Study Guide - Exam 2 (MS 1)

Study Guide — Exam 2 (MS 1) Infection Control • Immunosuppression • HIV/AIDS • Vision • Hearing/Ear Infection Control & Immunosuppression Standard Precautions (Basics) • Used for ALL patients (anyone may be colonized or infected). • Hand hygiene is the #1 intervention to prevent spread. • • Perform hand hygiene: • Before and after patient contact • After removing gloves • Effective handwashing: at least 20 seconds, scrub nail beds + between fingers. • Alcohol-based hand rubs are faster, more effective, and better tolerated than soap. • PPE is based on expected exposure (gloves, masks, eye protection, gowns). • Sharps safety: never recap needles; dispose immediately in puncture-resistant containers. Isolation Types (Contact / Droplet / Airborne) • Contact: direct/indirect contact → gown + gloves (ex: C. difficile). • Droplet: large respiratory droplets → facemask within 3–6 feet (ex: influenza, meningitis). • Airborne: small particles → N95 + negative pressure room (ex: TB, varicella). Immunosuppressed Clients (Early Detection Priority) • Main priority: early recognition of infection. • Symptoms may be subtle (fatigue, low-grade fever, change in mental status). • Teach: clean (not sterile) environment, strict hygiene, avoid sick contacts. • Special precautions: restrict contagious visitors + follow food safety to prevent enteric infections. Exposure / Needlestick (PEP & Immediate Action) • Prevention: do not recap needles; use safety-engineered devices. • If exposure occurs: follow post-exposure protocol immediately. • If PEP is prescribed: adherence is critical. • Patient teaching: medication schedule, side effects, follow-up testing, counseling resources. Key Points • Hands of healthcare workers are the most frequent cause of bacterial transmission. • Standard precautions apply to every patient. • Transmission-based precautions are added for known/suspected infections. • OSHA requires safe sharps disposal + needleless systems. HIV/AIDS Core Concepts (What Actually Harms) • HIV is a retrovirus that targets WBCs, especially cells with CD4+ receptors. • Greatest danger is immune suppression → opportunistic infections + complications. • AIDS (Stage 3) occurs when CD4+ < 200 or an AIDS-defining condition is present. • HIV is managed as a chronic disease, but prevention and adherence remain critical. • Nursing priorities: infection prevention, supportive care, maintain immune function. Key Complications (Recognize) • Respiratory: SOB, dyspnea, cough, chest pain, fever. • GI: appetite loss, N/V, oral/esophageal candidiasis, chronic diarrhea → dehydration/electrolyte imbalance. • Neuro: cognitive changes, motor impairment, HAND. • Oncologic: Kaposi sarcoma, lymphoma, invasive cervical cancer. Emergency Red Flags (Escalate) • Worsening respiratory distress (severe dyspnea, chest pain, fever). • Sudden neurologic decline (confusion, cognitive or motor changes). • Severe dehydration signs from chronic diarrhea. • Evidence of serious opportunistic infection in late-stage disease. Education (Adherence + Prevention) • Combination ART is essential; adherence suppresses viral load + preserves immune function. • Transmission prevention: blood, semen, vaginal secretions, breast milk. • Risk reduction: condoms, avoid needle sharing, testing + early treatment. • PrEP is a highly effective prevention strategy. • Complementary therapies only if they do not replace ART; assess drug interactions. Key Points • HIV targets CD4+ WBCs (not RBCs). • Stage 3 HIV = AIDS = CD4 < 200. • Biggest threat = opportunistic infections. • Nursing care: hydration, nutrition, skin care, symptom management. • Confidentiality + stigma support are major responsibilities. Vision Disorders Glaucoma • Elevated IOP damages the optic nerve (“silent thief of sight”). • Cause: impaired aqueous humor outflow (trabecular meshwork/canal of Schlemm). • No cure, but controllable with lifelong treatment. • Later symptoms: blurred vision/halos, difficulty in low light, loss of peripheral vision, aching/headache. • Teaching: strict eye drop adherence; temporary blur possible; family exams q2 years. Cataracts • Lens opacities/cloudiness; classic sign: painless blurry vision. • Surroundings appear dim; increased glare; reduced contrast. • No nonsurgical cure for age-related cataracts. • Definitive treatment: surgery when ADLs affected. • Post-op: eye shield at night 1 week; report floaters/flashes, decreased vision, pain, redness. Eye Emergency • Chemical burns: irrigate immediately with tap water/NS; do not delay for assessment. • Continue irrigation until conjunctival pH normalizes; alkali burns are especially severe. • Foreign object: do NOT remove; protect eye and seek emergency care. Low Vision Safety • Priorities: optimize remaining vision, promote independence, prevent injury (falls). • Home strategies: improve lighting; keep furniture consistent; refer to low-vision/OT/rehab. • Emotional adjustment often follows grief stages; reinforce coping/community resources. Key Points • Glaucoma = optic nerve damage from elevated IOP → lifelong therapy. • Cataracts = painless blurry vision → surgery definitive. • Chemical exposure = irrigate immediately. • Low vision priority = fall prevention + rehab support. Hearing & Ear Disorders Presbycusis • Progressive age-related sensorineural hearing loss (high-frequency sounds). • Contributors: loud noise exposure, chronic disease (diabetes), cochlear degeneration. • Effects: frustration, insecurity, depression, isolation. • Increased risk of falls and hospitalization. Assessment & Communication • Normal hearing: air conduction > bone conduction. • Assess tinnitus, difficulty hearing in groups, increasing TV volume. • Identify preferred communication method (speech reading, writing, interpreters). • Communication tips: face patient, good lighting, speak slowly and distinctly. Ototoxicity • Medication damage to cochlea/vestibular system/CN VIII. • Common meds: aminoglycosides, antineoplastics, loop diuretics. • Aspirin toxicity → bilateral tinnitus (reversible when stopped). • Nursing: report hearing changes, monitor drug levels, audiograms may be twice weekly. Vertigo • Illusion of motion/spinning due to vestibular dysfunction. • Priority: fall risk. • Teach: slow position changes, safe ambulation, environmental fall precautions. Other Common Causes • Ménière disease: episodic vertigo + tinnitus + fluctuating hearing loss. • Treatment: low-sodium diet (< 2000 mg/day), meclizine, antiemetics, diuretics. • BPPV: brief vertigo triggered by head position changes. • First-line: canalith repositioning procedure. Key Points • Presbycusis = age-related high-frequency sensorineural hearing loss. • Normal hearing: air conduction > bone conduction. • Aspirin toxicity → bilateral tinnitus. • Vertigo priority = fall prevention + safety teaching.