Test 4 Study Guide Flashcards
Goals of Humidity Therapy
To provide adequate heat and humidity.
* To treat hypothermia.
* To prevent reactive airway response to cold air.
* To aid removal of thick secretions
For premature and newborn infants, a ____ ______ environment should be
maintained.
Neutral Thermal
the point at which inspired gas
reaches body temperature and humidity
isothermic saturation boundary (ISB)
5 cm below the carina
* 44 mg/L at 37˚C
Breathing ____ _____ moves the ISB deeper into the respiratory tract.
Dry gas
During exhalation, heat is transferred from exhaled gas to the ____ and ____
mucosa by convection
Trachea and Nasal
____ is a poor conductor of heat, the mouth is less efficient than the nose at
heating inspired air.
Air
Humidiers that add water or heat or both to the inspired gas.
Active Humidifier
Types of active humidifiers:
- Cool passover humidifier
- Heated passover humidifier
- Bubble humidifier
- Jet nebulizer
Can be used with intubated patients.
* Flows 10 to 120 L/min.
* Risk of bacterial transmission from
humidifier reservoir to patient .
Heated Bubble Humidifier
Types of active humidifiers:
- Cool passover humidifier
- Heated passover humidifier
- Bubble humidifier
- Jet nebulizer
Can be used with intubated patients.
* Flows 10 to 120 L/min.
* Risk of bacterial transmission from
humidifier reservoir to patient .
Heated Bubble Humidifier
Humidifier used that captures exhaled heat and moisture and transfers part of heat and humidity back to patient with each breath.
- Passive humidifiers
Types of passive humidifiers
Heat moisture exchangers (HME)/artificial nose
What to consider when choosing humidifier therapy
- Source, temperature, humidity the patient is breathing.
- Point of entry of airway
- rate of inspiratory flow or minute volume
- normal or diseased lungs?
- increased, thick secretions or a humidity deficit?
- Are special needs imposed by dead space or the patient’s size, age, ability to
tolerate administration, or sensitivity to changes in the work of breathing?
Used to administer pentamidine for Antifungal or Pneumocystis jiroveci (carinii).
Respirgard nebulizer
Primary indications for aerosol therapy (humidification)
- Tracheostomy.
- Upper airway inflammation;
- Cool mist for local vasoconstriction.
- Prevent occlusions of airway stents.
- Induce sputum for diagnostic purposes.
a simple open-ended tube or bag that provides space for the pMDI
plume to expand by allowing the propellant to evaporate.
Spacer
allows the plume from the pMDI to expand and incorporates a one-way valve that permits the aerosol to be drawn from the
chamber during inhalation only.
Valved holding chamber
Purpose of spacers and valve holding chambers
Reduce oropharyngeal deposition of drugs.
* Ameliorate the bad taste of some medications.
* Eliminate the cold Freon effect.
* Reduce the need for hand-breath coordination; (valved holding chamber)
Hazards associated with HME use
Impaction of pulmonary secretions.
* Higher resistive work of breathing.
* Mucus plugging.
* Hypercapnia.
* Hypothermia.
What is an HME?
Heat Moisture Exchanger
Free floating bacteria
planktonic
Bacteria that are capable of forming complex and stable aggregate communities
Bacterial mats and Biofilms.
What can biofilms attach to?
Biofilms attach to any surface, liquid or solid.
Biofilms are ____ times more resistant to antibiotics than free-floating bacteria.
100 x
2 ways that toxins are formed
Endotoxins and Exotoxins
Integral part of cell walls of gramnegative bacteria.
* Released with cellular lysis or death.
* Moderately toxic.
* Heat tolerant.
Endotoxins
Excreted by gram-positive bacteria or
gram-negative bacteria.
* Secreted or released following lysis.
* Highly toxic, fatal in large quantities.
* Inactivated at high temperatures.
Exotoxins
How does bacteria cause disease?
- Toxin formation
- Direct damage
- Inflammatory response
Deplete host tissue nutrients.
Produce substances that cause tissue damage and spread bacteria.
Direct damage
2 substances that cause tissue damage and spread bacteria
Collagenase and hyaluronidase (Strep-pyogenes);
Panton-Valentine leucocidin toxin (MRSA);
What does Strep-pyogenes do to cause tissue damage and spread bacteria?
Digest intracellular matrix.
What does MRSA do to cause tissue damage and spread bacteria?
Tissue necrosis, abscess formation, high mortality.
Signs of inflammatory response to a bacteria
Fever
Hypotension
Muscle aches
Malaise/loss of appetite
Confusion
Temporary liver and heart dysfunction
Bacteria that requires oxygen for survival.
Aerobe
Examples of aerobe bacteria
Pseudomonas aeruginosa (water, soil, leaves and plants
Bacteria that requires the absence of oxygen
Anaerobe
Examples of anaerobe bacteria
Clostridium (GI tract, soil).
Bacteria that has limited oxygen tolerance
facultative anaerobe
Examples of facultative anaerobe bacteria
Escherichia coli (GI tract, animals).
Detects the presence of an immune response to mycobacteria by eliciting a
delayed-type hypersensitive response.
PPD or tuberculin skin
test
Positive TB test = induration of ___ to __ mm in diameter.
5 to 15 mm
Represents positive exposure in past, not necessarily active infection.
