Study Guide Ch 7-8 EXAM 1 PDF

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Study Guide Exam 1 – Chapter 7 & 8

1. Know and understand what causes the transmission of diseases, their characteristics, and how transmission of diseases are prevented. • Infection Prevention and Control: Handwashing, PPE’s, cleanliness and disinfection • Asepsis: Absence of pathogenic microorganisms o Medical Asepsis (Clean Technique) ▪ Inhibit growth & transmission of pathogenic microorganisms ▪ Used in daily activities such as handwashing o Surgical Asepsis (Sterile Technique) ▪ Destroys all microorganisms and their spores (Fungi & Protozoa) ▪ Used in operating rooms, during invasive procedures (catheter insertion) • Chain of Infection: o Infectious agent: A pathogen ▪ Can be bacteria, viruses, yeasts, fungi, and protozoa ▪ How to get rid of them? Disinfection: The use of a chemical that can be applied to objects to destroy microorganisms Antiseptic: substance that tends to inhibit the growth and reproduction of microorganisms and may be used on humans Diagnostic testing: focuses on the unique characteristics for identification of specific types of bacteria. Sensitivity tests: assist the practitioner in determining which antimicrobial (antibiotic) medication will inhibit the pathogens’ growth effectively; antimicrobial agents on the basis of these tests, which typically take 48 to 72 hours to complete o Reservoir: Where pathogen can grow ▪ Characteristics of an environment that supports organism growth include an available food source, oxygen, water, light, and desirable temperatures and levels of acidity or alkalinity ▪ Any natural habitat of a microorganism that promotes growth and reproduction ▪ Within the health care environment, infection may breed and thrive in soiled dressings and medical equipment, including stethoscopes, bedside tables, and overbed tables o Portal of Exit: Exit route from the reservoir ▪ Examples of exit routes in human’s: are any body fluids produced from the patient, such as those from the gastrointestinal, respiratory, and genitourinary systems or from an open area on the patient’s body o Mode of Transmission: Method or vehicle of transportation, such as exudate, feces, air droplets, hands, and needles ▪ Vehicle: is the means by which micro-organisms are carried about and transported to the next host, once they have left the reservoir.

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Contamination: means a condition of being soiled, stained, touched by, or otherwise exposed to harmful agents o Portal of Entry: Entrance through skin, mucous lining, or mouth ▪ If the patient has a weak immune system, it becomes easier for the microorganism to gain entry and infect the host o Host: Another person or animal that is susceptible to the pathogen ▪ Immunizations have proven effective in reducing susceptibility to some types of infectious diseases 2. Know and understand infectious agents, be able to give examples of how they spread infections, and any complications that occur with each. • Infectious agent: A pathogen o Bacteria: three basic shapes (round, oblong, and spiral) ▪ Aerobic bacteria: grow only in the presence of oxygen ▪ Anaerobic bacteria: grow only in the absence of oxygen ▪ Some bacteria are capable of movement (flagella) ▪ Spore: is a round body that is formed by the bacterium when conditions are unfavorable for growth of the bacterium; it remains dormant until environmental conditions become favorable for growth and then the spore germinates and begins reproducing; high degree of resistance to heat and disinfectants ▪ Mucilaginous: (of a thick, sticky, slimy substance) envelopes form when the bacterial environment is hostile; formation of the capsule is a defense mechanism to help protect the bacteria ; Capsule formation also contributes to the development of multidrug resistance, and when capsules are present, antibiotic therapy is sometimes ineffective because the capsule prevents the drug from reaching the bacteria within the capsule and destroying it. ▪ Streptococcus bacterium: is responsible for more diseases than any other organism (pneumonia) ▪ Tubercle bacillus (Mycobacterium tuberculosis): Tuberculosis infection ▪ Methicillin-resistant Staphylococcus aureus (MRSA): has been proven responsible for a number of serious and sometimes fatal infections. ▪ Spore-forming bacterium Bacillus anthracis causes the acute infectious disease of anthrax. Anthrax infection occurs in three forms: • Cutaneous (skin), Gastrointestinal, and Inhalation Treatment consists of antibiotics such as: • Ciprofloxacin (Cipro) or Doxycycline (Vibramycin) o Viruses: are the smallest known agents to cause disease ; are not complete cells but are composed of either RNA or DNA ▪ Viruses gain entrance to the body through various portals such as the respiratory tract, the gastrointestinal tract, and broken skin. ▪ Virus can infect a susceptible host through a mosquito bite or during an accidental needlestick with a contaminated needle 2

