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NURS 327 Medical Surgical Nursing > Inflammation/Infection/UTI/Sepsis/HIV/AIDS > Flashcards

Inflammation/Infection/UTI/Sepsis/HIV/AIDS Flashcards

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1
Q

What can cause inflammation?

A

Broken bones, sprains, cuts, asthma

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2
Q

When we have inflammation , does that mean there is an infection too?

A

No

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3
Q

When we have an infection, does that mean there is inflammation ?

A

Yes, when there is an infection there is also inflammation

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4
Q

Inflammatory pathophysiologic response involves ……

A

vascular response
cellular response
cell mediators

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5
Q

What is the cellular response in the inflammatory process?

A

When the monocytes, neutrophils and macrophages come into the injured area

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6
Q

Cell mediators include the

A

complement protein cascade systems, prostaglandins, leukotrienes

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7
Q

Inflammatory response depends on the ________ __________ of the individual

A

reactive capacity

How well does a person respond to injury - think what factors enable a stronger response

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8
Q

A patient who is ________________ would be lacking in white blood cells and would have trouble initiating an effective _____________________.

A

immunocompromised; inflammatory response

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9
Q

The inflammatory response depends on the ____________ of the injury -

A

nature; there is a difference between being pricked by a pin and being stabbed by a knife

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10
Q

Three basic types of inflammation

A

Acute
Subacute
Chronic

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11
Q

Acute Inflammation

Who are the prominent cell types present at this inflammation ?

A

healing occurs within 2-3 weeks

neutrophils are prominent cell type at area of inflammation

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12
Q

Subacute inflammation

A

persists a little longer than acute inflammation

endocarditis for example

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13
Q

Chronic Inflammation

A

anything greater than 3-6 months
prominent cell types involved are the lymphocytes and the macrophages
may result from changes to the immune system (rheumatoid arthritis)
asthma and arthritis are examples

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14
Q

Chronic inflammation can lead to _____________

A

deterioration, depending on the severity

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15
Q

Older patients may have less response to _________

A

temperature. If they have an infection, we could see a slower than normal rise in temperature

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16
Q

3 things that will help us address inflammation

A

Vital signs, labs and assessment

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17
Q

Clinical Manifestations

A 
Color (erythema ) 
 temperature, 
swelling,
 function,
 drainage (color, amount, odor)
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18
Q

Questions you would ask the patient

A

how did the injury happen?

what medications are you taking ? (pregnisone can decrease the inflammatory process)
medical history - any diabetes (slow healing time) history of arthritis

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19
Q

lab findings

A

CBC - any increase in WBC, or neutrophils or BANS

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20
Q

Local Inflammation

A

Redness, heat, pain, swelling, loss of function

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21
Q

Systemic inflammation

A

increase in WBC with a shift to the left (increased number of immature WBC) malaise, nausea, anorexia, increased temp, pulse and respiratory rate

These symptoms would point to more of a systemic infection that is throughout the body

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22
Q

Vital signs

A

temperature, respirations, pulse, BP, pulse ox, pain

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23
Q

How can we minimize inflammation and infection ?

A

Immunizations (Tetanus, pneumonia and flu)
Good hand hygiene
nutrition helps to regenerate tissue

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24
Q

What is one way to assess patients nutritional level?

A

Albumin levels

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25
Q

What might we first see in the older adult when there is an infection?

A

Confusion

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26
Q

Manifestations of systemic infection

A

increase in temperature, pulse, respiration, decrease in pulse ox and decrease inBP

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27
Q

What can happen with too elevated fever levels ?

A

seizures

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28
Q

Drug therapy to decrease the inflammatory response

A

aspirin (blocks prostaglandin synthesis in the hypothalamus)
Tylenol (acts on the temperature regulatory center in the hypothalamus)
NSAIDS (motrin, advil have antipyretic effects)
corticosteroids
antipyretics should be give around the clock

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29
Q

Benefits of fever

A

increase destruction of microbes

increased proliferation of T cells

increased phagocytosis

higher body temp may enhance activity of interferons

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30
Q

RICE

A

Rest, Ice, Compression, Elevation

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31
Q

Heat can help promote healing by increasing

A

circulation to inflamed site, done 24-48 hours after injury

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32
Q

What can ice do to the vessels ?

