Test #2 Flashcards
(139 cards)
1
Q
What types of areas do Germs like?
A
Germs like dark, moist, cold/warm temps
2
Q
What are some sources of infection?
A
- hospital elevators
- toilet seats/stalls
- door knobs
3
Q
What is normal flora?
A
Germs that reside in us, and make up our mircrobio. It can be disrupted with antibiotics, etc.
4
Q
What happens when normal flora is impaired?
A
Gi disruptions
5
Q
What is our relationship with bugs?
A
- Symbiotic relationship
- Bugs help us build our immunity and our microbiome
6
Q
What are the barriers/facilitators when it comes to germs and infections? (10)
A
- Immunizations
- Diet
- Nutrition
- Age
- Virulence
- Stress
- Comorbidities
- Previous exposure
- Water, sanitation
- Global context
7
Q
Describe Colonization:
A
Microorganisms present without host interference or interaction
8
Q
Describe what occurs when there is an infection:
A
Host interaction with an organism
9
Q
What is a surgical wound in the context of infection?
A
Sterile 0% exposure to bugs, infection
10
Q
What is a pressure sore in context of infection?
A
More exposure to bugs, colonization
11
Q
What are the two definitions of Infectious Disease?
A
Symptomatic: When host displays a decline in wellness due to the infection
Asymptomatic: When host interacts immunologically with an organism but remains symptom free
12
Q
What is Localized Infectious Disease?
A
Infection that is confined to a certain area, not spreading
13
Q
What is Systemic Infectious Disease?
A
Infection that affects the entire body, spreading through the rest of the body
14
Q
What are the phases of Infection? (4)
A
- Incubation Period
- Prodromal Stage
- Illness stage
- Convalescence
15
Q
What is the Incubation Period?
A
When a microorganism has entered your body but you have no symptoms
16
Q
What is the Prodromal Stage?
A
Onset of symptoms, not specific symptoms. ex. cough, not feeling well, myalgia
17
Q
What is the Illness Stage?
A
Onset of specific symptoms. ex. flu
18
Q
What is Convalescence?
A
When the symptoms start to dissolve, and we get back to normal base line
19
Q
When is an infection likely to spread? During which phase of the course of infection?
A
Incubation period - you don’t know you are a risk
20
Q
What is Surgical Asepsis?
A
- Surgical tools that go into the body
- Complete absence of microorganism
ex. Sterile to Sterile
21
Q
What is Medical Asepsis?
A
Extremely clean, not 100% sterile
22
Q
What is Cleaning?
A
When cleaning non-critical items such as bp cuffs
23
Q
What is Disinfection?
A
Cleaning everything except spores
24
Q
What is Sterilization?
A
Cleaning everything
25
What is the Oligodynamic Effect?
When materials clean themselves over time
ex. Copper and Brass
26
How are germs spread?
- Contact
- Droplets
- Airborne
27
What is Nosocomial?
Health care associated infections
28
What are Health Care Associated Infections (HCAI)?
- infections acquired in a hospital, when admitted for a reason other than that infection
- Includes infections acquired in hospital, but appear after discharge
29
What are high risk HCAI?
- pneumonia
- wound/surgical
- urinary tract infections
- blood stream infections
30
What is CBC?
Complete Blood Count
31
What is C&S?
Culture and Sensitivity
32
What does Iron Level indicate?
Decreased chronic infection
33
What is ESR?
- Erythrocyte Sedimentation Rate
- it shows inflammation in the body
- Can't determine where specifically the inflammation is
34
What is CRP?
- C-Reactive Protein
- Shows inflammation in the body
- Can't determine where specifically the inflammation is
35
What is the major mode of transmission in health facilities?
Indirect contact
36
What is Resident Hand Bacteria?
bacteria that resides on the hand
37
What is Transient Hand Bacteria?
Bacteria that is acquired by healthcare workers from other clients
38
What are the 5 steps of Transmission as determined by WHO?
1. Organisms present on patients, or have been shed onto objects
2. Transfer to the hands of HCW
3. organisms survive more than several minutes on the HWC's hands
4. Inadequate or entire omission of handwashing
5. contaminated hands come into direct contact with patient or object
39
When did Safety Culture first appear?
