Questions Flashcards
A patient develops diarrhea several days after being treated for a severe respiratory infection. Which information is needed by the nurse to assess the cause of the diarrhea?
The medication used for tx of the infection
Which behavior is frequently observed in adolescents who have acquired sexually transmitted diseases (std)?
Adolescent deny having the disease
The nurse is reviewing discharge instructions with a patient with a UTI. Which instructions should be included?
Drink 2 -3 liters of fluid daily, void every 2-3 hours
Which pathophysiological factor accounts for the increased incidence of opportunistic infections and rumors among patients with AIDS?
A decreased number of T-cells
The nurse is evaluating a patient who is on warfarin (Coumadin) therapy, which patient behavior indicates the need for further instructions regarding medication?
Taking Ibuprofen for a headache (NSAIDS may increase gastric irritation and possible irritation)
Why should Tetris toxoid be administered to a patient who has a puncture wound?
To stimulate antibody production
What is Pulmonary Tuberculosis?
A pulmonary disease affecting the lungs parenchyma
What other organs can Pulmonary Tuberculosis spread to?
Meninges, kidneys, bones, lymph nodes
What is the infectious agent (bacteria) in Pulmonary Tuberculosis?
Mycobacterium Tuberculosis
How is pulmonary tuberculosis transmitted?
Droplet nuclei (airborne transmission)
What are noted on the lungs that are infected with Pulmonary Tuberculosis?
Tubercle lesions (primary lesions)
If the Pulmonary Tb enters lymph system, what inflammatory response can occur?
granulomatous inflammation
What are some signs and symptoms of Pulmonary Tb?
Low grade fever, cough, night sweats, fatigue, wt. loss, hemoptysis, lethargy, and chills
Elderly patients are know to have_______, symptoms of Tb?
decreased symptoms
Young patients (youth) are know to have_________, symptoms of TB?
Increased symptoms
What complications with AIDS patients with Pulmonary TB are usually seen?
Extrapulmonary disease
Pulmonary Tb is dx by?
Tuberculin skin test (Mantoux), CXR, sputum culture, acid fact bacillus smear, quantiferon tb gold test
People in foreign countries are given what vaccine to decrease the incidences of Tb?
Bacille camette Guerin vaccine (patients will always have positive Tb test)
What is Lung Parenchyma?
Lung alveolar tissue (bronchioles, bronchi, blood vessels, interstitium, and alveoli
What are some medications used to treat Pulmonary TB?
INH, rifampin (Rifadine), pyrazinamide, ethambutol (myambutol), rifapentine (Priftin), rifabutin (Myocodentia)
Vitamin B (pyridaoxine) with INH is used to prevent?
INH associated neuropathy
What is Rheumatic Endocarditis (Fever)?
Acute rheumatic fever, and exacerbation of strep B throat infection, affects school age children
What is the infectious (bacteria) agent that causes Rheumatic Endocarditis (fever)?
Group A beta hemolytic streptococcal pharyngitis
List some signs and symptoms of Rheumatic Endocarditis (fever)?
Fever (101-104F), chills, sore throat, throat redness, enlarged and tender lymph nodes, acute sinusitis and otitis media
How can Rheumatic Endocarditis (fever) be prevented?
dx and treat Strep B prior to acute episodes of Rheumatic fever
If Strep B is dx and treated, what can it prevent?
Rheumatic Endocarditis (fever)
How is Rheumatic Endocarditis spread?
Direct contact with oral or respiratory secretions
Rheumatic Endocarditis is dx by?
Throat culture, positive Strep B test (culture)
Rheumatic Endocarditis can progress to?
Rheumatic heart disease
Rheumatic Heart disease is characterized by which clinical manifestations?
new heart murmurs, cardiomegaly, pericarditis, heart failure, and aschoff body lesions
Rheumatic Fever affects which valves?
Mitral valve
What is Infective Endocarditis?
microbial infection of endothelial surface of the heart
Which types of patients are usually seen with Infective endocarditis?
Prosthetic heart valves, structural cardiac defects, IV drug users, degenerative or calcific valve lesions, pt. with indwelling catheter (dialysis pt.)
List some signs and symptoms of Infective Endocarditis:
Fever, heart murmur, petechial clusters, osler nodes, janeway lesions, roth spots, splinter hemorrhages, cardiomegaly, HF, tachycardia, splenomegaly
How is Infective endocarditis dx?
Blood cultures, Doppler echocardiography
How can Infective endocarditis treated?
