Exam 3 Flashcards
1
Q
Absence of germs or microorganisms
A
Asepsis
2
Q
Prevents growth and reproduction of bacteria
Ex: cold temperatures
A
Bacteriostasis
3
Q
Disease that can be transmitted from one person to another by direct or indirect contact or by vectors
A
Communicable disease
4
Q
Process of destroying all pathogenic organisms except spores
A
Disinfection
5
Q
Infections produced within a cell or organism
A
Endogenous infection
6
Q
Infection originating outside an organ or part
A
Exogenous infection
7
Q
Infection resulting from the delivery of health services in a health care agency
A
Health care associated infections
8
Q
Ways health care associated infections can occur
A
As a result of an invasive procedure
Antibiotic administration
The presence of multi drug resistant organisms
Breaks in infection prevention and control activities
9
Q
Type of HAI caused by invasive diagnostic or therapeutic procedure
A
Iatrogenic infection
10
Q
Examples of procedures that could cause an iatrogenic infection
A
Bronchoscopy
Treatment with broad spectrum antibiotics
11
Q
Procedures used to reduce the number of microorganisms and prevent their spread
A
Medical asepsis
12
Q
Microorganisms capable of producing disease
A
Pathogens
13
Q
Guidelines recommended by the CDC to reduce the risk of transmission of blood borne and other pathogens in hospitals
A
Standard precautions
14
Q
Area free of microorganisms and prepared to receive sterile items
A
Sterile field
15
Q
Eliminating or destroying all forms of microbial life, including spores
A
Sterilization
16
Q
Secondary infection usually caused by an opportunistic pathogen
A
Suprainfection
17
Q
Procedures used to eliminate any microorganism from an area
A
Surgical asepsis
(AKA sterile technique)
18
Q
An individuals degree of resistance to pathogens
A
Susceptibility
19
Q
External mechanical transfer through living things (bugs)
A
Vector
20
Q
Ability of an organism to rapidly produce disease
A
Virulence
21
Q
List the steps in the chain of infection
A
Infectious agent
Reservoir
Portal of exit
Modes of transmission
Portal of entry
Susceptible host
22
Q
Examples of infectious agents
A
Bacteria (c diff)
Virus
Spore
23
Q
What things do a reservoir need?
A
Right amount of food, oxygen, water, temperature, pH, light
Ex: stool
24
Q
Types of portals of exit
A
Skin and mucous membranes
Respiratory tract
Urinary tract
GI tract (booty hole)
Reproductive tract
Blood
25
Examples of modes of transmission
Airborne, direct contact
Ex: unwashed hands or equipment, splatter from coughing
26
What is direct contact?
Person to person (fecal, oral) physical contact between the source and susceptible host
27
What is indirect contact?
Personal contact of susceptible host with contaminated inanimate object (ex: needles, soiled linen, dressings, etc)
28
Explain airborne transmission
Organisms are carried in droplet nuclei or residue or in air during coughing or sneezing
Or germs are aerosolized by medical equipment or dust from a construction site
29
What are vehicles?
Contaminated items
30
Examples of vehicles
Water
Drugs, solutions
Blood
Food (improperly handled or stored)
31
What is a vector?
External mechanical transfer (Ex: flies)
Or internal transmission such as parasitic conditions between vector and host (Ex: mosquito, louse, flea, tick)
32
List our defenses against infection
Normal flora
Body system defenses
Inflammation
33
Examples of body system defenses
Skin
Respiratory tract
GI tract
34
*Two types of health care-associated infections
Endogenous
Exogenous
35
*What is the difference between endogenous and exogenous HAIs?
Endogenous - part of the pt’s flora becomes altered and organism overgrowth occurs
Exogenous - originates outside of the body (ex: salmonella)
36
*Factors influencing infection prevention and control
Age
Sex
Nutritional status
Stress
Disease process
37
How does age influence infection prevention and control?
Immunity goes down as you get older
Ex: older people can’t take as deep of a breath = more susceptible to pneumonia
38
How does sex influence infection prevention and control?
Women tend to be more prone
39
How does nutritional factors influence infection prevention and control?
Poor diet = won’t heal well
40
How does stress influence infection prevention and control?
Suppresses immunity
41
How does the disease process influence infection prevention and control?
