Test 1 Flashcards
Nosocomial Infection
Hospital acquired infection
Iatrogenic Infection
An infection that occurs after medical or surgical procedure
Medical Asepsis
clean technique
disinfection
Surgical Asepsis
sterile technique
sterilization
Disinfection
cleaning something to destroy bacteria
Sterilization
A procedure to kill all organisms
How does the Infection Cycle work?
infectious agent
reservoir
portal of exit
means of transmission
portal of entry
susceptible host
Which of the following is the most significant and commonly found infection-causing agent in healthcare institutions?
Bacteria
Fungi
Viruses
Mold
Bacteria
Virus
smallest microorganism
infections: common cold and do not respond to antibiotics
Fungi (molds and yeasts)
plantlike organisms
can cause infection and are present in the air, soil, and water
What are factors that affect an organisms potential to produce disease?
number of microorganisms
Virulence of microorganisms
Competence of persons immune system
Length and intimacy of contact between person and microorganism
What are possible reservoirs for microorganisms?
humans-carriers
animals- vectors
soil- vehicles
food, water, milk- vehicles
inanimate objects- vehicles or fomites
Which one of the following infectious agents or diseases may be spread by touching a contaminated inanimate article?
Rabies
Giardia
E. Coli
Influenza
Influenza
What are common portals of exit?
respiratory
gastrointestinal
genitourinary tracts
breaks in skin
blood and tissue
What is direct contact?
close proximity with susceptible host
EX: touching, kissing, and sexual intercourse
What is indirect contact?
vectors: nonhuman organisms
fomites: inanimate objects
Airborne vs Droplet transmission
Airborne: less than 5
Droplet: greater than 5
Body’s defense against infection
body’s normal flora (help to keep harmful bacteria from invading the body)
inflammatory response
immune response
Factors affecting host susceptibility
intact skin and mucus membranes
normal ph levels
body’s wbc
age, sex, race. hereditary factors
immunization, natural, or acquired
fatigue, climate, nutritional, and general health status
stress
use of invasive or indwelling medical devices
In which of the following stages of infection is the patient most contagious?
incubation
prodromal
full stage
convalescent
prodromal stage
Stages of infection
1.Incubation Period: organisms growing and multiplying
2.Prodromal Stage: person is most infectious, vague and non specific signs of disease
patient unaware
Malaise (discomfort)
Fatigue (low fever)
3.Full stage of illness: presence of signs and symptoms
4.Convalescent Period: recovery from the infection
Laboratory Data Indicating Infection
elevated WBC
-4,500 to 10,000
increase in specific types of WBC
elevated erythrocyte sedimentation rate
0-15mm/hr for males
0-20mm/hr for females
presence of pathogen in urine, blood, sputum, or draining cultures
What are antibiotic resistant organisms?
have contact transmission
What are factors predisposing patients to nosocomial infection?
use of invasive medical devices
-urinary catheter or venous access catheter
What are some antibiotic resistant organisms developed in hospitals?
c diff
mrsa
visa
vrsa
vre
Transient Flora
attached loosely on skin
removed with relative ease
Resident Flora
found in creases in skin
requires friction with brush to remove
T or F
After inserting nasogastric tubes, a nurse found that the gloves remained clean. Bc her hands were clean when she put her gloves on and the gloves werentt dirty, it is not necessary to preform hand hygiene on nonsoiled hands
f
What to do for clean technique?
routine hand washing
using non sterile gloves when touching intact skin, intact mucus membranes or dirty items
When is clean technique appropriate for?
taking BP
examining patients
feeding patients
What to use for aseptic technique?
sterile gloves
used for invasive procedures
antiseptic on patients skin
used in clean and dedicated area
When is aseptic technique appropriate?
placing an intravenous catheter
placing a urinary catheter
What are some standard precautions used in care of all hospitalized patients?
hand hygiene
wear nonsterile gloves when touch blood, body fluids, secretions, non-intact skin
wear PPE
respiratory hygiene
use safe injection practices
avoid recapping used needles
What are some PPE?
gloves, gowns, masks, protective eye gear
Which one should be removed first?
gloves
Last action after removing ppes?