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Viral infections are usually self-limiting, they run a given course, and recovery usually occurs; One exception is acquired immunodeficiency syndrome (AIDS) ▪ Varicella zoster virus: Varicella (chickenpox) primary infection, herpes zoster (shingles) reactivation o Fungal (mycotic): infections are among the most common diseases found in humans; the most plentiful forms of life ▪ Mycotic infections: are diseases caused by yeasts and molds ▪ Coccidioidomycosis: valley fever ▪ Histoplasmosis: a systemic fungal respiratory disease o Protozoa: are single-celled animals; in some form, they exist everywhere in nature ▪ responsible for malaria, amebic dysentery, and African sleeping sickness ▪ Plasmodium falciparum: Malaria → Mosquito ▪ Entamoeba histolytica: Diarrhea, colitis → Intestinal tract (specifically the large intestine) Reservoir: Where pathogen can grow o Carrier (Vector): is a person or animal that does not become ill but harbors and spreads an organism, causing disease in others. Portal of Exit: Exit route from the reservoir o Hand Hygiene and the patient covering their nose and mouth when coughing or sneezing can break the chain or prevent infection from spreading Mode of Transmission: Method or vehicle of transportation, such as exudate, feces, air droplets, hands, and needles o Vector: A living carrier; indirect contact o Fomite: vehicle is an inanimate (nonliving) object; indirect contact o Direct contact: when the nurse uses poor hand hygiene technique and then touches a patient while providing care such as assessing, bathing, or repositioning the client or during medication administration. o DON’T shake linen; use a damp towel when dusting Portal of Entry: Entrance through skin, mucous lining, or mouth o Skin is the first line of defense; should be kept intact, lubricated, and clean o An indwelling urinary catheter or another type of drainage equipment often provides an entrance for microorganisms; ensure that tubes remain connected and intact. Host: Another person or animal that is susceptible to the pathogen o As the pathogen’s strength and numbers increase, the person becomes more susceptible.

3. Know and understand the difference between a fomite, vector, and spore and give examples of each. • Vector: A living carrier; indirect contact • Fomite: vehicle is an inanimate (nonliving) object; indirect contact • Spore: is a round body that is formed by the bacterium when conditions are unfavorable for growth of the bacterium; it remains dormant until environmental conditions become favorable for growth and then the spore germinates and begins reproducing; high degree of resistance to heat and disinfectants 3

4. Know and understand the chain of infection and how it can be broken at each stage. • Infection Prevention and Control: Handwashing, PPE’s, cleanliness and disinfection • Asepsis: Absence of pathogenic microorganisms o Medical Asepsis (Clean Technique) ▪ Inhibit growth & transmission of pathogenic microorganisms ▪ Used in daily activities such as handwashing o Surgical Asepsis (Sterile Technique) ▪ Destroys all microorganisms and their spores (Fungi & Protozoa) ▪ Used in operating rooms, during invasive procedures (catheter insertion)

5. Know and understand inflammatory response, the rationales, and prevention techniques. • Inflammation: is the body’s response to injury or infection at the cellular level o A protective vascular reaction that delivers fluid, blood products, and nutrients to interstitial tissues in the area of an injury. • Inflammation process: neutralizes and eliminates pathogens or necrotic (dead) tissues and establishes a means of repairing body cells and tissues • Signs of inflammation: o Edema (swelling) o Rubor (redness) o Heat o Pain or tenderness o Loss of function in the affected body part • Signs of Systemic Inflammation: o Fever o Leukocytosis (increased white blood cell count) o Malaise (generalized discomfort) o Anorexia o Nausea o Vomiting o Lymph node enlargement • Inflammatory Response: • Triggered by physical agents, chemical agents, or microorganisms o Physical Agents: ▪ Mechanical trauma ▪ Temperature extremes ▪ Radiation o Chemical agents: ▪ External and internal irritants (harsh poisons or gastric acid) o Microorganisms: trigger this response • Inflammatory response sometimes occurs in the absence of an infectious process

