CNT Review Exam Flashcards

Question

Which types of hepatitis can become chronic?

Answer 1

B: depends on age group- 6% are lifelong carriers C: 60-70% develop chronic hepatitis

Answer 2

Fever, nausea/vomiting, fatigue, no appetite, muscle ache

Answer 3

Flu-like, joints pain, fatigue, depression (2-6 weeks later) Asymptomatic in **30%** of cases and in **children**

Answer 4

After chronic carrier goes to cirrhosis, LR cancer may result in **adult**

Answer 5

Need **hepatitis B** replicated fulminating

Answer 6

Sudden onset of fever, malaise, nausea and anorexia

Answer 7

Human immunodeficiency virus * HIV targets CD4 (T4) lymphocytes as its host. * play an important role in immune system * HIV destroys T4 lymphocytes producing immune deficits

Answer 8

1. **HIV-1:** most infectious & most common 2. **HIV-2**: less infectious

Answer 9

* initially infection is usually followed within **2-4 weeks** by a febrile illness resembling mononucleosis or influenza which resolves spontaneously * As immune damage progresses, symptoms of **malaise, body aches, fever, skin rash, lymphadenopathy** develop * **Other s/s:** weight loss, chronic diarrhea, persistent cough, persistent fever and night sweats, flat or raised pigmented lesion on the skin ranging from faint pink to red, brown or blue * **Late stage development of infection diseases:** candidiasis, cytomegalovirus, Kaposi's sarcoma & Pneumocystis carinii * **Pneumonia:** **_the most common opportunistic infection and cause of death in AIDS_**

Answer 10

* **The population distribution of HIV:** initially found primarily among men who had sex w/ men, injection dug users, sex workers, and transfusion recipients. Today HIV is no longer limited to these initial populations. Recently, more cases are associated with **unprotected sex between mixed gender couples.** Due to successful protocols for perinatal cases, newborns are acquiring HIV from their mothers much less frequently. * **Incubation:** due to its long incubation period (**2-15 years** to AIDS) most infected individuals are unaware * **HIV may NOT be transmitted via:** shaking hands, touching, hugging, holding hands, or casual kissing, use of objects handled or touched by an HIV-infected person (i.e. toilet seat or phone) * **Risk of infection:** **0-3%**

Answer 11

* "Wasting disease", severe involuntary weight loss, chronic diarrhea, constant or intermittent weakness * **If HIV enters the CSF:** encephalopathy, myelopathy, peripheral neuropathy, dementia, death * **Rate of disease progression may vary:** * *Contributing factors:* stress, nutrition, alcohol, drugs, STD's * **Secondary infections pose additional risks to practitioners:** tuberculosis, staphylococcus, herpes, hepatitis

Answer 12

* PPD (tuberculosis test)--\> **once/year** * Practitioners who work in an inner city clinic w/ AIDS patients or drug addicts --\> **every 6 month**

Answer 13

* **ELISA** (Enzyme-Linked ImmunoSorbent Assay) * **IFA** (Immuno Fluorescence Assay) * **Western Blot** (Protein Immunoblot)

Answer 14

**Methicillin-resistant staphylococcus aureus** * Recently, MRSA has become a significant source of **antibiotic resistant infections** * The bacterium Staphylococcus aureus is a **gram positive**, coagulase positive aerobic coccus associated with wound infections and other medically significant infections * Between **25-30%** of the population may be carriers of **MRSA** * Majority of MRSA infections appear to be acquired from the health care setting (**nosocomial**) * **12%** of the MRSA are community-acquired

Answer 15

* Appropriate **handwashing** and the use of hand disinfectants * The use of **barrier protection** such as gloves, lab coats or gowns and face masks as necessary * **Proper handling of potentially contaminated materials** such as sharps, disposable supplies such as cotton and gauze, and soiled or blood-stained linen * **Avoid contact** with draining wounds or skin lesions that may be a site of infection * Scrupulous **use of disinfectants**