In 1988 after a really big disaster, Chernobal. Nuclear powerplant
40
Why are safety protocols mandatory?
Because if something was optional, people wouldn't participate in them, even when it came to safety
41
What is Safety Culture? (long one)
The product of individual and group values, attitudes, competencies and patterns of behaviour that determine the commitment to, and the style and proficiency of, and organization's health and safety programmes
42
How does culture (often) trump policy?
Policy says wash your hands, but the culture influences if people actually do it
43
How many adverse events occur in hospitals in Canada?
185,000 (injury, disability, death)
44
How many adverse events are preventable?
70,000
45
What are the most common adverse events?
- Surgical
- Drug
- fluid related incidences
46
What are Never events?
A call-to-action, not a demand or an attempt to shame mistakes
47
What are the Never events for surgery?
- Wrong body part
- wrong pt
- wrong procedure
- foreign object left in pt
48
What are other Never events that can occur? (4)
- death/harm due to failure to inquire whether a patient has a known allergy to med'n
- Death/harm as a result of wrong route, IV admin of concentrated K+
- any stage 3 or 4 pressure ucler acquired after admission to hospital
- Patient death or serious harm due to uncontrolled movement of ferromagnetic object in an MRI area
49
What is a Near Miss?
- AKA close call
- Event that could have resulted in unwanted consequences, but did not because either by chance or through timely intervention the event did not reach the patient
50
Describe a critical incident report of an error:
1. Describe incident in as much detail as possible
2. describe thoughts, feelings, concerns
3. factors that you think contributed directly or indirectly
4. impact on yourself, family, others
5. what you have learned
51
Of 2,455 sentinel event, what precent is due to communication errors?
75%
52
What is SBAR?
Tool for communication
53
Describe SBAR:
S - Situation (intro; who you are, provide basic details)
B - Background (relevant info to the current problem)
A - Assessment (why we're calling; done after looking at the client, this is what is going on)
R - Recommendation (what do we want the physician to do)
54
What is the most common treatment intervention used in healthcare around the world?
Prescription Medications
55
What is Medication Safety?
Freedom from preventable harm with medication use
56
Are some medications riskier than others?
Yes, that is why some medications are over the counter and others prescription
57
What is the major risk/concern of Acetaminophen?
Liver damage
58
What are the medications we want to be careful when using? PINCH
P - Potassium
I - Insulin
N - Narcotics
C - Chemotherapy
H - Heparin
59
What is the difference between an Adverse Event and an Error?
an Adverse event occurs when there is no knowledge of the possible outcome, and the action is completed. ex. medication given, pt has NKA, but an allergic reaction occurs
an Error occurs when there is knowledge of the possible outcome, but the action is still done. ex. medication given, pt has known allx, and a severe reaction occurs
60
What is the impact of bullying in nursing?
- nurses consider leaving profession
- affects physical and emotional health
- can threaten patient safety and outcomes
61
Does the amount or type of tissue damage influence pain response?
Yes, for example paper cut vs. breaking an arm
62
What is particularly painful?
Burns
63
What is the assessment of pain called?
the 5th vital sign
64
What is Acute Pain? (4)
- short term
- Sudden onset (ex. surgery)
- Resolves
- Protective
65
What is Chronic Pain? (5)
- long term
- longer healing time
- affects quality of life
- ability of function
- not serving a physiological purpose
66
What are the different types of pain? (6)
- Acute
- Break-through
- Chronic
- Cancer related
- Idopathic/incident
- Procedural: biopsy
67
What is Break-through pain?
When we have controlled pain, and then a sudden onset of pain
68
What is Gate Control Theory?
You can open and close different pathways of pain. These gates can open and close changing the pain experience. ex. hit your head and rub it/distraction
69
What is Nociceptive pain?
Aching or throbbing pain, well localized. Damage to somatic or visceral tissue
70
What is Neuropathic pain?
