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Final review Flashcards

1
Q

stages of infection (IPFC)

A

Incubation period
Prodromal stage
Full (acute) stage of illness
Convalescent period

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2
Q

incubation period (think incubate)

A

The incubation period is the interval between the pathogen’s invasion of the body and the appearance of symptoms of infection. During this stage, the organisms are growing and multiplying. The length of incubation may vary. For example, the common cold has an incubation period of 1 to 2 days, whereas tetanus has an incubation period ranging from 2 to 21 days.

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3
Q

prodromal stage

A

A person is most infectious during the prodromal stage. Early signs and symptoms of disease are present, but these are often vague and nonspecific, ranging from fatigue and malaise to a low-grade fever. This period lasts from several hours to several days. During this phase, the patient often is unaware of being contagious. As a result, the infection spreads to other hosts.

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4
Q

full stage illness

A

The presence of infection-specific signs and symptoms indicates the full stage of illness. The type of infection determines the length of the illness and the severity of the manifestations. Symptoms that are limited or occur in only one body area are referred to as localized symptoms, whereas symptoms manifested throughout the entire body are referred to as systemic symptoms.

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5
Q

convalescent period

A

The convalescent period involves the recovery from the infection. Convalescence may vary according to the severity of the infection and the patient’s general condition. The signs and symptoms disappear, and the person returns to a healthy state. However, depending on the type of infection, there may be a temporary or permanent change in the patient’s previous health state even after the convalescent period.

A person may continually pass through the four phases with the same infectious process, such as with herpes simplex. Although there may have been only one infectious exposure, the infection may continue to cycle through the phase

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6
Q

5 times to wash hands

A

before touching a patient, before asceptic procedure, after body fluid exposure risk, after touching a patient, and after touching a patient’s surroundings

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7
Q

use alcohol rub to clean hands if…

A

they are not visibly soiled or have not come into contact with blood or bodily fluids, if moving from a contaminated body site to a clean body site during patient care, before and after each patient contact, after contact with surfaces in a patient environment, and after removing gloves.

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8
Q

if patient has PVD or diabetes, only who can perform foot care?

A

nurse - can only perform assessment of foot care. No foot soaks for diabetics.

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9
Q

how often is oral care for unconscious patient?

A

every 2 hours. That includes oral care brushing and suctioning, and place them on their side when performing that care. Bacteria in teeth causes pneumonia

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10
Q

modes of transmission - think transmission

A

droplet and airborne. droplet (large molecules) = coughing and sneezing. airborne = droplets suspended in air or dust

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11
Q

modes of transmissions - vectors - types of illnesses

A

malaria, Zika, Lyme, Plague. and you need a susceptible host.

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12
Q

things to consider before bathing (what you always forget)

A

is there a patient order, is the patient able to take care of themselves, are they bedridden.

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13
Q

transient pathogen

A

you can pick it up, easily removed by hand hygiene or hand washing. if you don’t, then they will become resident pathogens. Could be part of your normal flora.

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14
Q

people who carry bacteria without evidence of infection (fever, increased wbc) are

A

colonized

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15
Q

nebulizers have what bacteria?

A

pseudomonas

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16
Q

modes of transmission - what are the most common? (not airborne, etc)

A

contact.

direct contact (handshake)
indirect contact - stethascope

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17
Q

pneumonia - droplet - what precautions?

A

surgical mask would be acceptable. if you’re within 6 feet of patient, wear a mask

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18
Q

airborne - examples of viruses (VCT - victor is airborne) (and what do you need to wear)

A

TB, Covid, varicella - need to wear an N95 and negative pressure room.

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19
Q

most common HAI

A

Catheter associated urinary tract infections (CAUTI)

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20
Q

CDC tier I and II

A

tier 1 - hand hygiene, ppe, don’t recap needles, etc
tier 2 - airborne, droplet, contact with MRSA

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21
Q

Apical pulse measurement is the preferred method of pulse assessment for what age? (2 apical)

A

infants and children less than 2 years of age

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22
Q

tachypnea (tacky at 24) (FEVER)

A

> 24 breaths/min; Shallow -
Fever, anxiety, exercise, respiratory disorders

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23
Q

Bradypnea and how many (brady is so low)

A

<10 breaths/min; Regular - Depression of the respiratory center by medications, brain damage

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24
Q

Cheyne–Stokes respirations (Cheyne is friends with alden)

