Unit 3 - Infection - NCO & Class Notes

A nurse is assessing the laboratory findings of cerebrospinal fluids of four different clients. Which finding is consistent with meningitis? 1 Client A 2 Client B 3 Client C 4 Client D

1 Client A Increased BP WBC >1000 Protein >500 Decreased Glucose Cloudy urine The clinical findings of cerebrospinal fluid (CSF) in client A indicates that he or she has meningitis. Client B's findings indicate encephalitis. Client C's findings indicate a brain abscess. Client D has normal cerebrospinal fluid values. The normal values of cerebrospinal fluid are: a pressure between 70 and 150 mmH 2O, white blood cell count (WBC) between 0 and 5 cells/µL, protein levels between 15 and 45 mg/dL (0.15-0.45 g/L), glucose levels between 40 and 70 mg/dL (2.2 -3.9 mmol/L). In addition the CSF should appear clear.

STERILE warm saline soaks three times a day are prescribed for a client with cellulitis from a puncture wound. The primary nurse places a clean basin, washcloth, and protective pad at the bedside in preparation for the soak but is unable to continue the procedure. What should the nurse assigned to complete the soak do? 1 Continue the procedure as started. 2 Collect new supplies before starting. 3 Discuss the type of soak with the primary healthcare provider. 4 Report the primary nurse to the unit's nurse manager.

2 Collect new supplies before starting. The supplies at the bedside are not sterile, and the primary healthcare provider prescribed sterile soaks; new supplies must be gathered. Continuing the procedure as started is unsafe; a clean basin and washcloth are not sterile. It is unnecessary to discuss the type of soak with the primary healthcare provider; the primary healthcare provider has already indicated the type of soak desired. Reporting the primary nurse to the unit's nurse manager is not the priority; client safety is the priority at this time.

A 1-year-old infant has been admitted with a tentative diagnosis of bacterial meningitis. A lumbar puncture is performed to confirm the diagnosis. What laboratory report on the cerebrospinal fluid (CSF) supports this diagnosis? 1 Decreased cell count 2 Increased protein level 3 Increased glucose level 4 Low spinal fluid pressure

2 Increased protein level The blood-brain barrier is affected in bacterial meningitis, permitting the passage of protein into the CSF. The cell count will be increased. The glucose level is decreased in proportion to the duration of the disease. Spinal fluid pressure will be increased.

A child is admitted to the pediatric unit with a diagnosis of meningococcal meningitis. What does the nurse conclude about isolation? 1 It is unnecessary during the incubation period. 2 It is required for 7 to 10 days until the fever subsides. 3 It will be unnecessary after the diagnosis is confirmed. 4 It will be necessary for 24 to 72 hours after the initiation of antibiotic therapy.

4 - It will be necessary for 24 to 72 hours after the initiation of antibiotic therapy. The meningococcal organism is rendered inactive after 24 to 72 hours of antibiotic therapy; isolation is not required after this time. Meningitis is not evident during the incubation period. The presence of a fever is not the influencing factor indicating the need for isolation. After the diagnosis of meningitis is confirmed, isolation is required for 24 to 72 hours after the institution of antibiotic therapy.

A client is admitted with cellulitis of the left leg and a temperature of 103° F (39.4° C). The primary healthcare provider prescribes intravenous (IV) antibiotics. Which action is the priority before administering the antibiotics? 1 Determine the client's allergies. 2 Apply a warm, moist dressing over the cellulitis. 3 Measure the amount of swelling in the client's left leg. 4 Obtain the results of the culture and sensitivity tests.

1 Determine the client's allergies. Allergies are important. Drug hypersensitivity and anaphylaxis are most common with antimicrobial agents. Applying a warm, moist dressing over the area is a dependent function; it is not crucial to starting antibiotic therapy. Measuring the amount of swelling in the client's leg is an important assessment, but it is not crucial to starting antibiotic therapy. Withholding treatment until culture results are available may extend the infection.

A child is admitted to the hospital with a tentative diagnosis of meningitis, and a lumbar puncture is performed to confirm the diagnosis. What finding from the spinal fluid report should lead the nurse to conclude that bacterial meningitis is present? 1 Increased protein 2 Increased glucose 3 Decreased specific gravity 4 Decreased white blood cell count

1 Increased protein Bacterial meningitis causes increased permeability of the blood-cerebrospinal fluid barrier, resulting in increased protein in cerebrospinal fluid. The glucose level will be within the expected range. The specific gravity will be increased, as will the white blood cell count.

Which clinical manifestation is associated with cellulitis? 1 Lymphadenopathy 2 Occasional papules 3 Vesicles that evolve into pustules 4 Isolated erythematous pustules

1 Lymphadenopathy Cellulitis is accompanied by lymphadenopathy. Occasional papules are present in folliculitis. Herpes simplex viral infections evolve the vesicles into pustules. Isolated erythematous pustules occur in folliculitis bacterial infections.

A nurse places a school-aged child with bacterial meningitis in isolation with droplet precautions. What is the purpose of these precautions? 1 They keep the child away from uninfected people. 2 The infectious process is interrupted as quickly as possible. 3 The child is protected from contracting a secondary infection. 4 They prevent the development of a hospital-acquired infection.

1 They keep the child away from uninfected people. Droplet precautions reduce the transmission of infection from the child to other individuals (cross-infection). The microorganisms are transmitted to others in respiratory droplets. Droplet precautions do not interrupt the infectious process; they protect those in contact with the child from contracting the infection. Droplet precautions do not protect the child from contracting secondary infections; they protect others from being exposed to the child's pathogens. Thorough hand washing and aseptic techniques, not droplet precautions, limit the spread of hospital-acquired infections.

A nurse is caring for an infant with bacterial meningitis. The parents ask how their baby could have contracted the illness. What does the nurse consider as the most likely route of transmission to the central nervous system? 1 Genitourinary tract 2 Gastrointestinal tract 3 Skin or mucous membranes 4 Cranial apertures or sinuses

4 Cranial apertures or sinuses Infections of cranial structures can cause meningitis because bacteria travel by way of direct anatomic route to the meninges and cerebrospinal fluid (CSF). The other parts of the body do not come into contact with CSF.

Which of the following lab tests would apply to skin infection SATA:

CBC C&S CMP *CMP - Comprehensive metabolic panel (measures blood sugar; electrolytes balance, kidney function; liver function)

Which of the following are signs of infection SATA:

Swelling Redness Fever

What is the strongest defense against infection?

Tissue Integrity Adequate nutrition Strong immune system

A 13-month-old child is undergoing lumbar puncture for confirmation of a diagnosis of bacterial meningitis. During the procedure the nurse notes that the spinal fluid is cloudy. What does this finding indicate? 1 Healthy spinal fluid 2 Increased glucose level 3 Increased white blood cell (WBC) count 4 Rising number of red blood cells (RBCs)

3 Increased white blood cell (WBC) count A high WBC count causes spinal fluid to appear cloudy and possibly milky white; it is a sign of infection. Healthy spinal fluid is clear. An increased glucose level does not affect the color or clarity of the spinal fluid. RBCs give the spinal fluid a sanguineous, not cloudy, appearance.