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Reservoir
the source of infectionpeople, animals, insectswater, food, medical equipmentpathogens can colonize skin, fecal material, saliva TERM 2
Host
DEFINITION 2 Susceptible hosts: immune status-immunocompromised patients (allergies, asthma, cancer, etc.)-elderly-infants and children-malnutrition-environmental factors (water contamination, construction contamination, etc.)-invasive procedures (skin is first line of defense; breaking skin puts body at risk and site)-alteration in normal flora TERM 3
Methods for transmitting disease
DEFINITION 3 -Airborne-Droplet-Contact (direct or indirect) TERM 4
Direct Contact
DEFINITION 4 transmission method-break in skinEX: catheters TERM 5
Indirect Contact
DEFINITION 5 transmission method-uniforms-lab coats-thermometers-BP cuffs-stethoscopes
Pathogen
microorganisms capable of producing diseases TERM 7
Communicable Pathogens
DEFINITION 7 MeaselsTB TERM 8
Self limited Pathogens
DEFINITION 8 Urinary Tract Infectioncan't pass on to someone else TERM 9
Virulence
DEFINITION 9 frequency in which a pathogen causes a diseaseEX: Cholera in Haiti (close proximity; tight living conditions; no sanitation) TERM 10
Colonization
DEFINITION 10 pathogens that reside on or in tissues without causing disease-area becomes colonized with bacteria-usually areas of the body that are in contact with environmentGI tract, Respiratory tract, conjunctiva
What can suppress immune functioning?
steroidschemotherapyanti-rejection medications TERM 17
What can increase susceptibility?
DEFINITION 17 diabetessmoking, ETOHmalnutritiondevices: endotracheal tubes, heart devicesbreak in integumentary system TERM 18
Body Defense Mechanisms: Body Tissue
DEFINITION 18 Skin (acidic=GOOD)Mucous membranes--secretions (tears, saliva) -contain lysozymes--breakdown the cell walls of bacteria -dissolve cell walls of bacteriaGI tract (stomach acids, intestinal secretions)Respiratory tract (filtration system, coughing) TERM 19
Body Defense Mechanisms: Macrophages
DEFINITION 19 Through phagocytosiseat bacteriahelp alert immune system through cytokines secreted during digestion TERM 20
Body Defense Mechanisms: Inflammation
DEFINITION 20 leukocytesdamaged cells release enzymes that attract neutrophils=pus
Body Defense Mechanisms: Immune System
communication system for non selfneutrophils jump right in to where they are needed TERM 22
Assessing for
infection
DEFINITION 22 Vital signssigns and symptoms (S/S) TERM 23
Ways to Communicate
findings
DEFINITION 23 DocumentReport-->document everything you have examinedRounds-->get to know patient and watch/notice surrounding and patient conditionInfection Control Department TERM 24
How to educate patients and
families
DEFINITION 24 Preventing infectionsrecognizing symptomswhen and how to report symptoms TERM 25
Direct Contact Transmission
DEFINITION 25 Person to Person -skin-mucous membrane
Disinfection
HAI preventionreduces disease causing organismsclean technique TERM 32
Patient placement/transport
DEFINITION 32 HAI preventionisolation/private roomscohorting (putting a patient with another patient that has the same disease/infection TERM 33
Oral health
DEFINITION 33 HAI preventionhave found that bacteria in/on the mouth can cause pneumonia in immunocompromisedshows importance of cleaning mouth of patient TERM 34
Infection Control Department
DEFINITION 34 Certified NursesProgram designed to reduce risks for healthcare associated infectionsTJC (The Joint Commission) National Patient Safety Goals TERM 35
TJC National Patient Safety Goals
DEFINITION 35 Identify patients correctly (Name, DOB, ID bands)Improve staff communication (EMR, documentation, report, rounds, huddles)Use medications safely (medication reconciliation, look alike, sound alike)Prevent infections (monitor risks, infections)Identify patient safety risksPrevent surgical errors (time-outs)
List 2 multi-resistant bacterial infections
diagnosed in hospital patients
Methicillin-Resistant Staphylococcus Auresu (MRSA)Vancomycin-Resistant Enterococcus (VRE) TERM 37
MRSA
DEFINITION 37 S. Aureus commonly found on skin and perineum, nosebreak in skin can result in monor infectionsdeep wounds (i.e. surgical site infections), lungs or bloodstream (BSI)becoming more common in U.S. hospitalsPatients or staff may be colonizedSpread by direct contact (catheters, endothraceal tubes)Patients may become septic (130,000 cases each year)usually responsive to Vancomycin TERM 38
Nursing care for MRSA
DEFINITION 38 private or cohort roomgloves when entering roomwash hands before leaving roomgown to prevent contact with conatminated areas in roomremove gown and gloves before leaving roomdedicated equipment (don't use personal gear)double bag laundry, waste materialeducate patient and family on preventing spread of infection TERM 39