A

Alternating periods of deep, rapid breathing followed by periods of apnea; regular. Drug overdose, heart failure, increased intracranial pressure, renal failure

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25
Biot’s respirations (don bot is totally irregular)
Varying depth and rate of breathing, followed by periods of apnea; irregular. Meningitis, severe brain damage
26
phase 5 bp (tap, whisper, yell, blow, silent) bp
The last sound heard before a period of continuous silence
27
adult’s orthostatic blood pressure (lie, dangle, stand - 10,3,2)
adult’s orthostatic blood pressure (lie, dangle, stand - 10,3,2)
28
What results would indicate to the nurse the client is experiencing orthostatic hypotension (the number)
A decrease in systolic pressure >20 mm Hg
29
when to assess vital signs
When it is ordered (minimum requirement) - very minimum may be pre-op and post-op, or every 30 min - you can use judgement to assess you may need to document vital signs before giving meds. meds for heart rate, etc. you want to see how the medication is working. if patient is on bedrest, you may need to assess vital signs, possibly orthostatis (lying, sitting, standing) or might want to assess after (tachycardia) * On Admission to hospital or at office visit * When coming on to shift Policy Guidelines * Before during or after surgery or certain procedures * To monitor effect of medications or interventions Nurses Judgment * Before activity * To monitor effect of activity * Change in behavior or assessment
30
rectal temp is (and when not to use?)
core temp (appropriate choice for ppl w/ unstable temp) only if necessary. Is most reliable measurement of core temp, better than temporal. don't use for cardiac and bleeding problems. only use for good core temp (better than temporal) - don't use for young children
31
if patient has irregular rate, you must do
apical for one full minute.
32
orthopnea (ortho feet up)
difficultly breathing when lying flat - first thing raise head of bed
33
New blood pressure guidelines: YOU NEED TO KNOW THIS
Normal: Less than 120/80 mm Hg; * Elevated: Systolic between 120-129 and diastolic less than 80; * Stage 1: Systolic between 130-139 or diastolic between 80-89; * Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg; * Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.
34
P A T I E N T C O N D I T I O N S T HA T M A Y N O T B E A P P R O P R I A T E F O R E L E C T R O N I C B L O O D P R E S S U R E M E A S U R E M E N T (IPV L) (don't forget low...) this is just jittery, not medical.
* Peripheral vascular obstruction (e.g., clots, narrowed vessels) * Shivering * Seizures * Excessive tremors * Inability to cooperate
35
if someone has an irregular heart rate, or Blood pressure less than 90 mm Hg systolics, DO NOT
use electronic BP device
36
Isolation guidelines - just hand hygiene***add to this
CDC Guidelines (1996) Two Tiered Approach:  Tier One: Use Standard Precautions, hand hygiene and appropriate PPE  Applies to all body fluids (except sweat), non-intact skin, mucous membranes
37
prodromal (the prodrome is achy)
How you feel the day before you get sick. Achy, I'm coming down with something, low grade fever. most multiplication of disease and the most infectious stage.
38
incubation period of common cold (short cold)
about 24 hours
39
ticks - direct or indirect
indirect - vector
40
E. Coli - direct or indirect?
both, contaminated food or feces
41
Hep B - direct or indirect?
direct, indirect possible but unlikely. blood, feces, body fluid
42
HIV direct or indirect?
direct
43
TB contact precautions
airborne, sputum
44
salmonella - direct or indirect?
both. intestinal tract animals and humans. diarrhea (food = indirect) (human to human = direct)
45
staph - direct or indirect?
both. skin surface, mouth, nose
46
undiagnosed or transmissible respiratory infection - do this w/ ppl in the hospital
offer a surgical mask, maintain more than 3 ft of separation.
47
if airborne, follow what procedure?
private room w/ negative air pressure, 6 -12 air changes per hour, monitor filtration if air is recirculated. keep door closed. wear a respirator w/ TB patients.
48
if patient has vacirella (chicken pox) or ruebella (measles)...
wear respiratory protection unless person has immunity
49
droplet precaution
place patient in private room if possible. wear PPE, change gloves after contact w/ infected material. limit movement in and out of room. avoid sharing patient equipment
50
