Exam 2 Flashcards
Which nerve is implicated in the Chvostek’s sign?
Facial
What is the function of the immune system?
to remove foreign antigens such as viruses and bacteria to maintain homeostasis
What 2 labs are specific to measuring an inflammatory response?
WBC
CRP or ESR - markers for inflammation
Natural immunity
NONSPECIFIC RESPONSE TO FOREIGN INVADERS
WBC - release cell mediators such as histamine, bradykinin and prostaglandins and engulf foreign substances
inflammatory response
Physical barriers
Acquired immunity
Results of prior exposure to an antigen
active or passive
Active immunity is
Immunologic defenses developed by persons own body
Active immunity is
Immunologic defenses developed by persons own body
Passive immunity
Temporary
Results from a transfer of a source outside of the body
Ex. transfer of antibodies from mother to infant, injections
What leukocytes are assoc with inflammation?
Neutrophils
What are the 4 stages of immune response?
-Recognition - Lymph for surveillance/Macrophages
-Proliferation - Lympho stims T and B and they enlarge, divide and turn into cytotoxic or antibodies
-Response -
-Effector -
HUmoral immunity
Interplay of antibodies
Cellular immunity
cytotoxic T cells
Research shows that stem cells can
Restore an immune system that has been destroyed
Immune deficiency is acquired in what 2 ways?
-Due to medical treatment such as chemotherapy
-Infection from agents such as HIV
HIV-1 is transmitted through what body fluids?
Blood & Blood products
Seminal fluid
Vaginal secretions
Mother-to-child: amniotic fluid, breast milk
What is the prevention education for HIV & AIDS
-Behavioral interventions
-HIV testing
-Linkage to treatment and care
What is reproduction education for HIV?
Artificial insemination
ART -
Refrain from breastfeeding
What is the confirmatory testing for HIV
Western blot test
What precautions are used with HIV patients?
Standard precautions
HIV is in the subfamily of lentiviruses and is a ——– virus?
Retrovirus bc it carries genetic material in the form of RNA rather than DNA
HIV targets cells with
CD4+ receptors - which are expressed on the surface of T lymphocytes, monocytes, dendritic cells and brain microglia
What are the steps in HIV life cycle?
Attachment
Uncoating/fusion
DNA synthesis
Integration
transcription
translation
Cleavage
Budding
What is Stage 0
Early HIV, inferred from lab testing
What is Stage 1 HIV
–The period from infection with HIV to the development of HIV-specific antibodies
-Dramatic drops in CD4 T cell counts normally 500 to 1500 cells/mm3 of blood
What is the CD4 T cell count determinant for AIDS?
Below 200
What is Stage 2 HIV?
Occurs when T lymphocytes are between 200-499 cells/mm3
What is Stage 3 HIV?
When CD4 T cell count drops below 200
*AIDS
What is the main symptom for later stages HIV/AIDs
Respiratory manifestions
SOB, dyspnea, cough, chest pain
–Pneumocystis pneumonia
TB
What are the GI manifestions of HIV
Loss of appetite
Oral candidiasis
diarrhea
wasting syndrome
What are oncologic manifestations of HIV?
Kaposi sarcoma
Aids related lymphomas
What are the neurologic manifestations of HIV
Effects on cognition, motor function, attention, visual, memory
Peripheral neuropathy
HIV encephalopathy
Fungal infections - cryptococcus neoformans
Depression and apathy
What are the integumentary manifestations of HIV?
Herpes zpster
Seborrheic dermatitis
What are the gynecologic manifestations of HIV?
Genital ulcers
Persistent, recurrent vaginal candidiasis
Pelvic inflammatory disease
Menstrual abnormalities
What is Antiretroviral therapy?
-Goal to suppress HIV replications
-Reduce HIV associated morbidity and prolong duration and quality of life
-Restore and preserve immunologic function
-Prevent transmission
What are the problems/potential complications of patients with HIV?
Development of HAND -
Body images change
Adverse effects of meds
What is HIV encephalopathy?
Formerly AIDS dementia complex
Progressive decline in cognitive, behavioral and motor functions as a direct results of HIV
What is the chain of infection?
Susceptible host
Causative organism
A reservoir of available organisms
a portal of exit
a mode of transmission
a mode of entry to a susceptible host
What is a person who provides living conditions to support a microorganism called?
a HOST
What is a person who carries an organism without apparent signs and is able to transmit to others?
A carrier
What is colonization?
Microorganisms present without host inference or interaction
Define infection
Indicates host interaction with organism
Define infectious disease.
The infected host displays a decline in wellness caused by infection
What are the standard precautions to prevent the transmission of microorganisms?
Used for all patients
Primary strategy for preventing health care associated infection
What are transmission-based precautions?
for patients with known infectious disease spread by airborne, droplet, or contact
For airborne precautions
-What diseases
-what are the precautions
TB, varicella
-Hospitalized patient should be in a negative pressure room with door closed; healthcare should wear an N-95
DROPLET PRECAUTIONS
-Diseases
-Precautions
-Used for organisms transmitted by close contact with respiratory or pharyngeal secretions, flu, meningococcus
-Face mask/door may remain open/transmission is limited to close contact
CONTACT PRECAUTIONS
-Diseases
-Precautions
-Organisms spread skin-to-skin contact, antibiotic-resistant organisms or Cdiff
Use of barriers to prevent transmission
Masks not needed
What are organisms with HAI potential?