A

Vasoconstriction

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33
Q

Can local infection be contained ?

A

Yes

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34
Q

Symptoms of local infection

A

change in vital signs (fever, tachycardia, tachpynea)
pain, redness, swelling, temperature, motion

later signs would be hypotension and decreased pulse ox

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35
Q

Symptoms of systemic infection

A

change in vital signs (fever, tachycardia, tachpynea)
pain, redness, swelling, temperature, motion

malaise, anorexia,lymph node enlargement, altered Mental status (blood cells in brain not getting oxygen they need because of hypoxemia (decreased oxygen flow) , changes in renal function and/or cardiac output , hypotension, hypoxemia

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36
Q

What is sepsis ?

A

Sepsis is SIRS + infection

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37
Q

normal WBC count

A

4500-11,000

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38
Q

Infections can be ……

A

localized, disseminated, or systemic

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39
Q

For infection, clinical manifestations are the result of the …………………… response

A

inflammation and immune response

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40
Q

Systemic affects only one body part…. true or false …..

A

obviously False. ….. Systemic affects the whole body at once

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41
Q

Leukocytosis

A

increased in white blood cells

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42
Q

Immature neutrophils can not fight infections. true or false

A

true

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43
Q

For a patient exhibiting symptoms of an infection, what kind of antibiotics would we start them out on

A

broad spectrum antibiotics

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44
Q

SIRS

A

Systemic inflammatory response syndrome - inflammatory response is going on throughout the body - can be indicative of infection, ischemia, infarction , asthma - SIRS does not necessarily mean there is an infection

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45
Q

Sepsis

A

SIRS + possible infection - a body’s response to infection

Sepsis can cause life threatening organ dysfunction

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46
Q

Risk factors for sepsis

A

Age - very old and very young
co-morbidities
medical devices - foley catheter is a risk for sepsis
immunocompromised patients - transplant patients

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47
Q

sepsis spectrum

A

can be from mild to severe

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48
Q

criteria for SIRS

A

increased pulse, increased respiration, inc/dec in WBC, inc/dec in temperature

2 of these 4 lead to SIRS

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49
Q

severe sepsis

A

sepsis + end organ damage

altered mental status, edema, renal impairment - with hypoxemia, renal cells will not be getting oxygen they need to make urine

we have to work quickly on getting cultures and fluids and antibiotics for them

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50
Q

septic shock worry

A

death

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51
Q

septic shock =

A

severe sepsis and prolonged hypotension

there is vasodilation, maldistribution blood flow and myocardial depression

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52
Q

leukopenia

A

decreased number of white blood cells

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53
Q

If a patient comes in with elevated temp, elevated pulse, productive cough, decreased pulse ox, confusion - we need to monitor them and give them

A

IV fluids, quick boluses-

we could give boluses but their blood pressure might still be hypotensive - indicating septic shock

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54
Q

severe sepsis , lactic acid levels are

A

lactic acid > 2

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55
Q

septic shock , lactic acid levels are

A

lactic acid > 4

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56
Q

multiorgan dysfunction syndrome

A

failure of two or more organs as the result of severe sepsis

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57
Q

sepsis diagnostics

A

no specific diagnostic test but an array are looked at

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58
Q

sepsis diagnostics

CBC

A

CBC - leukocytosis/leukopenia/increase in BANS

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59
Q

sepsis diagnostics

electrolytes

A

increased glucose, Na+ , decreased K+ (shock)

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60
Q

when we are doing the bloodwork, we are looking to see if our patient is in _____________, _____________ , ___________.