ex. of exogenous HAI bloodborne, cohorting w/ covid)
(bloodborne from IV therapy, or patient cohorted w/ another infected patient, Covid spread in facilities) community acquired pneumonia
51
Intentional Torts: (intentional torte is BAID)
* Assault * Battery * Defamation of Character * Invasion of Privacy
52
T E L E P H O N E O R V E R B A L O R D E R S
(usually only in emergent situations) write order as you heard it, then read it back verbatim to provider. make sure they agree with what you wrote. * Countersigned within 24 hours * Limit to emergent need when there is no alternative * Document order exactly as given * Read back order after entered to provider for confirmation * Follow policy guidelines * Document the order with time, date and situation necessitating order * Text message orders? providers have secure ipads.
53
informed consent must Must meet three requirements (CVU)
1. Individual has capacity to consent 2. Voluntary 3. The individual understands treatment and information presented Includes * What is being done * Why it is being done * Risks of procedure * Possible alternatives
54
Unintentional Torts: 2 types
* Malpractice * Negligence
55
malpractice (malpractice is just plain unprofessional)
any professional misconduct or unreasonable lack of professional skill
56
unintentional torts - * Negligence (I'm an unintentionally negligent not prudent)
failure to do what a reasonable and prudent person would do (including failure to follow policy and procedures)
57
Equipment Related Accidents (remember heating pads)
Equipment malfunction and failures – What is the appropriate action: * Label clearly, send appropriate department to be repaired * Wrong application, inappropriate use or unapproved use - example- heating pads! (remember this) they can burn someone. Ppl with pain don't feel the burn. * New equipment issues (training, lack of supervision) make sure you are oriented to all equipment
58
Fire and how to use fire exstinguisher (RACE AND PASS) WHAT TO DO WHEN THERE IS FIRE: (YOU NEED TO MEMORIZE THIS)
Fire (RACE AND PASS) WHAT TO DO WHEN THERE IS FIRE: * Rescue the patient * Activate alarm * Confine fire * Extinguish fire/Evacuate HOW TO OPERATE FIRE EXTINGUISHER: * Pull out safety pin * Aim nozzle at base of fire * Squeeze lever and handle * Sweeping motion you need to know where fire alarms are, exits, and extinguishers
59
4 Types of Assessments (I need COFE to be comprehensive, ongoing, focused and emergent) REMEMBER this
● Comprehensive ● Ongoing ● Focused ● Emergent
60
ongoing assessment - how often?
ex. 2-4 hour checks, changes in patient's status or meds. BP meds, or alcohol issues - looking for withdrawal bp.
61
Focused (focus on rash)*
Focused on a particular topic, specific part,or function of the body* Rash on leg.* (outline to make sure it's not getting bigger) Abd pain-Location, rebound, positional, last BM & void, last period, etc
62
Adventitious Lung Sounds (fine, of course, rhonda is striding in)
Fine Crackles (rales) (better) Coarse crackles (rales) (worse) Rhonchi (even worse) Stridor (very dangerous)
63
Preventable Adverse Event (preventable at every turn)
reasonable and prudent person would not carry out that error. failing to turn patient every 2 hours.
64
Sentinel Event (sentinelly severe)
so severe that it can cause death or severe harm, permanent severe harm or temporary severe harm
65
Never Event
events that should never happen, several ppl failing to turn patient and getting pressure ulcer, surgery on wrong limb. not monitoring patient who is at fall risk
66
anurea
no urine
67
collecting urine - do not collect from where?
Do not collect from foley bag * Observe sterile technique while collecting specimen
68
bladder scanner***
Used to measure urinary retention or post void residual (PVR) ❖Bladder distention ❖May result from BPH (prostate problem) prostate CA, neurogenic bladder, after long period of foley catheter use ❖S/S include frequent voids with
69
CAUTI
Formation of biofilms by urinary pathogens common on the surfaces of catheters and collecting systems ***Bacteria with biofilms resistant to antimicrobials and host defenses ❖CAUTI rates often a benchmark measure in the National Healthcare Quality and Disparities Reports (NHQDR)
70
CAUTI prevention***(catheters) (CDC guidelines)
❖Insert catheters only for appropriate indications consider external devices ***Remove catheter as soon as possible ***Normal and expected to feel burning sensation initially after catheter removal ❖Ensure sterile technique throughout insertion procedure ❖Proper hand hygiene and Standard Precautions
