Fundamentals - Safety and Infection Control

polycythemia vera

condition characterized by too many erythrocytes; blood becomes too thick to flow easily through blood vessels

Dysplastic nevus

a mole with precancerous changes

what are circumscribed skin lesions?

are well defined with sharp borders.

Impetigo

bacterial skin infection characterized by isolated pustules that become crusted and rupture

The hospital administrator receives a text message from the city emergency management team that an 80-car pileup on the interstate has occurred because of icy road conditions and over 125 victims are being transported to the facility. How should this information be shared with all hospital staff? Select all that apply.

Group paging systems, telephone trees, and instant computer-based alert messages are the most common means of notifying essential personnel of a mass casualty incident or disaster. The National Guard would not communicate a disaster to a hospital, although they might be dispatched to assist. Public service announcements on television would be appropriate if a catastrophic event occurred.

Trough

Minimum blood serum concentration of medication reached just before the next scheduled dose

Partial Agonists

Other medications attach and produce only a small response or prevent other reactions from occurring.

A client is admitted in active labor at 39 weeks' gestation. During the initial examination the nurse identifies multiple red blisterlike lesions on the edges of the client's vaginal orifice. Once the nurse has spoken to the primary healthcare provider and received prescriptions, what is the priority nursing action?

Preparing for C-section The lesions are probably a herpes infection, which can be fatal to the newborn if it is transmitted during a vaginal birth. Herpes is a viral infection that does not respond to antibiotics. A client in active labor will give birth vaginally, before the test results of the smear become available. Standard precautions should be used; double gloving is unnecessary.

duration of action

The length of time during which the medication is present in a concentration great enough to produce a response is termed ________.

A client with cellulitis of the leg asks why bed rest has been prescribed to prevent sepsis. Which purpose will the nurse explain to the client?

This limits muscle contractions that may force causative organisms into the bloodstream. Exercise will promote extension of the local infection from the leg into the circulation, causing septicemia (sepsis). Although bed rest does decrease catabolism to promote healing at the site of injury, it is not the purpose for bed rest in this situation. Although bed rest does reduce the energy demands on the body in the presence of infection and lowers metabolic rate, it is not the purpose for bed rest in this situation.

Methemoglobinemia

a blood disorder in which an abnormal amount of methemoglobin, a form of hemoglobin, is produced

a macule is

a circumscribed, flat area with a change in skin color.

A vesicle is

a circumscribed, superficial collection of serous fluid.

Erysipelas

a contagious disease of the skin and subcutaneous tissues caused by infection with streptococci organisms; redness and swelling of affected areas

actinic keratosis

a precancerous skin growth that occurs on sun-damaged skin

Diabetes mellitus is associated with

a yellow-orange color of the palms and soles

Airborne precautions

are used when known or suspected contagious diseases can be transmitted by means of small droplets or particles that can remain suspended in the air for prolonged periods of time. Small droplets or particles can cause disease transmission over a greater distance and longer time than larger droplets ØPrecautions include the following: •A negative-pressure room with a high-efficiency particulate air (HEPA) filtration system is necessary. •A special N95 respirator mask is required. Medical evaluation and measurement for the wearer are required before obtaining the respirator. It must be fit-tested by the facility. ØTypical diseases and pathogens include the following: •Varicella or disseminated varicella zoster (chickenpox) •Rubeola (measles) •Mycobacterium tuberculosis (pulmonary or laryngeal tuberculosis)

A safe therapeutic range is achieved when the medication blood level is producing a desired effect while remaining ________ the level of toxicity.

below

furuncle

boil; a painful nodule formed in the skin by inflammation originating in a hair follicle; caused by staphylococcosis

The second line of defense is the

inflammatory response. Inflammation is a local response to cellular injury or infection that includes capillary dilation and leukocyte infiltration. This response produces redness, heat, pain, and swelling. •Inflammation activates the immune response, which is the body's attempt to protect itself from foreign and harmful substances. The immune response is initiated by recognition of antigens. An antigen is any substance that provokes an adaptive immune response. The immune system recognizes and destroys substances that contain foreign antigens.

papilloma

is a benign tumor that forms on the surface of the epithelium

Montgomery straps

may be used instead of a binder. Montgomery straps are adhesive, multi-holed straps placed on the skin on opposite sides of a wound

A bluish color of the mucous membranes may indicate

methemoglobinemia (the presence of methemoglobin in the blood, which is an oxidized form of hemoglobin) and cardiopulmonary disease in the client

carbuncle

skin infection composed of a cluster of boils caused by staphylococcal bacteria

wheal

small, round, raised area on the skin that may be accompanied by itching; usually seen in allergic reactions

cross tolerance

tolerance for a substance one has not taken before as a result of using another substance similar to it