A

sepsis, severe sepsis, or septic shock

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61
Q

Procalcitonin levels are present when

A

there is bacteria. it is released from every type of organ/tissue when bacterial infection is present

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62
Q

C reactive protein is produced by the _________ when there is inflammation

A

liver.

we look at C reactive protein together with WBC count

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63
Q

severe sepsis

A

lactic acid > 2

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64
Q

septic shock lactic acid levels

A

lactic acid > 4

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65
Q

we always do blood cultures before we get the specific

A

antibiotic

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66
Q

Culture sources

A

blood, urine, sputum

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67
Q

It is ideal to get _______________ before giving antibiotics so we can identify the _______________

A

blood cultures; pathogen

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68
Q

creatinine, ABG’s , radiography- indicative of

A

MODS - we look at these labs for indications of organ function

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69
Q

MODS

A

multiple organ dysfunction syndrome

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70
Q

prevention of sepsis

A

aseptic care, prophylaxis , patient teaching

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71
Q

prophylaxis

A

action taken to prevent disease, especially by specified means or against a specified disease

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72
Q

management of sepsis - early stages - uncomplicated

A

oxygen therapy
ABCs
optimize fluid status IV therapy (1000 ml of fluid within 5-10 minutes b/c body needs that fluid)
broad spectrum antimicrobial therapy - within 1 hour of sepsis - Get culture first ideally
temp & pain management
emotional support
ongoing monitor for change in condition

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73
Q

for sepsis patients, what is one thing we will always give …..

A

fluids are always something we can give….

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74
Q

management of sepsis - complicated - SEPTIC SHOCK

A

same care as prevention and early sepsis - oxygen may require mechanical ventilation

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75
Q

management of sepsis - complicated - SEPTIC SHOCK

  • IV considerations
A

large IVS, at least 2 so we can get crystalloids 30 ml/kg into them…..

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76
Q

when we give IVs, we evaluate effectiveness by paying attention to

A

urine output, pulse Ox , vital signs

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77
Q

If IV’s are not raising certain vital signs, what can we administer

A

vasopressins

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78
Q

HAI’s

A

health care associated infections - infections that occur within the hospital through delivery of care

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79
Q

endogenous infections

A

from client themselves

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80
Q

exogenous infection

A

from the hospital/personnel

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81
Q

iatrogenic infection

A

occurs from the interventional procedure themselves

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82
Q

Preventing HAI’s

A

hand washing, asepsis, environmental controls

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83
Q

about how many deaths occur a year because of HAI’s

A

about 75,000

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84
Q

Tier One Standard Precautions

A

applies to all patients

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85
Q

tier two transmission precautions

A

when person has a known disease - airborne, droplet, contact precautions

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86
Q

airborne particle size

A

less than 5 microns

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87
Q

droplet particle size

A

greater than 5 microns

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88
Q

Important factors when it comes to preventing transmission and infections

A

hand washing, immunizations, nutrition, stress management, hydration, rest and sleep

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89
Q

ARO

A

antimicrobial resistant organisms - can be bacterial, viral, fungal, parasitic

organism changes in such a way that it becomes resistant to antibiotic. changes happen that decrease ability of drug to destroy it

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90
Q

Etiologic factors for ARO development

A

administration of antibiotics for viral infections
submitting to pressure from patients for Rx
using inadequate drug regimes
using broad therapy in place of first line therapy
patients - incomplete therapy

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91
Q

VRE

A

a common ARO

vancomycin Resistant Enterococci

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92
Q

VRSA

A

Vancomycin Resistant Staph Aureus

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93
Q

MRSA

A

Methicillin Resistant Staph Aureus

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94
Q

Patient teaching to prevent development of ARO’s

A 
only take prescribed medication 
finish all prescriptions 
do not request antibiotics for colds and flu
do not take "left over" medications 
following directions
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95
Q

Chain of Infection

A 
A microbe 
a reservoir 
path from reservoir 
mode of transmission 
path of entry
susceptible hosts
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96
Q

What is the number one cause of UTI’s ?

A

Escherichia coli (E. Coli)

normally found in the intestinal tracts

women might not be wiping from front to back
older adults might be incontinent of stool and not cleaning themselves as well

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97
Q

Classification of UTI

A

Upper vs Lower

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98
Q

Lower UTI

A

usually no systemic manifestations

99
Q

Who gets more UTI’s: women or men ?