71
Assessment of GI System
Assessment of GI System Assessment order: Inspect, auscultate, percuss, palpate Inspect: ❖ Moist pink lips, mucosal membrane, oral hygiene ❖ Cough, gag, dysphagia ❖ Contour, lesions, for visible peristaltic waves ❖ Anal fissures, hemorrhoids Auscultate: ❖ Bowel sounds in all quadrants Palpation: ❖ Use warm hands ❖ Palpate for tender areas Percuss: ❖ General tympany is normal
72
how much fiber for constipation?
20-35 g fiber/day
73
Infectious Diarrhea: Clostridium Difficile
Etiology: ▪ Antibiotics (abx) kill off normal flora increasing susceptibility to pathogenic organisms ▪ C-diff spores can survive many months on objects- commodes, bedside tables, thermometers, etc. ▪ Must use soap and water for hand hygiene (Etoh base not effective) ▪ Enteric isolation in private room ▪ Do not give anti-diarrheals as the diarrhea is infectious ▪ C. diff is treated with combo abx-Metronidazole and Vancomycin ▪ Fecal transplantation ▪ Test all patients for C-diff if having ≥ 3 loose stools in 24 hr period ▪ Avoid giving unnecessary broad spectrum abx
74
bowel diversion - Ileostomy****(illeana was a fluid dancer)
End of ileum (small intestine) brought through opening to abd wall to form a stoma. liquid to semi-liquid
75
Characteristics of stoma
➢ pink/red normal (pale-anemia, maroon/purple-ischemia) ➢ Edema (severe d/t obstruction, allergic rxn, gastroenteritis) ➢ Bleeding (small amount normal d/t high vascularity
76
stoma - Characteristics of drainage/stool - change how often?
depends on new or existing ostomy and location of ostomy ❖ Note amount and frequency ❖ Change ostomy bag every 3 days or policy (more frequent if needed) ❖ Physical and Psychological support
77
ascending stoma (ascending, but not there yet)
semi-liquid
78
transverse stoma (trans can be either)
semi-liquid to semiformed, possibly increased
79
sigmoid stoma (sigfried is formed)
colostomy - large intestine. formed.
80
is minor bleeding with stoma normal?
yes
81
Infectious – Clostridium Difficile***what to do if you suspect it?
Initiate enteric contact isolation and send stool sample for C-diff
82
intrarenal
vancomycin - damage inside the kidneys
83
post renal
back up, kidney stones
84
pre renal
direct damage - hit, accident
85
use a bladder scanner if the patient has...
not voided during your shift. if scanner shows around 300 ml, it's the cutoff
86
implicit bias
Unconscious Bias Implicit Bias - it's the same as unconscious bias - WE all have it within us - identify it and reduce it with patients Explicit Bias - this is conscious
87
State Nurse Practice Act (NPA) (the practice defines the scope)
Influences nursing practice and defines SCOPE of practice, mandating reporting
88
Adverse drug reactions -
Preventable or unintentional
89
Medication Errors-what to do (VS, notify, tell, report, root cause)***
1. Assess the patient’s VS and any other symptoms 2. Notify the primary care team, charge nurse and manager 3. Inform the patient and family 4. Complete an Incident Report 5. Root cause analysis for sentinel
90
10 rights of meds
1. Right patient 2. Right medication 3. Right dosage 4. Right route 5. Right time 6. Right to refuse 7. Right documentation other Rights 8. Right assessment 9. Right education 10. Right response
91
Antihypertensives: - when to hold
○ Know current BP and HR administration (within 30min): generally hold for SBP <100, HR <60 ○ Some antihypertensives have no specified hold parameters; use judgment
92
Diuretics: - what to check for? (you've had personal experience)
○ Check BP and Creatinine level ○ Check K and Mg level (hold and report if <3.5 mEQ/L) ○ Monitor I and O ○ Assess weight esp for patients with heart failure
93
Digoxin (digging for a new heart) what to do before giving to patient? (And what else? Same as spiro)
Digoxin-for heart failure; Take APICAL pulse for 1 min; Check Potassium Levels – low K+ ↑ risk of digitalis (this is just digoxin) toxicity
94
Nitrates -when to hold (same)
Nitrates-hold SBP < 100
95
Heparin infusion - what to check before giving - hepburn loves Pilates
Know platelet count (Heparin may induce thrombocytopenia “HITT) ○ IV Heparin- check aPTT
96
Inhalers/Nebulizer treatments - what to do before and after albuterol - think LUNGS
○ lung sounds, RR, O2 sat before and after (Albuterol will increase HR)
97
Antibiotics: (you know this - AND antibotics have highs and lows)