IV ABT, debridement or excision of valves, valve replacement
List some CNS signs and symptoms displayed with Infective endocarditis?
headache, temporary/transient cerebral ischemia, strokes, embolic PNA, HF, AV block
What is Viral Hepatitis A?
RNA virus of enterovirus family, Infectious Hepatitis (HAV)
How is the Hepatitis Virus A transmitted?
Oral-Fecal transmission (ingest food or liquids infected by the virus)
When children or young adults acquire this infection (HVA) it usually due to?
poor hygiene, hand to mouth contact, or close contact during play
List signs and symptoms of Hepatitis A Virus:
Pt. may be asymptomatic; flulike symptoms, headache, malaise, fatigue, anorexia, fever, dark urine, Jaundice (sclera and skin), tender liver, indigestion (GI disturbances), cigarette smoke smell
How is Hepatitis A Virus Dx?
Enlarged liver and spleen, Hepatitis A antigen present
Describe some tx options for HAV?
(treat symptoms), bed rest, small frequent meals, IV fluids with glucose
Hepatitis A Virus patients should avoid which type of drink?
Alcohol
The most used resource to decrease the transmission of Hepatitis A virus is?
Hand washing, good personal hygiene, and good environmental sanitation practices.
Which vaccine is used for Hep A and B?
Twinrix
What is Viral Hepatitis B?
Serum Hepatitis, (HBV), DNA virus, No proteins
What type of transmission is usually seen with HBV?
Blood transmission, percutaneous and per mucosal route
Other bodily fluid transmission of HBV are?
Blood, saliva, semen, vaginal secretions, and mother to infant, also breast milk
HBV has an incubation period of how long?
6 months
List some signs and symptoms of HBV:
Pt. may be asymptomatic, arthralgia and rashes, decreased appetite, dyspepsia, abdominal pain, generalized aching, malaise, weakness, jaundice, liver tenderness and enlargement, light colored stools, dark urine, enlarges spleen and lymph nodes
How is HBV dx?
HBsAg
How Is HBV treated?
decreased liver inflammation: alpha interferon, iamivudine (Epivir), adefovir (Hepsera), oral nucleoside
What is Viral Hepatitis C?
HCV,
How is HCV transmitted?
through blood, blood products, IV drug use, drug paraphernalia, sex
Hepatitis C Virus increased the risk for?
Cirrhosis of the liver and Liver cancer
____________increase the progression of the disease?
Alcohol
List some signs and symptoms of HCV:
arthragias and rash, decreased appetite, dyspepsia, abdominal pain, aching, malaise, jaundice
What Rx treatments are used for Hep C?
interferon (Intron-A), ribavirin (Rebetol)
What is non-viral Hepatitis?
Hepatitis that is induced by toxic chemicals or medications. Toxic effect on liver=acute liver necrosis or toxic hepatitis
Which chemicals cause non viral hepatitis?
carbon tetrachloride, phosphorous, chloroform, gold compound (hepatotoxins)
Which chemical cause non viral hepatitis?
isonizazid (Nydrazid), halothane (Fluthane), acetaminophen, methylodopa (Aldonmet), ABTs
What is a urinary tract infection?
Infections caused by pathogenic microorganisms in the urinary tract.
List the different types of UTIs:
Lower UTIs: bacterial cystitis (inflammation of the urinary bladder), Bacterial prostatitis (inflammation of the prostate gland), bacterial urethritis (inflammation of the urethra)
List the different types of upper UTIs:
acute pyelonephritis and chronic pyelonephritis
Acute pyelonephritis affects which organs?
the bladder, kidneys, and renal pelvis become infected by bacteria
Acute pyelonephritis can cause the kidney’s to?
Enlarge
What are some signs and symptoms of Acute pyelonephritis?
chills, fever, leukocytosis, bacteriuria, pyuria, low back pain, n/v, headache, malaise, painful urination, tenderness in costovertebral angle, urinarI urgency and frequency
How Is Acute pyelonephritis dx?
ultrasound, CT, UA/C&S, IV pyelogram, radionuclide image with gallium citrate and indium-111
What are some tx options for Acute pyelonephritis?
Antibiotic therapy and increase fluids
What is chronic pyelonephritis?
inflammation of the renal pelvis, interstitial nephritis (inflammation of kidneys)
What leads to chronic pyelonephritis?
repeat bouts of Acute pyelonephritis
List some signs and symptoms of chronic pyelonephritis:
no symptoms until Acute pyelonephritis exacerbation, fatigue, headache, poor appetite, polyuria, excessive thirst, decreased weight
Treatment options for Chronic Pyelonephritis include:
increase intake to 3-4 Liters of fluids, prevent dehydration, antipyretics and antibiotics
What is Trichomoniasis?
flagellated protozoan, trichomonas vaginalis, sexually transmitted vaginitis
Trichomonas puts a patient at risk for which diseases?
