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81 Cards in this Set

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Define Sepsis.
A toxic condition resulting from the multiplication of pathogenic microorganisms and their products.
Describe the chain of infection.
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
Describe the fundamental of asepsis.
Asepsis is freedom from disease producing microorganisms and to prevent the sepsis
Define carriers.
Carries: a person or animal reservoir that does not manifest any clinical signs of disease.
Differentiate colonization and normal resident flora.
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.
What is the difference between infected and colonized?
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.
Bacteria can be transmitted only when the patient is infected. True or False?
False. Bacteria can be transmitted even if the patient is not infected.
Describe the difference between vehicle-borne transmission and vector-borne transmission.
- 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.
What are the signs and symptoms of systemic infection?
Fever, malaise, increase pulse and respiratory rate, anorexia or nausea and vomiting
What are the signs and symptoms of local infection?
Erythema (redness), edema (swelling), pain or tenderness, palpate heat at the area, possible loss of function of the affected area
White blood count 10,000/cu mm indicates infection. True or False?
False. White blood count 11,000/cu mm
Define HAIS.
Healthcare-Associated Infections (Nosocomial) - infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting.
Antimicrobial soap is more effective than alcohol-based hand rub. True or False?
False! Unless you have some scars on your hand -> wash your hands!
PPE includes??
Personal protective equipment includes gloves, masks, eye protection, and gowns
Explain the sequence for PPE.
Personal Protective Equipment
1. Gown
2. Mask or respirator
3. Goggles or face shied
4. Gloves over wrist of gown.
Describe the setting of the room with airborne precautions.
- 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.
Particles for airborne precautions is smaller than 10 microns. True or False?
False! Smaller than 5 microns
Describe the setting of the room with droplet precautions.
- Private room or with another person with same microbes.
- Wear a mask within 3 feet of patient.
Describe the setting of the room with contact precautions.
- 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.
List the microbes which are categorized in airborne pathogens.
Measles, varicella, TB
List the microbes which are categorized in droplet pathogens.
Meningococcus - meningitis
Influenza
Pertussis - whooping cough
List the microbes which are categorized in contact pathogens.
MRSA (Methicillin-resistant Staphylococcus aureus)
VRE (Vancomycin-resistant Enterococcus)
C. difficile (Clostridium difficile)
Who is affected by HA-MRSA?
Immunocompromised, residency in long term care facilities, recent hospitalizations, dialysis patients, recent surgery.
How is affected by HA-MRSA? What about CA-MRSA?
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)
VRE infections often occur in the public area such as school or gym. True or False?
False. Most of them occur in hospitals
Name the major infections due to acinetobacter.
Ventilator-associated pneumonia
Acinetobacter cannot live outside of the host. True or False?
False. Acinetobacter has been found on contaminated surfaces for days to months (up to 120 days)
What makes Clostridium difficile so dangerous?
It produces spore, which make it possible to live up to two years on inanimate objects.
What is the clinical symptoms and disease caused by C. difficile?
Watery diarrhea -> dehydration
Fever, nausea, abdominal pain
Resulting in colitis (大腸炎), sepsis, and death.
What is the prevention from C. difficile? Is alcohol-based hand wash OK?
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.
Differentiate the primary, secondary, tertiary health care service.
Primary - Health promotion and illness prevention
Secondary - Diagnosis and treatment
Tertiary - Rehabilitation, health restoration, and palliative care
Describe the primary health care service.
Goal is prevention.
Any health promotion.
Ex: immunization, BP screening, national campaign.
Describe the secondary health care service.
Goal is screening and treatment.
Ex: lab test, surgeries, hospitalization
Describe the tertiary health care service.
Goal is restoration and rehabilitation.
Ex: hospice care, nursing home for old people
Differentiate the inpatient and outpatient.
"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.
Define Long Term Acute Care.
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.
Standard Precautions apply to what?
a) Blood
b) All body fluids, excretions, and secretions except sweat
c) nonintact or broken skin
d) mucous membranes
Under Standard Precautions, you do not need to wash hands after the procedure when you wear gloves. True or False?
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
Under Standard Precautions, when do you need to wear gloves?
When you touch blood, body fluids, secretions, excretions, and contaminated items.
Under Standard Precautions, you must recap needles and place directly into puncture-resistant containers. True or False?
False. You do not need to recap the needles. If you really need it, use the one-handed scoop technique.
List the types of infections cause by VRE.
- UTI: most common.
- Wound: usually intra-abdominal and pelvic-second most common.