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6. Know and understand the different stages of an infection. • Localized Infection: Example: a superficial wound infection; The patient usually experiences localized symptoms such as pain and tender-ness at the wound site. • Systemic Infection: An infection that affects the entire body instead of just a single organ or part; potential to be fatal • Supportive Therapy: includes providing adequate nutrition and rest to bolster the body’s defense against the infectious process. • Stages of Infection: o INCUBATION PERIOD: ▪ Interval between entrance of pathogen into body and appearance of first symptoms (e.g., chickenpox, 1 to 3 weeks; common cold, 1 to 2 days; influenza, 1 to 3 days; mumps, 12 to 26 days) ▪ The host may be infectious during this period o PRODROMAL STAGE: ▪ Interval from onset of nonspecific signs and symptoms (malaise, low-grade fever, fatigue) to more specific symptoms ▪ During this time, microorganisms grow and multiply, and patient is more capable of spreading disease to others ▪ Example: herpes simplex begins with itching and tingling at the site during the prodromal stage, before the lesion appears. o ACUTE STAGE: ▪ Interval when patient manifests signs and symptoms specific to type of infection (e.g., common cold manifested by sore throat, sinus congestion, rhinitis; mumps manifested by earache, high fever, parotid and salivary gland swelling) ▪ This is often the period in which the individual is most contagious. o CONVALESCENCE ▪ Interval when acute symptoms of infection disappear ▪ Length of recovery depends on severity of infection and patient’s general state of health, and recovery takes from several days to months.

7. Know and understand how to correctly handle contaminated equipment and the rationales. • Health Care Associated Infection: infections previously were referred to as nosocomial infections and include infections patients get when undergoing medical treatment in a health care facility o Hospitals harbor microorganisms that are often highly virulent (exceedingly pathogenic) o Exogenous: growing outside the body; infection is caused by microorganisms from another person o Endogenous: growing within the body; infection is caused by the patient’s own normal micro-organisms, which become altered and overgrow or are transferred from one body site to another • The nurse is responsible for providing the patient with a clean and safe environment 5

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Federal law requires that health care employers make available the hepatitis B vaccine and vaccination series to all employees who have the risk for occupational exposure. A major risk to health care workers and facility personnel is in the improper disposal of sharps; for prevention of this problem, dispose of sharps into puncture-proof containers Place soiled linen in a laundry bag in the patient’s room; treat all linen as though it were infectious. Only double bag if there is a puncture in the bag

8. Know and understand all the PPE equipment, how and when they are necessary to be used, and the rationales. Be able to give examples. • Isolation Precaution Guidelines: (2 Types of Tiers) o (Tier 1) Standard Precautions: ▪ Use standard precautions for the care of all patients. o (Tier 2) Transmission Precautions: ▪ Airborne Precautions: for patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei Airborne Illnesses: • Measles • TB • Varicella zoster virus (including disseminated zoster), responsible for chickenpox and shingles Isolation is mandatory in a single-patient room designated as negativepressure airflow and having at least 6 to 12 air exchanges per hour. It is mandatory that health care workers wear an N-95 or higher particulate respirator mask ▪ Droplet Precautions: for patients known or suspected to have serious illness transmitted by large particle droplets Droplet Illness: • Invasive Haemophilus influenzae, including meningitis, pneumonia, epiglottitis, and sepsis • Invasive Neisseria meningitidis disease, including meningitis, pneumonia, and sepsis Bacterial respiratory infections of Droplet: • Diphtheria (pharyngeal) • Mycoplasma pneumonia • Pertussis • Pneumonic plague • Streptococcal pharyngitis, pneumonia, and scarlet fever in infants and young children Viral infections spread by droplet • Adenovirus 6

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• Influenza • Mumps • Parvovirus B19 • Rubella Contact Precautions: for patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient’s environment Contact Illness: • Gastrointestinal, respiratory, skin, or wound infections or colonization with multidrug-resistant bacteria Enteric infections with a low infectious dose or prolonged environmental survival • Clostridium difficile (C.Diff) • Diapered or incontinent patients with the following: 1. Escherichia coli O157:H7 2. Shigella 3. Hepatitis A 4. Rotavirus Respiratory syncytial virus, parainfluenza virus, and enteroviral infections in infants and young children Skin infections that are highly contagious or that tend to occur on dry skin, including the following: • Diphtheria (cutaneous) • Herpes simplex virus (neonatal or mucocutaneous) • Impetigo d. Major (noncontaminated) abscesses, cellulitis, or decubitus ulcers • Pediculosis f. Scabies • Staphylococcal furunculosis in infants and young children • Methicillin-resistant Staphylococcus aureus (MRSA) • Vancomycin-resistant enterococci (VRE) • Extended-spectrum beta-lactamase (ESBL); this enzyme attaches to the cell wall of E. coli and some Klebsiella organisms, which in turn makes the organisms multidrug resistant • Varicella zoster virus (disseminated or in the immunocompromised host) • Viral or hemorrhagic conjunctivitis • Viral hemorrhagic infections (Ebola, Lassa, Marburg) Patients with Immunocompromised Conditions They are generally at increased risk for bacterial, fungal, parasitic, and viral infections from endogenous and exogenous sources. Patients with leukopenia sometimes require protective measures in addition to standard precautions.

