Nurs 3209 Exam 1

Front 1

Define Sepsis.

Back 1

A toxic condition resulting from the multiplication of pathogenic microorganisms and their products.

Front 2

Describe the chain of infection.

Back 2

The etiologic agent or microorganism -> the place where the organism naturally reside (reservoir) -> a portal of exit from the reservoir -> a method of transmission -> a portal of entry into a host -> the susceptibility of the host

Front 3

Describe the fundamental of asepsis.

Back 3

Asepsis is freedom from disease producing microorganisms and to prevent the sepsis

Front 4

Define carriers.

Back 4

Carries: a person or animal reservoir that does not manifest any clinical signs of disease.

Front 5

Differentiate colonization and normal resident flora.

Back 5

Colonization is the process by which strains of microbs become resident flora. In this state, microbes may grow and multiply but do not cause disease.
Normal resident flora, which keeps other bacterias from causing problems.

Front 6

What is the difference between infected and colonized?

Back 6

Infection occurs when newly introduced or resident microbes succeeded in invading a part of the body where the host's defense mechanisms are ineffective and the pathogens causes tissue damage.
If an infection develops, it is usually from bacteria that colonize patients.

Front 7

Bacteria can be transmitted only when the patient is infected. True or False?

Back 7

False. Bacteria can be transmitted even if the patient is not infected.

Front 8

Describe the difference between vehicle-borne transmission and vector-borne transmission.

Back 8

- Vehicle-borne transmission: any substances that serve as an intermediate means to transport and introduce an infectious agent into a susceptible host.
For example, toys, fomites (inanimate materials), surgical instruments, dressings.
- Vector-borne transmission: Animal or flying or insect that serve as an intermediate means of transporting the infectious agent. By injecting salivary fluid during biting or by depositing feces.

Front 9

What are the signs and symptoms of systemic infection?

Back 9

Fever, malaise, increase pulse and respiratory rate, anorexia or nausea and vomiting

Front 10

What are the signs and symptoms of local infection?

Back 10

Erythema (redness), edema (swelling), pain or tenderness, palpate heat at the area, possible loss of function of the affected area

Front 11

White blood count 10,000/cu mm indicates infection. True or False?

Back 11

False. White blood count 11,000/cu mm

Front 12

Define HAIS.

Back 12

Healthcare-Associated Infections (Nosocomial) - infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting.

Front 13

Antimicrobial soap is more effective than alcohol-based hand rub. True or False?

Back 13

False! Unless you have some scars on your hand -> wash your hands!

Front 14

PPE includes??

Back 14

Personal protective equipment includes gloves, masks, eye protection, and gowns

Front 15

Explain the sequence for PPE.

Back 15

Personal Protective Equipment
1. Gown
2. Mask or respirator
3. Goggles or face shied
4. Gloves over wrist of gown.

Front 16

Describe the setting of the room with airborne precautions.

Back 16

- Private room with negative air pressure. 6-12 air changes/hour and either a filtration system or D/C to outside.
- If no private room, place with same microbes.
- Wear an N95 respirator when entering room.
- Susceptible people should not enter if immune caregivers are available.

Front 17

Particles for airborne precautions is smaller than 10 microns. True or False?

Back 17

False! Smaller than 5 microns

Front 18

Describe the setting of the room with droplet precautions.

Back 18

- Private room or with another person with same microbes.
- Wear a mask within 3 feet of patient.

Front 19

Describe the setting of the room with contact precautions.

Back 19

- Private room or with another person with same microbes.
- Extra attention to glove and gown use as in standard precautions.
- Limit patient movement outside the room
- Dedicate the use of client care equipment of this single patient.

Front 20

List the microbes which are categorized in airborne pathogens.

Back 20

Measles, varicella, TB

Front 21

List the microbes which are categorized in droplet pathogens.

Back 21

Meningococcus - meningitis
Influenza
Pertussis - whooping cough

Front 22

List the microbes which are categorized in contact pathogens.

Back 22

MRSA (Methicillin-resistant Staphylococcus aureus)
VRE (Vancomycin-resistant Enterococcus)
C. difficile (Clostridium difficile)

Front 23

Who is affected by HA-MRSA?

Back 23

Immunocompromised, residency in long term care facilities, recent hospitalizations, dialysis patients, recent surgery.

Front 24

How is affected by HA-MRSA? What about CA-MRSA?

Back 24

Skin-to-skin contact with someone who has a steph infection.
Contact with surface that have staph on them
Compromised immune system
Contaminated equipment

For CA-MRSA, same above, and poor hygiene, close contact living conditions (dorms, facilities, gyms)

Front 25

VRE infections often occur in the public area such as school or gym. True or False?

Back 25

False. Most of them occur in hospitals

Front 26

Name the major infections due to acinetobacter.

Back 26

Ventilator-associated pneumonia

Front 27

Acinetobacter cannot live outside of the host. True or False?

