COTAC II exam 5- shock, MODS, & infectious diseases

A ____________ is a painless lesion at the site of primary syphilis infection which usually resolves spontaneously within 3 to 12 weeks.

chancre

A modified _________ position is recommended for patients in hypovolemic shock to assist with fluid redistribution.

down

A nurse should wear a facemask within 3 to 6 feet of a hospitalized patient receiving ____________ precautions for an infection.

droplet

Regardless of the initial cause of shock, certain physiologic responses common to all types include hypoperfusion of tissues, ___________, and activation of the inflammatory response.

holistic

What is the biggest thing to prevent the spread of diseases?

isolation is the biggest thing to prevent spread!

Dosage calculations: (1?)

mLs/kg/min calculation

Failure of ______________ mechanisms to effectively restore physiologic balance is the final pathway of all shock states and results in end-organ dysfunction and death.

mutations

Higher risk central lines: (1?)

non-tunneled catheters

Elevated body temperature (hyperthermia), common with sepsis, is considered to be at a dangerous level when it reaches ________________________.

phenylketonuria

The ____________ _________ organism is responsible for the chickenpox infection.

varicella zoster

T/F: Normal pulse pressure, which is 60 to 80 mm Hg, is calculated by dividing the diastolic measurement from the systolic measurement.

F

T/F: The most common and serious side effects of fluid replacement are cardiovascular overload and pulmonary edema.

F

T/F: Vancomycin-resistant Enterococcus (VRE) is the most frequently isolated source of health care--associated infections in the United States.

F

A medical nurse is careful to adhere to infection control protocols, including handwashing. Which statement about handwashing supports the nurse's practice? -Wearing gloves is known to be an adequate substitute for handwashing. -Frequent handwashing reduces transmission of pathogens from one client to another -Waterless products should be avoided in situations where running water is unavailable -Bar soap is preferable to liquid soap

Frequent handwashing reduces transmission of pathogens from one client to another

The nurse is caring for a client in the ICU whose condition is deteriorating. The nurse receives orders to initiate an infusion of dopamine. What assessments and interventions should the nurse prioritize? -Routine monitoring of vital signs, monitoring the peripheral IV site, and providing early discharge instructions -Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug titration -Reviewing medications, performing a focused cardiovascular assessment, and providing client education -Reviewing the laboratory findings, monitoring urine output, and assessing for peripheral edema

Frequent monitoring of vital signs, monitoring the central line site, and providing accurate drug titration

Pt needs blood or fluids and they only have one IV, what is your priority?

Get them another 16-18 g IV!

The nurse is caring for a client admitted with cardiogenic shock. The client is experiencing chest pain and there is an order for the administration of morphine. In addition to pain control, what is the main rationale for administering morphine to this client? -It promotes coping and slows catecholamine release -It stimulates the client so he or she is more alert. -It decreases gastric secretions -It dilates the blood vessels

It dilates the blood vessels

The critical care nurse is preparing to initiate an infusion of a vasoactive medication to a client in shock. What goal of this treatment should the nurse identify? -Absence of pulmonary and peripheral edema -Maintenance of adequate mean arterial pressure -Absence of infarcts or emboli -Reduced stroke volume and cardiac output

Maintenance of adequate mean arterial pressure

The nurse places a client in isolation. Isolation techniques have the potential to break the chain of infection by interfering with what component of the chain of infection? -Agent -Mode of transmission -Susceptible host -Portal of entry

Mode of transmission

A nurse in the ICU receives report from the nurse in the ED about a new client being admitted with a neck injury he received while diving into a lake. The ED nurse reports that his blood pressure is 85/54, heart rate is 53 beats per minute, and his skin is warm and dry. What does the ICU nurse recognize that that client is probably experiencing? -Anaphylactic shock -Neurogenic shock -Septic shock -Hypovolemic shock

Neurogenic shock

Calicivirus, also referred to as _______________, is the most common cause of foodborne illness and gastroenteritis in the United States.