Cold therapy causes

vasoconstriction, reducing the oxygen demands of the tissue; it decreases pain, decreases swelling, decreases blood flow, prevents edema, provides anesthesia, and relieves muscle spasms. It can be applied through the use of ice bags, cool compresses, cool soaks or baths, or pads through which cool water is circulated

Herpes zoster

viral disease affecting the peripheral nerves, characterized by painful blisters that spread over the skin following the affected nerves, usually unilateral; also known as shingles

Shingles

viral disease that affects the peripheral nerves and causes blisters on the skin that follow the course of the affected nerves

Heat causes

Øvasodilation, improving blood flow and bringing oxygen, nutrients, and leukocytes to the area; it decreases edema, promotes muscle relaxation and decreases stiffness, helps to debride wounds, and can be soothing for the patient. It can be applied through moist heat in compresses, soaks, or baths; through dry heat delivered using electric heating pads, disposable hot packs, or pads through which warm water is circulated; or through radiant heat from a heat lamp.

ØUAP care for patients under these conditions. UAP should report any of the following to the nurse:

•Any need for further patient education regarding use of PPE •Personnel or visitors not following required PPE guidelines •Concerns regarding care of patients when PPE is required

ØUAP should be instructed in the following:

•Appropriate technique and PPE equipment required for patient care •Appropriate donning and removal of PPE •Appropriate communication techniques for discussing the need for PPE with the patient

Wound cultures are performed to

•Determine whether infection exists •Determine appropriate treatment for infection (by testing the sensitivity of the cultures to various medications) •Evaluate the effectiveness of treatment for infection

•An infection control nurse

•Documents any confirmed infection •Places the patient on appropriate isolation precautions •Consults with the primary care provider (PCP) for appropriate actions •Coordinate the procedure with a physical therapist if other wound debridement or stimulation treatments, such as whirlpool or e-stimulation, are required. •Collaborate with the PCP or the surgeon and coordinate the procedure with the physician's rounds if the wound needs to be examined. •It is important for health care providers at the next level of care to be aware of the wound care treatment plan. It may be necessary to order supplies and equipment for the patient to take home or for the next facility before the patient is discharged from the acute care facility.

•A wound care nurse specialist

•May perform the procedure •Coordinates assessment and timing with other procedures

intermittent suturing

•each suture is tied and knotted individually. Each suture is created from a single piece of material. Numerous pieces of suture material create the suture line.

. Closed drainage systems

•such as Jackson-Pratt (JP) drains and Hemovac drains are soft drains attached to a bulblike (JP) or springlike (Hemovac) suction device. When the drain is compressed and plugged, it provides suction by pulling drainage from the wound as it re-expands. Although many closed drainage systems are placed during surgery, they can be inserted into fluid collections using ultrasound or CT guidance.

continuous suturing

•the suture line is one continuous piece of material with a tie or knot at the beginning of the line and a second tie or knot at the end.

After an earthquake, why would the federal government send a Disaster Medical Assistance Team (DMAT) to the site?

A Disaster Medical Assistance Team (DMAT) is a medical relief team made up of civilian medical, paraprofessional, and support personnel that is deployed to a disaster area with enough medical equipment for 72 hours. The Medical Reserve Corps (MRC) provides acute care to clients for anywhere from a few hours to weeks. The National Disaster Life Support Foundation offers Core, Basic, and Advanced disaster life support training courses. International Medical Surgical Response Teams (IMSuRTs) provide fully functional field surgical facilities at any time.

Cross Tolerance example:

A patient with a history of alcohol abuse. He requires a large amount of pain medication to relieve his postoperative pain.

What is the color of a client's wound caused by skin tears?

A wound that is caused by skin tears is red in color. A wound caused by a full-thickness or third-degree burn is gray or black in color. Wounds with nonviable necrotic tissue that create an ideal situation for bacterial growth are yellow in color.

The nursing assistant asks you the difference between a wound that heals by primary or secondary intention. You will reply that a wound heals by primary intention when the skin edges A.Are approximated. Are approximated. B.Migrate across the incision. C.Appear slightly pink. D.Slightly overlap each other.

A. Are approximated.

What is an Idiosyncratic Reaction?

An idiosyncratic reaction is an unpredictable effect in which a patient overreacts or underreacts to a medication or has a reaction different from normal.

A local emergency department (ED) recently implemented an automated tracking system for triage during mass casualty incidents (MCIs). Which items can the nurse track using this system? Select all that apply.

Automated tracking systems using infrared and radiofrequency technology (RFT) are available in some emergency departments to track a client's triage priority upon arrival, location, and process of care. The interactions the client has with caregivers can also be tracked; this is an important safety strategy if the client is later found to have contaminants or a disease that could pose a risk to staff members who had close contact and require decontamination or prophylaxis. Clinical manifestations cannot be tracked using this system.

Benefits of wraps, bandages and binders

Benefits include promoting venous return, decreasing blood pooling in lower extremities, increasing hemostatic pressure, and maintaining dressing placement

Plateu

Blood serum concentration reached and maintained after repeated, fixed doses

What is a tepid bath?

