Precautions
A Patient comes in to the ER who is showing signs and symptoms of MRSA (Fever, wound drainage) what Precautions should you have for this patient and what does that precaution include?
CONTACT- private room, gloves, gown, handwashing, disposable supplies
1). A patient with an Upper Respiratory Infection coughing up yellow sputum
2). A 5 post op liver transplant patient about to be discharged
3). A patient in a coma who is on a ventilator
2- because assume on immunosuppressants
How often should you check the vitals of someone with sepsis
every 15 minutes (cont SPO2)
What is the greatest risk of meningitis and what do we assess neurological changes for (looking for a specific series of sign/symptoms that are grouped together and called one umbrella term)
Greatest risk is and increase in intracranial pressure which of the brain and death
early neurological changes should be monitored to catch the development of Cushings triad (Sev HTN, widened pulse pressure, bradycardia)
What is culturing a specimen and what is testing it for sensitivity?
Culturing= examination of specimen for microorgs (IDing)
Sensitivity= testing to see which antibiotics work against the microorgs
A Patient has active TB but OH NO their precaution sign fell off their door!!! DO not worry, it's ok you happen to know what precaution is for tuberculosis. What does the nurse get/do to prepare to enter this patient's room?
Mask with special respirator (N-95), gloves, private room, negative air flow, handwashing
Which patient is ok for the pregnant nurse to treat?
1). A patient with severe C.Diff you needs a rectal tube inserted
2). A patient with chicken pox
3). A patient who thinks they have Chylamydia and needs a vaginal exam
4). A patient with Hepatitis B and needs to be prepped for surgery
1). C.Diff
The rest are part of the
CHEAP TORCHES list of infections that are particularly harmful to pregnant women.
S/Sx of low perfusion... GO!\
(CNS, RESP, METAB, GUT, KIDN, SKIN, CVS)
CNS- aggitated/confused/coma
RESP- increased ventilation (RR)
METAB- acidosis
GUT- decreased peristalsis/ileus
KIDN- Olig/Anuria
SKIN- cyanotic/cold
CVS- Increased HR
Hyperglycemia**
Define: Urethritis, Cystitis, Pyelonephritis and what causes each
Urethritis- inflammation of urethra
Cystitis- inflammation of the bladder
Pyelonephritis- infection/inflammation of kidney
E.coli (UTI)
Your patient has signs and symptoms of a respiratory infection, while you are waiting for their sputum sample to have culture and sensitivity testing, what should you give the patient (with HCP orders)
broad spectrum antibiotics
A patient comes into your clinic with nuchal rigidity and a fever. What precautions are you going to assign to this patient?
(meningitis)
Droplet precautions- private room, mask, gloves, disposable supplies, handwashing
Which antibiotics are safe for pregnant people?
Erythromycin (macrolides)
Penecillan G
Cephalosporin
SIRS
SEPSIS
SEVERE SEPSIS
SEPTIC SHOCK
Hyponaturemia, Hypokalemia, Increased creatinine, Increased BUN (because of poor perfusion)
What is a trough and what is a peak related to drug administration. Why do we care?
Trough- lowest conc in blood stream
Peak- highest conc in blood stream
because drugs have very narrow therapeutic windows.
Standard for LTBI
A patient come in with sign and symptoms of sepsis what should the nurse do first? (first line therapy)
Fluid Resuscitation is the first line therapy
0.9% NaCl (maintain MAP and urine output)
Monitor/hep resp and CV function w/O2
We need two "sirs" criteria to suspect sepsis. Name 2 (out of 4) of those criteria
high or low temp
increased respirations
HR > 90
WBC high or low
Diagnose these three patients:
1). Low grade fever, night sweats, anorexia, weight loss, fatigue, depending on location: cough, purulent, SOB, dyspnea and hemoptysis in late stages
2). Fever, chills, flank pain, CVA tenderness, sepsis if not treated
3). Fever, chills, fatigue, crackles, cough with sputum, dyspnea
TB
Pyelonephritis
Pneumonia
When should we draw for a trough
30 mins before next dose (for all routes)
ALWAYS depends on the route not the drug
What precautions are appropriate for a patient with chicken pox?
Airborne and contact
HELP! you gave a patient Vancomycin 30 minutes ago with an IV push and now their skin is red with a rash on their face and neck. Their BP is 222/89.
Since you are a good nurse you know exactly what is happening and why
the patient is experiencing Red Man Syndrome (from from pushing the drug vancomycin to fast)stop administering the drug and start diphenhydramine
What are the characteristics of SEVERE SEPSIS?
What is the difference between this and SEPTIC SHOCK
HOTN <90 sys
LA > 4 (organ damage)
SEPTIC SHOCK
Your patient has C.Diff and has lost a lot of water. Now she is going into cardiac arrythmias. Why is this happening?
The electrolyte imbalances can cause cardiac arrythmias. (low K)
You are educating a patient about their antibiotic. What are some commonalities about all antibiotics you can start off by explaining?
Gi distress, N/V, abd pain/diarrhea, fungal/superinfections, resistance