Norovirus

A critical care nurse is aware of the high incidence of ventilator-associated pneumonia (VAP) in clients who are being treated for shock. What intervention should be specified in the client's plan of care while the client is ventilated? -Performing frequent oral care -Suctioning the client every 15 minutes unless contraindicated -Maintaining the client in a supine position -Administering prophylactic antibiotics, as prescribed

Performing frequent oral care

The nurse is caring for a client in the ICU who has been diagnosed with multiple organ dysfunction syndrome (MODS). The nurse's plan of care should include what intervention? -Promoting communication with the client and family along with addressing end-of-life issues -Encouraging the family to leave the hospital and to take time for themselves as acute care of MODS clients may last for several months -Discussing organ donation on a number of different occasions to allow the family time to adjust to the idea -Encouraging the family to stay hopeful and educating them to the fact that, in nearly all cases, the prognosis is good

Promoting communication with the client and family along with addressing end-of-life issues

An immunocompromised older adult has developed a urinary tract infection and the care team recognizes the need to prevent an exacerbation of the client's infection that could result in urosepsis and septic shock. What action should the nurse perform to reduce the client's risk of septic shock? -Initiate total parenteral nutrition (TPN) -Remove invasive devices as soon as they are no longer needed -Perform passive range-of-motion exercises unless contraindicated -Apply an antibiotic ointment to the client's mucous membranes, as prescribed.

Remove invasive devices as soon as they are no longer needed

T/F: Cardiogenic shock, the most common type of shock, occurs when there is a reduction in intravascular volume by 15% to 30%.

T

T/F: Currently, there is no treatment for West Nile virus infection.

T

T/F: Failure of the cardiac pump occurs in the progressive stage of shock.

T

T/F: Penicillin G benzathine is the medication of choice for early syphilis or early latent syphilis of less than 1 year's duration.

T

T/F: Shock is a life-threatening condition that results from inadequate tissue perfusion. Rapid assessment with early recognition and response to shock states is essential to the patient's recovery.

T

T/F: The first tier of isolation guidelines, called standard precautions, is designed for the care of all patients in the hospital and is the primary strategy for preventing health care--associated infections.

T

T/F: The three usual modes of transmission for the human immunodeficiency virus are sexual, percutaneous, and perinatal.

T

When you are bleeding out...

your body's RAS kicks in

An adult client in the ICU has a central venous catheter in place. Over the past 24 hours, the client has developed signs and symptoms that are suggestive of a central line associated bloodstream infection (CLABSI). What aspect of the client's care may have increased susceptibility to CLABSI? -The client was treated for vancomycin-resistant enterococcus (VRE) during a previous admission. -The client had blood cultures drawn from the central line -The client's central line was placed in the femoral vein. -The client has received antibiotics and IV fluids through the same line.

The client's central line was placed in the femoral vein.

What is the best rationale for health care providers receiving the influenza vaccination on a yearly basis? -To eventually eradicate the influenza virus in the United States -To decrease nurses' susceptibility to healthcare-associated infections -To decrease risk of transmission to vulnerable clients -To prevent the emergence of drug-resistant strains of the influenza virus

To decrease risk of transmission to vulnerable clients

A client on airborne precautions asks the nurse to leave his door open. What is the nurse's best reply? -"I have to keep your door shut at all times. I'll open the curtains so that you don't feel so closed in." -"I can open your door, but I'll have to come back and close it in a few minutes." -"I'll keep the door open for you, but please try to avoid moving around the room too much." -"I can open your door if you wear this mask."

"I have to keep your door shut at all times. I'll open the curtains so that you don't feel so closed in."

A clinic nurse is caring for a male client diagnosed with gonorrhea who has been prescribed ceftriaxone and doxycycline. The client asks why he is receiving two antibiotics. What is the nurse's best response? -"The combination of these two antibiotics reduces the later risk of reinfection." -"This combination of medications will eradicate the infection twice as fast than a single antibiotic." -"There are many drug-resistant strains of gonorrhea, so more than one antibiotic may be required for successful treatment." -"Many people infected with gonorrhea are infected with chlamydia as well."

"Many people infected with gonorrhea are infected with chlamydia as well."

Shock IS... (& 2 s/s?)

-*inadequate tissue perfusion* -hypermetabolism -decreased oxygen supply! (S/s : cold clammy skin, decreased UOP)

Shock stages: (first stage s/s in what type of shock? Irreversible stages s/s & nursing consideration?)

-1st-cold clammy skin (in compensatory shock) -irreversible stages (continually very low BP); get family to spend time with pt

Colloid solutions: (2?)

-5% albumin -hesban (man made volume expander)

Shingles vaccine: (how effective? Get it when?)