N95
Transmission Based Precautions?
Contact: private room, PPE
Droplet: Private room, PPE
Airborne: private room , PPE, negative air pressure, N95
Contact precautions
infections by multidrug resistant organism
Droplet is used for what precautions
mumps, rubella, diphtheria, adenovirus infection
Airborne is used for what precautions
Tuberculosis, measles, varicella
When caring for a patient who has an infection such as rubella, mumps, or diptheria, which of the following precautions would be appropriate?
Contact
droplet
airborne
exposure
droplet
Carriers that transmit organisms from one living thing to another, such as mosquitos, ticks, lice, are known as:
vectors
Infection control measures supported evidence that when implemented together improve patient outcomes are known as:
policies
standards
requirements
bundles
bundles
Acquiring disease via a vector or fomite is an example of:
indirect contact
What does the skeletal system do?
Supports soft tissues of body
Protects crucial components of the body
Provides storage areas for minerals and fats
Produce blood cells
Which of the following classifications describes the bones located in the wrist?
Long bones
Short bones
Flat bones
Irregular bone
Short bones
What are long bones used for?
height and length
What are flat bones used for?
for structural contour/ shape
What are short bones used for?
for movement
What are irregular bones used for?
for protecting nervous tissue and bringing support to the pharnyx and trachea
What are sesamoid bones?
protects tendons from stress and tear
What is flexion?
bending
Extension
state of being straight lined
Hyperextension
exaggerated extension
Abduction
Movement away from midling
Adduction
movement toward midline
Circumduction
turning in a circular motion
Dorsiflexion
Backward bending of the foot
Plantar flexion
flexion of the foot
Internal rotation
a body part turning on its axis toward the midline
External rotation
a body part turning on its axis away from the midline
Pronation
lying on the abdomen, turning hands down
Supination
assumption of spine position
Inversion
inward movement of foot
Eversion
outward movement of foot
Hinge Joint
flexion/extension
EX: knees and elbow
Pivot joint
rotation
EX: neck
Ball and socket joint
Flexion/extension/hyperextension/abduction/adduction/internal and external rotation/circumduction
EX: shoulder and hip
Saddle joint
Flexion/extension/abduction/adduction/circumduction
EX: Carpometacarpal joint (thumb)
Condyloid joint
Flexion/extension/abduction/adduction/circumduction
EX: metacarpophlangeal (wrist)
Gliding joint
gliding movements
EX:intercarpal joints (palm)
A nurse stretches out a patients leg and moves it away from the body. This is an example of what type of body movement?
A. Abduction
B. Flexion
C. Circumduction
D. Dorsiflexion
A. Abduction
What is skeletal muscle?
framework that supports soft tissues
provides protection
furnishes attachment surfaces
stores minerals/fats
produces blood cells
What is a cardiac muscle?
forms bulk of heart
produces heart contraction
What is smooth or visceral muscle?
forms walls of hollow organs, bvs, and tubes
What are the 4 skeletal muscles function?
motion
maintenance of posture
protection
heat production
What is isotonic exercise?
same tension: muscle contracts and muscle length changes
What is isometric exercise?
same length: muscle contracts but muscle length does not change
What is isokinetic exercise?