Answer 16

1. Critical 2. Strongly recommended 3. Recommended

Answer 17

1. Always wash hands between patients 2. Always wash hands just prior to inserting needles if hands are contaminated 3. Always use **"DISPOSABLE"** sterile needles 4. Always establish clean field 5. Always immediately isolate used needles

Answer 18

Products designed to reduce the density of microbial life on **LIVING TISSUE**, particularly on the skin of the patient or practitioner

Answer 19

* Techniques for preventing infection during invasive procedures such as surgical operations, dressing wounds, or some laboratory procedures * **Acupuncture is _NOT_** **an aseptic procedure** because it is not performed in a manner that preserves the sterility of the acupuncturist's hands or the skin of the patient * **Acupuncture is a clean rather than sterile procedure**. Acupuncture needles must be kept in a sterile condition for use in CNT

Answer 20

* The area that has been prepared to contain the equipment necessary for acupuncture in such a way as to protect the sterility of the needles * By extension, this includes not only **the clean surface on which equipment** will be placed, but also **the patient's skin around prepared acupuncture points, and anything that touches the skin** * *Clean field is not the same as a sterile field*

Answer 21

* The use of techniques (such as **antisepsis, disinfection, sterilization, handwashing, and isolation of sharps**) designed to reduce the risk of infection of patients, practitioners, and office personnel by reducing the number of pathogens * Thereby reducing the chances for contact between the pathogens and the patients and personnel

Answer 22

The introduction of contamination **viruses, bacteria, or other organisms** into or onto previously clean or sterile objects, rendering them unclean or non-sterile

Answer 23

The chemicals employed in disinfection. They should only be used on **_INANIMATE_** objects, and are not to be confused with antiseptics that are applied to the body. Examples: hypochlorite dilutions such as bleach, commercial disinfectants

Answer 24

The use of procedures that destroy **_ALL_** microbial life, including viruses This is a rigid, uncompromising term. there is NO SUCH THING as PARTIAL STERILITY In acupuncture, sterilization is required for **_all instruments that pierce the skin**_ (needles, plum-blossom needles, seven-star hammers, and lancets) and _**insertion tubes_**

Answer 25

**Primary sterilization**: for the practitioners and staff **Secondary sterilization**: for the patient

Answer 26

**Autoclave**: 30 minutes at 250 degrees F/ 15 pounds pressure/ rapid decompression at end **Dry Heat**: 2 hours at 338 degrees F

Answer 27

* Should wear clean, washable or disposable protective clothing while performing treatment * The fabric should be chosen to avoid trapping and shedding contaminating particles or microorganisms in the clean field * Loose or large jewelry, clothing and hairstyles that touch the client or break the clean field should be avoided

Answer 28

* It is strongly recommended that all cuts and wounds on the practitioners hands must be washed and dressed immediately for the protection of both patient and practitioner * **_All cuts, wounds, abrasions, chapped hands, hang nails, torn cuticles, etc. must be covered with rubber gloves or finger cots (these do not need to be sterile)_**

Answer 29

* A sink with running hot or cold water must be located in or near the treatment rooms * **Liquid soap**, not bar soap. Liquid soap container must be washed and dried before refilling. * **Single use, disposable towels** (i.e. clean paper towels), not cloth towels * Working surfaces should have a smooth impervious surface, be in good repair, and **cleaned once a day with a suitable disinfectant** (i.e. Clorox, Lysol, Microquat--\> must be labeled with date it was mixed and concentration if not in original bottle)

Answer 30

* Positive practitioners should not perform exposure-prone procedures unless they have received counseling from an expert review panel * Infected practitioners should notify prospective patients of their seropositive status before undertaking exposure-prone invasive procedures * Mandatory testing for practitioner's for HIV antibodies. HBsAg is **_NOT_** recommended * In healthcare workplace, the risk of infection from exposure to contaminated blood is greater for HBV than HIV. The risk is lower for both diseases if universal precautions are followed. * Universal precautions are defined by the CDC as **use of gloves, masks, gowns, goggles, and prevention techniques**