A

Women

100
Q

Cystitis

A

inflammation of the bladder

101
Q

Urethritis

A

Inflammation of the urethra

102
Q

Urosepsis

A

characterized by bacteriuria and bacteremia

this is a UTI that has spread systemically

103
Q

bacteriuria

A

bacteria in the urine

104
Q

signs of symptoms of urosepsis

A 
incr/decr temp
increase pulse
incres RR
incres/decres WBC 
2/4 of these lead to SIRS

frequency of urination
confusion
pain

105
Q

Urosepsis treatment

A

fluids, fluids, fluids

Broad spectrum antibiotic after we get cultures

106
Q

Do not hesitate to ask the doctor for an order for an __________ to get a urine sample

A

in and out catheter so we can obtain a sensitivity test to get a more specific antibiotic

107
Q

Why do we choose isotonic fluids with patients when we are talking about giving fluids for Severe Sepsis and septic shock and sepsis ?

A

Because we want to keep that fluid within the vascular system. isotonic fluid stays within a vascular system

108
Q

Why do we give colloids

A

IV solutions that increase osmotic pressure. Pull for volume expansion- will keep fluid within the vascular space

109
Q

When we are giving fluids for sepsis, what do we want to do?

A

Increase the amount of fluid within the intravascular space

110
Q

Isotonic fluid stays within the ________________

A

vascular system

111
Q

How does rest help during inflammation process?

A

rest helps body to use nutrients

112
Q

Cold is applied when during the inflammatory process?

A

at times of initial trauma to induce vasoconstriction and reduce swelling

113
Q

What does compression do ?

A

compression serves to counter effects of vasodilation

114
Q

Clinical manifestations of infection are the result of which two responses ?

A

Inflammatory and immune response

115
Q

Different types of infection

A

local, disseminated, systemic

116
Q

Local infection

A

limited to specific body part like an organ or area of body

117
Q

Systemic infection

A

infection that affects the entire body at once - it is in the bloodstream

118
Q

Disseminated infection

A

spread of organisms beyond initial site

119
Q

Local infection manifestations

A

pain, redness, swelling, warmth, decreased motion -

change in vital signs: fever, tachycardia, tachypnea

120
Q

Systemic infection manifestations

A

pain, redness, swelling, warmth, decreased motion,
change in vital signs: fever, tachycardia, tachypnea

malaise

121
Q

With UTI’s think of ……..

A

cystitis

122
Q

symptoms of cystitis

A 
frequency
urgency 
dysuria 
hematuria 
fever 
confusion in older adults 
suprapubic pain
123
Q

Diagnostics for UTI

A

dipstick for leukocyte estrace

nitrates

Urinary Analysis/ Culture and Sensitivity

124
Q

dipstick for leukocyte estrace - what does it indicate ?

A

pyuria - pus from bacteria

125
Q

When nitrates are present, this shows that …..

A

bacteria are present

126
Q

Treatment for UTI’s

A

antimicrobials
increased fluid intake
prevention

127
Q

Teaching and Prevention for UTI prevention

A 
showers better than baths 
perineal cleaning "from front to back"
voiding after intercourse 
anti-microbial therapy 
no scented toilet paper 
no perfumes to perineal area 
empty bladder regularly
128
Q

Urinary tract above urethra is normally ______________

A

sterile

129
Q

What defense mechanisms exist to maintain sterility/prevent UTI’s?