Once converted most patients are positive indefinitely.
Positive PPD/TB test
A PPD/TB test manifests within ____ hours
72
Patients that fail to demonstrate immune response even after exposure to TB
Anergic
With the exception of prions, ____ are the smallest and simplest class
of pathogens.
Viruses
Viruses are ____ X smaller than bacteria
100 times
Size range of viruses
0.02 to 0.3 microns.
_____ are infectious agents that are unable to grow or reproduce
outside a host cell.
Viruses
Viruses produce clinical disease when:
- Host cell ruptures and death.
- Host cell dysfunctions (including fusion with other cells)
- Malignant transformation (cancer)
- Stimulating the body’s cellular host defenses against infection
systemic symptoms associated with viral infection
Loss of appetite, fever, malaise, increased mucus production.
a plant or animal that lives with or on another, deriving benefit from the
association but having a detrimental effect on the host.
Parasite
Parasite that lives inside host
- Endoparasites:
Parasites that live on the hosts surface.
- Ectoparasites
A sputum collection technique designed to bypass the upper airway, with its potential contaminants.
Transtracheal aspiration (TTA)
A Transtracheal aspiration (TTA) is Obtained with a sterile needle directly
inserted into the trachea through the
_____ membrane.
cricothyroid
Examples of direct contact viruses
Influenza, HIV, Ebola
Examples of indirect contact viruses
Staph, Hep B and C, HIV, Pseudomonas Aeruginosa
Examples of droplet viruses
Rhinovirus, SARS, Rubella
3 types of contact transmission
- Direct
- Indirect
- Droplets
3 types of noncontact transmission
- Airborne
- Vehicle
- Vector-borne
Examples of airborne viruses
Legionellosis, TB, and varicella
Examples of vehicle viruses
Cholera (waterborne), Salmonella and hep (foodborne)
Examples of vector-borne viruses
Rickettsia and Lyme disease (ticks), Malaria (mosquitos)
Common opportunistic infection during first decade of AIDS.
* Causes PCP pneumonia.
Pneumocystis jiroveci (carinii)
Common in patients with weakened immune systems, such as AIDS patients.
Transplant patients.
Medium to high dose corticosteroids.
Severe malnutrition (children and elderly).
Pneumocystis jiroveci (carinii)
These procedures decrease the spread of infection.
Infection control
Strategies for infection control
Protective equipment
* Safety training
* Immunization of healthcare providers:
Immunizations for healthcare providers
Hepatitis A and B.
* Immunity against varicella, rubella, and measles.
* Annual influenza vaccinations.
* Employees should not report to work if they have a potentially infectious condition.
____ _____ remains the most important infection control measure.
Hand hygiene
Appropriate hand hygiene
Washing with soap and water for 20 seconds.
* The use of alcohol-based gels, foams, or rubs.
used to prevent the
transmission of infectious agents that are spread by
direct contact.
Contact precautions
Patient is placed in single patient room to protect the patient and patient environment. Providers wear gloves and gowns.
Contact precautions
Infections are transmitted during patient care primarily through:
human contact or inanimate surfaces.
For transmission of infectious agents three conditions are necessary:
A source of infection.
* A susceptible host with a portal of entry receptive to the agent.
* A mode of transmission for the agent.
Levels of equipment processing
- Critical
- Semi-critical
- Non-critical
Must be sterile.
* No viable (living) organisms.
* Chest tubes
Critical processing
Must be disinfected.
* Few organisms remaining, with spores and
non-lipid viruses possibly remaining viable.
* Ventilator expiratory cassette.
Semi-critical processing
Must be clean
* Grossly appreciable organic matter (dirt)
removed.
* Touches only intact skin;
* Pulse oximeter
* Stethoscope
* Blood pressure cuf
Non-critical processing
Is the complete destruction of all microorganisms, including spores.
Sterilization prevents the transmission of diseases.
Sterilization
2 types of sterilization
Physical and Chemical
Sterilization involving Steam (autoclaving) and Radiation
Physical sterilization
Sterilization involving Ethylene oxide
* Hydrogen peroxide gas
plasma
* Peracetic acid sterilization
Chemical sterilization
A quantity of sterile saline is drawn through the lumen of the equipment to
be tested, after which the saline is cultured.
Aspiration
- Irregular surfaces that are not easily rolled onto an agar plate may be rubbed
with a sterile swab coated with culture medium. - The swab may then be used to inoculate a agar plate.
Swabbing
2 Equipment Surveillance Methods
Aspiration and swabbing
Occurs when microorganisms are
transmitted via contaminated:
* Food
* Water
* Medications
* Equipment
Vehicle transmission
used to prevent the
transmission of infectious agents over a long
distance when suspended in the air.
Airborne precautions
Precautions where patient must be placed in single patient negative-pressure
room.
Airborne precautions
Examples of pathogens causing airborne precautions
Tuberculosis
* Ebola
* Measles
* Smallpox
Spherical gram-positive coccus.
* Turns gold on blood agar.
Staphylococcus aureus
Virus that is Methicillin antibiotic (MRSA) resistant
(Patnon-Valentine Leukocidin toxin).
Staphylococcus aureus
Causes of staphylococcus aureus
Clot formation
Minor skin infections
Pneumonia
Meningitis
Toxic shock syndrome
Severe necrotizing pneumonia in children