Nursing care of VRE patient
DEFINITION 39 contact precautionscontamination of bathroom facilities and door handles may lingerfollow same care as MRSA TERM 40
Multidrug Resistant Organisms (MDRO)
DEFINITION 40 TB, Pneumonia, GonorrheaUse of antibiotics for non bacterial infectionsOveruse of antibioticsIncreased use of antibiotics in farm animalsNursing Safety: Wear scrubs at work, change into street clothes, take a shower when you get home, clean stethoscope several times a day
Psychosocial Assessment
concerned about risks (to self, family, friends)Assess family's understanding (provide education about testing being done)if sexually transmitted (social stigma, family issues) TERM 47
Cultures
DEFINITION 47 urine, sputum, bloodcollected in specific containersmust label with name, date, time collected, MR#isolates pathogenscan determine drug sensitivities TERM 48
CBC with differential
DEFINITION 48 WBC often elevated with bacterial infection -may decrease with viral infections -changes in differential (shift to left)--> looks at monocytes TERM 49
Erythrocyte sedimentation rate
(ESR)
DEFINITION 49 Increase in rate indicates inflammation TERM 50
Bands
DEFINITION 50 immature white blood cellsincrease in infection
Imaging Assessment
CT ScanMRIUltrasound -imaging tests identify -fluid collections -abscessesRadioactive substances can identify tissue inflammation TERM 52
Functions of body fluid
DEFINITION 52 Delivers nutrients, electrolytes to organs, tissues and cellsMust be carefully balanced to maintain homeostasis TERM 53
Solvent
DEFINITION 53 water portion of fluid TERM 54
Solutes
DEFINITION 54 particles dissolved or suspended in watervary from one space to anotherelecrically charged solutes are electrolytescontrolled by filtration, diffusion, osmosis TERM 55
Filtration
DEFINITION 55 movement of fluid through a cell or blood vessel due to hydrostatic pressuemechanical force of water pushing against cellular membranesforce pushes water across capillary membranes into intersitial space (filtration)EX: Edema--tissue swelling due to changes in hydrostatic pressure
Fluid balance
measuring intake to output TERM 62
Output fluid
DEFINITION 62 obligatory urine output (400-600 ml)orders usually call if < ml/hour (720)normal specific gravity of urine 1.005- 1.030below obligatory rate -critical electrolyte imbalances - hypernatremia -hyperkalemia TERM 63
Sodium in
serum
DEFINITION 63 135-145 mEq/Lhypernatremia: excessive loss of waterhyponatremia:heart failure, cirrhosis, nephrosis, excess fluid intake TERM 64
Potassium in
serum
DEFINITION 64 3.5-5.0 mEq/Lhyperkalemia: aldosterone deficiency, sodium depletion, acidosis, traumahypokalemia:lack of intake, vomiting TERM 65
Calcium in
serum
DEFINITION 65 8.5-10.5 mg/dLhypercalcemia: excessive vitamin D, ACE inhibitorshypocalcemia: insufficient vitamin D, inadequate intake, hypoalbuminemia, diarrhea
Magnesium in
serum
1.5-2.5 mg/dLhypermagnesemia: excessive use of antacids or laxatives, untreated ketoacidosishypomagnesemia: loss of GI fluids, acute alcoholism/cirrhosis TERM 67
Aldosterone
DEFINITION 67 hormone secreted by adrenal cortexacts on kidney nephrons to reabsorb sodium and water from urine back into bloodregulates and prevents water and sodium lossregulates and prevents hyperkalemia*kicks in when water needs to retain fluid TERM 68
Antidiuretic hormone
DEFINITION 68 vasopressionresponds to changes in blood osmolarity (change in plasma sodium triggers ADH)acts directly on kidney tubules, increasing the reabsorption of water, making blood more dilute (sodium decreases, osmoreceptors swell, inhibit release of ADH)kidneys are a major player in regulating fluid balance TERM 69
Renin angiotensin
pathway
DEFINITION 69 kidneys are a mjor regulator of luid and sodiummonitor and balance BP, perfusion of tissues and organshypotension, hyponatremia -kidneys secrete renin-->sets off a response to raise BP, renin activates angiotensin 1, angiotensin converting enzyme activates angiotensin 2-->increases blood volume, increases BP (vasoconstricotr, decreases glomerular filtration rate, aldosterone is released by adrenals) TERM 70
Renin Angiotensin 2 pathway
DEFINITION 70 stimulated with hypotension (shock)urine output is a significant parameter to monitorhypertension (limit sodium intake, diuretics, ACE inhibitors decrease release of angiotension 2, angiotensin receptor blockers (ARBs) block receptors that bind with angiotensin 2)results in fluid release
Dehyrdration interventions
fluid replacementpatient safetydrug therapy TERM 77
Fluid overload clinical issues