A

Complete emptying of bladder, ureterovesical junction competence, ureteral peristaltic activity

130
Q

ureterovesical junction competence

A

the ureter connects to the bladder

131
Q

ureteral peristaltic activity

A

forward movement of urine- urine should not be backing up in system, but moving forward

132
Q

Foley catheter should never go past the level of

A

the bladder, in order to prevent UTI’s

133
Q

The pH of our urine is

A

less than 6.0 pH - it is acidic. this is an antibacterial defense

134
Q

High urea concentration and abundant glycoproteins interfere with

A

the development of UTI’s

135
Q

CAUTI

A

catheter associated UTI’s - most common HAI’s

136
Q

often Causes of UTI- bacterial wise

A

E. Coli is often UTI cause

less frequently: Pseudomonas species

137
Q

Most UTI’s are under ______ and under_______

A

underrecognized and undertreated

138
Q

Clinical Manifestations of UTI

A 
urinary frequency 
urgency 
incontinence 
nocturia 
nocturnal enuresis 
weak stream
hesitancy
intermittency 
post void dribbling
urinary retention 
dysuria
139
Q

in older adults symptoms for UTI are often

A

absent

140
Q

In older adults, what are some signs of UTI?

A

nonlocalized abdominal discomfort rather than dysuria (more of suprapubic pain)
cognitive impairment possible
fever less likely

141
Q

IF we have an older adult that is confused think….

A

UTI, infection, pneumonia, maybe diabetes too – the point is just to start thinking about different possibilities when symptoms arise

142
Q

Diagnostic Studies for UTIs

A

first we do history and physical - think of risk factors (age, gender)
do they have urinary catheter in place, or use in/out catheters, are they/have they been on antibiotics, previous UTI’s, immunocompromised, BPH, tumors, renal calculi

dipstick urinalysis
- identify presence of nitrites, WBC and leukocyte esterase

  • urine for culture and sensitivity
143
Q

in a patient suspected of having UTI’s, we will conduct __________________

A

dipstick urinalysis

culture and sensitivity tests

144
Q

regarding a dipstick urinalysis test, elevated/ decreased WBC indicates we may have an

A

infection

145
Q

regarding a dipstick urinalysis test, nitrites would indicate the presence of

A

bacteria

146
Q

Antibiotic worries/ education

A

It is important to educate patients about antibiotic regime for UTI treatment
medications themselves - some we have to worry about when to give them (with food/without food)
and avoidance of sunlight

147
Q

Antibiotics to keep in mind for UTI’s (will not be tested on )

A

Trimethoprim/sulfamethoxazole

Nitrofurantoin (Macrodantin)

Fluoroquinolones

Ampicillin, Amoxicillin, Cephalosporins

148
Q

Antifungals for fungal infections

A

Amphotericin or Fluconazole

149
Q

UTI’s can be very painful so we will be giving

A

urinary analgesics

150
Q

Phenazopyridine

A

used in combination with antibiotics

provides soothing effect on urinary tract mucosa
stains urine reddish orange color
can be mistaken for blood and stain underclothing

151
Q

Which analgesic medication can stain a patients urine a reddish/orange color ?

A

Phenazopyridine

152
Q

It is important to recognize those individuals more at risk of a UTI - who are they ?

A

debilitated persons
older adults
underlying diseases (HIV/diabetes)
those taking immunosuppressive drug or corticosteroids

153
Q

Health promotion for UTI’s

A

wipe perineal area from front to back
emptying bladder regularly and completely
evacuating bowel regularly
drinking adequate fluids (persons weight x 2)

cranberry juice or cranberry tablets may reduce # of UTI’s
avoid unnecessary catheterization and early removal of indwelling catheters
aseptic technique must be followed during instrumentation procedures
routine and thorough perineal care for all hospitalized patients
answer call lights and offer bedpan or urinal at frequent intervals

154
Q

prevention of CAUTI

A

wash your hands ! before and after patient contact
avoidance of unnecessary catheterization
early removing of indwelling catheters
follow aseptic technique for procedures
wear gloves for care of urinary catheters

155
Q

In teaching our patients, what are some potential bladder irritants ?

A

caffeine, alcohol, citrus juices, chocolate, highly spiced foods

156
Q

we should emphasize to our patients the importance of taking the full course of _______ despite the disappearance of _______

A

antibiotics; symptoms

157
Q

What else to teach patients about UTI prevention and treatment ?

