Exam 3 Flashcards
Absence of germs or microorganisms
Asepsis
Prevents growth and reproduction of bacteria
Ex: cold temperatures
Bacteriostasis
Disease that can be transmitted from one person to another by direct or indirect contact or by vectors
Communicable disease
Process of destroying all pathogenic organisms except spores
Disinfection
Infections produced within a cell or organism
Endogenous infection
Infection originating outside an organ or part
Exogenous infection
Infection resulting from the delivery of health services in a health care agency
Health care associated infections
Ways health care associated infections can occur
As a result of an invasive procedure
Antibiotic administration
The presence of multi drug resistant organisms
Breaks in infection prevention and control activities
Type of HAI caused by invasive diagnostic or therapeutic procedure
Iatrogenic infection
Examples of procedures that could cause an iatrogenic infection
Bronchoscopy
Treatment with broad spectrum antibiotics
Procedures used to reduce the number of microorganisms and prevent their spread
Medical asepsis
Microorganisms capable of producing disease
Pathogens
Guidelines recommended by the CDC to reduce the risk of transmission of blood borne and other pathogens in hospitals
Standard precautions
Area free of microorganisms and prepared to receive sterile items
Sterile field
Eliminating or destroying all forms of microbial life, including spores
Sterilization
Secondary infection usually caused by an opportunistic pathogen
Suprainfection
Procedures used to eliminate any microorganism from an area
Surgical asepsis
(AKA sterile technique)
An individuals degree of resistance to pathogens
Susceptibility
External mechanical transfer through living things (bugs)
Vector
Ability of an organism to rapidly produce disease
Virulence
List the steps in the chain of infection
Infectious agent
Reservoir
Portal of exit
Modes of transmission
Portal of entry
Susceptible host
Examples of infectious agents
Bacteria (c diff)
Virus
Spore
What things do a reservoir need?
Right amount of food, oxygen, water, temperature, pH, light
Ex: stool
Types of portals of exit
Skin and mucous membranes
Respiratory tract
Urinary tract
GI tract (booty hole)
Reproductive tract
Blood
Examples of modes of transmission
Airborne, direct contact
Ex: unwashed hands or equipment, splatter from coughing
What is direct contact?
Person to person (fecal, oral) physical contact between the source and susceptible host
What is indirect contact?
Personal contact of susceptible host with contaminated inanimate object (ex: needles, soiled linen, dressings, etc)
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
What are vehicles?
Contaminated items
Examples of vehicles
Water
Drugs, solutions
Blood
Food (improperly handled or stored)
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)
List our defenses against infection
Normal flora
Body system defenses
Inflammation
Examples of body system defenses
Skin
Respiratory tract
GI tract
*Two types of health care-associated infections
Endogenous
Exogenous
*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)
*Factors influencing infection prevention and control
Age
Sex
Nutritional status
Stress
Disease process
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
How does sex influence infection prevention and control?
Women tend to be more prone
How does nutritional factors influence infection prevention and control?
Poor diet = won’t heal well
How does stress influence infection prevention and control?
Suppresses immunity
How does the disease process influence infection prevention and control?
Pts with diseases of the immune system are at risk for infection
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
What is a normal range for WBCs?
5,000-10,000
One important question to ask pt when assessing for infection
Do you have or feel as if you have a fever?
Nursing diagnosis outcomes for risk for infection
Pt will remain free from symptoms of infection
Pt will describe ways to prevent infection before discharge
What are cancer patients more at risk for regarding infection?
Infection due to impaired oral mucous membrane
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)
Which type of transmission precaution for TB?
Airborne
Which type of transmission precaution for MERS?
Airborne
Which type of transmission precaution for SARS?
Airborne
Which type of transmission precaution for measles?
Airborne
Which type of transmission precaution for influenza?
Droplet
Which type of transmission precaution for mumps?
Droplet
Which type of transmission precaution for rubella?
Droplet
Which type of transmission precaution for Scarlett fever?
Droplet
Which type of transmission precaution for meningococcal meningitis?
Droplet
Which type of transmission precaution for diphtheria?
Droplet
Which type of transmission precaution for MRSA?
