NURS 642 Test Questions and Answers
Most common cause of hospital acquired infection?
catheter associated UTI
What should happen if a patient presents with existing foley?
Change the foley, if possible just remove the foley and not replace
How to reduce HAIs
use proper hand hygiene recommendations, follow infection prevention protocols, keep
patients in the best possible physical conditions to help them fight infections, and learn to deal
with multi drug resistant organisms, remove lines if possible.
Systemic signs of infection
delirium, lethargy, fever or hypothermia, tachycardia, hypotension
Anatomic site of infection you take into account what?
proximity to vital structures or joints
Presence of purulence can indicate what?
infection
When do symptoms of necrotizing infection occur?
late in the process
Symptoms of necrotizing inection
pain disproportionate to physical findings
violaceous bullae, cutaneous hemorrhage, skin sloughing, skin anesthesia, rapid progression,
gas in tissue
Most effective preventative measure of infection?
handwashing
,what percentage of patients acquire a Healthcare associated infection?
10%
Most common types of HAI infections?
UTI from indwelling catheters or procedures
blood stream infection from catheter or secondary sites
pneumonia of intubated unconscious patient
SSI
MRSA
CDIFF
Preventative measures (aside from handwashing) of HAI?
early removal of invasive devices or lines
limit spectrum of antibiotic coverage and unnecessary duration to prevent multidrug resistance
What are indications for line removal?
-purulence at insertion site
-S.areus, candida, or gram neg rods
-persistent bacteremia (>48hr on abx)
-complications (thromboemboli)
What is empiric antibiotics
vanco for MRSA
consider gram neg coverage for immunocompromised/critically ill
treatment if patient presents with UTI symptoms and a foley present
-remove foley
-treat with 7 days abx specific to culture results
-treat for 14 days if fever, back pain, leukocytosis, or suggest pyelonephritis
SSI (surgical site infection) prevention
, prophylactic abx IV at induction of anesthesia or 30-60min prior to skin incision
Treatment for SSI?
most common pathogens postop wound infection are: S.Areus, coagulase-neg staph.
Tx: opening wound, drainage, debriding, culturing, and antibiotics
empiric coverage driven for gram stain for patients with SSI include?
MRSA- vanc
(linezolid if vanc allergy)
s/s, evaluation, and management of cholecystitis:
S/s: RUQ/epigastric pain, fever, nausea, vomiting, murphy sign
eval: blood cultures, RUQ US, amylase, lipase
mgt: admission to hospital, cholecystectomy, antibiotics
presentation of pancreatitis- acute and chronic
acute: presents with gallstone obstruction of pancreatic duct, chronic excessive alcohol, high
triglycerides (>500), hypercalcemia
Chronic presents: multiple overlapping risk factors of alcohol, tobacco, genetics, autoimmune
disease
does a patient with chronic pancreatitis require surgical consult?
no.
eval and mgt of cholelithiasis
eval: labs (cbc, fts, pancreatic enzymes), transabdominal us
mgt: If patient has cholangitis- tx ERCP or percutaneous biliary drainage. May need ERCP or
elective cholecystectomy
post cholecystectomy syndromes
biliary stricture or retained common bile duct stones
Most common cause of hospital acquired infection?
catheter associated UTI
What should happen if a patient presents with existing foley?
Change the foley, if possible just remove the foley and not replace
How to reduce HAIs
use proper hand hygiene recommendations, follow infection prevention protocols, keep
patients in the best possible physical conditions to help them fight infections, and learn to deal
with multi drug resistant organisms, remove lines if possible.
Systemic signs of infection
delirium, lethargy, fever or hypothermia, tachycardia, hypotension
Anatomic site of infection you take into account what?
proximity to vital structures or joints
Presence of purulence can indicate what?
infection
When do symptoms of necrotizing infection occur?
late in the process
Symptoms of necrotizing inection
pain disproportionate to physical findings
violaceous bullae, cutaneous hemorrhage, skin sloughing, skin anesthesia, rapid progression,
gas in tissue
Most effective preventative measure of infection?
handwashing
,what percentage of patients acquire a Healthcare associated infection?
10%
Most common types of HAI infections?
UTI from indwelling catheters or procedures
blood stream infection from catheter or secondary sites
pneumonia of intubated unconscious patient
SSI
MRSA
CDIFF
Preventative measures (aside from handwashing) of HAI?
early removal of invasive devices or lines
limit spectrum of antibiotic coverage and unnecessary duration to prevent multidrug resistance
What are indications for line removal?
-purulence at insertion site
-S.areus, candida, or gram neg rods
-persistent bacteremia (>48hr on abx)
-complications (thromboemboli)
What is empiric antibiotics
vanco for MRSA
consider gram neg coverage for immunocompromised/critically ill
treatment if patient presents with UTI symptoms and a foley present
-remove foley
-treat with 7 days abx specific to culture results
-treat for 14 days if fever, back pain, leukocytosis, or suggest pyelonephritis
SSI (surgical site infection) prevention
, prophylactic abx IV at induction of anesthesia or 30-60min prior to skin incision
Treatment for SSI?
most common pathogens postop wound infection are: S.Areus, coagulase-neg staph.
Tx: opening wound, drainage, debriding, culturing, and antibiotics
empiric coverage driven for gram stain for patients with SSI include?
MRSA- vanc
(linezolid if vanc allergy)
s/s, evaluation, and management of cholecystitis:
S/s: RUQ/epigastric pain, fever, nausea, vomiting, murphy sign
eval: blood cultures, RUQ US, amylase, lipase
mgt: admission to hospital, cholecystectomy, antibiotics
presentation of pancreatitis- acute and chronic
acute: presents with gallstone obstruction of pancreatic duct, chronic excessive alcohol, high
triglycerides (>500), hypercalcemia
Chronic presents: multiple overlapping risk factors of alcohol, tobacco, genetics, autoimmune
disease
does a patient with chronic pancreatitis require surgical consult?
no.
eval and mgt of cholelithiasis
eval: labs (cbc, fts, pancreatic enzymes), transabdominal us
mgt: If patient has cholangitis- tx ERCP or percutaneous biliary drainage. May need ERCP or
elective cholecystectomy
post cholecystectomy syndromes
biliary stricture or retained common bile duct stones
