Chapter 8 Nursing Care of Patients with Infections

Answers CHAPTER 8 NURSING CARE OF PATIENTS WITH INFECTIONS AUDIO CASE STUDY Tisha and Treating Patients With Infections 1. It is hard to treat, has a high mortality rate, and affects mainly the older adult and the chronically ill. 2. The assumption that all patients and their body fluids and substances are infectious regardless of their diagnosis. 3. Direct or indirect contact. 4. Tisha washes her hands; when she gets home, she puts her uniform in the washing machine and steps into the shower. Afterward, she cleans her shoes and stores them in a container. Pathogens Definition: Microorganisms or substances capable of producing a disease. Personal Protective Equipment Definition: Items such as gloves, gowns, masks, goggles, and face shields that help prevent the spread of infection to those wearing them. Phagocytosis Definition: Ingestion and digestion of bacteria and particles by phagocytes that destroy particulate substances such as bacteria, protozoa, and cell debris. Sepsis VOCABULARY Antigen Definition: Immune system response to a serious infection with systemic inflammation. Definition: A protein marker on a cell’s surface that identifies the cell as self or nonself. Virulence Asepsis Definition: A condition free from germs, infection, and any form of life. Definition: The ability of the organisms to produce disease. Viruses Definition: Small intracellular parasites that can live only inside cells and may produce disease when they enter a cell. Bacteria PATHOGEN TRANSMISSION Definition: One-celled organisms that can reproduce but need a host for food and a supportive environment. Bacteria can be harmless normal flora or disease-producing pathogens. Definition: A Gram-positive bacteria normally found in the intestine that can multiply after antibiotic therapy and release toxins that cause diarrhea. 1. (4) 2. (4) 3. (3) 4. (4) 5. (2) 6. (2) 7. (3) 8. (2) 9. (2) 10. (1) Hand Hygiene PATHOGENS AND INFECTIOUS DISEASES Definition: Cleansing of the hands with hand washing or the use of alcohol-based hand rubs. 1. staphylococci 2. fungi Clostridium difficile (C. diff) 1 2 Chapter 8 Answers 3. Candida albicans 4. Epstein-Barr 5. pneumonia (histoplasmosis) 6. toxoplasmosis 7. protozoa 8. viruses 9. rickettsia 10. Clostridium difficile (C. difficile) CRITICAL THINKING 1. Mask, gown, gloves, a sign reading “Contact Precautions,” soap and paper towels, special bags for linen and trash, wash area in the room. 2. Disposable thermometer, blood pressure cuff, stethoscope, grooming items, bedpan, bathing equipment, and sharps container that all remain in the room. Nondisposable intravenous (IV) equipment and any other equipment needed for the care of the patient must be able to be disinfected. 3. Because visitors are limited, the patient has few social contacts and may lack a support system. Environmental stimuli are limited. Activities are limited. Patient is dependent on others for some needs due to confinement. 4. Allow visitors as appropriate and instruct them on how to implement isolation precautions. Offer visitors masks or respirators as appropriate. Encourage contact via telephone with family and friends who cannot visit. Maintain a cheery environment; open curtains; maintain sensory stimuli by remaining with the patient as long as possible. Encourage diversional activities and things the patient likes to do, such as TV or reading books. Always answer call light promptly. 5. C. difficile REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (1) is correct. Warm skin is a sign of local infection. (2, 4) are seen in shock. (3) is typical of a systemic infection. 2. (2) is correct. Use of autoclaves is a method of sterile technique. (1, 3, 4) are all medical asepsis practices. 3. (3) is correct. Health care–associated infections result from hospitalization. (1) is a chronic infection, and (2) is due to a sexually transmitted infection. (4) is incorrect because the infection was present before hospitalization. 4. (4) is correct. Vancomycin is the treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA). (1, 2, 3) are incorrect. 5. (1, 3, 5) are correct. All pathogens require moisture, food, and warmth. (2, 4) are incorrect. All pathogenic organisms need darkness to multiply. Some need oxygen, but others do not. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 6. (2, 3, 5 ,6) are correct. Stethoscopes have been found to be contaminated with harmful organisms and should be cleaned before and after each patient use. Washing hands before and after patient contact is considered the most important method of infection prevention. Patient hand hygiene is often overlooked and is a key link in preventing health care–associated infection. It should be done after toileting, before meals, when handling own secretions, upon return to own room, and throughout the day as needed. (1) is incorrect. Hands cannot be sterilized. (4) is incorrect. Gloves are worn only during certain procedures when the caregiver is likely to come in contact with blood or body fluids. Even when gloves are worn, hand washing before and after wearing the gloves is essential for infection control. 7. (1) is correct. Surgical asepsis is aimed at the destruction of microbes before they enter the body. (2, 4) describe medical asepsis. (3) is not related to surgical asepsis. 8. (4) is correct. Tuberculosis is transmitted by airborne transmission, and anyone entering the room of a patient with tuberculosis must wear a fit-tested high-efficiency particulate air (HEPA) mask, which filters the tiniest particles from the air. Other types of masks and personal protective equipment will not provide protection from airborne pathogens. (1, 2, 3) are incorrect because they are not transmitted by air. 9. (3, 6) are correct. The only way to obtain a sterile specimen is to catheterize the patient, and the specimen must be placed into a sterile specimen container. (1, 2, 4, 5) are incorrect because any voided specimen is contaminated. 10. (1) is correct. Urinary catheters are a cause of health care–associated infections and should be avoided if possible. (2, 3, 4) do not prevent infection, and restricting fluids may promote infection and dehydration. 11. (4) is correct. A high fever indicates that the patient has developed a secondary bacterial infection. (1, 2, 3) are incorrect. Viral infections such as the common cold are usually associated with a low-grade fever. Symptoms of the common cold include stuffy nose with watery discharge, scratchy throat, dry cough, sneezing, and watery eyes. 12. (1) is correct. A culture identifies pathogen presence. (2) is incorrect. A drug level or peak and trough would measure antibiotic levels. (3) is incorrect. A sensitivity report would indicate what pathogens are sensitive to certain antibiotics. (4) is incorrect. 13. (2, 4, 5) are correct. Irritability, restlessness, and pacing behavior can be signs of infection in an older adult. (1, 3, 6) are not signs of infection. Chapter 8 14. (2) is correct. Sterile water should be used instead of tap water for an immunocompromised patient to prevent infection. (1, 3, 4) are appropriate actions so they would not require further instruction. 15. The most essential personal protective equipment, a fittested disposable respirator, is worn by the nurse prior to entering the room of a patient with tuberculosis. Answers 3