Med.Surg. Test 4

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Med.Surg. Test 4
2014-11-14 02:44:46
Med Surg Test

Med.Surg. Test 4 second semester
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  1. what is TB and where can it be found
    TB is an infectious disease

    • and can be found in the :
    • lung (lung parenchyma)
    • meninges
    • kidneys
    • bones
    • lymph nodes
  2. what is causing TB
    infectious agent called

    M. tuberculosis

    it is an acid fast aerobic rod

    grows slowly

    is sensitive to heat and ultraviolet light

    (rarely Mycobacterium bovis/ or  - avium)
  3. riskfactors for TB
    close contact to a person with active TB

    immunocompromised patients (cancer, HIV, organtransplant, meds: coticosteroidshighdose therapy)

    substance abuse (IV, alcohol)

    poverty, malnutrition, overcrowding, substandard housing, inadequate healthcare,
  4. transmission of TB
    airborne transmission through talking, coughing, sneezing, laughing,singing,
  5. Allergy response, latex

    1 characteristics subj. + objective
    • 1 subj.
    • feeling breathless, tight in breast, abdominal pain, nausea, itching eyes/ face, generalized discomfort, decreasing complaint reg. rising temp.
    • later occurring reactions -> type 4-> discomfort reaction to additives

    2. edema, dyspnea, hypotension, cardiac arrest, restlessness, flushing, facial erythema, type 4 reaction: eczema, irritation, redness
  6. contributing factors, latex allergies
    existing food allergies like banana, avocado, chestnut, kiwi, papaya, peach, nectarine

    occupationally exposed to latex

    neural tube defects like spina bifida

    frequent surgery or catheterization
  7. when do the most severe latex allergy incidents happen
    during invasive procedures like surgeries, with latex proteins contacting mucous membranes of mouth, vagina, urethra or rectum
  8. how can I find out if person has allergy to latex
    ask regarding any reaction when blowing balloons, using powdered gloves, latex diaphragm, or condom

    SPT skin-prick test positive when tested with latex

    challenge/patch test with known TYPE 4 reaction

    • RAST radioallergosorbent test  or ELISA enzymelinked assays of latex specific IGE
  9. nursing interventions regarding allergies

    take measures to reduce/limit allergic response/ avoid exposure

    promote wellness -> teaching/learning
  10. how to take measure of allergic response
    noting reports of rash, hives, itching, edema, diarrhea, nausea feeling of faintness

    determine time since exposure

    assess skin, for dry, hard bumps, scaling, lesions, horizontal cracks (contact dermatitis, least serious and most common) or (allergic contact dermatitis - delayed onset and more severe form of skin reaction)

    assist with type 4 reaction: washing with mild soap and water, possible application of steroid ointment, avoidance of further exposure
  11. what are possible treatments, if severe life-threatening  allergic reactions occur (systemic)
    • antihistamines
    • epinephrine
    • IV fluids
    • corticosteroids
    • oxygen/mechanical ventilation
  12. Levaquin
    drug class
    side effects
    nursing measures
    • antibacterial
    • fluoroquinolones (quinolones)

    interferes with enzyme DNA gyrase-> needed for bacteria DNA

    against gram negative organisms like pneumonia, UTI, gonorrhea

    • taken together with NSAID's-> ! seizures can occur
    • taken together with Levofloxacin -> can increase oral hypoglycemics
    • dizziness, photosensitvity

    • take baseline vitals for comparison
    • check renal function (BUN + serum creatinine)
    • antacids and iron decrease absorption -> take 2 hours before/after
    • check 750 ml urine per day + well hydration >= 2000 ml per day
    • check for superinfection
    • no caffeine-> increases effect
    • monitor infection

    -floxacin (cipro-, levo-, moxi-, nor-,)
  13. Vancomycin
    side effects
    nursing measures
    (antibacterial) -> bactericidal

    inhibits cell wall synthesis, gram positive bacteria -> rupture

    substitute for penicillin, against s.aureus, cardiac surgery prophylaxis, staphylococcus infection, complicated skin infections, MRSA

    red neck syndrome, ototoxic (8th nerve for hearing)-> loss of balance +hearing,
    vascular collapse, nephrotox

    monitor serum level of vancomycin to prevent hearingloss
  14. Prednisone
    drug class
    side effects
    nursing measures
    endocrine drug, Glucocorticoid, cortisone drug