A

maintain adequate fluids
void after intercourse
regular voiding

158
Q

Renal colic

A

a type of pain someone gets when urinary stones block part of your urinary tract

159
Q

common source of UTI is

A

HAI’s and CAUTI’s are the most often source

160
Q

How can you get HIV?

A

sex without a condom
passed from mother to baby
sharing injecting equipment
contaminated blood transfusions & organ transplants

161
Q

Thrombocytopenia

A

a deficiency of platelets, which increases the risk for bleeding

162
Q

What is the only way to know for sure that you have HIV ?

A

To get tested

163
Q

If left untreated HIV can lead to ……

A

AIDS

164
Q

HIV is a __________ acid virus

A

ribonucleic

165
Q

Why is HIV called a retrovirus ?

A

Because it replicates in a “backward” manner going from RNA to DNA

166
Q

What is the target cell for HIV ?

A

CD4+ T cell - a type of lymphocyte

167
Q

How does HIV bind to its target cells?

A

Through fusion

168
Q

HIV cannot replicate unless it is inside what ?

A

A living cell….. this is the case for all viruses

169
Q

HIV disease progression - important points to remember

A

highly individualized progression of disease
treatment can alter the disease pattern
individual prognosis is unpredictable

170
Q

When does the HIV antibody test become positive ?

A

From 3 week to 3 months

171
Q

Acute Infection for HIV occurs from

A

1-3 weeks. This is the time when the person does not know they have HIV but are experiencing some flu-like symptoms

172
Q

Asymptomatic period of HIV infection lasts for about how long in those untreated ?

A

10 years

173
Q

Acute HIV infection Clinical Manifestations

  • when does this start occuring
A

occurs about 2-4 weeks after infection- it is highly infectious at this point
Flu like symptoms- fever, swollen lymph nodes, joint pain, diarrhea, sore throat, headache, nausea, malaise, muscle/joint pain, diffuse rash
may have 1-2 or 3 or these symptoms - very similar to flu symptoms

potential for neurological complications such as aseptic meningitis, peripheral neuropathy, facial palsy

174
Q

HIV advances to a more active stage as the ______ cell count declines closer to ________ cells/uL and the viral load increases.

What is this stage called ?

A

CD4 T cell count; 200

This stage is the symptomatic infection progression of HIV

175
Q

HIV Symptomatic infection symptoms

A

persistent fever, chronic diarrhea, recurrent headaches, frequent night sweats, severe fatigue

Also it is more common to have certain infections like thrush, shingles, bacterial infections, persistent vaginal candida infections, outbreaks of oral or genital herpes, and Kaposi Sarcoma

176
Q

Oropharyngeal Candidiasis

A

as known as “Thrush”

177
Q

HIV/AIDS patient teaching

A

immune system support - can help delay HIV progression, whether patient chooses to take ART or not

178
Q

What is the goal of HIV treatment ?

A

To decrease the viral load and to increase CD4 T cells

179
Q

The lower the viral load of HIV, the ________ active the disease.

A

less

180
Q

Two things to pay attention to when monitoring HIV

A

CD4 T cell count

Viral Load

181
Q

What does the CD4 T cell count provide ?

A

A marker of immune function

182
Q

HIV/AIDS Monitoring for Complications (opportunistic diseases/therapy complications)

A

decreased WBC counts
low platelet counts
Anemia is associated with ART (antiretroviral therapy)
altered liver function

183
Q

Opportunistic infections such as pneumocystosis or malignancies such as Kaposi’s sarcoma can signal the final stage of HIV, infection, which is

A

AIDS

184
Q

Resistance tests can help determine what ?

A

If the person’s HIV is resistant to the medications being used

185
Q

What helps health care providers know which medications may be effective in HIV therapy?

