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