5
C diff
MRSA
VRE
MDROS - multidrug resistant organism
CLABSI - health care assoc bloodstream infections
What medication is assoc with C Diff besides antibiotics
stomach med - PPI’s
What are the 5 P’s?
Partners
Prevention of pregnancy
Protection from STI
Practices
Past history of STI
Diarrheal diseases
- port of entry
- Causes
port of entry is oral ingestion
Caused by:
*Bacterial; campylobacter, salmonella, shigella & E coli
*Viral; rotavirus, callicvirus
*Parasitic; giardia, cryptosporidium, entamoeba histolytica
What are the clinical manifestations of pts with infectious diarrhea?
Thirst
Dry mucous membranes
weak pulse
loss of skin turgor
sunken eyes
I&O
MILD DEHYDRATION
Signs
Rehydration goal
Dry oral mucous membranes & increased thirst
50mL/kg per 1 kg ORS over 4 hrs
MODERATE DEHYDRATION
signs
rehydration goals
SUnken eyes, loss of skin turgor, increased thirst, dry oral
100mL/kg of ORS over 4 hrs
SEVERE DEHYDRATION
signs
rehydration goals
Signs of shock (rapid thready pulse, cyanosis, cold extremities, rapid breathing, lethargy, coma)
IV replacment until normal than treat with ORS
what is the preoperative phase?
Begins when decision to proceed with surgical interventions and ends with transfer of patient to OR
-preop testing
**used to identify any risks!!
What is the intraoperative phase?
begins when pt is transferred to the OR bed and ends with admission to PACU (postanesthesia care unit)
**Focus on SAFETY
What is postoperative phase?
Begins with admission to PACU and ends iwth follow up eval in clincal setting or home
What is the pre-intra-post operative called?
Perioperative
What is palliative surgery?
Ex. cancer is not curable but the surgery can give better quality of life = less pain
What is preadmission testing?
Initiates nursing process
Admin data: demographics, health history, other info
Verifies completion of preop testing
Begins discharge planning (transportation & care)
Whats included in preop health assessment?
Health history & physcial exam
Meds and allergies
Nutritional and fluid status
Drug/alcohol abuse
Respiratory & cardio status
Hepatic & renal function
Dentition - any teeth that are loose? teeth rotting?
What are some meds that can affect surgery?
Corticosteriods
Diuretics - cause a circulatory collapse/electrolyte disorders
Phenothiazines - hypersensitivity
Tranquilizers - withdrawl
Insulin -
Antibiotics - on a reg basis?
Anticoagulants - affect clotting
Opioids
Herbal/supplements
Anticonvulsant - LOC and respiratory
Thyroid hormone - affect hr and metabolism
What are special considerations during pre-op period?
Obesity
Diabilities
Undergoing ambulatory surgery - dont drive after surgery!
Undergoing emergency surgery
What is informed consent?
Should be in writing before nonemergent surgery
legal
Surgeon must explain procedure, benefits, risks, complications
Nurse clarifies and witnesses
Consent is valid only before giving meds that alter mind
consent goes with pt to OR
Preop nursing interventions
Pt changes into gown, hair back, mouth inspected, jewerly removed
admin preanesthetic meds
Maintain preop record
Transport to presurgical area
attending family needs
What is the role of
-Circulating nurse
-Scrub nurse
-Surgeon
-Circulating nurse - double checks everything Checks consent/labs/etc
-Scrub nurse - monitors everyone to make sure sticking to aseptic technique
-Surgeon
What is the role of
RN first assist
Anesthetist
RNFA - skin closures, harvest veins, etc
Anesthetist - puts patient to sleep/controls life functions
What cells increase during allergic or stress response?
Eosinophils and basophils
What is C difficle
spore-forming bacterium
Releases toxins into lumen of bowel
Bleach based cleaning products
What is MRSA?
S. aures resistant to methicillin, oxacillin, nafcillin
Skin colonization
What is multidrug resistant enterobacteriaceae?
gram negative organsims, associated with GI colonolization
E.coli and Klebsiellla
What is candida auris?
multi-drug resistant fungus
What is VRE
Vancomycin resistant enterococcu
blood, wouds and uti
What is an ambulatory surgery
surgery that does not require a hospital stay
What is an emergent surgery
without delay
Pt requires immediate attention/life threatening
What is a required surgery
planned w/in a few weeks or months
What is an urgent surgery
within 24-30 hours
closed fractures, infected wounds,
What is an elective surgery
failure to have surgery not catastropic
repair of scars, simple hernia, vaginal repair
What is optional surgery
Personal preference
cosmetic
What are the responsibilities of the circulating nurse?
Manages OR
Verify consent
ensures cleanliness, temp, lighting, avail of supplies
Monitors aseptic & “time-out”
What are the responsibilities of the scrub nurse
Hand hygeine
setting up sterile field
preparing equipment
anticipating instruments needed
counting needles, spounges