Answer 31

* **Sodium Hypochlorite** * **Stabilized Hydrogen Peroxide** * **Phenolic compounds** * **70% Ethyl & Isopropyl Alcohol** * **Betadyne (Benzylconium chloride)**

Answer 32

**Household bleach** Solutions should be made within **24 hours of use** Concentration **1:100 concentration:** smooth surfaces **1:10 concentration:** porous surfaces or organic materials

Answer 33

this is **NOT** over the counter hydrogen peroxide (3%) Concentration must be **6%-25%**

Answer 34

**Lysol**. Cannot be used as *sterilants* Effective **intermediate or low level disinfectants** for housekeeping purposes

Answer 35

**Intermediate level disinfectants** **70%- _NOT_ 90%** Isopropyl Alcohol

Answer 36

Recommended for **immunocompromised** patients **Betadyne** then an **alcohol swab**

Answer 37

* Visibly dirty or contaminated (with soap and water, **not** alcohol based disinfectant) * Hands are not visibly solid (with soap and water **or** alcohol based disinfectant) * Immediately before and at the end of acupuncture treatments * Before contact with patients * After contact with patients intact skin * After contact with fluids or patients dressing * After removing gloves * After contact with blood or body fluids or obvious environmental contaminants * Before and after eating

Answer 38

1. Always wash hands with soap and water. If unavailable use an alcohol-based or germicidal hand rub 2. Always wash hands with soap and water before and after work shifts and just prior to inserting needles 3. Always wash hands after contact with blood or body fluids or obvious environmental contaminants 4. Always wash hands at the end of the treatment or between treatments 5. Always wash hands whenever they become contaminated during treatment. Examples of potential contamination before treatment include the practitioner touching his/her face, hair, eye or using a pen, helping a patient adjust clothing or remove shoes, picking up dropped items from the floor and answering telephone

Answer 39

1. Gather the equipment: paper towels, **liquid soap**, and running water 2. Roll up sleeves, remove watch and jewelry (plain wedding band is ok) 3. Wet the soap and hands thoroughly 4. Rub soap to make lather 5. Wash the entire surface of the hands 6. Rub water over the hands again to clean them 7. Lower hand so that the water and soap drain off th fingertips as they are rinsed 8. Give the hands a final rinse 9. Turn off the tap with a towel or use an elbow so that the hands do not become soiled. **Do not** dry hands with the towel used to turn off the tap 10. Dry hands carefully using a clean paper towel or shake the hands dry in the air

Answer 40

* All acupuncture needles and instruments that penetrate the skin must be sterile for each insertion * Needles must be **filiform** (solid) and made from **stainless steel** since softer metals are more likely to pit, corrode, tarnish, or break * **All needles must be disposable and sterile for each insertion** **Packaging:** 1. **Must be appropriate**: no bubble wrap, open seals, moisture on the package, or bent packaging 2. Remove needles from sterile packaging in such a was as to avoid contamination 3. Needles in soft plastic bags must be carried in hard containers

Answer 41

* Must be sterile for each patient but not for each point * Guide tubes are **NOT** recommended for auricular acupuncture

Answer 42

* Must be sterile * The practitioner's bare hands may not come into contact with the needle shaft. If the needle shaft needs support a **STERILE gauze pad** or cotton ball is used, **NOT** a *clean gauze or cotton ball*

Answer 43

* Seven-star and plum-blossom needles **must be sterile** * Either the whole device must be a single use and disposable device, or the head portion that contacts the patient's skin must be sterile and disposable * Do not attempt to sterilize, disinfect, or reuse these devices * Each seven-star hammer should be used on one region of the body only

Answer 44

* Cupping is not a sterile procedure. Cups **must be CLEAN but need not be sterile** * After use on a patient, cups must be disinfected in a dilution of hypochlorite (bleach) or other appropriate disinfectant and then cleaned with soap and water * In some hospitals, cups must be sterilized in an autoclave or other on-site sterilizer before using

Answer 45

* Make sure the skin areas to be treated are **free of any cuts, wounds, or diseases** * Never insert needles through inflamed, irritated, diseased or broken skin * **Ensure that the part of the body to be treated is clean**: If dirty, wash with soap and water

