signs of shingles?

Answer 45

Objective Data: 1. Physical Assessment Findings: Low-grade fever and Unilateral Rash that is erythematous, vesicular, pustular, or crusting (depending on the stage) that usually resolves in 14 to 21 days. 2. Laboratory Tests: Cultures provide a definitive diagnosis. But, the virus grows so slowly that cultures are often of minimal diagnostic use. Occasionally, an immunofluorescence assay can be done.

Question 46

What are the symptoms of shingles?

Answer 46

Subjective Data: 1. Paresthesia, a sensation of tingling, tickling, pricking, or burning of a person's skin 2. Pain that is unilateral and extends horizontally along a dermatome

Question 47

Which two classes of medications are often used to treat shingles?

Answer 47

1. Analgesics (NSAIDs, narcotics) enhance client comfort. | 2. Antiviral agents, such as acyclovir (Zovirax), may shorten the clinical course.

Question 48

What is a common complication of shingles?

Answer 48

Postherpetic neuralgia is pain that persists for longer than 1 month following resolution of the vesicular rash. Tricyclic antidepressants may be prescribed. Postherpetic neuralgia is common in adults older than 60 years of age

Question 49

You are caring for a patient who underwent surgery 48 hours ago. On physical assessment, you notice that the wound looks red and swollen. The patient’s WBCs are elevated. You should A. Start antibiotics. B. Notify the physician. C. Document the findings and reassess in 2 hours. D. Place the patient on isolation precautions.

Answer 49

B. Notify the physician.

Question 50

What is "aseptic technique"?

Answer 50

Asepsis = Absence of pathogenic (disease-producing) microorganisms. Aseptic technique = Practices/ procedures that assist in reducing the risk for infection.

Question 51

What is "medical asepsis"?

Answer 51

Medical asepsis, or clean technique, includes procedures or practices for reducing the number, growth, and spread of organisms present and preventing the transfer of organisms.

Question 52

What is "surgical asepsis"?

Answer 52

Surgical asepsis or sterile technique, includes procedures or practices to eliminate or prevents contamination of an open wound, serves to isolate the operative area from the unsterile environment, and maintains a sterile field for surgery.

Question 53

What is "Disinfection"?

Answer 53

Disinfection: a process that eliminates many or all microorganisms, with the exception of bacterial spores, from inanimate objects.

Question 54

What is "Sterilization"?

Answer 54

Sterilization: the complete elimination or destruction of all microorganisms, including spores