- More sharpe, sometime described as electoral
- caused by damage to nerve cells or changes in spinal cord processing
71
How can pain be easy?
by being more linear
72
Why can pain be Complex? (9)
- accessibility
- cultural values
- medical values
- medical racism
- money
- transportation
- addiction
- fear
- age
73
What are the factors influencing pain response? (7)
- anxiety/depression
- sleep/fatigue
- hereditary
- previous experience
- culture
- age
- meaning you assign to the experience
74
What are the barriers to pain control? (6)
beliefs about pain-related practices shaped by:
- past experiences
- age
- education
- culture
- ethnicity
- gender
75
What do nurses and healthcare workers often do when patients self report pain?
they doubt the patient
76
What do nurses tend to do when it comes to pain and their patients?
- over-estimate when clients report no pain
- underestimate when mild to intense
- nurse's personal opinion about client's report of pain affects titration of opioid
77
What are some pain related beliefs/concerns? (6)
- fear of injections
- fear of addiction or tolerance
- fatalism about the possibility of achieving pain control
- belief that "good" patients do not complain about pain
- fear of distracting physician from treating disease
- belief that pain signifies disease progression
78
What is Pain?
Multidimensional
79
What are some examples of non-pharmacological pain relief? (8)
- environment
- music
- lighting
- temperature
- positioning
- tight dressings
- skin care
- hygiene
80
What is the safest and cheapest way to administer pain medications?
Orally
81
What are the different routes for administering pain medication? (7)
- Oral
- epidural
- Transdermal
- Transmucosal
- Intraspinal
- Parenteral
- Inhalation
82
What is the WHO Analgesic Ladder?
A guideline to decide which medication you should use
83
What are the main forms of Analgesic (pain med)?
- NSAIDS/non-opioid
- Opioids
- Co-analgesic/adjuvant
84
What are the different types of Analgesic pain medications?
Step 1: Over-the-counter, for mild pain
- Tynelol
- Advil
Step 2: for moderate pain. ex. dental procedure
- Codeine
- Oxycodon
Step 3: for severe pain
- Morphine
- Fentanyl
- Hydromorphone
- Dilaudid
85
What should we be aware of when administering pain medications to Pediatric patients? (4)
- newborns can't report
- remember assessment scales
- be cautious around codeine
- infants older than 1 month of age can metabolize drugs in the same manner as older infants and children
86
What should we be aware of when administering pain medications to Elderly patients? (4)
- "start low and go slow"
- Comorbidities + drug interactions
- Use of NSAIDS
- constipation
87
What are the side effects of Opiates? (5)
- respiratory depression (changes respirations + depths)
- Drowsiness/lethargy
- Nausea + vomiting
- Constipation
- Tolerance + addiction
88
What is Addiction?
Use of a drug, even when we know the adverse effects
89
What is Tolerance?
When our body is getting use to the drug/medication
90
What are Opioids?
Psychoactive substance derived from the opium poppy, or synthetic analogues ex. morphine and heroin
91
How many people in the world suffer from dependence/addiction on Opioids?
15 million
92
How many deaths are estimated around the world per year due to Opioids?
69,000
93
What is the percent of people who get help with Opioid dependence/addiction?
10%
94
What drug is used to reverse the effects of opioids?
Narcan/Naloxone
95
How did we get to an Opioid Crisis? (5)
- misunderstanding of addictive risk
- Frequent and high amounts of prescribing
- lack of access to prescriptions leading to illicit use
- Contamination
- Stigma towards substance use disorders
96
What is Venipuncture?
Technique in which a vein is punctured through the skin by a sharp rigid stylet
97
Why do we not use arteries during venipuncture?
- there is increased pressure
- they are deeper than veins
98
What is Secondary IV?
If you want to piggy back, or run a med with iv fluid
99
What is Bolus IV?
Giving volume of meds quicker over a shorter period of time
100
What is Push IV?
When you are bolusing a medication, you are using a syringe and push it in, below the drip chamber
101
What is Patent IV?
Pre-flowing, no blockage, just flowing normally
102
Why do we use IVs?
- onset is faster
- some medications can't be given orally
- quicker way to give fluids, blood
103
What is TPN?
Total Parenteral Nutrition
Supplies all daily nutritional requirements; placed along with a central venous catheter
104
What are Crystalloids?
- Solutions which contain water-soluble electrolytes including Na and Cl
- Small molecules, and therefore can cross the vein membrane
- Ex. Glucose, NaCl, Lactated Ringers
105
What are Colloids?