Answer 46

* **R12**: 0.5 inch in a thin patient * **Head and face:** superficially or obliquely * **Region with caution**: UB-1, ST-1, DU-16, RN-22, near the femoral artery or groin * Children needling depths are less than those of adults * **Thoracic and back**: puncture with caution

Answer 47

* Swab in a way that touches area only once as not to re-contaminate the area * The same swab can be used for points in the same general area * A new swab should be used when changing areas of the body or if the swab begins to change color * Spiral & C Swab

Answer 48

Using a rotary scrubbing motion, spiral out from the center

Answer 49

Swab from one end of the area to another or in a wide "C" motion

Answer 50

* Used needles should be isolated until they are discarded * A **sharp container** should be right beside the treatment table so that there is no delay in placing the needles away from potential accidental contact * Used needle containers should be **replaced regularly** and not be over-filled above the fill mark so that used needles are not stickingout of the top. Replace containers when they are **three quarters full**, do not attempt to push down the content so that more may be placed inside * All needles that are not in such specially designed containers must be sterilized before being discarded

Answer 51

1. Use **gloves** and **forceps** for picking them up 2. If there is chance of dropping used needles on the practitioners clothing and contaminating it, a gown or impervious apron should be used 3. Wipe all exposed surfaces with a **germicide** since HBV virus can survive on surfaces for more than one week at room temperature 4. Bleach, **1:10 dilution**, can be used as the **first-step cleanser** but since contact with the contaminated surface deactivates the cleanser, a **second cleaning** with bleach must still be done 5. All material used in the clean up job should be discarded in **double wrapping** 6. Wash hands with soap and water

Answer 52

1. Gather gloves and cleaning material 2. Put on **gloves** 3. Remove cups, take care to **prevent body fluids from spreading and splashing** 4. Stop bleeding through the use of appropriate pressure 5. Clean up any bleeding that has occured 6. Immediately isolate the cups 7. handle and dispose of all materials used in the cleaning process as biohazardous wastes 8. **Disinfect** the cups 9. Wash the cups with soal and water

Answer 53

1. Put on rubber gloves, a gown or impervious apron if there is a risk of contaminating your clothing during clean up 2. IF it is a large spill, safety glasses and a disposable or sterilized clothing protector should be worn 3. Clean hte spill first with **soap and water** 4. WIpe all exposed surfaces with **germicide** 5. All materials used in the clean up job should be discarded in **double wrapping** 6. Hands should be washed at the end of the clean up

Answer 54

* Must wear when there will be contact with other potentially infectious materials, mucus membranes and non-intake skin, when performing vascular access procedures and when handling or touching contaminated items or surfaces * Use during procedures such as bleeding where there is a great risk of contact with large amounts of blood. When working with patients who have open lesions or weeping exudates from their skin * When the practitioner has **cuts, abrasions, chapped skin, hang nails or broken cuticles** on his or her hand and the lesions are located in a location where they pose a hazard * **Gloves do not provide protection from accidental needle stick and if improperly used may actualy increase the risk of accidental needle stick during an acupuncture procedure**

Answer 55

**Needle stick** **58-80%** of exposure to **HIV** in healthcare is from needle stick **Risk of infection** from needle stick: * **HIV:** 0.3% * **HBV:** 6-30% Once stuck by a needle, go directly to a physician If negative at initial tests, follow-up tests are 3, 6, 23 month check-up

Answer 56

* people with neural injury, diabetes mellitus or pathology resulting in paralysis have reduced sensitivity of local nerves and are especially susceptible to burns (**moxa or heat lamps**) * **First degree:** run cool water over burn (never ice), apply sterile gauze and secure with medical tape. If no running water can apply burn cream. * **Second degree**: refer to physician

Answer 57

* **Cause:** nervous tension, hunger, fatigue or extreme weakness, forceful manipulation * **Management:** * Remove all needles * Lie patient flat with the feet or legs slightly elevated * Offer warm drinks or administer emergency acupuncture * If no response- Call 911 * **Emergency acupuncture for Fainting:** * **General:** press **DU26** with fingernail or puncture Du-26 with **PC-6** * **If upper body has been needled:** press, moxa, or needle **ST-36** * **If lower body has been needled:** press, moxa, or needle **LI-4**