A

assays

186
Q

HIV/AIDS interprofessional care

A

monitor disease progression, immune function, and manage symptoms

initiate and monitor Antiretroviral therapy

prevent, detect, and/or treat opportunistic infections

prevent or decrease complications of therapies

prevent further transmission of HIV

187
Q

To prevent the emergence of ARO, patients need to take the entire course of antibiotics, even when _________ have resolved

A

symptoms

188
Q

ART

A

antiretroviral therapy

189
Q

ART can significantly slow HIV progression but it

A

is complex
has side effects
does not work for everyone
is expensive

190
Q

lipodystrophy

A

changes in body shape caused by a redistribution in fat in the abdomen, upper back, and breasts along with fat loss in the arms, legs, and face

191
Q

some HIV infected patients, especially those who have been infected and on ART for a ling time, may develop a set of _____________

A

metabolic disorders

192
Q

What are some of the metabolic disorders some HIV infected patients may eventually develop ?

A 
lipodystrophy
hyperlipidemia
insulin resistance
hyperglycemia
bone disease (osteoporosis, osteopenia, avascular necrosis) 
lactic acid acidosis 
renal disease
cardiovascular disease
193
Q

For HIV patients, goals for care are aimed at

A 
compliance with drug regimens 
adopting a healthy lifestyle 
beneficial relationships 
spiritual well being in regard to life and death 
coping with disease and treatment
194
Q

Early recognition and treatment of HIV can

A

slow down the disease progression itself

195
Q

What is the normal range of CD4 T cell count ?

A

800-1200 cell/uL

196
Q

Oral Thrush

A

a common opportunistic infection associated with those in symptomatic stage of HIV

uncommon in the healthy person

197
Q

Kaposi Sarcoma

A

a common infection for those who have HIV

malignant vascular lesions that appear anywhere on the skin surface or on internal organs
lesions vary in size from pinpoint to large and may appear in a variety of shades

198
Q

PJP

A

Pneumocystis Jiroveci Pneumonia
- see this as common infection in those with HIV

can be deadly for those with HIV

not normally seen in those with regular immune system

199
Q

Signs and Symptoms HIV infected patients need to Report

A

altered level of consciousness, nausea, vomiting, seizures, dehydration

200
Q

patients with HIV must take at least one _____ a day for how long?

A

One pill a day for the rest of their lives

201
Q

Most common methods of transmission of HIV

A

unprotected sex with an infected partner

sharing needles with infected person

202
Q

The “almost eliminated as risk factors for HIV transmission” are

A

transmission from mother to fetus

infection from blood products

203
Q

What is the final stage of HIV infection ?

A

AIDS

204
Q

Opportunistic infections such as pneumocystosis or malignancies such as Kaposi’s sarcoma can signal the final stage of HIV, infection, which is

A

AIDS

205
Q

many HIV patients, despite the treatments, experience

A

disease progression and death

206
Q

persons with undetectable HIV viruses must take what on a daily basis to continue to suppress their HIV virus ?

A

their HIV medications

207
Q

What are prophylactic antibiotics ?

A

Antibiotics to prevent a certain infection like pneumonia - we don’t like prophylactic antibiotics

208
Q

To prevent the emergence of ARO, patients need to take the entire course of antibiotics, even when _________ have resolved

A

symptoms

209
Q

What is the final phase of the inflammatory response ?

A

Healing

210
Q

Healing includes what two major components ?

A

Regeneration and Repair

211
Q

Regeneration consists of

A

replacing the lost cells and tissues with cells of the same type

212
Q

Repair consists of

A

healing and usually results in scar formation

213
Q

Repair healing occurs by ________, ________ , or _______ __________

A

primary, secondary, tertiary intention

214
Q

What is primary intention ?

A

Primary intention healing takes place when wound margins are neatly approximated, as in a surgical incision or a paper cut.

215
Q

Primary intention healing includes what 3 phases ?

A

Initial phase, Granulation Phase and Maturation Phase and Scar Contraction

216
Q

What happens in the initial phase of healing ?

A

Acute Inflammatory response brings neutrophils and macrophages to the area. Blood clots form and macrophages digest debris. The fibrin clots serve as an inviting ground for future capillary growth and epithelial cell migration

217
Q

What happens during the granulation phase of healing ?