Pts with diseases of the immune system are at risk for infection
42
Systemic symptoms we should watch for while assessing a pt for infection
*Pallor/absence of color
*Fever
Nausea/vomiting
Malaise
Enlarged lymph nodes near infection
43
What is a normal range for WBCs?
5,000-10,000
44
One important question to ask pt when assessing for infection
Do you have or feel as if you have a fever?
45
Nursing diagnosis outcomes for risk for infection
Pt will remain free from symptoms of infection
Pt will describe ways to prevent infection before discharge
46
What are cancer patients more at risk for regarding infection?
Infection due to impaired oral mucous membrane
47
What is the difference between surgical asepsis and medical asepsis?
Medical asepsis is clean and surgical asepsis takes more steps to maintain sterility (especially spores)
48
Which type of transmission precaution for TB?
Airborne
49
Which type of transmission precaution for MERS?
Airborne
50
Which type of transmission precaution for SARS?
Airborne
51
Which type of transmission precaution for measles?
Airborne
52
Which type of transmission precaution for influenza?
Droplet
53
Which type of transmission precaution for mumps?
Droplet
54
Which type of transmission precaution for rubella?
Droplet
55
Which type of transmission precaution for Scarlett fever?
Droplet
56
Which type of transmission precaution for meningococcal meningitis?
Droplet
57
Which type of transmission precaution for diphtheria?
Droplet
58
Which type of transmission precaution for MRSA?
Contact
59
Which type of transmission precaution for VRE?
Contact
60
Which type of transmission precaution for CPE/CPO?
Contact
61
Which type of transmission precaution for ESBL?
Contact
62
Which type of transmission precaution for c. Diff?
Contact
63
Which type of transmission precaution for salmonella/food poisoning?
Contact
64
Which type of transmission precaution for scabies?
Contact
65
Which type of transmission precaution for burn patients?
Protective
66
Which type of transmission precaution for immunosuppressed patients?
Protective
67
PPEs for patient on airborne precautions
Mask or respiratory protection device, N95 respirator
68
PPEs for a patient on droplet precautions
Mask or respirator
69
PPEs for patient on contact precautions
Gloves
Gowns
70
PPEs for a patient on protective isolation
Mask
Gloves
Gowns
71
5 moments for hand hygiene
Before touching a patient
Before a clean/aseptic procedure
After body fluid exposure risk
After touching a patient
After touching patient surroundings
72
What should a nurse wear when there is a risk for splashing?
Gown
Mask
*Eye protection
73
Another name for a MI
Acute coronary syndrome
74
The resistance to the ejection of blood from the left ventricle
Afterload
75
Device that maintains a positive airway pressure and improves alveolar ventilation without the need for an artificial airway
Noninvasive positive-pressure ventilation (NPPV)
76
Device that works by providing assistance during inspiration and preventing alveolar closure during expiration
Bilevel positive airway pressure (BiPAP)
77
What are BiPAPs used for?
Reduced airway closure
Expansion of areas of atelectasis
For improved oxygenation
78
Procedure done to visualize the inside of airways
Bronchoscopy
79
Provides info on how effectively CO2 is being eliminated by the pulmonary system
Capnography
80
Amount of blood ejected from the left ventricle each minute
Cardiac output
81
Formula to find the cardiac output
CO = SV x HR
82
Helps patient achieve optimal level of health through controlled physical exercise, nutritional counseling, relaxation and stress management techniques, and prescribed medications and oxygen
Cardiopulmonary rehabilitation
83
External chest wall manipulation using percussion, vibration, or high frequency chest wall compression to mobilize pulmonary secretions
Chest physiotherapy (CPT)
84
Catheter inserted through the rib cage into the pleural space
Chest tube
85
Functions of a chest tube
Remove air, fluids, or blood
To prevent the air or fluid from reentering the pleural space
To reestablish normal intrapleural and intrapulmonic pressures after trauma or surgery
86
Abnormal respiratory pattern with periods of apnea, followed by periods of deep breathing and then shallow breathing, followed by more apnea
Cheyne-Stokes respiration
87
What causes Cheyne-Stokes respiration?
Decreased blood flow or injury to the brain stem
88
Device that maintains a steady stream of pressure throughout a patient’s breathing cycle
Continuous positive airway pressure (CPAP)
89
Who would use a CPAP?