DEFINITION 77 in ECFCHF, Kidney failuredecreased hemoglobin and hematocritcrackling in lungsS3 gallop in HRpitting edemareduced urine outputincreased neck vein distentionprogress to increased abdominal girth/ascites TERM 78
Sodium levels impact
DEFINITION 78 skeletal and cardiac muscle contractionnerve impuse transmissionwater follows sodium TERM 79
Hyponatremia
DEFINITION 79 <135asses cognitive and behaviorial patterns, LOCdecreased deep tendon reflexesdecrease leg and arm muscle strengthincreased motility in GI=cramping, diarrhea, nausea; hyperactive soundsdecrease in plasma volume; poor pulse palpability; hypotension; orthostatic pressure changesTreatment: decrease fluid intake, skin protection, measure I and O, skin integrity, VS TERM 80
Hypernatremia
DEFINITION 80
145indicates sodium has left ICF for ECFsevere cellular dehydrationneuro-mental status changesskeletal muscle twitching, reduced deep tendon reflexesdecreased cardiovascular contracctilitymonitor VSneck veins distendedTreatments: fluid replacement, monitor kidney functioning
Hypokalemia
<3.5affected by function of kidneyscan be caused by diuretics, steroids, beta blockersTreatment: -kayexalate (enima) -insulin will lower much faster -monitor EKG TERM 82
Hypocalcemia
DEFINITION 82 <9.0 mg/dlcauses: inadequate intake, lactose intolerance, malabsorption syndrome, inadequate vit D, kidney failure, GI wound, parathyroid gland decreased function TERM 83
Hypocalcemia assessment
DEFINITION 83 neuromuscular changes: hands, feet, parasthesias, tingling, numbness, twitching,Trousseau's, Chvostek'sEKG changes, prolonged ST and QT intervals, thready pulse, hypotension TERM 84
Hypercalcemia
DEFINITION 84
10.5 mg/dLincreased heart rate and BPsevere hypercalcemia depresses electrical conductionsevere muscle weakness, altered LOCdecreased peristalsis, constipation, anorexia, abdominal pain, increase abdominal girth TERM 85
Calcium chelators
DEFINITION 85 will attach to calcium to pull out of cellDrugs that bind to Ca: -plicamycin, penicillamineDrugs that inhibit calcium resorption: -Calcitonin, biphosphonates, prostaglandin synthesis inhibitors (ASA, NSAIDS)
Paralytic
Ileus
aka pseudo-obstructionmajor causes of intestinal obstruction in infants and childrenCauses:-chemical, electrolyte, or mineral disturbances-decreased blood supply to the abdominal area injury to abdominal blood supply-use of certain medications, especially narcotics TERM 92
Patient Safety
DEFINITION 92 assess patients for fall risksmeasure I and Omonitor EKGuse pump to deliver IV fluids with electrolytescollaborate with dietitianeducation of patients and families TERM 93
Diabetes characteristics
DEFINITION 93 multisystem diseaseendocrine (vascular problems, MI, stroke, blindness, amputation)impaired insulin productionimpaired insulin utilzation6.2% of US population has diabetes1/3 not diagnosed11 types of diabetes; most common: type 1, type 2, gestational, secondary TERM 94
Etiology of diabetes
DEFINITION 94 geneticautoimmuneviralenvironmental (obesity, stress)problem of glucose metabolism related to supply of insulin or poor utilization of insulintype 1--beta cell destruction, autoimmune, idiopathictype 2--insulin resistance, insulin deficiency, secretory defect TERM 95
Type 1 Diabetes
DEFINITION 95 diagnosed <30abrupt onsetnot obeseinsulin dependent
Type 2 Diabetes
adult onsetmore children have nowslower onset>60% obese20-30% require insulin TERM 97
Hyperglycemia
DEFINITION 97 drug induced: steroids, Calcineurin inhibitors, thiazides= diabetogenic drugsinfections--viruses often destroy beta cellsendocrinopathies: acromegally (growth hormone counters insulin), Cushing's diseasedown sydrom TERM 98
Diabetes pathophysiology
DEFINITION 98 insulin produced by beta cells in Islets of Langerhans of pancreas2% of pancreasRelease of insulin: continuous, pulsatile; into blood stream; maintains homeostasis of blood glucose (70-120) 60-150 mg/dl; average adult secretes 40- units of insulin into liverlow levels screted during fasting (basal)increase release with food consumption (prandial) TERM 99
Islets of Langerhans
DEFINITION 99 1 million small glandsscattered throughout pancreasalpha cells secrete glucagonbeta cells secrete insulinglucagon is considered a Co-regulatory hormone TERM 100
Function of Insulin
DEFINITION 100 required to move glucose into the cellhyperglycemia develops when glucose remains in blood -causes fluid and electrolyte imbalances -polyuria, polydipsia, polyphagiapromotes glucose transort from bloodstream across cell membrane to cytoplasm of cellsrise of insulin after eating stimulates storage of glucose as glycogenfall of insulin facilitates release of stroed glucose from liver, protein from muscle and fat from adipose tissue