Contact
Which type of transmission precaution for VRE?
Contact
Which type of transmission precaution for CPE/CPO?
Contact
Which type of transmission precaution for ESBL?
Contact
Which type of transmission precaution for c. Diff?
Contact
Which type of transmission precaution for salmonella/food poisoning?
Contact
Which type of transmission precaution for scabies?
Contact
Which type of transmission precaution for burn patients?
Protective
Which type of transmission precaution for immunosuppressed patients?
Protective
PPEs for patient on airborne precautions
Mask or respiratory protection device, N95 respirator
PPEs for a patient on droplet precautions
Mask or respirator
PPEs for patient on contact precautions
Gloves
Gowns
PPEs for a patient on protective isolation
Mask
Gloves
Gowns
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
What should a nurse wear when there is a risk for splashing?
Gown
Mask
*Eye protection
Another name for a MI
Acute coronary syndrome
The resistance to the ejection of blood from the left ventricle
Afterload
Device that maintains a positive airway pressure and improves alveolar ventilation without the need for an artificial airway
Noninvasive positive-pressure ventilation (NPPV)
Device that works by providing assistance during inspiration and preventing alveolar closure during expiration
Bilevel positive airway pressure (BiPAP)
What are BiPAPs used for?
Reduced airway closure
Expansion of areas of atelectasis
For improved oxygenation
Procedure done to visualize the inside of airways
Bronchoscopy
Provides info on how effectively CO2 is being eliminated by the pulmonary system
Capnography
Amount of blood ejected from the left ventricle each minute
Cardiac output
Formula to find the cardiac output
CO = SV x HR
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
External chest wall manipulation using percussion, vibration, or high frequency chest wall compression to mobilize pulmonary secretions
Chest physiotherapy (CPT)
Catheter inserted through the rib cage into the pleural space
Chest tube
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
Abnormal respiratory pattern with periods of apnea, followed by periods of deep breathing and then shallow breathing, followed by more apnea
Cheyne-Stokes respiration
What causes Cheyne-Stokes respiration?
Decreased blood flow or injury to the brain stem
Device that maintains a steady stream of pressure throughout a patient’s breathing cycle
Continuous positive airway pressure (CPAP)
Who would use a CPAP?
Patients with obstructive sleep apnea, heart failure, and preterm infants with underdeveloped lungs
Type of breathing that increases tidal volume and decreases respiratory rate, which leads to overall improved breathing pattern and quality of life
Diaphragmatic breathing
Which patients should use diaphragmatic breathing?
With pulmonary disease and dyspnea secondary to heart failure
Short-term artificial airway
Endotracheal (ET) tube
What are ET tubes used for?
To administer invasive mechanical ventilation, relieve upper airway obstruction, protect against aspiration, or clear secretions
Where does an ET tube sit in a patient’s throat?
Goes through pt’s mouth, past the pharynx and into the trachea
Bleeding from the GI tract
Hematamesis
Bloody sputum
Hemoptysis
Accumulation of blood and fluid in the pleural space, usually resulting from trauma
Hemothorax
When would a patient need Humidification of their oxygen?
If it is at a flow rate greater than 4L/min or children
Lungs remove carbon dioxide faster than it is produced by cellular metabolism
Hyperventilation
Alveolar ventilation is inadequate to meet oxygen demand of the body or eliminate enough carbon dioxide
Hypoventilation
Reduced circulating blood volume
Hypovolemia
Inadequate tissue oxygenation
Hypoxia
Increase in breathing rate, usually greater than 35 breaths per minute and increased depth of respirations
Kussmaul respiration
What causes Kussmaul respiration?
Acidic pH stimulates the increase in breathing rate
Ex: metabolic acidosis
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
Adds moisture to inspired air by mixing particles of varying sizes in with the air
Nebulization
When is noninvasive positive-pressure ventilation (NPPV) used?
Obstructive sleep apnea
Respiratory failure
Following extubation of an ET tube
Difficulty breathing while laying down flat
Orthopnea
Collection of air in the pleural space
Pneumothorax
Amount of blood in the left ventricle at the end of diastole
Preload
Volume of blood ejected from the ventricles during systole
Stroke volume
Artificial airway for long-term assistance
Tracheostomy
Life threatening dysrhythmia
Ventricular tachycardia
What causes ventricular tachycardia?