Patients with obstructive sleep apnea, heart failure, and preterm infants with underdeveloped lungs
90
Type of breathing that increases tidal volume and decreases respiratory rate, which leads to overall improved breathing pattern and quality of life
Diaphragmatic breathing
91
Which patients should use diaphragmatic breathing?
With pulmonary disease and dyspnea secondary to heart failure
92
Short-term artificial airway
Endotracheal (ET) tube
93
What are ET tubes used for?
To administer invasive mechanical ventilation, relieve upper airway obstruction, protect against aspiration, or clear secretions
94
Where does an ET tube sit in a patient’s throat?
Goes through pt’s mouth, past the pharynx and into the trachea
95
Bleeding from the GI tract
Hematamesis
96
Bloody sputum
Hemoptysis
97
Accumulation of blood and fluid in the pleural space, usually resulting from trauma
Hemothorax
98
When would a patient need Humidification of their oxygen?
If it is at a flow rate greater than 4L/min or children
99
Lungs remove carbon dioxide faster than it is produced by cellular metabolism
Hyperventilation
100
Alveolar ventilation is inadequate to meet oxygen demand of the body or eliminate enough carbon dioxide
Hypoventilation
101
Reduced circulating blood volume
Hypovolemia
102
Inadequate tissue oxygenation
Hypoxia
103
Increase in breathing rate, usually greater than 35 breaths per minute and increased depth of respirations
Kussmaul respiration
104
What causes Kussmaul respiration?
Acidic pH stimulates the increase in breathing rate
Ex: metabolic acidosis
105
Results from sudden decreases in coronary blood flow or an increase in myocardial oxygen demand without adequate coronary perfusion and is not reversed
Myocardial infarction
106
Adds moisture to inspired air by mixing particles of varying sizes in with the air
Nebulization
107
When is noninvasive positive-pressure ventilation (NPPV) used?
Obstructive sleep apnea
Respiratory failure
Following extubation of an ET tube
108
Difficulty breathing while laying down flat
Orthopnea
109
Collection of air in the pleural space
Pneumothorax
110
Amount of blood in the left ventricle at the end of diastole
Preload
111
Volume of blood ejected from the ventricles during systole
Stroke volume
112
Artificial airway for long-term assistance
Tracheostomy
113
Life threatening dysrhythmia
Ventricular tachycardia
114
What causes ventricular tachycardia?
Decreased cardiac output
115
What does ventricular tachycardia have the potential to deteoriate to?
Ventricular fibrillation or sudden cardiac death
116
Process of moving gases into and out of the lungs
Ventilation
117
Ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs
Perfusion
118
Moving the respiratory gases from one area to another by concentration gradient
Diffusion
119
What needs to occur for air to be able to flow into the lungs?
Negative intrapleural pressure
120
Primary function of pulmonary circulation
To move blood to and from the alveolar capillary membrane for gas exchange
121
What regulates respiratory gas exchange?
Oxygen transport - the lungs and cardiovascular system allow for ventilation, perfusion, rate of diffusion, and allow for oxygen to be carried on hemoglobin
122
What is ventilation controlled by?
Neural and chemical regulators
123
*What is the path of blood flow through the heart?
Right atrium
Tricuspid valve
Right ventricle
Pulmonary valve
Pulmonary artery
Lungs
Pulmonary vein
Left atrium
Mitral valve
Left ventricle
Aorta
Body
124
What type of valves are the aortic and pulmonary valves?
Semilunar valves
125
When do coronary arteries fill?
During ventricular diastole
126
How much blood is normal for cardiac output?
4-8 L/min
127
What is the conduction system of the heart?
Organized transmission of electrical impulses that the relaxation and contraction of the heart depend on
128
What does decreased oxygen-carrying capacity affect?
Hemoglobin can’t carry oxygen to the tissues
129
Symptoms of decreased oxygen-carrying capacity
Fatigue
Decreased activity tolerance
Increased breathlessness
Increased heart rate
Pallor
130
What happens when someone has hypovolemia?
Body tries to adapt by peripheral vasoconstriction and increasing heart rate to increase volume of blood returned to the heart, thus increasing cardiac output
Can result in hypoxia
131
How does decreased inspired oxygen concentration affect breathing?
