Exam 2

Question 1

Body surfaces, such as the skin and digestive tract, normally contain a small number of resident bacteria and fungi called

Answer 1

Microflora

Question 2

What is the body’s first line of defense against infection?

Answer 2

skin surface barriers, skin and body’s immune system help protect against infection.

Question 3

What is considered the normal pH of the skin?

Answer 3

5.5, it’s an acidic enviornment, so that it discorages microbial growth

Question 4

What is the body’s second line of defense?

Answer 4

cellular and chemical defenses, such as neutrophils, langerhan cells, macrophages, the inflammatory response helps direct many of these cells.

Question 5

A cascade of proteins produced by the body that enhances the body’s defense against pathogens. Made up of 30 inactive circulating plasma proteins. Activated when it recognizes antibodies on the surface of a pathogen. This is known as

Answer 5

the complement system.

Question 6

Presence of microbes on wound surface, that is considered normal and has no effect on wound healing.

Answer 6

contamination

Question 7

Presence of replicating microbes on wound surface, that is considered normal and has no effect on wound healing

Answer 7

Colonization

Question 8

Increasing wound biorburned that reaches a critical point and begins to adversely affect the host, is considered abnormal. Causes a plateu in wound healing or decline in wound status. Signs and symptoms of infection are likely. Considered an abnormal response. Is known as

Answer 8

Critical colonization. can have critical colonization in a different area from the wound, which means it will not affect the status of the wound.

Question 9

Replicating microbes invade viable body tissues, abnormal response, decline in would status, signs and symptoms of infection likely is known as

Answer 9

infection, infection is microbe concentration of greater than 10^5 microorganisms /gram of tissue, infection will delay or stop wound healing

Question 10

What is the equation for wound healing?

Answer 10

(number of bacteria x bacterial virulence)+ interaction between microbes/ host resistance + modifying factors

Question 11

Modifying factors include

Answer 11

1. Host’s overall health
2. Presence of pathology
3. Steriod use
4. Presence of nonviable tissue
5. Proper wound management

Question 12

List 4 Adverse Effects of high Microbe concentrations

Answer 12

1. Compete with host cells for oxygen and nutrients
2. Bacterial EXOTOXINS may be cytotoixic
3. BACTERIAL ENDOtoxins may activate host inflammatory process
4. Wound infections delay and may prevent wound healing

Question 13

List the Local Factors that can increase risk of infection

Answer 13

1. Ischemia
2. Necrotic tissue
3. Wound debris
4. Chronic wounds

Question 14

List host factors that can increase risk of infection

Answer 14

1. Break in the skin
2. diabetes
3. Malnutrition
4. Obesity
5. Steriod use
6. Immunocompromised
7. Increased age

Question 15

What is the difference between signs of inflammation vs. signs of infection?

Answer 15

same as signs of inflammation except excessive and disproportionate to size and extent of wound. Also there is a noted decline in wound status despite appropiate care

Question 16

If Rubor in a patient’s wound is present what is considered a sign that it is just inflammation and not infection?

Answer 16

Well-Define erythemal border

Question 17

If Rubor in a patient’s wound is present what is considered that it is a sign of infection?

Answer 17

-POORLY define erthyemal border
disproportionate amount of erythema
possible PROXIMALLY directed erythemal streaking

Question 18

What is considered “a tell-tale sign” of vascular invovlvement?

Answer 18

streaking

Question 19

If calor was present in a patient’s wound how can a you tell if it is just inflammation vs. infection?

Answer 19

with inflammation there would be a localized increase in temp

Question 20

If calor was present in a pateint’s wound how can you tell that the wound is infected?

Answer 20

Large localized temperature increase; may be febrile

Question 21

If TUMOR was present in a wound how can you tell it’s just due to inflammation?

Answer 21

small amount of edema, proportioanate to wound

Question 22

If TUMOR was present in a wound how can tell it’s due to infection?

Answer 22

Edema would be dispropotionate to wound size.
Periwound may be indurated, which is to push on the wound and it feels like pushing into clay, very hard and firm and doesn’t rebound

Question 23

If DOLOR was present how can you tell if a wound is inflamed vs. infected?

Answer 23

-Pain that is proportionate to wound size/extend: will be inflammed

Pain that is increased or new pain and disproportionate to size is infected

Question 24

If the patient presented with loss of function how can you tell if a would is infected or just inflammed?