Cervical neoplasia, PID, infertility
List some signs and symptoms of Trichomonas:
Vaginal discharge (frothy), yellow to green discharge, malodorous, irritating, burning and itching, vulvitis, vaginal and cervical erythema with multiple small petechial “strawberry spots”
Treatment options for Trichomonas are:
metronidazole (Flagyl), tinidzole (Trindamax)
A Patient with Trichmonas harbor organism where?
urogenital tract
Flagyl may leave and unpleasant taste in a patients mouth that is somewhat of?
A metallic taste
If Flagyl is taken with alcohol what symptoms may the patient experience?
Nausea and vomiting, flushed feeling
Flagyl is contraindicated for patients with:
blood dyscrasia or CNS diseases, women In the first trimester of pregnancy, and breast feeding women
Trinidazole (Trindamax) is not safe for which type of patients?
Patients who are pregnant
Candidiasis is also known as?
Yeast Infections, (vulvovaginal candidiasis; funga yeast infections) (cell mediated immunity)
What is the infectious organism that causes Candidiasis?
Candida albi and candida glabrata
What puts a patient at greater risk for contracting Candidiasis?
Antibiotic use, pregnancy, DM, HIV, oral contraceptive and corticosteroids
How is Candidiasis Diagnosed?
Spores and hyphae mixed with K+HO2 slide (pH 4.5 or less)
What are the treatment options for Candidiasis?
decrease symptoms
Antifungal agents: miconazole (Monistat)
nystantin (Mycostatin)
clotrimazole (Gyne-Lotrimin)
terconazole (Terazole)
fluconazole (Diflucan)
What is Bacterial Vaginosis?
An overgrowth of anaerobic bacteria and gardnerella vaginalis, and an absence of lactobacilli
List some signs and symptoms of Bacterial Vaginosis?
Discharge (grey, yellow, and white), Fish like odor
How is Bacterial Vaginosis diagnosed?
positive (+) wiff test, discharge pH greater than 4.7, No lactobacilli, slide with vaginal discharge with K+HO2 (clue cells)
What are some treatment options for Bacterial Vaginosis?
metronidazole (Flagyl), clindamycin (Cleocin)
Bacterial Vaginosis risks are increased by acts such as:
douching after menses, smoking, STDs, and multiple sex partner
Bacterial Vaginosis is associated with:
premature labor, premature rupture of membranes, endometritis, and recurrent UTIs
What is Human Papillomon Virus (HPV)?
STD, Genital Warts (condylomata), cervical changes (kilocytosis)
Human Papillomon Virus (HPV) puts women at increased risk of having?
cervical and anogenital cancers
Risk factors the predispose women to HPV are:
being sexually active and multiple sex partners
What is the new Vaccine to protect men and women from Human Papillomon Virus (HPV)?
Gardasil
What are some signs and symptoms of Human Papillomon Virus (HPV)?
asymptomatic
Human Papillomon Virus (HPV) can be diagnose by?
a pap smear and cervical changes
Treament options for Human Papillomon Virus (HPV) include:
Topical Trichloroacetic Acid, interferon podofin, podocon (Podophyllin), podofilox (Condylox), imiquimod (Aldara)
Patients with Human Papillomon Virus (HPV) should have annual?
Pap smears, condoms decrease risk of HPV, decrease the patients emotional distress
What is Pelvic Inflammatory Disease (PID)?
inflammatory condition of the pelvic cavity, begins with cervicitis, endometritis, salpingitis (fallopian tubes), oophoritis (ovaries), pelvic peritoneum, pelvic vascular system
PID can be caused by?
Gonorrhea and chlamydia, CMV (bacteria, fungus, or virus)
PID puts female patients at risk for:
increased ectopic pregnancies (narrowed fallopian tubes and scarring), infertility, pelvic pain, tubo-ovarian abscess
List some signs and symptoms of PID?
Vaginal discharge, dysparenuria, lower abdominal pain, pelvic pain, tenderness after menses, pain increase when voiding or bm, fever, malaise, anorexia, n/v, headache, tenderness=uterus and cervix, leukocytosis
Complication that can arise with PID include:
peritonitis, abscess, strictness and fallopian tube obstruction, adhesions, bacteremia with septic shock, thrombophlebitis with embolization
What nursing management measures should be taken for a patient with PID?