Back 27

False. Acinetobacter has been found on contaminated surfaces for days to months (up to 120 days)

Front 28

What makes Clostridium difficile so dangerous?

Back 28

It produces spore, which make it possible to live up to two years on inanimate objects.

Front 29

What is the clinical symptoms and disease caused by C. difficile?

Back 29

Watery diarrhea -> dehydration
Fever, nausea, abdominal pain
Resulting in colitis (大腸炎), sepsis, and death.

Front 30

What is the prevention from C. difficile? Is alcohol-based hand wash OK?

Back 30

Standard precautions with contact precautions for PT known or suspected to have C. difficile.
Traditional hand washing with soap and water for the mechanical removal and rinsing of spores from hands.

Front 31

Differentiate the primary, secondary, tertiary health care service.

Back 31

Primary - Health promotion and illness prevention
Secondary - Diagnosis and treatment
Tertiary - Rehabilitation, health restoration, and palliative care

Front 32

Describe the primary health care service.

Back 32

Goal is prevention.
Any health promotion.
Ex: immunization, BP screening, national campaign.

Front 33

Describe the secondary health care service.

Back 33

Goal is screening and treatment.
Ex: lab test, surgeries, hospitalization

Front 34

Describe the tertiary health care service.

Back 34

Goal is restoration and rehabilitation.
Ex: hospice care, nursing home for old people

Front 35

Differentiate the inpatient and outpatient.

Back 35

"Inpatient" means the admitted patients who need to be closely monitored during the procedure or during recovery.
"Outpatient" means that the procedure does not require hospital admission, or stay in the hospital less than 24 hours.

Front 36

Define Long Term Acute Care.

Back 36

LTAC serves patients with complex medical needs requiring long-term hospitalization in an acute setting. In many LTAC hospitals, patients are admitted directly from short-stay hospital intensive care units with respiratory/ventilator-dependent or other complex medical conditions.

Front 37

Standard Precautions apply to what?

Back 37

a) Blood
b) All body fluids, excretions, and secretions except sweat
c) nonintact or broken skin
d) mucous membranes

Front 38

Under Standard Precautions, you do not need to wash hands after the procedure when you wear gloves. True or False?

Back 38

False! Whether you wear gloves or not, you need to perform proper hand hygiene after contact with blood, body fluids, secretions, excretions, and contaminated objects

Front 39

Under Standard Precautions, when do you need to wear gloves?

Back 39

When you touch blood, body fluids, secretions, excretions, and contaminated items.

Front 40

Under Standard Precautions, you must recap needles and place directly into puncture-resistant containers. True or False?

Back 40

False. You do not need to recap the needles. If you really need it, use the one-handed scoop technique.

Front 41

List the types of infections cause by VRE.

Back 41

- UTI: most common.
- Wound: usually intra-abdominal and pelvic-second most common.
- Bacteremia: the presence of bacteria in the blood

Front 42

Give the purposes and examples of each type of surgeries.
- Diagnostic
- Palliative
- Ablative
- Constructive
- Transport

Back 42

- Diagnostic: confirms and establishes a diagnose, i.e., biopsy of a mass in a breat
- Palliative: relieve or reduce a pain, i.e., resection of nerve roots
- Ablative: removes a diseased body part, i.e., removal of gallbladder and appendectomy
- Constructive: restores function or appearance, i.e., breast implant and plastic surgery
- Transport: replaces organs

Front 43

Describe how respiratory disease such as COPD and emphysema increases surgical risk.

Back 43

Hypoventilation, respiratory depression, a decrease of ability to compensate for acid-base imbalances

Front 44

Describe how cardiovascular disease increases surgical risk.

Back 44

Increased demands on myocardium (surgical stress), a increase risk of MI, increase hemorrhage risk

Front 45

Describe how diabetes increases surgical risk.

Back 45

Increased risk for infection, delayed wound healing, fluctuating bloodglucose levels

Front 46

Describe how renal & liver disease increases surgical risk.

Back 46

Altered metabolism & elimination of drugs, poor tolerance for general anesthesia

Front 47

Describe how malnutrition increases surgical risk.

Back 47

Increased risk for F&E, and acid-base imbalances, predisposed for hemorrhage & delayed wound healing

Front 48

Describe how obesity increases surgical risk.

Back 48

Delayed wound healing & risk for infection, wound dehiscence, pneumonia & thrombophlebitis

Front 49

Describe how alcoholism increases surgical risk.

Back 49

- Arrhythmias (不整脈), hemorrhage, Increased risk of infection, possible need for increased doses of anesthesia
- Respiratory complications

Front 50

What is the chief disadvantages of general anesthesia?

Back 50

Decreased respiration and circulation

Front 51

What is the chief disadvantages of regional anesthesia?

Back 51

Hypotension, H/A, Urinary retention

Front 52

A patient who is on general anesthesia still have reflexes such as cough or gag. True or False?

Back 52

False!!! Coughing and gagging are lost.