Answer 24

1. Temporary in affected area-inflammation

2. malaise, tachycarida, hypotension, altered mental status–>infection

Question 25

If a patient's wound presented with drainage, how can you tell it is inflammed vs. infected?

Answer 25

1. Drainage is proportinate to size, Thin consistency, serous or serosaguinous- inflammed 2. IF drainage is disporportionate to size, thick, purulent, creamy, white, green, blue colors, may have odor-->infection

Question 26

If you note there is a decline a patient's wound status how can you tell it't due to inflammation vs. infection?

Answer 26

1. Inflammation follows 3 normal phases of wound helaing | 2. Infection healing plateus, decreased granulation tissue looks like cobble-stone and changes color.

Question 27

What type of patient is at great risk to present with a "silent infection"?

Answer 27

patients who are immunocompromised or have inadequate perfusion are at greater risk and are less likely to exhibit the classic signs of infection because of their tempered immune system.

Question 28

List 2 examples of a silent infection

Answer 28

1. Abcess: localized collection of pus composed of devitlaized tissue. Because the infection is contained within the abcess, the body may no recognize the actual infection 2. Aterial Insufficiency leading to gangrenous toe. the body may not be able to mount a proper defense against infection because of inadequate circulation to the affected area. This will make the classic s/s of infection unapparent.

Question 29

What are considered "systemic signs of infection"

Answer 29

1. elevated WBC 2. Fever 3. Increased HR and RR 4. Fatigue 5. Confusion

Question 30

Communities of microorganisms attached to wound surface encased in extracellular polysaccharide matrix. Protected against harsh enviornments, antiseptics and antimicroials. May increase bacterial virulence and resistance Generally located on devitalized tisssues, implanted devices and in gastric mucosa this is known as

Answer 30

biofilms

Question 31

What is considered the GOLD STANDARD to disagnose a wound that is infected?

Answer 31

tissue biopsy, cultures can confirm the presence of infection. swab cultures can identify two types (aerobic and anaerobic) Aerobic culture are standard procedure due to oxygen-metabolizing microbes are more likely ot be present in most wounds Anaerobic microbes can be located in deep, tunneling or undermining wounds

Question 32

What is considered the gold standard to diagnose and treat osteomyelitis

Answer 32

bone biopsy

Question 33

When obtaining a swab culture what are you not allowed to swab?

Answer 33

exudate, eschar, pus, slough, ONLY viabe tissue rotate the end of the algniate tipped applicator over 1 cm vialbe wound area for 5 sec while applying enough pressure to express tissue fluid.

Question 34

Microbe Identification: Gram positive will stain? Gram negative will stain?

Answer 34

1. crystal violet | 2. Safranin

Question 35

Name the characteristics of bacteria

Answer 35

1. Unicellular 2. rigid cell wall 3. Lack nuclear membrane 4. need external medium for growth 5. Reproduce via cellular division (mitosis)

Question 36

What are the most common types of fungi?

Answer 36

Skin and nail Fungi (Tinea and Candida)

Question 37

What is the increased risk for fungal infections?

Answer 37

1. Taking antibiotics 2. Immunocompromised 3. Diabetes 4. Moist, occluded areas of skin

Question 38

What is used to treat fungi associated with wounds?

Answer 38

Statin cream

Question 39

What med is used to destory unicellular organisms and used to treat infection or prophylactically?

Answer 39

Antimicrobials

Question 40

What are the two types of Antibacterials?

Answer 40

1. Bactericidal causing cell death | 2. Bacteriostatic inhibit cell growth/reproduction

Question 41

Antifungals treat what two types fungi?

Answer 41

1. Yeast | 2. Molds

Question 42

If you are taking antibiotic, you are vulunerable to what type of infection?

Answer 42

fungal, the antibiotic lowers bacterial levels, less competition for food for the fungi (physicians must prescribe the correct antibiotic for the type of microorganism present; this is why we need cultures).

