Infection Control
Your patient is admitted from a nursing home, what testing is required?
MRSA Swabs
Why would a patient be on an enteral feed?
Patient is unable to safely swallow due to stroke, cancers, decreased level of consciousness etc, but their stomach and GI track is still able to process nutrition.
The patient is slowly trying to increase GI nutrition but is unable to tolerate eating po.
This can be via Kao feed in the nose or G/J-tubes surgically implanted.
What does a low LKC tell you?
White blood cells detect the presence of infection and supports diagnosis of inflammation.
Lower levels: an initial response to a new infection, leukemia
Higher levels: active unresolved infection, Sepsis, HIV, Autoimmune diseases, Cancers of the bone Marrow or damage to bone marrow.
What is an INR?
International Normalized Ratio: the standardized way to measure clotting factors.
High levels without medications indicate a lack of vitamin K due to liver disease, cirrhosis or liver injury. It could indication of DIC (disseminated Intravascular coagulation) which is life threatening.
The use of Warfarin for cardiac valves or afib. The level is 2.0 to 3.0 unless otherwise specified by the physician.
Blood in the stool is called?
Melena
How many loose stools in a day before you automatically send a sample for c.diff?
Three
What does a Renal Diet look like?
This diet is ordered for those with chronic kidney disease or limited kidney function. The diet consists of food that have lower, sodium, protein, potassium and phosphorus.
Foods to avoid: processed foods and meats, canned vegetables, cheese, pickles and nuts.
What does an elevated HGB tell you?
HGB is a protein that carries oxygen in your blood.
Lower levels: new or chronic blood loss, decreased nutritional status.
Higher levels: COPD, higher altitudes, polycyctemia
What is a Troponin level used for?
Troponins are a cardiac enzyme that lets us know if there is a possibility of a heart attack with chest pain. This is a specific marker for cardiac injury and used in conjunction with CK for a positive diagnosis. Often done as a serial trop meaning every three hours to see if the level increases.
Interfering factors include acute/chronic renal failure, chronic muscle disease, kidney injury, cardiomyopathy and substance abuse.
What is the name of the intestine that protrudes from the abdomen after an ostomy creation?
A stoma
How many covid symptoms does the patient need to have to be rapid covid swabbed?
One new symptom.
Fever, Cough, Diarrhea, SOB.
Why is your patient on po Vitamin B-12?
Decreased dietary intake of poultry, meat, fish and dairy. Vitamin B-12 is important for red blood cell formation and is often prescribed for those with anemia.
What does a higher Platelet level tell you?
Platelets tell us about clotting in the blood.
Lower levels: Acute Leukemia, Chemo, Hemorrhage, toxic effect of medications, Lupus, viral infections.
Higher levels: Acute infections, Chronic pancreatitis, Cirrhosis, iron deficiency, post splenectomy
What is a D-Dimer used for?
Used to check for blood-clotting problems like a DVT, PE, DIC or surgical complications. Unable to diagnosis with a high d-dimer alone but used in conjunction with ultrasounds and/or CT imaging.
Interfering factors: high titres of rheumatoid factor, inflammation, liver disease, advancing ovarian cancer, post-op, post-trauma or pregnancy.
What stool tests will not be preformed if patient has been in hospital for greater than 3 days?
Stool for C&S (culture and sensitivity) and O&P (ovum and parasites)
What PPE equipment is needed for droplet-contact?
Mask, face shield or goggles, gown, gloves
What does your patient’s albumin tell you?
Included on liver function tests, Albumin can tell you about the state of liver or kidney disease or the underlying nutritional status of your patient. It measures a protein in your plasma that helps to keep fluids in your blood vessels and not leak out causing edema or ascites.
What does a low hematocrit tell you?
Is the ratio of cells in the blood verses plasma.
Lower levels: hemorrhage or excessive iv fluids
Higher levels: dehydration
What is a BUN used for?
Used to check kidney function, BUN measures the amount of nitrogen in your blood which is a waste product of urea.
Lower levels can be caused by liver disease or damage but can appear lower because of a lower protein/high carb diet, low muscle mass, early pregnancy, over hydration.
Higher levels can indicate heart failure, dehydration, too much protein in the diet, shock or kidney injury. This can be a false high if the patient is in late pregnancy, old or has medication interference.
Why would your patient have clay colored stool?
A lack of bile in the stool, issues with the biliary system like: gallstones, cholangitis, hepatitis, cirrhosis. Or large doses of bismuth or anti-diarrheal drugs (as per the Mayo clinic)
What are the two important differences with isolation for c.diff?
One: You must wash your hands with soap and water.
Two: Equipment must be cleaned with bleach wipes (Clorox wipes) not virox.
What is Total Parenteral Nutrition?
TPN is nutrition given intravenously to correct or prevent malnutrition. TPN provides carbohydrates, proteins, fats, vitamins, minerals and electrolytes all via the IV.
A unit of packed red blood cells should increase what blood level and by how much?
HGB by 10 points. Example pre-infusion hgb was 72 we should expect one unit to increase the hgb in the morning to 82.
Testing a HGB immediately after transfusing will not give you an accurate HGB but will tell you if there is still active bleeding.
What does Amylase indicate?
Used to diagnose issues with the pancreas. When there is inflammation of the pancreas or salivary gland amylase is released into the blood.
Lower levels: acute alcoholism, liver cirrhosis, or extensive destruction of the pancreas.
Higher levels: acute pancreatitis, pancreatic cancer, inflammation of the salivary glands (mumps), Severe damage to the intestines, stomach ulcer, Diabetic ketoacidosis, and/or kidney failure.
Interfering factors: Narcotics, IV fluids with glucose, having bloodwork drawn within two hours of eating.
What are the types of stool in the Bristol stool chart?
Seven Types: one is small and hard to seven which is watery with no liquid.
1 - Separate hard lumps
2 – lumpy sausage
3 – sausage with cracks
4 – smooth soft sausage
5 - soft blobs with clear edges
6 – Fluffy pieces with rages edges/mushy
7 – watery with no solid pieces