Decreased cardiac output
What does ventricular tachycardia have the potential to deteoriate to?
Ventricular fibrillation or sudden cardiac death
Process of moving gases into and out of the lungs
Ventilation
Ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs
Perfusion
Moving the respiratory gases from one area to another by concentration gradient
Diffusion
What needs to occur for air to be able to flow into the lungs?
Negative intrapleural pressure
Primary function of pulmonary circulation
To move blood to and from the alveolar capillary membrane for gas exchange
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
What is ventilation controlled by?
Neural and chemical regulators
*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
What type of valves are the aortic and pulmonary valves?
Semilunar valves
When do coronary arteries fill?
During ventricular diastole
How much blood is normal for cardiac output?
4-8 L/min
What is the conduction system of the heart?
Organized transmission of electrical impulses that the relaxation and contraction of the heart depend on
What does decreased oxygen-carrying capacity affect?
Hemoglobin can’t carry oxygen to the tissues
Symptoms of decreased oxygen-carrying capacity
Fatigue
Decreased activity tolerance
Increased breathlessness
Increased heart rate
Pallor
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
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
How does increased metabolic rate affect breathing?
It increased oxygen demand. levels of oxygenation decline when the body cannot meet this demand
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
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
Very late sign of hypoxia
Cyanosis
What causes disturbances in conduction (dysrhythmias)?
Electrical impulses do not originate from the SA node
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
Failure of the myocardium to eject sufficient volume to the systemic and pulmonary circulations
Altered cardiac output
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
Signs and symptoms of left sided heart failure
Crackles in lungs
Fatigue
Breathlessness
Confusion
Dizziness
Paroxysmal nocturnal dyspnea (late sign)
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
Signs and symptoms of right sided heart failure
Weight gain
Distended neck veins
Hepatomegaly
Splenomegaly
Dependent peripheral edema
What is stenosis of valves?
Hardening of the valves
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
What is regurgitation of heart valves?
Impaired closure
What happens in the heart when there is regurgitation?
Backflow of blood into adjacent chamber, can cause a whooshing sound or murmur
Types of myocardial ischemia
Angina
MI
What causes angina?
When oxygen supply is less than demand
Usually lasts 3-5 mins and is relieved with rest and coronary vasodialtors
What causes MI?
Occurs when ischemia is not reversed
Cellular death occurs after 20 mins
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
What do cardiac enzymes show?
This level plus troponin to diagnose acute myocardial infarcts
What do cardiac troponins show?
Elevates as early as 3 hours after myocardial injury
What do serum electrolytes show?
Good for monitoring potassium
What do brain natriuretic peptides show?
Increases levels may help determine severity of congestive heart failure
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
What do arterial blood gases show?
Assessment of a pt’s respiratory and metabolic acid/base balance and adequacy of oxygenation
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
What does peak expiratory flow rate (PEFR) show?
Reflects changes in large airway sizes
Predictor of overall airway resistance in a pt with asthma
What does a bronchoscopy show?
Trachial tree
Used to obtain fluid, sputum, or biopsy samples
Or to remove mucous plugs or foreign bodies
What do lung scans show?
Identify abnormal masses by size and location
Or to find blood clot preventing normal perfusion or ventilation
What does a thoracentesis show?
Specimen of pleural fluid obtained for cytological exam
Can indicate infection or cancer
Dyspnea and nasal flaring can be cues for which nursing diagnoses?
Impaired gas exchange
Impaired breathing
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
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
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
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
Two top priorities in acute care nursing interventions
Dyspnea management
Airway maintenance
What is involved in airway maintenance?
Adequate hydration to prevent thick, tenacious secretions
Proper coughing techniques
Suctioning
Chest physiotherapy
Nebulizer therapy
What should you teach patients when you’re trying to mobilize secretions in their airways?
TCDB (turn, cough, deep breathe)
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
Which patients is chest wall percussion contraindicated in?
Pts with thoracic trauma or surgery
How often should patients use incentive spirometers?