- Bacteremia: the presence of bacteria in the blood
Give the purposes and examples of each type of surgeries.
- Diagnostic
- Palliative
- Ablative
- Constructive
- Transport
- 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
Describe how respiratory disease such as COPD and emphysema increases surgical risk.
Hypoventilation, respiratory depression, a decrease of ability to compensate for acid-base imbalances
Describe how cardiovascular disease increases surgical risk.
Increased demands on myocardium (surgical stress), a increase risk of MI, increase hemorrhage risk
Describe how diabetes increases surgical risk.
Increased risk for infection, delayed wound healing, fluctuating bloodglucose levels
Describe how renal & liver disease increases surgical risk.
Altered metabolism & elimination of drugs, poor tolerance for general anesthesia
Describe how malnutrition increases surgical risk.
Increased risk for F&E, and acid-base imbalances, predisposed for hemorrhage & delayed wound healing
Describe how obesity increases surgical risk.
Delayed wound healing & risk for infection, wound dehiscence, pneumonia & thrombophlebitis
Describe how alcoholism increases surgical risk.
- Arrhythmias (不整脈), hemorrhage, Increased risk of infection, possible need for increased doses of anesthesia
- Respiratory complications
What is the chief disadvantages of general anesthesia?
Decreased respiration and circulation
What is the chief disadvantages of regional anesthesia?
Hypotension, H/A, Urinary retention
A patient who is on general anesthesia still have reflexes such as cough or gag. True or False?
False!!! Coughing and gagging are lost.
Describe how malignant hyperthermia is caused during operation and its signs and symptoms.
- 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
During the postanesthetic stage, patients are often placed on their side with the face positioned downward-no pillow. Why?
Gravity keeps the tongue forward, preventing occlusion of the pharynx and allowing drainage of mucus or vomitus out of the mouth.
What important protocols should be included in the nurses postoperative assessment???
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
Differentiate serous, sanguineous, and serosanguineous.
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
Define dehiscence.
Separation of surgical wound often 6-8 days postop -> needs sterlie and saline-moistened dressing
Define evisceration.
A complication where the organs begin to push outside of the open incision through area of dehiscence-emergency - needs sterlie and saline-moistened dressing
What are the common complications for post-operative obese patients?
- Tissue perfusion
- Cardiopulmonary disease
Define the thrombophlebitis and cause of that. What prevents patients from having this during operation?
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.
The greenish would drainage of the post-operative patient indicates what? What would you need to do?
Wound infection. Need to check the temperature and WBC count
Dehiscence occurs when the patient coughs. You need to do what?
Cover the wound with sterile, saline-moistened dressing.
You would conclude "very effective" for the evaluation of the preoperative teaching when your patient could ...?
Demonstrate all you taught well and explain all the procedure and reason for the activities.
Define the PICO model.
Patient/Population (Among…)
Intervention (does…)
Comparison (versus…)
Outcome of intervention (affect…)
Explain the process of Evidence Based Practice.
- 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
Define the medicare.
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.
Define the medicaid.
A federal health program to paid out of general taxes to certain people and families with low incomes and resources
What factors promoting transmission of Acinetobacter in ICU?
- Long survival time on inanimate surfaces
- Highly antibiotic resistant
Precautions recommended to prevent spread of MDRO (multi-drug resistant organism) is what?
Standard precaution plus contact precaution
What is the normal temperature?
96.8-100.4° F or 36-38° C
Which method is the most accurate measurement of core body temperature without internal monitoring?
Rectal temp
Axillary temperature is about 2 degree less that accurate oral temp. True or False?
Approximately 1° less accurate than oral measurement and 2 degrees less than rectal
When you measure the tympanic temp for adult, you pull auricle down and back. True or False?
False. For adult: pull auricle up and back
For children: pull auricle down and back
Define the pulse.
Amount of beats the heart makes in one minute
What is the normal pulse rate?
Adult normal: 60-100/min (well conditioned athletes may be slower)
When do you use bell and diaphragm of stethoscope?
Bell: low pitch
Diaphragm: high pitch sounds
Where can you find apical pulse?
5th intercostal space, left midclavicular line
Why do you need to choose proper size of cuff for a patient?
Too tight=increases pressure causing a false high reading
Too loose=decreases pressure causing a false low reading
Pulse Oximetry measures what?
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.
What is the normal value of pause oximetry?
Normal: 95-100%
What is the normal fasting BG level?
Normal Fasting Blood Glucose:
70-100 mg/dl