same speed: muscle contracts and shortens with a constant speed and resistance
Isotonic example
swimming, bicycling, walking, jogging
Isometric example
yoga, squats
isokinetic exercise
weight lifting, stationary bike
Jogging is an example of isokinetic exercise. T or F
False
Supine positon
on back
Prone position
face down
Right and Left lateral recumbent
lying down on side
Fowler’s positon
head is upright
Trendelenburg position
-lie in supine
-head is lower than legs
-used when BP is low
Reverse Trendelenberg Position
head higher than legs
-used to reduce blood in brain
High fowlers position degree
80-90 degrees
Standard Fowler’s Position Degree
45-60
Semi-Fowlers Degree
30-45
-most pts in hospital
Low-Fowlers degree
15-30 degrees
Dorsal recumbent position
pt lies flat on the back with head and shoulders slightly elevated with a pillow
Lithotomy position
used for pelvic exams or child birth
Sims position
pt lies on stomach but lower arm is behind the pt and upper arm is flexed
-middle of prone and lateral
Oblique Position
places less pressure on trochanter and saccrococcygeal area
-middle of supine and lateral
Atrophy Vs Hypertrophy
-loss of muscle mass
-increase in muscle mass
Hypotonicity or Flaccidity VS Hypertonicity or spacisty
-muscles feel soft and weak
-decreased tone
VS.
-tight
-increased tone
Paresis VS Paralysis
-partial weakness
VS
-complete loss of strength
What are factors influencing mobility>
developmental considerations
physical health
mental health
lifestyle
attitude
fatigue and stress
external factors
Complications of immobility
respiratory system : pneumonia
circulatory system: DVT
integumentary system: pressure ulcers
muscular system: atrophy
skeletal system: osteoporosis
genitourinary system: UTI and kidney stones
gastrointestinal: indigestions, constipstion
nervous: insomnia
mental: depression
What do range of motion exercises do?
prevent muscle atrophy and joint contractures
maintain muscle strength and mass, and normal joint mobility and flexibility
passive vs active
How should we do range of motion exercises?
-using a cupped hand to support join
-supporting the joint by holding the distal and proximal areas adjacent to the joint
-cradling the distal portion of a lower extremity
What is the importance of protective positioning?
they need to change positions at least 2 hours
-position change
-extremities exercise
-assess and massage pressure area
What are common devices to promote correct alignment?
pillows
mattresses
adjustable beds
bed side rails
trochanter rolls
high-top sneakers
a hand roll
trapeze bar
What does a trochanter roll do?
support hips and legs to prevent external rotation of the hips
What do high-top sneakers prevent?
foot drop
What does a hand roll help with?
keep hand in a functional position
What does a trapeze roll help with?
makes moving and turning easy
How do we prevent deep vein thrombosis?
-antiembolism stockings
-graduated compression stockings
-pneumatic compression stockings
What are some physical conditioning to use?
-quadriceps and gluteal setting drills
-pushups
-dangling
What are the two types of crutches?
Forearm crutches
-long term support with permanent limitations
Axillary crutches
-temporary restrictions
-significant strength to use
When walking on crutches, what are some key things to remember?
prevent pressure on the axillae
keep elbows close to sides
prevent crutches from getting close than 12 inches to feet
What are 4 categories of pain?
duration
source
mode of transmission
etiology
What is cutaneous pain?
involves skin or subcutaneous tissue
EX: papercut or sunburn
What is deep somatic pain?
orginates in tendons, ligaments, bones, blood
EX: sprained ankle
What is visceral/somatic pain?
originates in body organs in thorax, cranium, abdoment
EX: appendicitis, IBS, Migraine
A patient who has bone cancer is most likely experiencing which of the following types of pain?
A. cutaneous
B. Somatic
C. Visceral
D. Referred
Somatic
What is the pain process?
Transduction
transmission
Perception of pain
Modulation of pain
Trandsuction
The initial recognition of pain via pain receptors
key ideas:
nociceptors
convergence of stimulus to electric signals
Transmission
The transmission pathway of pain electrical signals to brain
Key ideas:
affferent pathways
adelta fibers
c fibers
perception of pain
sensory process of how a person interprets pain
key ideas:
pain characteristics
pain threshold
Modulation of pain
how a pain sensation is inhibited or modified
key ideas:
endorphins
modulators
What is the gate control theory of pain?
how the brain decides to feel or not to feel pain
What does TENS do?
it reduces postoperative pain and improves mobility after surgery
What are stimulator of nociceptors or pain receptors?
respond selectively to mechanical, thermal, chemical stimuli that are noxious
EX: bradykinins
prostaglandins
substance P
What are pain modulators?
morphine like chemical regulation in spinal cord and brain
EX:
endorphins, dynorphins, enkephalins
A client comes to the emergency department complaining of a shooting pain in his chest. When assessing the clients pain, which behavioral response would the nurse expect to find?