A

Fibroblasts migrate to the healing site and secrete collagen. Capillary sprouts proliferate and begin to mature. A thin layer of epithelium migrates across the wound surface ikn a one cell thick layer until it contacts cells from the opposite direction . The epithelium begins to thicken and mature and wound now closely resembles adjacent skin

218
Q

What happens during the maturation phase of healing ?

A

Collagen fibers are further organized and a mature scar is formed. This is the remodeling stage

219
Q

What is secondary intention?

A

A type of repair healing for wounds which are not approximated and that have large amounts of exudate , and wide, irregular margins. The inflammatory reaction may be greater than in primary healing.

220
Q

Healing and granulation take place from the edges _______ and from the _________ of the wound upward until the defect is filled.

A

inward; bottom

221
Q

What are the components of granulation tissue ?

A

Proliferating fibroblasts, proliferating capillary sprouts (angioblasts) various types of WBC, exudate and loose semi fluid ground substance

222
Q

Tertiary intention

A

healing occurs with delayed suturing of a wound in which two layers of granulation tissue are sutured together. This occurs when a contaminated wound is left open and sutured closed after the infection is controlled.
It also occurs when a primary wound becomes infected, is opened, is allowed to granulate and is then sutured.

223
Q

___________ _______ usually results in a longer and deeper scar than primary or secondary intention.

A

Tertiary intention

224
Q

Purulent exudate contains

A

WBCs, live and dead microbes, liquefied dead cells, and other debris

225
Q

If the demand for neutrophils during the acute inflammatory response increases, what happens?

A

A shift to the left….

the bone marrow releases immature forms of neutrophils (bands) into circulation

226
Q

What does it mean to debride a wound ?

A

Cleaning the debris from a wound before healing can take place

227
Q

RICE - it is important for treating …….

A

soft tissue injuries

228
Q

Why does rest help with soft tissue injury ?

A

it helps the body use its nutrients and O2 for the healing process, The repair process is facilitated by allowing fibrin and collagen to form across the wound edges with little disruption

229
Q

What does compression do ?

A

Counters the effects of vasodilation and edema by occluding blood vessels and stopping bleeding

230
Q

Important assessment point when applying compression bandages

A

check distal pulses and capillary refill to make sure circulation is not cut off (paleness and loss of feeling)

231
Q

Immobilization - how does it help the healing process ?

A

Promotes healing by decreasing the tissues metabolic needs

232
Q

Elevation - how does it help the healing process?

A

elevating extremity above level of the heart decreases edema by increasing venous and lymphatic return

it also helps reduce pain associated with blood engorgement at the injury site

233
Q

Cold therapy applied to a site of inflammation reduces

A

swelling, pain and congestion from increased metabolism in the area

234
Q

In wound healing, what three vitamins have essential roles ?

A

Vitamin C, vitamin B and Vitamin A

235
Q

Wound healing - Vitamin C is needed for

A

capillary synthesis and collagen production by fibroblasts

236
Q

Wound healing - Vitamin B is needed for

A

it is necessary as coenzymes for many metabolic reactions

237
Q

If a vitamin B deficiency develops, a disruption of what will occur?

A

Protein, fat, carbohydrate metabolism

238
Q

Why is vitamin A needed in healing ?

A

To aid in the process of epithelialization

239
Q

What are factors that can interfere with wound healing ?

A

Factors that can interfere with wound healing include malnutrition, obesity, decreased blood supply, tissue trauma, smoking, drugs (e.g., corticosteroids, chemotherapy), wound debris such as necrotic tissue, advancing age, diabetes mellitus, poor health, anemia, and infection

240
Q

Those with a Braden score of 16 or less are considered to be …..

A

at risk for pressure ulcers

241
Q

Patients with acute bacterial infections have elevated WBC counts with a shift to the left. True or false.

A

True

242
Q

When it comes to wound healing, what is adhesion ?

A

This is the band of scar tissue that forms between organs that can occur in the abdominal cavity and cause intestinal obstruction.

243
Q

what is fistula formation ?

A

An abnormal passageway between organs or between a hollow organ and the skin that will leak fluid or pus until it is healed

NURS 327 Medical Surgical Nursing (6 decks)

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