Semi-Fowlers position (aids in postural drainage) for abdominal distention, sx or intubation, bed rest, analgesics, heating pad, record vaginal discharge
List some treatment options for PID:
Antibiotic Therapy: ceftriaxone (Ceftin)
azithromycin (Zithromax)
doxycycline
What are the 6 types of Herpes Viruses?
- Herpes Simplex Type 1 (cold Sores)
- Herpes Simplex Type 2 (genital herpes)
- Varicella Zoster (Shingles)
- Epstein-Barr Virus
- Cytomegalovirus
- Human B lymphotrophic Virus
What is Herpes Simplex?
- 2 types of skin infections:
* HSV type 1 (mouth sores)
* HSV type 2 (genital sores) - Seropositive
- True primary infection
How can HSV be diagnosed?
Viral culture and rapid assays
Herpes Simplex Virus Complications or as follow:
eczema herpeticum, herpetic whitlow and intrauterine neonatal infection (Tx: IV acyclovir)
What are some fetal anomalies that are associated with Herpes Simplex Virus?
skin lesions, mircocephaly, encephalitis, intracerebral calcifications
Herpes Simplex Virus Type 1 is also known as:
Orolabial Herpes (mouth)
Herpes Simplex Virus Type 1 is characterized by which signs and symptoms:
fever blisters, cold sores, erythematous based clusters grouped vesicles on the LIPS, tingling & burning with pain 24hrs before blister appears, flulike symptoms
What are some triggers for Herpes Simplex Virus Type 1?
increased stress, sunlight exposure
Some complications that may arise with Herpes Simplex Virus Type 1 include:
herpetic gingivostomatitis (high fever, regional lymphadenopathy, generalized malaise), erythema multiforme (acute skin inflammation and mucous membrane lesions that look like “targets”)
Treatment measures for Herpes Simplex Virus Type 1 include:
- sunscreen
- acyclovir 200g 5x daily x 5days
Herpes Simplex Type 2 is also know as:
Herpes Genitalis (genital)
What does Herpes Simplex Virus Type 2 cause?
recurrent, lifelong viral infection that causes herpetic lesions (blisters) on the genitalia, vagina and cervix, rectum, and penis
How is Herpes Simplex Virus Type 2 transmitted?
sex, cold sore to genitals, mother to baby during delivery (mother must have C-section) (no scalp electrodes during delivery)
What are some signs and symptoms of Herpes Simplex Virus Type 2:
itching and pain at infected area, red and edematous, macules and papules progress to vesicles and ulcers. Blister=coalesces=ulcerates=encrusts. Inguinal lymphadenopathy, increased temp, malaise, myalgia, fever and flulike symptoms, burning and tingling 24hrs before vesicles appear
List some treatment option for Herpes Simplex Virus:
-no cure, relieve symptoms of pain, itching and burning, prevent spread, relieve anxiety, increase knowledge about disease
-Rx: acyclovir (Zovirax)
valacyclovir (Valtrex)
famciclovir (Famvir)
What is Herpes Zoster (Shingles)?
-Shingles virus affect nerve ganglia, Varicella (chicken pox painful vesicles along the sensory area of distribution of the sensory nerves from on or more posterior ganglia
List some signs and symptoms of Herpes Zoster (Shingles):
red rash, fluid filled blisters, painful eruptions that may radiate over an entire region of affected nerves. Pain=burning, lancinating, stabbing, aching. Malaise, vesicles purulent and crust over.
The inflammation that Herpes Zoster (Shingles) causes is usually seen where?
unilateral, involving the thorax, cervical and crania nerves in bandlike configurations (eye pain may be present)
Herpes Zoster (Shingles) may flare up when?
cellular immunity decreases, with aging natural immunity decreases and the virus reactivates itself
What is a complication of Herpes Zoster (Shingles)?
Postherapetic Neuraglia (persistent pain of affected nerve after healing)
If Herpes Zoster (Shingles) is in the eye it is referred to as?
Ophthalmic Herpes Zoster; (ophthalmic emergency) refer to ophthalmologist immediately, prevent keratitis, uveitis, ulcerations
What are some treatment options for Herpes Zoster (Shingles)?