A. decreased heart rate
B Guarding of the chest area
C. Increased respiratory rate
D. High BP
B
What are some examples of a sympathetic response?
-increased BP, pulse, respirations
-pupil dilation
-muscle tension and rigidity
-pallor
-increased glucose
What are some examples of parasympathetic responses?
a. nausea + vomitting
b. decreased BP
c. decreased pulse rate
d. rapid and irregular breathing
e. fainting and unconsciousness
Behavioral response (voluntary) reflect what?
reflect body movements
-posture
-gross motor activities
-facial features
-verbal expression
Affective Response (Psychological) reflects what?
mood and emotions
-anxiety, depression, insomnia
-hopelessness, fear, anger
-fatigue, withdrawal from others
-anorexia
What are factors that can affect pain experience?
culture
ethnic variables
family, gender, and age variables
religious beliefs
environment and support people
anxiety
past pain experience
T or F. The best judge of the existence and severity of a patients pain is the physician or nurse caring for the patient.
False
CRIES pain scale
from 0-6 months
FLACC scale
infant to children (7 years)
Wong-Baker Faces
less than three years old
Beyer Oucher pain scale
combines 0-100 scale with 6 photographic images
PAINAD scale
dementia patients
-breathing (normal to noisy labored breathing)
-negative vocalization (moan, groan)
-facial expression (inexpressive, frown)
-body language (relaxed, tense, rigid)
-consolability
COMFORT scale
used in unconscious and ventilated infants, children, and adolescents
Which of the following pain assessment tools is recommended for use with neonates ages 0 to 6 months?
CRIES pain scale
What are 3 pharmacologic pain relief measures?
1.nonopiod analgestics
2. opiod analgesics
3. adjuvant drugs
What are examples of nonopiod analgestics?
acetaminophen, NSAIDS
What is the mechanism of nonopiod analgestics?
reduce inflammation and pain by inhibiting the cyclooxygenase enzymes that are involved in prostaglandins
What to consider about nonopiod analgestics?
lower risk of addiction, but potential for gastrointesinal issues with prolonged use
EXAMPLES of opiod analgestics
morphine
codeine
Mechanism of opiod analgestics
bind to opiod receptors in the CNS to block pain signals
Consideration for opiod analgesics
effective for severe pain but carries risk of addidction, tolerance, and respiratory depression
Adjuvant drugs example
anticonvulsants
antidepressants
corticosteroids
Anticonvulsants
stabilize nerve cell membranes to reduce neuropathic pain
Antidepressants
enhance serotonin and norepinephrine levels in the brain which can modulate pain perception
Corticosteroids
reduce inflammation by suppressing the immune response leading to pain relief
Side effects of opioid use
sedation
nausea
constipation
physical dependence
tolerance
addiction
A sedated patient is frequently drowsy and drifts off during his convo with the nurse. What number on the sedation scale best describes the patient?
3
Numeric Sedation Scale
1: awake and alert
2: Occasionally drowsy, but easy to arouse: no action necessary
3: frequently drowsy, driffs off to sleep during conv.: reduce dosage
4: somnolent with minimal or no response to stimuli: discontinue opiod, consider use of naloxone
Cold therapy
reduce swelling
reduce inflammation
relieves pain
immediately after an injury
may continue to use for 3-5 days
Hot therapy
increase blood circulation
promote healing process
relax stiff muscles
increase ROM
soother sore muscles
DO NOT APPLY COLD OR HEAT FOR LONGER than 20 minutes