- solution used for fluid replacement (IV)
- large molecules and therefore stay in the blood longer
- Albumin, Pentaspan, PRBCs
106
What are some common IV fluids?
- Normal Saline NaCl 0.9%
- D5W Dextrose 5% in water
- 2/3 (Dextrose) and 1/3 (NaCl)
107
What joins arteries and veins?
Capillaries
108
What are the different types of IV solutions?
- Isotonic
- Hypotonic
- Hypertonic
109
What are Isotonic Solutions?
- most common
- does not cause a fluid shift
- Used for rehydration, expanding/replacing volume, ECF
110
What is an example of an Isotonic solution?
0.9% NaCl normal saline
111
Who is at particular risk for fluid over load with 0.9% NaCl NS?
Clients with cardiac problems and kidney problems
Typically older clients
112
What is a Hypertonic Solution?
- solution that causes fluid to shift into intravascular space from intracellular and into the interstitial
- cell shrinks
113
Why is Hypertonic solution not used for dehydrated patients?
Because it pulls water out of our cells; the cell shrinks
114
What is an example of a Hypertonic Solution?
3% or 5% NaCl
115
What are some situations we should be cautious of when administering a Hypertonic solution?
- renal failure
- heart failure
116
What is a Hypotonic solution?
- solution that causes fluid to shift from intravascular into cells and interstitial spaces
- cell swells
117
What are Hypotonic solutions used for?
- For hydrating intracellular fluid (ICF) and interstitial spaces
- for if the client had high Na
118
What is one of the most common electrolyte imbalances?
Hypokalemia
119
What do we need to ensure our clients have adequate function of when giving them fluids?
Renal/kidneys
120
Why can't we give potassium as a bolus/push IV?
Because if we give it fast, it will stop the patients heart
121
Do you need a physician order to initiate an IV?
Yes
122
What information is included in a physicians order when initiating an IV?
- type
- solution
- rate
- timing
123
What is the difference between a Peripheral vs. Central IVs?
Peripheral:
- increased distance to heart/central circulation
- easier to manage, change, and insert
- inserted to the top of the hand, forearm
Central:
- closer to the heart
- decreased chances of infiltration
- disperse quicker
- longer term
124
What are the different types of Central Lines?
- Peripherally Inserted Central Catheter = PICC
- Tunneled
- Portacath
- Subclavian
125
What is PICC?
- IV inserted in the grove of the arm by the brachial artery, into the superior vena cava of the heart
- Can be inserted at the bed side, can stay in
126
What is a Tunneled Central Line?
Under the skin - protects from infection
- most commonly placed in the neck into the internal jugular vein and extends down to a larger vein just above the heart
127
What is a Portacath Central Line?
- Surgically placed catheter
- typically right side of the chest
- super long term
- for someone who has cystic fibrosis
128
What is a Subclavian Central Line?
- Directly into the vein
- by the upper part of the shoulder
129
Why is air in an IV line a concern?
possibly risk for an embolism
130
Where should a peripheral IV be inserted?
the distal site whenever possible, starting with the top of the hand and moving up the forearm
131
Why should we use the distal site whenever possible for an IV insertion?
Because you can always move up, but not down
132
What influences the flow rate? (8)
- height of the bag
- diameter of the tubbing
- length of tubbing
- Viscosity of solution
- position
- dressing too tight
- kinked tubing
- clamp
133
What can Diuretics cause?
Loss of electrolytes
134
What can Hypokalemia cause?
Metabolic Alkalosis:
- kidneys conserve K+, H excretion increases
- cellular K+ moves out of the cells, H enters
135
What are some complications of IV therapy? (8)
- Inflitration/extravasation
- Phlebitis (mechanical or chemical)
- Volume/fluid overload
- bleeding
- infection
- air embolism
- sepsis
- hematoma
136
When infiltration occurs, what do you do?
Discontinue, resite, reinsert, vein another extremity
137
When Phlebitis develops, what do you do?
Discontinue, resite, reinsert, vein another extremity
138
What is the risk r/t phlebitis?
clot or embolism forming
139
When should you change the site of an IV?
Every 72 hours, depending on the facility policy