-50% effective -get it above 65 years old

A critical care nurse is planning assessments in the knowledge that clients in shock are vulnerable to developing fluid replacement complications. For what signs and symptoms should the nurse monitor the client? Select all that apply. -Hypoglycemia -Cardiovascular overload -Pulmonary edema -Hypovolemia -Difficulty breathing

-Cardiovascular overload -Pulmonary edema -Difficulty breathing

A nurse is participating in a vaccination clinic at the local public health clinic. The nurse is describing the public health benefits of vaccinations to participants. Vaccine programs addressing which of the following diseases have been deemed successful? Select all that apply. -Diphtheria -Hepatitis -Mumps -Polio -Chlamydia

-Diphtheria -Mumps -Polio

Although the incubation period for chickenpox is about 21 days, it is during the ____ days before the rash develops that the newly infected host is capable of transmitting the virus to other susceptible contacts.

2

If fluid therapy alone does not effectively improve tissue perfusion, vasopressor agents, specifically _____ or dopamine, may be initiated to achieve a MAP of 65 mm Hg or higher.

50%

A public health nurse is teaching a mother about vaccinations prior to obtaining informed consent for her child's vaccination. What should the nurse cite as the most common adverse effect of vaccinations? -Temporary photosensitivity -Allergic reactions to the antigen or carrier solution -Joint pain near the injection site -Nausea and vomiting

Allergic reactions to the antigen or carrier solution

A nurse is preparing to administer a client's scheduled dose of subcutaneous heparin. To reduce the risk of needlestick injury, the nurse should perform what action? -Wear gloves when administering the injection. -Recap the needle immediately before leaving the room. -Avoid recapping the needle before disposing of it -Recap the needle before leaving the bedside

Avoid recapping the needle before disposing of it

A nursing home resident has been diagnosed with Clostridium difficile. What type of precautions should the nurse implement to prevent the spread of this infectious disease to other residents? -Positive pressure isolation -Contact -Droplet -Airborne

Contact

The emergency nurse is admitting a client experiencing a GI bleed who is believed to be in the compensatory stage of shock. What assessment finding would be most consistent with the early stage of compensation? -Decreased heart rate -Increased urine output -Cool, clammy skin -Hyperactive bowel sounds

Cool, clammy skin

Salmonella: (causes (3)? Clinical manifestations (3)?)

-causes : (foods) poultry, vegetables, raw eggs (from fertilizers) -clinical manifestations : N/V/D

CLABSI: (what? Risk factors (2)? Prevention (3)?)

-central line associated blood stream infection -risk factors : femoral central line, drooling pt (in jugular) -prevention : make sure dressing is clean & change it q 7 days or when it's soiled, aseptic technique upon insertion

Syphilis: (clinical manifestation?)

-clinical manifestations : lesions (shankre) cold sores down there

Airborne precautions: (door open? Pt feeling isolated...? What test for what pressure rooms?)

-door CANNOT ever be open -if pt in these precautions are feeling isolated/claustrophobic they can FaceTime family and you can open their curtains -tissue test for negative pressure rooms

Contact precautions: (door open?)

-door can be open

Droplet precautions: (door open?)

-door can be open

MODS: (what? Plan of care? What is the last thing to go?)

-end stage disease -plan of care : get family to be able to see and talk to pt (bc hearing is the last thing to go)

Cardiogenic shock: (what/why? Tx steps & do NOT? Only shock with..? Clinical manifestations (2)? After giving.. we know pt is getting better because.. (3)?)

-ineffective beating of the heart (poor heart pump) due to heart failure (& over hydration) -tx: do not give fluids! First take some of the volume off (lasix), then give dobutamine to increase the strength of heart contractility and vasodilate; can use balloon pump and pulmonary artery catheter; then pt might be put on digoxin -only shock with fluid OVERload s/s -clinical manifestations : pts come in with chest pain and arrhythmias -after giving an inotropic drug, we know pt is getting better because... their BP goes lower and then increases, they loose their crackles in lungs, improved UOP

Gonnorhea: (male manifestations? Female manifestation?)

-males (burns when they pee and have green discharge) -females (sometimes get discharge)

West Nile: (transmission? Prevention? Who needs to protect themselves? What will West Nile virus lead to?)

-mosquito transmission -prevention : use mosquito repellant!! -elderly need to protect themselves from it to prevent pneumonia

Zika virus: (transmission? Education? Who needs to protect themselves? What will Zika virus lead to?)