Question 43

Bacteria unable to grow in the presence of a certain antimicrobial are known as

Answer 43

sensitive microbes

Question 44

Bacteria that continue to multiply in the presence of a drug are known as

Answer 44

resistant microbes (can increase resistance of microbes if antibiotic is over prescribed)

Question 45

This type of bacteria is usually acquired in a hosipital setting, highest percentage in the ICU. Gram-positive Resistant to penicillin class of drugs can live hours to days on surfaces can cause celuulitis, osteomyelisitis, abscess tx with mupirocin (Bactroban or cetany)

Answer 45

MRSA (can live hours to days on surfaces)

Question 46

What are the nosocomial risks for MRSA?

Answer 46

``` Increased age diabetes immunosupression Malnutrition recent surgery immobility/debility large burns prior antimicrobial ```

Question 47

What are the community Acquired Risks for MRSA?

Answer 47

Prision Contact sports Military People with aids

Question 48

This resistant bacteria is commonly seen in surgical wounds and UTIs and usually treated with ampicllin-amoxicillin

Answer 48

VRE

Question 49

T/F although resistant strains have become more prevalent, they have not become more resistant

Answer 49

true

Question 50

List 2 causes of resistance in bacteria

Answer 50

1. Misuse of Antimicrobials a. Prescription without presence of infection b. Wrong antimicrobial prescribed c. Taken incorrectly 2. Misuse of Antimicrobials In Animals (have been band by the European union)

Question 51

Adverse drug reactions are considered to be seen systemic ______frequent and ______severe than topic

Answer 51

are more frequent and more severe

Question 52

Range of Adverse Drug Reactions

Answer 52

Mild skin reactions, hives Difficulty breathing anapylactic shock, photosenstivity, hearing loss , fever Hepatitis, kidney damage (need to notify physician if any of these conditions are noted)

Question 53

What are the most common drugs to cause a reaction?

Answer 53

Pencillin and sulfa drugs

Question 54

T/F some topical agents can cause delayed sensitivity and can lead to loss of effectiveness if used to prolonged periods of time

Answer 54

true (includes neomycin, gentamycin, bacitarcin, lanolin-contianing)

Question 55

How often do you need to reapply a topical antimicrobial therapy?

Answer 55

every 8-24 hours.

Question 56

When is topical antimicrobial therapy very effective?

Answer 56

when treating areas of compromised circulation

Question 57

When should you stop topical antimicrobial therapy?

Answer 57

when signs and symtoms of infection reslove.

Question 58

When is there an exception made for topical antimicrobial prophylactic use>?

Answer 58

1. When there is an increased risk for infection 2. Grossly contiaminated wounds 3. 2 week trial for effectiveness on non-healing pressure ulcers (w/o) infection (may be appropiate for patients with open wounds who are at risk for infection and wounds that are grossly contaminated.

Question 59

Silver and idonie antimicrobial impregnated dressings

Answer 59

1. Lack evidence 2. must stay in contact with wound bed Recent evidence suggest honey-impregnated dressing may help control bioburden

Question 60

Name two antispectic agents that prevent infection by killing microorganisms and are used with standard percautions

Answer 60

1. Chloramine-t 2. Chlorhexadine gluconate (povidone-iodine)

Question 61

Anti-septic agents usually do what to the inflammatory process?

Answer 61

increase duration and intensity of inflammatory process. slow wound healing, rarely may be appropriate for short term use on open wounds

Question 62

Systemic Antimicrobial therapy (antiboitics) are usually prescribed by a physician for

Answer 62

1. sepsis 2. signs of advancing infection 3. with/without topical antimicrobials And can be given through IV

Question 63

Systemic Antimicirobial therapy ten to have more ___frequent and _______severe adverse reactions

Answer 63

frequent and severe

Question 64

Reduce number of microorganisms present to decrease risk of transmission/infection. (standard)

Answer 64

clean

Question 65

Only sterile equipment contacts patient's wound

Answer 65

sterile

Question 66

What are sterile equipment used for?

Answer 66

1. packing wounds, large surface area wounds ,serve burns, immunocompromised patients.

Question 67

Presence or anticipated presence of blood, wound fluid or other potentially infectioous waste

Answer 67

contamination (any item that contacts the patient's wound or wound drainage).

Question 68

free of gross contimination

Answer 68

clean (gloves, bandage scirros)

Question 69

to clean a surface with an antimicrobial

Answer 69

disinfect

Question 70

enviornment free of microbes

Answer 70

sterile. (gloves, debridement kit)