    • anti-inflammatory, anti-allergic, anti-stress
    • trauma, inflammation, surgery, emotional upsets, anxiety, autoimmune disorders, shock, hepatitis, asthma, anaphylaxis, contact dermatitis

    water retention, potassium loss, BP increase, together with NSAID's GI toxicity

    measure regarding side-effects,
    caution hypertension, diabetes, osteoperosis
  15. Penicillin
    drug class
    side effects
    nursing measures
    antibiotic (beta-lactam), penicillin

    against gram positive and negative bacteria, bacteriostatic and bactericidal (dep. on dosage), infection

    hypersensitivity, super-infection, nausea, vomiting, diarrhea, may decrease effectiveness of oral contraceptives, together with aminoglycocide in IV-> both deactivated

    can be taken after meals, no good absorption when taken orally-> IM and IV possible
  16. (Augmentin)
    amoxicillin/ clavulanate
    drug class
    side effects
    nursing measures
    • anti-infectives
    • aminopenicillin/ beta lactamase inhibitor
    • binds to bacteria cell wall-> bacteria death
    • treatment of variety of infections
    • gonorrhea, orally well absorbed
    • SE: diarrhea, rashes, may decrease effect or oral contraceptives, ma increase effect of warfarin
    • assess for allergy, infections, bowel function, may cause false direct coombs test result
  17. (Benadryl)
    drug class
    side effects
    nursing measures

    • relief of allergic reactions caused by histamine like anaphylaxis, allergic rhinitis, - dermatoses,
    • reduced sneezing, ocular tearing,...

    drowsiness anorexia, dry mouth,

    assess for confusion, dizziness...
  18. epinehrine
    (Adrenaline, EpiPen)
    drug class
    • adrenergic
    • anti-asthmatic, bronchodilators
    • asthma, COPD, Allergic reaction, cardiac arrest,

    bronchodilation, vasoconstriction, inhibits hypersensitivity reaction


    SE:  nervousness, restlessness, tremor, angina, tachycardia

    assess lung sounds, pulse BP before administration
  19. Atarax
    anti-histamine, anti-anxiety, sedative

    treatment of anxiety, preoperative sedation, decreased allergic symptoms related to release of histamines

    SE: drowsiness, dry mouth, local pain at IM site,

    Assess itching, sedation,nausea, vomiting
  20. anaphylaxis
    sudden, severe allergic reaction

    between an allergenic antigen + immunoglobulin E (IgE) bound to mast cells,

    ->stimulates the sudden release of immunological mediators locally or throughout the body.

    The first symptoms occur within minutes, and a recurrence may follow hours later (late-stage response).

    can only occur in someone previously sensitized to an allergen because the initial exposure causes immunoglobulin E (IgE) to bind to mast cells.

    Anaphylaxis may be local or systemic.

    Local: hay fever, hives, and allergic gastroenteritis.

    Systemic: peripheral vasodilation, bronchospasm, and laryngeal edema and can be life-threatening.
  21. infectious process
    (methods to break chain)
    1. infectious agent (rapid identification)

    2. reservoir (disinfection, employee health, sanitation)

    3. portal of exit (hand hygiene, control of secretions, waste disposal)

    4. mode of transmission (isolation, food handling, airflow control, standard precautions, sterilization, hand hygiene)

    5. portal of entry (aseptic technique, catheter care, wound care)

    6. susceptible host (recognition f high risk patients, treatment of underlying disease)
  22. what is MRSA
    • methicillin resistant staphylococcus aureus :
    • SA bacterium that is resistant to extended penicillin antibiotic formulas - cillin
  23. Mode of transmission of varicella/ chickenpox
    airborne or contact
  24. mode of transmission: herpes 1+2
    contact with mucous membrane secretions
  25. HAI's
    • health care associated infections
    • up o date: see CDC website
  26. Isolation precautions
    guidelines to prevent transmission of organism in hospital

    first tier= standard precautions for the care of ALL patients

    second tier = transmission based precautions for the care of patients with known or suspected infectious diseases spread by contact, droplet or airborne routes
  27. standard precautions
    -premise that all patients are infected

    -PPE (personal protective equipment) incl. mask, eye protection, cover gowns, depending on degree of expected exposure to patient excretions or secretions

    -elements: hand hygiene, use of PP, proper handling of patient equipment, linen, environmental control, prevention of injury from sharp devices, glove use, room assignments,
  28. airborne precautions
    pulmonary TB, chickenpox, small pox, measles

    negative pressure room, , wear N-95 respirator, protective mask
  29. droplet precautions
    • like influenza or meningococcus, mumps, rubella,
    • face mask,
  30. contact precautions
    • c-diff
    • private room
    • hand hygiene
  31. Hepatitis A Virus (HA)

    • -20-25% of cases of clinical hepatitis
    • transmitted fecal-oral
    • ingestion

    overcrowded, poor sanitation, contaminated water, poor hygiene of people with developmental or mental disabilities, multiple sexpartners,

    jaundice, dark urine, epigastric distress, or symptomless, like mild URI, severe anorexia (loss of appetite),
  32. Acute Otitis Media (AOM)
    • -infection of middle ear
    • most common in children
    • lasting less than 6 weeks
    • infectious agent enter middle ear after Eustachian tub dysfunction because of URI, allergy, inflammation.

