Final Exam cumulative notes Flashcards
As s nurse you can delegate to a CNA but you are responsible for oversight
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Prepackaged is better for cleaning
less infection risk
No baby powder for Perineal care
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When cleaning hair wear gloves to avoid the risk of coming in contact with a cut that you can’t see and getting an infection.
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Electric shave for the patient. if pt has a beard you need their consent. Check if they are on an anticuagulant
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As s nurse, you can delegate to a CNA but you are responsible for oversight
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for unconscious pt oral care every 2h to avoid aspiration pneumonia and infections
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The microorganisms that usually occupy a particular body site are called the resident flora. Cells of the resident flora outnumber a person’s own cells 10 to 1. Microorganisms that colonize people for hours to weeks but do not establish themselves permanently are called transient flora.
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Transient pathogens you can clean and remove however resident is harder. Resident flora can stop the growth of nonresidents.
fomites are objects that can carry infection.
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Colonized people carry a bacteria with symptoms.
The reservoir of an infectious agent is the habitat in which the agent normally lives, grows, and multiplies.
Strep aureus
pneumonia
The Portal of Exit from the reservoir. This describes the way the microorganism leaves the reservoir. For example, in the case of a person with flu, this would include coughing and sneezing. In the case of someone with gastro-enteritis microorganisms would be transmitted in the faeces or vomit. potal of entry is the opposite
Droplet (droplet of fluid ) large molecules
influenza
menengitis
pneumonia
pertussis
airborne suspended in the air
pathogen suspended in the air. Tb, varicella (shingles, chiken pox), covid,, measles. You need an N95 mask
With tb you need to take your medication because it’s a public health issue.
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1 Incubation stage
The number of days from when you get infected till you start seeing signs
2 predormal stage
Early symptoms- vague and nonspecific it’s when you have that weird feeling before getting sick
Fatigue, malaise, low-grade fever
Person most contagious during this stage
Illness stage.
symptoms manifest themselves.
convalescence
period of healing
Nosocomial infection
An infection you get while receiving healthcare.
Exogenous infections
Exogenous infections, in contrast, involve a pathogen entering a patient’s body from their environment. These pathogens can be introduced through a contaminated device, a healthcare worker like an IV, a surface, or a patient in the same room with another one. covid spread in a hospital.
Endogenous infection
Endogenous infections are caused by an overgrowth of organisms that are normally present in or on you (yeast on your skin for example)
iatrogenic infection
an infection after medical or surgical management, whether or not the patient was hospitalized. Iv or urine catheter
someone who is undergoing chemo is more susceptible to infection.
In cancer the highest cause of death is infection.
localized infection vs systemic infection
localized a certain part of the body ex wound
systematic ex virus you have systematic symptoms.
The major cause of infection in a healthcare setting
Insuficient hand hygiene.
The weakest link to infection is
Transmission. so hand hygiene is the best way to prevent it.
obtain cultures before antibiotics are started
Obtaining cultures before antibiotic use improves the chances of identifying the offending microorganism, which improves patient care.
5 moments of hand hygiene
1 Before pt contact
2 before an aseptic task
3 after body exposure risk
4 after pt contact
5 after contact with pt surroundings
study cdc basic guidlines for isolation.
Wash hands for 15 sec
Soap and water to avoid cdif coz it has spores and their tchick walls that can resist everything
asepsis technique.
Medical asepsis (is aimed at controlling the number of microorganisms and is used for all clinical patient care activities) vs surgical asepsis (sterilizing objects)
On air precautions
MTV
measesls
TB
varicella (shingles chicken pox)
N95 mask staff (not fluid resistat)
during transport, pt needs a surgical mask
Droplet precautions
Pneumonia
Miningitis
surgical mask (fluid resistance ), goggles and a single room for the pt
when putting on
1 gown
2 mask
3 goggles
4 gloves
When off
1 gloves
2 goggles
3 gown
4 mask
core temp deep in tissues stays constant
surface temp on skin
changes with environemment
temp is regulated in the hypothalamus and it acts as a thermostst
when the temp is under 36/98.6 you start shivering you get goosebumps your veins become invisible because they shrink from the surface to conserve heat
when the temp goes up you sweat, increase in resp rate to lose heat through evaporation
vessels close to the surface to lose heat.
older people, children, have a hard time regulating their temp and newborns can’t shiver.
factors affecting heat are BMR, exercise shivering and fever(caused by a change of the set point hypothalamus)
convection
loss of heat due to air currents
axillary temp (surface)
oral route (surface)
Temporal (core temp but not necessarily reliable)
IG only if necessary. contraindicated in young children to avoid puncturing the rectum. Not ok with hypotension coz it can cause disarrthmias. not ok with low platelets due to the risk of bleeding. not ok with spinal injury
Pyrexia is fever (aka true fever). It happens when the body when the hypothalamus changes the set point to kill a pathogen and its pyrogen (substance released by bacteria) Once pathogen is killed you are going to be sweating to lose heat
Types of fever:
sustained : constant above 38/100.4 with little fluctuation
intermittent : temp returns to normal every 24h
Remittent: fever spiked with no return to normal temp levels.
