NSG 232 Test 1

medical asepsis

"A state of cleanliness that decreases the potential for the spread of infections"

A nurse is working within the managed care delivery model. Which of the following is true regarding managed care? A-All plans have the same values underlying the delivery of care. B-Their values are not reflected in the decision making. C-All systems reflect the values of efficiency and effectiveness. D-There are no conflicts between cost-effectiveness and respectful care.

*A-All systems in the managed care delivery model reflect the values of efficiency and effectiveness* Different plans may have different values underlying the delivery of care. However, they all reflect the business plan values of efficiency and effectiveness. Their values are reflected in the decision making and the policy development of the organization. Value conflicts between cost-effectiveness and respectful care may be seen.

Which measure is contraindicated when the nurse assists a child who has leukemia with oral hygiene? applying petroleum jelly to the lips cleaning the teeth with a toothbrush swabbing the mouth with moistened cotton swabs rinsing the mouth with a nonirritating mouthwash

*The oral mucous membranes are easily damaged and are commonly ulcerated in the client with leukemia. It is better to provide oral hygiene without using a toothbrush, which can easily damage sensitive oral mucosa.* Applying petroleum jelly to the lips, swabbing the mouth with moistened cotton swabs, and rinsing the mouth with a nonirritating mouthwash are appropriate oral care measures for a child with leukemia.

Progression through stages of infection is dependent upon??

1. Virulence of Organism 2. Health of Pt

Chain of Infection Steps

1. infectious Agent 2. Reservoir 3. Portal of Exit 4. Mode of Transmission 5. Portal of Entry 6.Susceptible Host

3 factors determine whether person develops infection

1. virulence of organism 2. Number of organisms transmitted 3. Ability of host to defend itself against organism

_________is primary source of absorption

Small Intestine

TPN is 10% - ____% concentration of ________ in water along with amino acids and vitamins.

50%, dextrose

Tier 1 Standard precautions

Aka universal- if it's wet and it isn't yours, don't touch it For ALL patients

In evaluating a client's response to nutrition therapy, which laboratory test would be of highest priority to examine? Serum potassium level Lymphocyte count Albumin level CBC differential

Albumin is a major plasma protein; therefore, a client's albumin level helps gauge his nutritional status. Protein and vitamin C-build and repair injured tissue. Potassium-fluid and electrolyte status. Lymphocyte count and differential count- infection.

Primary Defenses, aka Body Defenses

Anatomical features, limit pathogen entry

Fever Mobilizes the immune response •Helps to eradicate organisms that thrive at lower body temperatures •Enhances the effects of ___________ •Decreases the ________________concentration •Limits the growth of microorganisms

Antibiotics plasma iron

Resting energy expenditure (REE) (aka resting metabolic rate)

amount of energy that an individual needs to consume over a 24-hour period for the body to maintain all of its internal working activities while at rest

humoral immunity

B cells produce antibodies after exposure to specific antigens; type of adaptive immunity

Low Density Lipoprotein (LDL), known as ______ fats, Transports ________ to body cells, and are found in diets high in ________fats

Bad; cholesterol; saturated

Which action is contraindicated for a client who develops a temperature of 102° F (38.9° C)?

Because a client with a fever has an increased basal metabolism rate, he needs additional calories in his diet, not fewer calories.

Secondary Defenses

Biochemical processes activated by chemicals released by pathogens , Phagocytosis, Complement Cascade, Inflammation, Fever

With TPN, ______ _______ labs are monitored because most contain insulin. They must be prepared under strict _________ techniques bc they are ideal mediums for bacterial growth. Change frequently bc of this.

Blood Sugar Aseptic

Tertiary Defenses

Body's immune cells recognize and destroy old nemesis pathogens

Tier 2 Transmission Based Precautions

CDC provides guidelines for protection if a patient has a diagnosed or suspected highly communicable disease

Three different Transmission based precautions

Contact Airborne Droplet

With airborne precautions, Pathogen is spread via air ______ •Transmission via ventilation systems, ___________ sheets, ____________....

Currents, shaking sheets, sweeping floors

Factors that influence nutrition include

Developmental stage From infants to elders Includes lactating women Educational level Knowledge of nutrition Socioeconomic Status Ethnicity/culture Religious practices

Nursing Process for Nutrition: PRIORITIES

Diarrhea, Dysphagia, Lack of education

Enteral nutrition is the __________ method. Risks include:

Enteral; aspiration, infection, diarrhea, metabolic disturbances, alteration in drug absorption and metabolism.

Contact precautions

Examples include: •Draining wounds, dressings, patient supplies, fomites, secretions... •Herpes Simplex, MRSA, and RSV are spread by direct contact

Contact precautions include these steps

Follow Standard Precautions •Private room •Or with a patient with an active infection caused by the same organism and no other infections •Clean gown and gloves when you anticipate any contact with the patient or with any contaminated items in the room •Disposal of contaminated items in room •Double-bag linen and trash •mark contaminated

Three types of lipids:

Glycerides, Sterols, Phospholipds

Stages of infection

Incubation period, Prodromal stage, Full stage of illness, Convalescent period

Droplet precautions include these pathogens

Influenza, Pertussis, mumps

Illness stage is the time when the __________ symptoms are manifest

Specific

The incubation period is the time between __________of organism and onset of ________. Mircroorganisms are _________ and _________

Invasion, symptoms Growing, multiplying

Fat soluble vitamins __,__,__, AND __ are Stored primarily in the _______and adipose tissue. Vitamin ____ can be found in all body tissues

K, A, D, E. Liver E

What happens when fats are converted to glucose?