    -usually purulent exudate in middle ear -> conductive hearing loss
  33. symptoms of Otitis Media
    • -pain, unilateral in adults
    • drainage from ear
    • fever
    • hearing loss
    • tympanic membrane often bulging

    risk: chronic exposure of 2nd hand smoke

    antibiotic and early detection -> good

    hearing loss rare

    second infection rare but can occur like brain abscess

    myringotomy or tympanotomy-> take out drainage
  34. URI's
    • upper airway infections
    • most common cause of illness and reason of absence from work or school
    • acute or chronic
    • viruses (90%) or bacteria
    • nasal cavity, ethmoidal air cells, frontal, macillary and sphenoid sinuses, pharynx larynx, trachea
    • 2-4 URI's per year-> vide variety of viruses

    S+S: common cold,
  35. varicella
    • Because severe illness and death have resulted from varicella in children being treated with corticosteroids, these children should avoid exposure to varicella.
    • -transmitted by droplets  or direct contact with a lesion and contaminated equipment also can spread the virus.

    Reactivation of the virus in adults causes shingles.


    a rash, described clinically as having a “dewdrop on a rose petal” pattern, scattered in clusters (crops) over the trunk, face, scalp, upper extremities, and sometimes the thighs.

    After an incubation period of 2 to 3 weeks (usually 13 to 17 days), patients develop fever, malaise, anorexia, and lymphadenopathy, followed by the appearance of an extremely itchy rash that starts flat and,

    over time, becomes a small blister on a red base, and then eventually forms crusted scabs.

    All three stages of the rash may be present on the body at one time.

    Varicella may be transmitted to others until all lesions are crusted over.

    Immunization with varicella vaccine provided during infancy is designed to prevent these complications. Administration of varicella-zoster immune globulin (VZIg) within 72 hr of exposure will prevent clinical varicella in susceptible, healthy children. 

       Immunization with varicella vaccination is recommended.
  36. rheumatoid arthritis
    autoimmune disease of unknown origin

    • reaction in synovial tissue,
    • 1.phagocytosis produces enzymes in joint-> 2.these break down collagen->
    • 3.edema, proliferation of synovial membrane, pannus formation->
    • 4.destroys cartilage and bone->
    • 5.loss in articular surface and joint motion
  37. S+S of RA
    • acute and fast onset
    • symptoms bilateral and symmetric
    • joint stiffness in the morning
    • immobilization -> contractions-> soft tissue deformity
    • systemic disease
    • Raynod's phenomenon= cold and stress induced vasospasm-> cyanosis and blanching
    • nodules occur only in people with rheumatoid factor-> rapidly progressive and destructive disease
    • other extraarticaular features: arteritis, neuropathy, scleritis , sjoergens syndrome (dry eyes + mucous membranes)
  38. assessment RA
    Arthrocentesis shows synovial fluid that is clowdy, milky, dark yellow + contains lots of inflammatory components

    X-ray should be performed at baseline

    Rheumat. factor is present in 3/4 of patients
  39. treatment of RA
    • balance of rest and exercise
    • education
    • salicylates or NSAIDs

    cyclo oxygenase enzyme blocker, COX2-> blocks enzyme involved in inflammatory process-> less likely to cause gastric irritation (assossciated with cardiac risk)