Relapsing periods of febrile episodes and periods of acceptable temp values
Normal temp?
36-38 C
96.8 - 100.4 F
hyperthermia does not have a change in the set point of the hypothalamus it’s just high heat due to external temp and it can lead to a heat stroke which is when you lose your ability to sweat and lose electrolyes.
Alcoholics suffer from hypothermia, the very young and old as well.
Normal pulse
60-100
Stroke volume
The amount of blood pumped in one heart beat
cardiac output
the amount of blood pumped in 1 min
dorsalis pedis aka
popliteal
femoral
pedal pulse next to that big tendon that goes to the big toe
back of knee
ingle
beta blocker decrease heart rate
What is orthostatic bp and when does it happen?
Happens with poeple who have bad perfusion usually old. it is a reduction of systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg within 3 minutes of standing. coz the heart needs some
apical pulse: The point of maximal impulse, known as PMI, is the location at which the cardiac impulse can be best palpated on the chest wall. Frequently, this is at the fifth intercostal space at the midclavicular line.
A doppler is used when?
There is a difficulty palpating a pulse.
tachycardia
heartbeat that is faster than 100 bpm
Baricardia
heartbeat that is less than 60 heartbeat per min
Arrhythmia
irregular heart beat
pulse deficit is used to check for perfusion
it is the difference between 2 points. Ex: if the apical is 70 and the radial is 60. We do this to check for perfusion. because the pulse deficit is more than 2 then we have a pulse deficit.
The normal rate for respiration
12-24
If someone has 12 breaths per min don’t give them opioids so that they don’t go into respiratory distress.
The resp center is the medulla oblongata in the brain
Dyspnea
difficulty breathing
Apnea
Temporary absence of breathing
Orthopnea
difficulty breathing when laying flat
Systolic pressure and normal value?
The first sound that you hear. It happens due to contraction of the ventricles.
90/120
Diastolic pressure and normal values
The last sound that you hear when you are taking BP. it’s because the ventricles are filling with blood.
Normal is 60/80
Stages of hypertension. elevated systolic bp?
systolic between 120/129 and diastolic less than 80 (which is normal)
Stage 1 Stages of hypertension
systolic between 130/139 or diastolic between 80/89
Stages of hypertension stage 2
systolic at least 140 or diastolic at least 90
Stages of hypertension hypertensive crisis.
Systolic over 180 and diastolic over 120
Hypotension?
systolic under 90
Orthostatic hypotension aka postural hypotension.
drop by 20 in systolic pressure and 10 in diastolic
Diurnal variations bp
Usually, blood pressure starts to rise a few hours before a person wakes up. It continues to rise during the day, peaking in midday. Blood pressure typically drops in the late afternoon and evening. Blood pressure is usually lower at night while sleeping.
White coat syndrome
bp normal at home but not at the doctor (nervousness)
Rectal temps are the most accurate. Forehead temps are the next most accurate. Oral and ear temps are also accurate if done properly. Temps done in the armpit are the least accurate.
Cuff too big = low bp
cuff too tight= high bp
methods of getting BP.
Invasive direct into the artery
indirect includes auscultatory and palpatory
korotkoff sounds heard in auscultation of bp
Position limb: take a heart level
Orthopnea is the sensation of breathlessness in the recumbent position, relieved by sitting or standing.
Orthopnea
Orthopnea is the sensation of breathlessness in the recumbent position, relieved by sitting or standing.
A surgical mask has a shield this is why it is droplet proof
Look at past trends when assessing temp and vital signs in general such as respirations and heart rate
Axillary temp is affected by the environment because it’s surface temperature. n the NICU, the temperature is often measured at the axilla rather than the rectum as it is more accessible and less invasive.
Newborns and children under 5
temp is best in the axilla
No bP reading in a mastectomy.
The general concern about rectal temperatures post-MI is that it might stimulate the vagus nerve and cause bradyarrhythmias.
laparoscopy vs laparotomy
Laparotomy is basically a surgical procedure which involves a large incision in the abdomen to facilitate a procedure. While laparoscopy is a minimally invasive surgical procedure which sometimes referred as keyhole surgery as it uses a small incision.
Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you’re allergic to, such as peanuts or bee stings.
Hypovolemic shock is an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body.
Thrombophlebitis (throm-boe-fluh-BY-tis) is an inflammatory process that causes a blood clot to form and block one or more veins, usually in the legs
an extremely small amount.
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