Fast, shallow breaths cause a decrease in O2 because there is not enough time for CO2 to fall off
132
How does increased metabolic rate affect breathing?
It increased oxygen demand. levels of oxygenation decline when the body cannot meet this demand
133
Example that causes increased metabolic rate
Fever = increased oxygen need and increased CO2 production. When fever persists, metabolic rate remains high, body increases rate and depth of respiration.
Pt will eventually show s/s of hypoxemia
134
How can age affect a person’s breathing?
- School age children/adolescents experiment with smoking
- Young/middle-age adults have unhealthy diet, lack of exercise
- Older adults: calcification of heart valves, vascular stiffening, * osteoporosis leads to changes in size and shape of thorax, cant take as deep of a breath
135
Very late sign of hypoxia
Cyanosis
136
What causes disturbances in conduction (dysrhythmias)?
Electrical impulses do not originate from the SA node
137
Examples of disorders that could cause dysrhythmias
Ischemia
Valvular abnormality
Anxiety
Drug toxicity
Caffeine, alcohol, or tobacco use
Complication of acid-base or electrolyte imbalance
138
Failure of the myocardium to eject sufficient volume to the systemic and pulmonary circulations
Altered cardiac output
139
What occurs during left-sided heart failure?
Left ventricle gets hypertrophied, chamber can’t fill all the way
Not enough blood goes out to body, fluid gets backed up and leaks into lungs over time
140
Signs and symptoms of left sided heart failure
Crackles in lungs
Fatigue
Breathlessness
Confusion
Dizziness
Paroxysmal nocturnal dyspnea (late sign)
141
What occurs during right sided heart failure?
Result of long term left ventricular failure
Starts to back up in entire systemic circulation
This is a very late sign of heart failure
142
Signs and symptoms of right sided heart failure
Weight gain
Distended neck veins
Hepatomegaly
Splenomegaly
Dependent peripheral edema
143
What is stenosis of valves?
Hardening of the valves
144
What happens to the heart when there is stenosis?
Blood flow is obstructed and adjacent ventricles have to work harder to get blood through, causing ventricular hypertrophy
145
What is regurgitation of heart valves?
Impaired closure
146
What happens in the heart when there is regurgitation?
Backflow of blood into adjacent chamber, can cause a whooshing sound or murmur
147
Types of myocardial ischemia
Angina
MI
148
What causes angina?
When oxygen supply is less than demand
Usually lasts 3-5 mins and is relieved with rest and coronary vasodialtors
149
What causes MI?
Occurs when ischemia is not reversed
Cellular death occurs after 20 mins
150
What does a complete blood count show?
Determines number and type of red and white blood cells
White: infection
Red: presence of anemia and ability of the blood to carry oxygen to the tissues
151
What do cardiac enzymes show?
This level plus troponin to diagnose acute myocardial infarcts
152
What do cardiac troponins show?
Elevates as early as 3 hours after myocardial injury
153
What do serum electrolytes show?
Good for monitoring potassium
154
What do brain natriuretic peptides show?
Increases levels may help determine severity of congestive heart failure
155
What does C-reactive protein show?
To detect inflammation if there is high suspicion of injury or infection
Can also be used to evaluate pt’s risk of developing CAD or stroke
156
What do arterial blood gases show?
Assessment of a pt’s respiratory and metabolic acid/base balance and adequacy of oxygenation
157
What do pulmonary function tests show?
Determines ability of lungs to efficiently exchange oxygen and carbon dioxide
Also used to differentiate pulmonary obstructive from restrictive disease
158
What does peak expiratory flow rate (PEFR) show?
Reflects changes in large airway sizes
Predictor of overall airway resistance in a pt with asthma
159
What does a bronchoscopy show?
Trachial tree
Used to obtain fluid, sputum, or biopsy samples
Or to remove mucous plugs or foreign bodies
160
What do lung scans show?
Identify abnormal masses by size and location
Or to find blood clot preventing normal perfusion or ventilation
161
What does a thoracentesis show?
Specimen of pleural fluid obtained for cytological exam
Can indicate infection or cancer
162
Dyspnea and nasal flaring can be cues for which nursing diagnoses?