know cultures, WBC, temperature, any diarrhea, peak and trough levels, renal function (BUN/Cr)
98
meds via NG tube - how long to stop suction before feeding?
● If medication is to be given on an empty stomach, allow at least 30” before restarting feeding ● If NGT to suction in place, stop suction for 30 min for
99
Topical Nitroglycerin
Given for chest pain ⚫ Do not get on hands!!! ⚫ Squeeze ointment onto paper with designated markings ⚫ Ordered in inches as marked on paper ⚫ Cover with tape, date, time, and your initials ⚫ Evaluate effectiveness
100
inhaled meds
● Always rinse mouth after steroid inhalers to minimize risk of thrush oral (yeast infection) ● Recommend to wait one minute between puffs of inhalers
101
hypoglycemia
Non diabetic Glucose target: Fasting 60-100 mg/dl After meals < 140 mg/dl Diabetic Glucose target: Fasting 70-130 mg/dl After meals < 180mg/dl
102
type 1 diabetes (type 1 is so fruity it gives me a stomach ache)
*Fruity sweet breath if ketones present (DKA-ketone bodies) *Nausea and vomiting *Shortness of breath *Dry mouth *Abd pain *Weakness *Confusion *Coma
103
high alert meds
■High alert meds: Heparin, Insulin, narcotic drips and certain chemo medications require 2 RN check
104
ex of adverse drug reaction (ativan is adverse)
Ex - ativan can make elderly ppl more agitated and delirious or cancer drugs weaken immune system
105
most common med error involves what?
the route
106
insulin administration
clear before cloudy - Inject Air into NPH Insulin (Cloudy) ... Inject Air into Regular Insulin (Clear) ... Withdraw Regular Insulin Units. ... Withdraw NPH Units. ...
107
pain don't rely on what?
DONT rely on vital signs for pain - they aren't reliable.
108
● Pain threshold
amount of pain stimulation necessary before one feels pain.
109
acute pain
3 months, beyond is chronic.
110
Noninvasive Interventions pain
Cutaneous Stimulation - massage Cold or heat packs - good research on cold. getting more research on heat, but inflammatory not good in the first 24 hours due to inflammation. alternate hot and cold is good. Menthol ointments’ Contralateral Stimulation - knee surgery, they have pain on affected knee. you can massage opposite knee to help TENS
111
cox 2 inhibitors
COX-2 Inhibitors - only one left on market is celebrex. works well for arthritis, but risk for older adults of heart attack and stroke.
112
most dangerous med administraiton route
most dangerous route is IM - because the absorption is not steady. can result in aspiration, abcesses. safest route is oral.
113
Sensory Deprivation (think of the senses)
hearing, vision, not having glasses. confusion w/ older adults. interventions - try to orient them. turn on TV or music. engage in conversation. have family members come by. move closer to nurse's station, shared room. activities outside of room.
114
pulse deficit
+ or - 2
115
shane stokes
116
kusmall
117
pulse deficit
different pulse at different sites, difference of more than + or - 2, then the patient has a pulse deficit
118
PASS
pull, aim, squeeze, sweep
119
acetominphen
4000 mg/24 hrs, liver 2000 mg/24 hr
120
Fine Crackles (crackle you're poppin high) and ex.
Fine Crackles (rales) (better) * popping, crackling sound * high pitched pneumonia and pulmonary edema
121
Coarse crackles (course bubbling) and ex.
Coarse crackles (rales) (worse) * Bubbling sound * lower pitched than fine crackles inflammation or infection of the small bronchi and heart failure
122
Rhonchi (Rhonda is low and snoring) and ex.
Rhonchi (even worse) * Air passing through mucous and secretions in large airways * May be cleared by coughing * low pitched continuous, coarse snoring quality COPD and cystic fibrosis
123
Stridor (stide in when you're harsh and high)
* Narrowing of upper airway; Foreign body obstruction * Harsh loud high pitched
124
* Assault (my threat is assaulting)
* Assault – any intentional threat to bring about harmful or offensive contact
125
battery
* Battery – any intentional touching without consent
126
defamation of character
* Defamation of Character (slander or libel)
127
invasion of privacy
* Invasion of Privacy – all information about patients is considered private or confidential (HIPAA).
128
don't forget what with NG tube?
gag reflex!!!
129
equipment for NG tube
tube, connector - clear, pen light, tongue depressor, tape, water, basin, pad, tissues, lubricant, measure suction thing, ph test kit.
130
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