    Methotrexat (Rheumatex) standard treatment of RA_ preventing joint destruction

    opioids avoided because of need for continued pain relief

    for persistent erosive RA _ reconstructive surgery

    Arthroplasy= surgical repair/ replacement of joint

    Systemic corticosteroids for unremitting pain and inflammation, may be treated also as local injections with single large joints
  40. nursing management of RA
    • most common
    • pain, sleep disturbance, fatigue, altered mood, limited mobility, depression
  41. osteorthritis
    =degenerative joint disease

    primary (idiopathic)  with no prior event 

    secondary -> resulting from previous joint injury or inflammation disease

    increasing with age in weight bearing joints

    affects articular cartilage, subchondral bone and synovium

    congenital  developmental disorders-> predisposition to OA of hip

    risk factors: older age, obesity previous joint damage, repetitive use, anatomic deformity and genetic susceptibility
  42. clinical manifestations of OA
    pain, stiffness, functional impairment

    osteophytes (bone spurs)

    stiffness in the morning after awakening, less than 30 minutes

    no treatment halts degenerative process

    weight reduction,



    intra-articular corticosteroids


    visco supplementation (gel-like substances into joint (intra-articular)

    weight loss and exercise

    assistive devices
  43. Isolation
    • protective isolation:
    • disinfect equipment before entering the room
    • take linen and dishes directly to isolation room
    • handing to someone with protective garb

    • transmission based isolation:
    • disinfect equipment upon removal of patient room
    • linens ... in special isolation bags (2 workers), one inside with garb one at door
    • contaminated disposables in special isolation bags-> securely close -> into special isolation trash container (only for contaminated trash!)

    • specimen
    • label specimen before entering the room
    • put container into special plastic bag, outside of bag should not touch anything contaminated
  44. donning surgical attire
    gown, shoe covering, hat, wash hand ans may be mask, surgical scrub, eventually surgical attire, then gloves
  45. don sterile gloves
    • open package slowly
    • first glove on dominant hand,
    • second hand rule: touch glove to glove and skin to skin
  46. sterile field
    open sterile package with inside sterile

    sterile wrapper which creates sterile field when open

    sterile field only horizontal plane

    1 inch margin around is unsterile

    if any object falls on the field it is no longer sterile

    • unpack a bowl (large)
    • touch the wrap only outside, then place on sterile field

    excess fluid running of field-> contaminated
  47. exposed to bloodborne pathogens
    • 1. wash area (water, soap, disinfectant)
    • 2. report immediately to appropriate person
    • 3. seek medical attention, evtl. labwork
    • 4. incident report
    • 5. counseling session
  48. body's defenses against infection
    • first line of defense: anatomical features
    • like skin, mucous membrane, respiratory tree, eyes, mouth, gastrointestinal tract, genitourinary tract...

    • second line of defense: biochemical processes, unspecified, fight pathogens that enter,
    • like
    • - inflammation,
    • 1.start with histamine release
    • -> dilation, increased permeability of blood vessels,
    • -> increase flow of phagocytes, chemicals, oxygen, nutrients
    • (signs: warmth, redness, edema, pain)

    - phagocytosis (WBC), macrophage, eosinohils->binding to helmints and releasing toxins , complement cascade (complement=proteins 1. trigger release of toxins to attack cell membranes, 2. inform basophils to release histamine)

    • -fever:
    • 1. increases metabolism
    • 2.inhibits multiplication of pathogens
    • 3. triggers specific immune response
    • 4. evtl. do not treat fever lower than 102

    third line of defense: specific immune response against recognized invaders
  49. third line of defense
    production of antibodies = Ig immunoglobulins

    -proteins with a base region and 2 arms

    • bind to target antigens and destroy them by
    • 1. phagocytosis (signal to leukocytes)
    • 2. neutralization pathogens cannot invade anymore
    • 3. agglutination (2 attachment sites hold 2 pathogens-> decrease mobility, easier to detect for leukocytes)
    • 4. activation of complement and inflammation (trigger complement cascade and release or inflammatory chemicals)
  50. 5 classes of IGs
    • IgM
    • produced when antigen is seen for the first time
    • cannot pass placenta

    • IgG
    • most common
    • 1.body recognizes antigen and produces IgG
    • 2. special B memory cells are formed that produce IgG in response to infection
    • takes 10 days to produce IgG
    • 4. memory to IgG fades over time(pathogen, health, strength of initial response...)
    • 5. IgG is small enough to pass through placenta and breastmilk, can be given as injectable medication

    • IgE
    • 1. primarily responsible for allergic response
    • 2. body identifies antigen and tries to destroy, subsequent exposure results in more severe response
    • 3.typical allergic response: mucus prod. increased, itching, rashes, hives, eczema, tearing,sneezing, wheezing, anaphylactic shock

    • IgA
    • mucus membranes secrete IgA for additional protection

    • IgD
    • these are on the surface o B cells to trap antigens to prevent it from replicating
  51. what factors increase host susceptibility
    • age,
    • breaks in first line of defense,
    • illness,
    • injury,
    • tobacco use
    • substance abuse
    • multiple sex partners
    • environmental factors
    • chronic disease
    • meds
    • nursing and medical procedures