Impaired gas exchange
Impaired breathing
163
Examples of nursing diagnoses for oxygenation
Impaired gas exchange
Impaired breathing
Impaired cardiac output
Acute pain
Activity intolerance
Risk for activity intolerance
Impaired airway clearance
164
If a pt’s goal is to have an improved breathing pattern, what are three outcomes?
Pt’s respiratory rate is between 12-20 breaths per min
Pt achieves bilateral lung expansion
Pt breathes without the use of accessory muscles
165
Who is the flu vaccine recommended for?
Everyone 6 months and older
Especially pts with chronic illnesses, infants, older adults, pregnant women, and those in frequent contact with these groups
166
Who should get the pneumococcal vaccine?
Routinely given to children under 2 years
Recommended for pts with medical conditions that make them more susceptible to pneumonia (ex: heart disease)
Adults over 65
Smokers
167
Two top priorities in acute care nursing interventions
Dyspnea management
Airway maintenance
168
What is involved in airway maintenance?
Adequate hydration to prevent thick, tenacious secretions
Proper coughing techniques
Suctioning
Chest physiotherapy
Nebulizer therapy
169
What should you teach patients when you’re trying to mobilize secretions in their airways?
TCDB (turn, cough, deep breathe)
170
How often should patients who need them do deep breathing exercises?
Every 2 hours while awake
Pts with large amount of sputum should cough every hour while awake
171
Which patients is chest wall percussion contraindicated in?
Pts with thoracic trauma or surgery
172
How often should patients use incentive spirometers?
5-10 breaths per session, every hour
173
What is incentive spirometry used for?
To prevent / treat atelectasis in post operative patients
174
When should oropharynx and nasopharyngeal suctioning be used?
When a patient is able to cough effectively but is unable to clear secretions (apply suction after the pt has coughed)
175
When should orotracheal and nasotracheal suctioning be used?
Pt with pulmonary secretions is unable to manage secretions by coughing and does not have an artificial airway present
Catheter is inserted into trachea
176
When should you apply suction pressure when suctioning?
When removing the catheter, never while inserting
177
What are oral airways used for?
Prevents obstruction of the trachea by displacement of the tongue into the oropharynx
178
What are ET tubes used for?
Short term
To relieve upper airway obstruction
Protect against aspiration
To clear secretions
179
What are tracheostomies used for?
Same as ET tube but for long term assistance
180
What is invasive mechanical ventilation?
A lifesaving technique used with artificial airways
Can be used to fully or partially replace spontaneous breathing
181
When a patient has a chest tube, what should you check for?
Should be minimal intermittent, but continuous bubbling in suction chamber
(Continuous bubbling during inhalation and exhalation means there is a leak in the system)
Drainage system needs to be positioned lower than the patient’s chest
182
Amount of oxygen for a nasal cannula
1-6 L/min
183
Amount of oxygen for an oxygen-conserving cannula
8L/min
184
Amount of oxygen for a simple face mask
6-12 L/min
185
Amount of oxygen for partial and nonrebreather masks
10-15 L/min (reservoir bag should always be partially inflated)
186
Amount of oxygen for a Venturi mask
24-50%
187
Amount of oxygen for a high-flow nasal cannula
60 L/min
188
What is pursed-lip breathing?
Involved deep inspiration and prolonged expiration though pursed lips
189
What is pursed-lip breathing used for?
To prevent alveolar collapse
Helps improve exercise intolerance, breathing pattern, and arterial oxygen saturation
190
What is diaphragmatic breathing?
Increased tidal volume and decreased respiratory rate
191
What is diaphragmatic breathing used for?
Improved breathing pattern and quality of life
For patients with pulmonary disease and dyspnea secondary to heart failure
192
What is Leininger’s Transcultural Caring?
Even though caring is universal, the expressions, processes, and patterns of caring vary among people of different cultures
193
What is Watson’s transpersonal caring?
Conversations between patients and their families and nurses should be meaningful and address their needs
Nurse should look for deeper sources of inner healing
194
Swanson’s 5 caring processes
Knowing
Being with
Doing for
Enabling
Maintaining belief
195
What does knowing mean?
Striving to understand an event as it has meaning in the life of the other
196
What does being with mean?
Being emotionally present to the other
197
What does doing for mean?
Doing for the other as they would do for themself if it were possible
198
What does enabling mean?
Facilitating the other’s passage through life trasitions
199
What does maintaining belief mean?