Answer 58

* Relax muscle--\> massage or tap the skin around the point * Give another puncture nearby so as to relax the muscle * Turn it slightly in the opposite direction until it becomes loose

Answer 59

* Remain calm and advise the patient not to move * **Above the skin:** remove the forceps * **Same level:** press the tissues around the site until the needle is exposed * **Under the skin:** seek medical help

Answer 60

**S/S:** * **pain in the chest, cough** * if severe: dyspnea, pallor, cyanosis, coma, etc **Care:** * carefully remove all needles immediately * call 911

Answer 61

**S/S:** * Rupture w/ bleeding, abdominal pain, rigidity of abdominal muscles, and/or rebound pain upon pressure **Care:** * call 911

Answer 62

**S/S:** * pain in lumbar region, tenderness and pain upon percussion around KD region, bloody urine * Coma may result if blood loss is great **Care:** * call 911

Answer 63

**S/S:** * such points as **DU-15, DU-16,** or **DU** points **above T1** * Bleeding and other severe consequences: **convulsions, paralysis, coma** **Care:** * Call 911

Answer 64

**S/S:** * bleeding **Care:** * **VEIN:** direct pressure for 30 sec-1 min * **ARTERY:** direct pressure up to 5 min

Answer 65

Special care should be taken when puncturing regions close to the **stomach, intestine, urinary bladder, gallbladder,** and **eyes**

Answer 66

* Don't cross the midsagital line of the patient * Don't use silver needles (may electrolyze in body quickly and result in toxic reaction) * Recommended needles: Chinese **32** gauge, Japanese **#5**

Answer 67

**1st degree:** (if burn in small area) * Apply sterile gauze over a burn ointment **2nd or 3rd degree:** (if any signs of infection) * Refer patient to a physician

Answer 68

Suggested that two layers of gloves be used

Answer 69

Any **solid or liquid waste** that may present a **threat of infection** to humans, including non-liquid human tissue and body parts, laboratory disease-causing agents, discarded sharps, human blood or clinic waste such as table paper or cotton balls that contain human blood products and body fluids

Answer 70

* Acupuncturists * Hospitals * Medical offiices * Veterinary clinics * Funeral homes

Answer 71

* Biohazardous waste, except sharps, must be packed in **impermeable, red, polyethylene or polypropylene bags** and **sealed** * Sharps must be separated from all other waste and placed in **leak-resistant rigid, puncture resistant containers** * All containers must be **labeled properly**, especially if the treatment and disposal is taking place off-site

Answer 72

* Heat, incineration, steam sterilization, chemical treatment or other equivalent methods that renders the material inactive * An approved carrier should transport biohazardous waste

Answer 73

* Because of the volume of patients, it is not realistic for a practitioner to wash their hands in a sink after every treatment 1. Wash hands with soap and water on arrival and prior to leaving work, prior to eating and after restroom use 2. If hands are dirty with *organic material (blood),* wash with running water and either anti-microbial or non-antimicrobial soap 3. **Alcohol-based hand disinfectant** or **non-antimicrobial hand soap** should be used between treatments, provided *only needles; sterile packages or other materials* needed for the treatment werwe touched 4. Hands must be decontaminated between patients 5. Hands must be decontaminated after touching a patient's intact skin, as well as inanimate objects and medical devices near the patient 6. *Alcohol-based hand disinfectant* or *washing hands with non-antimicrobial soap* and water must be done between patients 7. *Gloves* should be available in the treatment area and should be worn when there is a *biohazardous spill* (i.e. bleeding from auricular acupuncture) 8. Wash hands immediately with soap and water after critical instances (i.e. contact with blood or break in the clean field between or during treatments) 9. Practitioners must have *hand disinfectant available* to them *at all times* in the public health treatment environment

CNT Review Exam Flashcards

(99 cards)