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9. Know and understand standard precautions. Provide details of use for each and the rationales. • Centers for Disease Control and Prevention (CDC): services for investigation, prevention, and control of disease. • Standard Precautions: recommended that health care workers use “universal blood and body fluid precautions,” or “universal precautions,” and body substance isolation when caring for all patients o These precautions promote hand hygiene and use of gloves, masks, eye protection, and gowns when appropriate for patient contact. o Hand hygiene: is the single most important and basic preventive technique that health care workers can use to interrupt the infectious process ▪ The standard is to wash for at least 20 seconds with facility-approved soap, running hands under water ▪ Wash hands before and after seeing a patient ▪ Only natural nails should be worn in the health care setting; these should be no longer than 1/4 inch o Gloving: Nurses and other health care personnel should don gloves if any possibility exists of contact with infectious material with their hands ▪ Suspect the presence of a latex allergy and obtain an evaluation by a physician when anyone has development of red, watery, itchy eyes; sinus or nasal congestion; tachycardia; or hypotension after exposure to latex. Anaphylaxis: A potentially life-threatening condition that can develop when someone is exposed to latex and has a severe latex allergy o Mask, Eye Protection , Face Shield: ▪ Nurses should change their masks at least every 20 to 30 minutes and/or when they become moist. o Gown: The nurse should don a gown when preparing to provide care for a patient in isolation to help protect the nurse’s clothing from becoming soiled; the gown also provides protection against unknown infectious microorganisms ▪ Another rationale for use of a gown is protection of a patient whose immune system is inadequate; in this situation, health care workers and visitors wear a gown ▪ Donning of an isolation gown is indicated in the care of patients with diseases characterized by heavy drainage or exudate, infectious and acute diarrhea, other gastro-intestinal disorders, respiratory disorders, skin wounds or burns, and urinary disorders.

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10. Know and understand the process involved which allows physicians to choose antibiotics to best inhibit pathogens growth and stop infection, and the rationales. • By evaluating signs and symptoms revealed during assessment, the nurse can determine whether a patient’s clinical condition indicates a risk for infection • Early recognition of infection helps the nurse identify a patient problem and thus establish an appropriate treatment plan. • Blood culture exams are performed to check if the microorganism is aerobic or anaerobic • Sensitivity tests: assist the practitioner in determining which antimicrobial (antibiotic) medication will inhibit the pathogens’ growth effectively; antimicrobial agents on the basis of these tests, which typically take 48 to 72 hours to complete

11. Know and understand range of motion exercises, how/why each is used, and the rationales. • Range-of-motion (ROM): movement of the body that involves the muscles and joints in natural directional movements/ exercises; prevent excessive muscle atrophy and joint contracture. o Passive ROM: exercise is performed by caregivers o Active ROM: exercise is performed by patients o The joint moved actively or passively to the point of resistance or pain, with avoidance of injury o To prevent contracture (an abnormal shortening of a muscle), do not allow patients with joint pain to remain continuously in position of comfort; joints must be exercised routinely. o The total amount of activity required to prevent disuse syndrome (a state in which an individual is at risk for deterioration of body systems as a result of prescribed or unavoidable inactivity) is only about 2 hours for every 24-hour period • Range of Motion exercises: o Flexion: Movement of certain joints that decreases angle between two adjoining bones. o Extension: Movement of certain joints that increases angle between two adjoining bones. o Hyperextension: Extreme or abnormal extension beyond normal joint ability. o Abduction: Movement of the arm or leg away from body. o Adduction: Movement of the arm or leg toward axis of body. o Circumduction: Movement of a body part in a 360-degree circular motion, usually involves the arm or leg o Supination: Movement of the palm of the hand from facing downward to facing upward. o Pronation: Movement of the palm of the hand from facing upward to facing downward o Dorsiflexion: Backward flexion of the hand of foot.

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12. Know and understand complications of mobility and preventa...