Sustaining faith in the other’s capacity to get through an event or transition and face a future with meaning
200
What does presence mean?
Person to person encounter conveying closeness and a sense of caring
201
What is knowing the patient?
Learning about the patient by talking to them and spending time with them
This occurs over time
Knowing your patient’s idiosyncrasies
Linked to patient satisfaction and successful outcomes of care
202
What is world view?
How people perceive others, how they interact with and relate to reality, and how they process informaiton
203
What is an emic world view?
And insider perspective
204
What is an etic world view?
And outsider perspective
205
What should you do when you are using and interpreter?
Use a medical interpreter
Ask for clarification if unsure about what the pt is saying
Speak directly to pt
Look at pt, not interpreter
Speak in short sentences
Ask pt for feedback and clarification at regular intervals
Be observant of the pt’s nonverbal and verbal behaviors
At end of convo, thank pt and interpreter
206
What is body alignment?
Positioning of the joints, tendons, ligaments, and muscles while standing, sitting, and lying
Individuals center of gravity is stable
207
How to perform passive range of potion
Carry out movements slowly and smoothly though prescribed range
Only move to point of resistance
208
When would passive range of motion be used?
Paralyzed extremities
Healing fractures
209
How should a patient use a cane?
Cane on stronger side of body
Top of cane at greater trochanter
Keep body weight on both legs
1- advance cane
2 - bring weaker leg to cane
3 - advance stronger leg past cane
210
What should you consider before attempting to lift a patient?
Weight of patient
Should a lift be used?
Is pt cooperative?
Can pt reposition independently?
211
When a patient is in bed for an extended period of time, what action should you take first?
Help pt to dangle position
Sit for 1-2 min
Assess for orthostatic hypotension
If dizziness lasts >60 sec, return pt to bed
212
4 factors to consider when assessing for activity intolerance
Physiological
Emotional
Developmental
Pregnancy
213
Exaggeration of anterior convex curve of lumbar spine
Lordosis
214
Increased convexity in curvature of thoracic spine
Kyphosis
215
Legs curved inward so knees come together as person walks
Knock-knee
216
What is a patient at risk for when they have respiratory changes from immobility?
Developing atelectasis (collapse of alveoli)
Hypostatic pneumonia (inflammation of the lung from stasis or pooling of secretions)
Prolonged recovery
Decreased oxygen
217
What is a patient at risk for regarding cardiovascular changes after being immobile?
Orthostatic hypotension
Increased cardiac workload
Thrombus formation
218
What is a patient at risk for regarding urinary elimination after immobilization?
Urinary stasis (gravity can’t assist urine flow so it fills renal pelvis before entering ureters)
Renal calculi (immobile pts frequently have Hyperkalemia, a risk for dehydration)
219
What is a patient at risk for regarding integumentary changes when they have been immobilized?
Pressure injuries
Changes in metabolism accompany immobility
220
How to assess for DVTs
Palpate calves and under thighs
Note tenderness/cramping or redness
Palpate for edema
Compare findings in both legs** (Measure)
Unilateral symptoms could indicate DVT
221
What are the pressure points of a patient placed in SIMs position?
Ileum
Humerus
Clavicle
Knees
Ankles
222
Psychosocial nursing diagnosis for a pt dealing with immobility
Social isolation
223
How would you assess for respiratory complications of a patient who is immobile?
Respiratory assessment every 2 hours
Inspect chest all movement
Auscultate entire lung region
Watch for s/s of pneumonia
224
Psychosocial nursing diagnoses for patient experiencing hearing and visual impairments
Risk for anxiety, fear
Impaired verbal communication
Impaired socialization
225
Factors that influence sensory functioning
Age
Meaningful stimuli
Amount of stimuli
Social interaction
Environmental factors
Cultural factors
226
What is expressive aphasia
Motor
Inability to name common objects or express simple ideas into words or writing
227
What is receptive aphasia?
Sensory
Inability to understand written or spoken language
228
What is global aphasia?
Inability to understand language or communicate
229
When assessing a patient who has right sided hemisphere stroke, which side do you dress first?
Left side
230
In preventing hospital acquired pneumonia, especially in elderly patients, what should you do?
Turn, cough, and encourage deep breathing with them every 2 hours