Hydrotherapy. A bath in which the individual is immersed up to the neck in water that is slightly cooler than the body's normal temperature; tepid baths are believed to be useful for anxiety, insomnia and menstrual disorders. *Luke warm temp*

what is a coalesced type of skin lesion?

LESIONS THAT MERGE WITH ONE ANOTHER AND APPEAR CONFLUENT.

Duration of action

Length of time during which a medication is present in a concentration great enough to produce a therapeutic effect

What are serpiginous lesions?

Lesions with wavy borders that resemble a snake

Which physical changes may cause longitudinal nail ridges?

Longitudinal ridges may be due to decreased blood flow to the nail beds. Decreased cell division in the skin may cause a delay in wound healing. Increased risk of fungal infections is due to decreased rate of growth. Increased risk of osteomalacia is due to a decrease in vitamin D levels.

A surgical wound requires a Hydrogel dressing. The primary advantage of this type of dressing is that it provides: •An absorbent surface to collect wound drainage. •Decreased incidence of skin maceration. •Protection from the external environment. •Moisture needed for wound healing.

Moisture needed for wound healing.

Basal cell carcinoma

Nodular and ulcerative basal cell carcinoma is manifested as a small, slowly enlarging papule. Borders are semitranslucent or pearly, with overlying telangiectasia showing erosion, ulceration, and depression in the center

You are caring for a patient who underwent surgery 48 hours ago. On physical assessment, you notice that the wound looks red and swollen. The patient's WBCs are elevated. You should A.Start antibiotics. B.Notify the physician. C.Document the findings and reassess in 2 hours. D.Place the patient on isolation precautions.

Notify the physician.

Antagonist

Some medications attach at the receptor site without producing a new chemical reaction by preventing activation of the receptor.

Peak action

The time it takes for a medication to reach its highest effective concentration is termed ________.

When is the peak and trough levels drawn?

The trough is drawn 30 minutes before the medication is administered, and the peak is drawn when peak concentration occurs.

Onset of medication action:

Time it takes after a medication is administered for it to produce a response

Peak Action

Time it takes for a medication to reach its highest effective peak concentration

Melanoma

black tumor

retention suturing

•stronger and deeper sutures are made and typically must be removed by the PCP. •Suture materials include silk, cotton, dacron, linen, nylon, wire, and steel.

What are annular skin lesions?

are ringlike with raised borders around flat centers of the normal skin.

Folliculitis

inflammation of the hair follicles

contact precautions

are used when a known or suspected contagious disease may be presents The following are typical diseases and conditions requiring use of contact precautions: •Multidrug-resistant organisms (MDROs) •Scabies and herpes simplex virus (HSV) •Draining wounds in which certain organisms have been cultured

Adenoma

forms on the glandular epithelium

The presence of a brown color of the distal lower extremities may indicate

hemochromatosis (deposition of iron salts in the tissues).

senile lentigines

dark-yellow or brown spots that develop on the skin as aging occurs

Pharmacokinetics is the study of the metabolism and action of medications with particular emphasis on which of the following?

Time required for absorption, distribution in the body, method of excretion of medication, duration of action

Which is essential for ensuring disaster readiness in a community?

Trauma System A well-functioning trauma system is essential to general public health and safety. It provides the structure necessary for disaster readiness and community emergency preparedness. Although most states now have at least some basic elements of a trauma system in place, significant gaps still exist in many regions. The federal government may provide oversight for disaster readiness; however, it does provide the fundamental structure. The emergency response system is one aspect of disaster readiness; however, it does not provide the structure.

Peak concentration

When a medication is administered repeatedly, its serum level fluctuates between doses. The highest level is called

trough concentration

When a medication is administered repeatedly, its serum level fluctuates between doses. The lowest level is called

The time it takes after a medication is administered for it to produce a response is called the onset of action and partially relates to the ________ rate of the medication.

absorption

A papule is

an elevated, solid skin lesion of less than 0.5 to 1 cm in diameter.

a pustule is

an elevated, superficial lesion filled with purulent fluid.

Penrose drain

an open drain that is a flexible piece of tubing, usually is not sutured into place. Care is taken to not inadvertently remove the drain during dressing changes. This type of drain usually is removed over a period of several days before discharge.

Cellulitis

diffuse, acute infection of the skin marked by local heat, redness, pain, and swelling

capillary fragility

due to vitamin C deficiency

The presence of a white color of the mucous membranes may indicate

edema in the client.

fibroma

fibrous tumor forms on fibrous tissue

The administration of ________, fixed doses of medication allows a blood serum concentration to be maintained.

fixed

chondroma

forms on the cartilage. benign cartilaginous tumor, which is encapsulated with a lobular growing pattern. Tumor cells resemble normal cells and produce the cartilaginous matrix.