Ketones

Lab values to be tracked with Enteral feedings

Lab values (glucose, BUN, & electrolytes)

Metabolism

Metabolism All biochemical reactions within the cells

Carbs Improve absorption of ___ and excretion of __

Na; Ca

Enteral feeding tubes include the NG, or _______ and NE, or ______. Less than ___ weeks preferred.

Nasogastric, nasoenteric. 4 weeks.

When Amino acids are metabolized, the _______ containing part is converted to _________ _and excreted in the urine as _______

Nitrogen; ammonia; urea

Prodormal period is the time between ___________ and _________. May be contagious, length of ______ to _______ Note- not all have this stage

Non specific symptoms, specific Hours, days

Main issue with proteins being used for energy:

Not available for tissue breakdown, growth and repair

convalescent period is the time during which remaining _________ reach ________ Can last _________ to _________

Organisms, zero Days, months

For parenteral feedings, there are two options: _______________ or (PPN) Can take some of their nutritional intake orally IV nutrition is supplemental AND _________________ or (TPN) Require total resting of GI tract Extensive burns or trauma, severely malnourished...

Partial Parenteral Nutrition; Total Parenteral Nutrition

S&S of infection: REEDA

Redness Edema Ecchymosis (bruising) Drainage Approximation (wounds don't close/connect)

Nursing Process for Nutrition: ASSESSMENT includes, plus physical examination to determine signs of ______or _______ nutrition

Screening Mini Nutritional Assessment Anthropometry Specific measurements of IBW & BMI Laboratory and Biochemical Tests Albumin, Pre-albumin, Transferrin Dietary History and Health History Drug-Nutrient Interactions GOOD; POOR

Exudate may appear: •_____________- clear (plasma) •Sanguineous -__________ —————->containing _________ •_______________- pus •contains WBC's and bacteria

Serous Red, RBCs Purulent

A nurse in the infection prevention and control program is conducting an assessment of infection control practices. The nurse is evaluating the infection control actions taken on the unit for a client with a decreased white blood cell count. Which of the following infection control practices does the nurse consider most important for this client? A-Diligent adherence to aseptic technique B-Using antimicrobial soap when providing care C-Requesting prophylactic antibiotic treatment D-Implementing respiratory isolation procedures

The client in this scenario is neutropenic, which places the client at risk for contracting an infection. All measures of aseptic technique must be used to protect the client. The other options do not provide complete protection for the client.

A client with peripheral artery disease has chronic, severe bilateral pretibial and ankle edema the client is on complete bed rest. To maintain skin integrity, what should the nurse do?

The client is at greater risk for skin breakdown in the lower extremities related to the edema and to remaining in one position, which increases capillary pressure. Turning the client every 1 to 2 hours promotes vasodilation and prevents vascular compression.

Complement Cascadei

Triggers chemicals and inflammatory mediators (histamine) to attack cell membrane of pathogen

_________ are _______substances present in small amounts in food that are essential to normal________ and in regulating body functions

Vitamins, organic, metabolism

When dealing with droplet precautions, follow _________, and _______ precautions, as well as

Wear a mask and eye protection when working within 3 feet of the patient

Cholesterol is Necessary for_______membrane, vitamin ___, _________, and testosterone formation

cell; D; estrogen

Proteins are vital to metabolism bc they are precursors to digestive______ and __________

digestive enzymes; hormones

If pt can not have food p.o., options include _________ Nutrition: Deliver liquid nutrition via a tube into the G.I. tract. and ___________ Nutrition: Deliver of nutrition intravenously

enteral, parenteral

Nursing Process for Nutrition: INTERVENTION; it is most important to identify the ________ of the imbalance, and then provide teaching for pt and families, as well as Check food ________ based on __________

etiology; security; income

Decreased ability to excrete fluids leads to

fluid restriction

term used when the body forms glucose from non-carbohydrate sources

gluconeogenesis

High density lipoproteins (HDL), known as ______fats, remove ________ from the bloodstream to liver where it is used to produce_____

good; cholesterol; bile

Nitrogen balance reflects

how well the body tissues are being maintained

Where is glucose stored? How? What is glycogenolysis?

liver and skeletal muscle Glycogen Breakdown of glycogen to glucose

Functions of minerals include: Help balance _____

pH

Phagocytosis

process in which phagocytes engulf and digest microorganisms and cellular debris

stomatitis

reddening of the mouth/lips/tongue

Basal metabolic rate (BMR)

the energy needed to maintain life-sustaining activities for a specific period of time at rest

Glycerides are considered ______ fats and ____glycerides are most common in food.

true; tri

cell mediated immunity

type of immunity produced by T cells that directly attack infected or abnormal body cells

Inflammations Leads to________ & increased capillary__________ •Increases the flow of white blood cells, nutrients & oxygen to the area

vasodilation, permeability

Washing from distal to proximal stimulates ______ _______

venous return; circulation

Proteins act as fluid balance by attracting ______ and regulating fluid balance in the bloodstream

water

Enteric Feedings greater than 4 weeks ___________ gastrostomy tube (PEG) ____________ tube

Percutaneous, jejunostomy

To protect with airborne precautions, follow ________ and _______ precautions, as well as these steps:

Standard, contact Negative Air Pressure Ventilation System •Air is discharged through a filtration system •Special mask (N95 Respirator) for Tuberculosis •Only immune healthcare workers should care for patients with Measles or Chickenpox.

QSEN minimizes risk of harm to patients and providers by •___________effectiveness •____________performance

System Individual

Airborne precautions include these diseases

TB, Measles (Rubeola), Chickenpox