-mosquito transmission -education : use mosquito repellant!! -young people serving missions need to protect themselves from these to prevent genetic problems (small brain and head) in their children down the road

Septic shock: (most..? Get blood.. and maintain sats above..? Give tons of what to support BP? Clinical manifestations (4)?)

-most intense shock to take care of -get blood cultures & maintain sats above 90 -give tons of fluids to support BP -clinical manifestations : elevated temp, WBC, lactic levels, procalcitonin levels

Vap protocols: (5?)

-oral care q 2 hours -chlorahexidine oral care once q 12 hours (& SCRUB tubing) -turn pt q2 hours -head of bed elevated to 30 degrees -assessed for extubation q24 hours

C-diff: (pt can become..? Prevention (2)?)

-pt can become super hypovolemic! -prevention : if a pt has 3 or more watery stools in a day, nurse needs to send sample off to lab for C-diff (can show pt didn't acquire it in the hospital); put pt in isolation! (Contact precautions before you even get the results back)

Anaphylaxis: (what? Moves to.. when it gets worse (3)? Very first thing we need is.. then.. then..? Do what if pt can't breathe anymore and has no heartbeat?)

-severe allergic reaction -moves to ANAPHYLACTIC SHOCK when it gets worse (severe peripheral vasodilation, BP drops, inadequate tissue perfusion) -very FIRST thing we need is epi! Then benadryl and then fluids -CPR& bagging if pt cannot breathe anymore and has no heartbeat

TB: (precautions?)

-standard and airborne precautions

Dobutamine: (used in? Action?)

-used in cardiogenic shock -improves strength of heart contraction & vasodilates

Dopamine: (used in? Action? Can you immediately turn off? BP how often? Make sure pt is well..? Can we bolus dopamine? Peripheral line or central line? VS how often? Monitor..?)

-used in neurogenic shock -vasoconstricts & improves strength of heart contraction -titrate up and taper down (don't immediately turn off) -BP q 15 minutes -make sure pt is well hydrated -never bolus! -never put a vasopressor drip through a peripheral line, want central line -q 15 min VS -monitor the site

Neurogenic shock: (s/s & MAIN s/s? Comes almost always in what pts? Drug of choice?)

-very relaxed muscles & body that are stimulated by something in the spinal cord, leading to low blood pressure and *very low HR* -comes almost always in spinal cord patients (Sometimes head trauma) -drug of choice is Dopamine

Community infection control: (when going into people's homes we need to..? Talk to them about..?)

-when going into people's homes we need to ask permission to do the things we do (ie- ask to wash our hands in their sink) -talk to them about the conditions in their home (common cleanliness/washing hands before dressing changes)

Crystalloid solutions for giving fluids: (2?) (& these will..?)

-LR -NS *these will improve BP*

The intensive care nurse is responsible for the care of a client who is in shock. What cardiac signs or symptoms would suggest to the nurse that the client may be experiencing acute organ dysfunction? Select all that apply. -Mean arterial pressure (MAP) of ˂65 mm Hg -Hypotension that responds to bolus fluid resuscitation -Exaggerated response to vasoactive medications -Drop in systolic blood pressure of 40 mm Hg from baselines -Serum lactate >4 mmol/L

-Mean arterial pressure (MAP) of ˂65 mm Hg -Drop in systolic blood pressure of 40 mm Hg from baselines -Serum lactate >4 mmol/L

Hypovolemic shock: (anything to do with low..? Clinical manifestations (6)? Will know pt is getting better..? Treatment & considerations?)

-anything to do with low volume -clinical manifestations : sunken eyeballs, confusion, poor capillary refill, inadequate blood pressure, low UOP, flattened neck veins (have pt lay supine to assess this) -will know pt is getting better because... improved blood pressure and improved urine output -treatment : give them blood/fluids! (Can start to get crackles in lungs, and hypothermia (try a blood warmer))

Emerging diseases: (because of.. (3)? Considerations (5)?)

-because of... antibiotic resistance (don't finish prescriptions), global travel & global food supply -always wash hands, wear gloves, put pts in correct form of isolation (isolation is the biggest thing to prevent spread!), don't recap needles, know portals of entry/exit for pathogens/diseases

CAUTI: (what? What upon insertion? Don't leave in... and assess...? Cath care when? Backflow?)

-catheter associated UTI -use sterile technique upon insertion -don't leave them in longer than they need to be (assess daily if the pt needs a cath) -do cath care q shift -no backflow (don't lift bag above their head level)