Infection Control: Critical Thinking Exercises Flashcards
Your patient had an in-dwelling urethral catheter for 1 week. The catheter has now been out for 24 hours. The patient complains of frequency of and pain on urination. The patient suggests that the catheter be reinserted so that she does not need to get up frequently.
- What can frequency of or pain on urination indicate?
- Should the catheter be reinserted? Why or why not?
- Describe at least one appropriate assessment measure and independent nursing action for this patient.
- Frequency of and pain on urination can indicate a urinary tract infection (UTI), which is a common complication after catheter removal.
- The catheter should not be reinserted solely for the patient’s convenience, as this increases the risk of further UTIs and other complications. Catheters should only be used when medically necessary.
- Appropriate assessments include obtaining a urinalysis and urine culture to check for UTI. Encourage increased fluid intake and provide analgesics if needed for dysuria. Monitor intake/output and instruct proper perineal hygiene. Consider alternative products like pads/undergarments if incontinence is an issue rather than recatheterizing.
You are caring for a patient who has a large, open, draining abdominal wound. You notice another health care worker changing the patient’s dressing without wearing gloves or using sterile supplies or sterile technique. When you question the health care worker regarding this practice, the person says, “Don’t worry, the wound is already infected, and the antibiotics and draining will take care of any contaminants.”
- How would you respond to this comment?
- What would your next steps be in following up on this incident?
- I would respectfully explain that even infected wounds require proper sterile technique and use of personal protective equipment to prevent further contamination and spread of infection. Antibiotics alone cannot fully protect against introduction of additional pathogens.
- My next steps would be to document the incident, report it to the nurse manager or infection control department, and provide education to the healthcare worker on proper wound care protocols. Ensuring all staff follow evidence-based practices for infection prevention is crucial for patient safety.
Penelope (preferred pronouns: she/her) is 83 years of age and lives alone. She has difficulty walking and relies on a church volunteer group to deliver lunches during the week. Her fixed income limits her ability to buy food. Last week, Penelope’s 79-year-old sister died. The two sisters had been very close.
- Explain the factors that might increase Penelope’s risk for infection.
Several factors may increase Penelope’s risk for infection:
- Advanced age (83 years old) - Aging is associated with a decline in immune function, increasing susceptibility to infections.
- Potential malnutrition - Her fixed income limits food access, which can lead to nutritional deficiencies that weaken the immune system.
- Mobility issues - Difficulty walking may impair her ability to maintain proper hygiene and increase risk of skin breakdown/wounds that allow pathogen entry.
- Grief/stress - The recent loss of her close sister is an emotional stressor, which can suppress immune responses.
- Social isolation - Living alone with limited social contact can negatively impact mental health and increase infection risk.
Addressing Penelope’s nutritional needs, mobility challenges, mental health support, and facilitating social engagement would be important nursing interventions to reduce her heightened infection risk during this difficult time.
A patient (preferred pronouns: he/him) is admitted to your facility with a history of recent weight loss, a cough that has persisted for 2 months, and hemoptysis. His chest X-ray film shows a cavity in one lung, and his physician suspects tuberculosis.
- What type of isolation precautions would you use for this patient?
- What protection would you use when providing care?
- What education would you provide for the patient and his family?
For a patient suspected of having tuberculosis, airborne precautions would be implemented. This involves placing the patient in a negative air pressure room and using a fit-tested N95 respirator when entering the room. Standard precautions like hand hygiene should also be followed.
Patient and family education is crucial. Explain that tuberculosis spreads through the air by coughing or sneezing. Instruct on cough etiquette and the importance of covering coughs. Discuss the need for isolation to prevent transmission. Provide reassurance that tuberculosis is treatable with appropriate antibiotic therapy. Encourage adherence to the full treatment course. Address any concerns they may have.
Shingles cannot be passed from one person to another. However, the virus (varicella zoster) that causes shingles can be spread from a person with active shingles to another person who has never had chickenpox. If an infection can be transmitted from one person to another, it is a:
a. Communicable disease
b. Portal of entry to a host
c. Portal of exit from a reservoir
d. Susceptible host
a
The patient, Susan, has been diagnosed with disseminated herpes zoster. The mode of transmission for disseminated herpes zoster is:
a. Direct and indirect contact
b. Droplet transmission
c. Airborne transmission
d. Airborne, droplet, and contact transmission
d
Disseminated herpes zoster is no longer infectious when:
a. All lesions are dry and crusted
b. Fever resolves
c. Generalized red rash blanches when touched
d. The patient no longer feels itchy
a
Susan was in the hospital for 7 days when she developed symptoms of Clostridioides difficile. The most common symptom of C. difficile is:
a. Bleeding gums
b. Diarrhea
c. Maculopapular rash
d. Headache
b
The most effective way to prevent transmission of microorganisms is hand hygiene. The minimum handwashing time with soap and water necessary to remove most transient microorganisms is:
a. 1.5 seconds
b. 15 seconds
c. 40–60 seconds
d. 3 minutes
c
Staff entering Susan’s room are required to use an N95 mask. Which organism requires the use of an N95 mask?
a. Methicillin-resistant Staphylococcus aureus (MRSA)
b. Herpes zoster
c. Influenza viruses
d. Paramyxoviruses
b
Disseminated herpes zoster is treated by:
a. Antifungal medication
b. Antibiotics
c. Antiviral medication
d. Antiemetics
c
Susan is placed on airborne and contact precautions. The most appropriate room placement would be:
a. A four-bed ward with each bed 2 metres apart and shared washroom
b. A two-bed room with shared washroom
c. A single room, with dedicated washroom and anteroom
d. A single room and dedicated washroom
c
Susan is at risk for disseminated herpes zoster because:
a. She is immunocompromised because she is taking prednisone.
b. She is in end-stage renal failure.
c. She has a central venous catheter for dialysis.
d. She is an inpatient in a hospital.
a
The people involved in direct or indirect patient care needs for Susan need to be concerned about hand hygiene and should be able to perform it correctly and at the right time. When should hand hygiene be performed?
a. Before entering Susan’s room.
b. Before and after direct contact with the patient or the patient’s environment; before an aseptic procedure, after exposure or risk of exposure to blood or body fluids; and following the removal or gloves and before gloves are put on.
c. After leaving Susan’s isolation room.
d. Before donning a gown and mask.
b