-relieve pain, decrease complications (ophthalmic HZ)
-oral antivirals within 24hrs: acyclovir (Zovirax)
valacyclovir (Valtrex)
Famciclovir (Famvir)
-Corticosteroids: Triminolone (aristocort, kenacort, kenalog)
What is the name of the vaccine use to prevent Herpes Zoster (Shingles)
Varicella Vaccine
Nursing management for Herpes Zoster (Shingles) include:
- ensure antiviral are taken
- wet to dry dressing to lesions or topical ointment applied
- diversionary techniques and relaxation to alleviate discomfort and ensure sleep
What Is Impetigo?
- superficial skin infection caused by streptococci, staphylococci
- bullous impetigo (S. aureus (infectious agent)=lg fluid filled blisters that rupture and leave raw areas)
What are some causes of Impetigo?
poor hygiene, malnutrition, excessive use of antibacterial soap (increases resistance to bacteria)
What parts of the body is Impetigo seen at?
face, hands, neck and extremities
List some signs and symptoms of Impetigo:
- small red macules that rupture, have a honey yellow crust (ringworm in the scalp)
- very contagious, follows: pediculosis capitis (head lice), scabies (itch mite), herpes simplex, insect bites, poison ivy, and eczema
Treatment measures use for Impetigo include:
-prevent acute glomerulonephritis (kidney infection that leads to streptococcal skin infection disease)
-RX: Penicillin (PCN)
benzathine Penicillin
cloxacillin (Cloxapen)
dicloxacillin (Dycill)
mupirocin (Bactroban)
*when applying topical crèmes, remove crust before applying
What is Pediculosis?
Lice infestation
List the 3 types of pediculosis:
- Pediculus humanus capitit (Head Lice)
- Pediculus humanus corporis (Body Louse)
- Phthirus Pubis (Pubic Louse, Crab Louse)
What role does the Lice play when attached to the body?
They feed on human blood, inject digestive juices and excrement into skin which produces severe itching
What are some complications of Pediculosis?
epidermic rickettsial disease
Pediculosis Capitis is also known as?
Head Louse, infestation of scalp by head louse, nits (eggs)=female louse
How is Pediculosis Capitis transmitted?
direct physical contact, combs, brushes, wigs, hats, and bedding
What are some signs and symptoms of Pediculosis Capitis?
- Head lice is found along the back of the head and behind the ears. Eggs (nits) look like silvery glistening oval bodies.
- severe pruritus and scratching leads to secondary bacterial infections (impetigo)
List some treatment options for Pediculosis Capitis:
- antipruritic, systemic antibiotics, topical corticosteroids
- lindane (Kwell) (TOXIC TO CNS)
- pyrethrin compound with piper butoxide (Rid or R&C shampoo)
- after washing, comb hair with vinegar dipped comb
Pediculosis Corporis is also referred to as?
Body Louse, infestation of body by louse
People who do not wash, and do not change clothes may have?
Pediculosis corporis (body louse)
Which parts of the body is usually associated with Pediculosis Corporis?
Neck, trunk, and thighs (Louse live in seams of underwear)
Signs and symptoms of Pediculosis Capitis include:
pruritus, minute hemorrhagic points, excoriation d/t scratching, linear scratches
Treatment options for Pediculosis Capitis are as follows:
bathe with soap and water with scabicide (Lindane), permethrin (Elimitel), petrolatum to lashes
Pediculosis Pubis is also know as:
Pubic Louse, infestation of genital region by louse (transmitted by sexual contact)
Signs and symptoms of Pediculosis Pubis are:
pruritus at night, reddish brown dust in underwear, grey blue macules
Treatment for Pediculosis Pubis include:
washing genitals with Lindane, scabicide
What is scabies?
Infestation of skin by “itch mite,” Sarcoptes Scabiei
List signs and symptoms of Scabies:
severe itching, red eruptions, increased itch at night, burrows (straight, wavy, brown or black, threadlike lesions) and papules.
Scabies usually affects which part of the body?
fingers and writs, hands, elbows, knees, edges of feet, around nipples, axillary folds, beneath pendulous breast, groin, gluteal folds, penis and scrotum
How is Scabies diagnosed?
recovering S. Scabiei mite, epidermis scrapping into slide and view under microscope
What are some treatment options for Scabies?
- warm soapy bath
- scabicide Lindane, crotamiton (Eurax), 5% Permethrin
What Nursing management techniques should be used to aid with Scabies treatment?
- clean laundered clothing and bedding, dry cleaning advised.
- topical corticosteroid, antihistamine
- apply scabicide immediately after bathing before skin dries and cools. Scabicide absorption can cause CNS abnormalities such as seizures
