Miscellaneous topics 5 Flashcards
______- is the most important method of infection prevention
Hand-washing
The most common source of bloodstream infection in hospitalize patients is
the central venous catheter
The preferred method of skin prep before central line placement is
chlorohexidine
Alcohol based products are ________________ and must be allowed to dry for __________
flammable; two minutes
What three surgical care improvement project (SCIP) measures are we responsible for
- a prophylactic abx is administered within 60 minutes of surgical incision (vancomycin is 120 minutes)
- cardiac surgery patients must achieve glycemic control (<200 mg/dL)
- colorectal patients are normothermic upon arrival to PACU (>36 C)
What is required in contact precautions?
gown and gloves
What is required for droplet precautions?
gown, gloves, and surgical mask
What is required for airborne precautions?
gowns, gloves, N95 respirator, negative pressure room
Creutfeldt-Jakob disease can lead to
encephalopathy and dementia
Etiologies of prion disease include
consumption of contaminated animal protein
contaminated implants (corneal or dural tissue)
cadaveric pituitary hormone supplementation
Which procedure places health care workers at the HIGHEST risk of developing a positive skin TB test?
a. bronchoscopy
b. VATs
c. cataract removal
d. Open reduction internal fixation of a femur
a. bronchoscopy
Tuberculosis targets the
anterior apical segments of the lung but it can also infect the brain, kidney, joints, spine, and GI tract
Patients with TB experience
a productive cough, hemoptysis, weight loss, fever, night sweats, anorexia, and general malaise
The most common test for TB is
a tuberculin skin test
A positive tuberculin skin test necessitates a
CXR
Treatment of TB includes
isoniazid, rifampin, pyridoxine
Side effects of TB treatment drugs include
thrombocytopenia & kidney failure
Providers should observe ______ precautions when caring for a patient with TB
airborne
Procedures that produce the highest TB exposure risk for health care personnel are
- bronchoscopy (highest risk)
- endotracheal intubation (second highest risk)
Elective procedures for the patient with TB should be delayed until the patient is
on antituberculous chemotherapy
has 3 negative acid-fast bacillus tests and demonstrates symptom improvement
If doing a procedure on a positive TB patient, observe the following:
wear N95 mask
HEPA filter placed between the y-piece and the patient’s airway
bacterial filter placed on the expiratory limb of the circle circuit
dedicated anesthesia machine and ventilator whenever possible
pre-and postop care in a negative pressure isolation room
What is the first-line treatment for tuberculosis?
isoniazid
What defines a positive Mantoux test?
induration >10 mm at side of injection
Anaphylaxis causes degranulation of: (select 2):
a. neutrophils
b. monocytes
c. basophils
d. mast cells
c. basophils
d. mast cells
White blood cells can be divided into
granulocytes and agranulocytes
Granulocytes include
neutrophils
basophils
eosinophils
Neutrophils (role)
immune defense
The role of basophils is
essential component of allergic reactions
The role of eosinophils is
immune defense against parasites
Agranulocytes include
monocytes
lymphocytes- B lymphocytes, T lymphocytes, natural killer cells
The role of monocytes is
immune defense
The role of B lymphocytes is
humoral immunity
The role of T lymphocytes is
cellular immunity
The role of natural killer cells is to
limit spread of tumor and microbial cells
_______________ prevents degranulation of basophils and mast cells
Epinephrine
B lymphocytes are different than t lymphocytes in that they
produce antibodies
The function of natural killer cells is reduced by
opioids (concern of cancer recurrence)
What are the four types of hypersensitivity reactions?
type 1: immediate hypersensitivity
type 2: antibody-mediated
type 3: immune complex mediated
Type 4: delayed
What is an example of a type 1 hypersensitivity reaction?
anaphylaxis
extrinsic asthma
What is an example of a type 2 hypersensitivity reaction?
ABO-incompatibility
heparin-induced thrombocytopenia
What is an example of a type 3 hypersensitivity reaction?
snake venom reaction
What is an example of a type 4 hypersensitivity reaction?
contact dermatitis
Common culprits for perioperative allergic reactions include
NMBD- succinylcholine, rocuronium
latex
antibiotics- beta-lactams are the most common
Treatment of intraoperative anaphylaxis includes
- discontinue the offending agent
- administer epinephrine
- liberal IV hydration
- Administer H1 & H2 receptor antagonists
- Hydrocortisone 250 mg IV
- albuterol for bronchospasm
What can be given for refractory hypotension in the setting of anaphylaxis?
vasopressin
What are the three ways in which epinephrine treats anaphylaxis?
prevents degranulation
provides CV support
dilates the airways
Anaphylaxis requires prior
sensitization or cross-reactivity
An anaphylactoid reaction requires
no prior exposure
Anaphylaxis and anaphylactoid reactions lead to the degranulation of
mast cells & basophils
What are the CV presentation of anaphylaxis?
hypotension
tachycardia
arrhythmia
cardiac arrest