5-10 breaths per session, every hour
What is incentive spirometry used for?
To prevent / treat atelectasis in post operative patients
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)
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
When should you apply suction pressure when suctioning?
When removing the catheter, never while inserting
What are oral airways used for?
Prevents obstruction of the trachea by displacement of the tongue into the oropharynx
What are ET tubes used for?
Short term
To relieve upper airway obstruction
Protect against aspiration
To clear secretions
What are tracheostomies used for?
Same as ET tube but for long term assistance
What is invasive mechanical ventilation?
A lifesaving technique used with artificial airways
Can be used to fully or partially replace spontaneous breathing
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
Amount of oxygen for a nasal cannula
1-6 L/min
Amount of oxygen for an oxygen-conserving cannula
8L/min
Amount of oxygen for a simple face mask
6-12 L/min
Amount of oxygen for partial and nonrebreather masks
10-15 L/min (reservoir bag should always be partially inflated)
Amount of oxygen for a Venturi mask
24-50%
Amount of oxygen for a high-flow nasal cannula
60 L/min
What is pursed-lip breathing?
Involved deep inspiration and prolonged expiration though pursed lips
What is pursed-lip breathing used for?
To prevent alveolar collapse
Helps improve exercise intolerance, breathing pattern, and arterial oxygen saturation
What is diaphragmatic breathing?
Increased tidal volume and decreased respiratory rate
What is diaphragmatic breathing used for?
Improved breathing pattern and quality of life
For patients with pulmonary disease and dyspnea secondary to heart failure
What is Leininger’s Transcultural Caring?
Even though caring is universal, the expressions, processes, and patterns of caring vary among people of different cultures
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
Swanson’s 5 caring processes
Knowing
Being with
Doing for
Enabling
Maintaining belief
What does knowing mean?
Striving to understand an event as it has meaning in the life of the other
What does being with mean?
Being emotionally present to the other
What does doing for mean?
Doing for the other as they would do for themself if it were possible
What does enabling mean?
Facilitating the other’s passage through life trasitions
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
What does presence mean?
Person to person encounter conveying closeness and a sense of caring
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
What is world view?
How people perceive others, how they interact with and relate to reality, and how they process informaiton
What is an emic world view?
And insider perspective
What is an etic world view?
And outsider perspective
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
What is body alignment?
Positioning of the joints, tendons, ligaments, and muscles while standing, sitting, and lying
Individuals center of gravity is stable
How to perform passive range of potion
Carry out movements slowly and smoothly though prescribed range
Only move to point of resistance
When would passive range of motion be used?
Paralyzed extremities
Healing fractures
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
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?
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
4 factors to consider when assessing for activity intolerance
Physiological
Emotional
Developmental
Pregnancy
Exaggeration of anterior convex curve of lumbar spine
Lordosis
Increased convexity in curvature of thoracic spine
Kyphosis
Legs curved inward so knees come together as person walks
Knock-knee
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
What is a patient at risk for regarding cardiovascular changes after being immobile?
Orthostatic hypotension
Increased cardiac workload
Thrombus formation
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)
What is a patient at risk for regarding integumentary changes when they have been immobilized?
Pressure injuries
Changes in metabolism accompany immobility
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
What are the pressure points of a patient placed in SIMs position?
Ileum
Humerus
Clavicle
Knees
Ankles
Psychosocial nursing diagnosis for a pt dealing with immobility
Social isolation
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
Psychosocial nursing diagnoses for patient experiencing hearing and visual impairments
Risk for anxiety, fear
Impaired verbal communication
Impaired socialization
Factors that influence sensory functioning
Age
Meaningful stimuli
Amount of stimuli
Social interaction
Environmental factors
Cultural factors
What is expressive aphasia
Motor
Inability to name common objects or express simple ideas into words or writing
What is receptive aphasia?
Sensory
Inability to understand written or spoken language
What is global aphasia?
Inability to understand language or communicate
When assessing a patient who has right sided hemisphere stroke, which side do you dress first?
Left side
In preventing hospital acquired pneumonia, especially in elderly patients, what should you do?
Turn, cough, and encourage deep breathing with them every 2 hours