Front 53

Describe how malignant hyperthermia is caused during operation and its signs and symptoms.

Back 53

- Triggered by exposure to certain drugs used for general anesthesia
- Due to abnormal and excessive intracellular collection of Ca+ resulting in hypermetabolism and increased muscle contraction.
- High fever, tachycardia, muscle rigidity, heart failure, pseudotetany, and CNS damage. Can be FATAL

Front 54

During the postanesthetic stage, patients are often placed on their side with the face positioned downward-no pillow. Why?

Back 54

Gravity keeps the tongue forward, preventing occlusion of the pharynx and allowing drainage of mucus or vomitus out of the mouth.

Front 55

What important protocols should be included in the nurses postoperative assessment???

Back 55

Level of consciousness
Vital signs
Skin color (tissue perfusion of lips and nail beds) and temperate
Pain
Fluid balance
Dressing and bedclothes
Drains and tubes
Airways

Front 56

Differentiate serous, sanguineous, and serosanguineous.

Back 56

Serous - like serum,watery and clear
Sanguineous - bloody may be dark or bright red and purulent-thick contains pus
Serosanguineous - composed of serum and blood

Front 57

Define dehiscence.

Back 57

Separation of surgical wound often 6-8 days postop -> needs sterlie and saline-moistened dressing

Front 58

Define evisceration.

Back 58

A complication where the organs begin to push outside of the open incision through area of dehiscence-emergency - needs sterlie and saline-moistened dressing

Front 59

What are the common complications for post-operative obese patients?

Back 59

- Tissue perfusion
- Cardiopulmonary disease

Front 60

Define the thrombophlebitis and cause of that. What prevents patients from having this during operation?

Back 60

Inflammation of the veins, usually of the legs and associated with a blood clot.
It is caused by slowed venous return flow due to immobility or prolonged sitting or supine position. Antiemboli stockings are effective because this compress the vein of the legs and promotes the venous return to the heart and improves arterial circulation to the feet.

Front 61

The greenish would drainage of the post-operative patient indicates what? What would you need to do?

Back 61

Wound infection. Need to check the temperature and WBC count

Front 62

Dehiscence occurs when the patient coughs. You need to do what?

Back 62

Cover the wound with sterile, saline-moistened dressing.

Front 63

You would conclude "very effective" for the evaluation of the preoperative teaching when your patient could ...?

Back 63

Demonstrate all you taught well and explain all the procedure and reason for the activities.

Front 64

Define the PICO model.

Back 64

Patient/Population (Among…)
Intervention (does…)
Comparison (versus…)
Outcome of intervention (affect…)

Front 65

Explain the process of Evidence Based Practice.

Back 65

- Ask: develop an answerable question
- Acquire: Search for the best research
- Appraise the research for validity and usefulness
- Apply the findings
- Assess: Evaluate the effectiveness of the application of the findings

Front 66

Define the medicare.

Back 66

A system providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability.

Front 67

Define the medicaid.

Back 67

A federal health program to paid out of general taxes to certain people and families with low incomes and resources

Front 68

What factors promoting transmission of Acinetobacter in ICU?

Back 68

- Long survival time on inanimate surfaces
- Highly antibiotic resistant

Front 69

Precautions recommended to prevent spread of MDRO (multi-drug resistant organism) is what?

Back 69

Standard precaution plus contact precaution

Front 70

What is the normal temperature?

Back 70

96.8-100.4° F or 36-38° C

Front 71

Which method is the most accurate measurement of core body temperature without internal monitoring?

Back 71

Rectal temp

Front 72

Axillary temperature is about 2 degree less that accurate oral temp. True or False?

Back 72

Approximately 1° less accurate than oral measurement and 2 degrees less than rectal

Front 73

When you measure the tympanic temp for adult, you pull auricle down and back. True or False?

Back 73

False. For adult: pull auricle up and back
For children: pull auricle down and back

Front 74

Define the pulse.

Back 74

Amount of beats the heart makes in one minute

Front 75

What is the normal pulse rate?

Back 75

Adult normal: 60-100/min (well conditioned athletes may be slower)

Front 76

When do you use bell and diaphragm of stethoscope?

Back 76

Bell: low pitch
Diaphragm: high pitch sounds

Front 77

Where can you find apical pulse?

Back 77

5th intercostal space, left midclavicular line

Front 78

Why do you need to choose proper size of cuff for a patient?

Back 78

Too tight=increases pressure causing a false high reading
Too loose=decreases pressure causing a false low reading

Front 79

Pulse Oximetry measures what?

Back 79

The saturation of oxygen in the blood (SpO2), the oxygen value which is the percent of all hemoglobin binding sites that are occupied by oxygen.

Front 80

What is the normal value of pause oximetry?

Back 80

Normal: 95-100%

Front 81

What is the normal fasting BG level?

Back 81

Normal Fasting Blood Glucose:
70-100 mg/dl