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INPA LEVEL 4 PREP / 4006 FINAL PREP
What is colonization? - Answers :No S&S of illness What is infection? - Answers :Organism gets past host defences, becomes pathogen, causes disease What is an epidemic? - Answers :Periodic occurrence of a disease affecting large # of people. What is the S in C&S? - Answers :Sensitivity What is TB? - Answers :Tuberculosis - airborne, kills more adults, low income countries What is the TB infectious agent? - Answers :Mycobacterium tuberculosis - acid fast aerobic rod, slow growth incubation 2-12 weeks, sensitive to heat & UV. Can lay dormant for years. What are TB risk factors? - Answers :Exposure, immunosuppressed, substance abuse, poor living conditions, limited access to health care, Hx of inadequate Tx. What are TB symptoms? - Answers :Insidious, low grade fever, cough 3+ weeks / nonproductive / mucopurulent / blood tinged, night sweats, weight loss, chest pain, fatigue. What is a normal Mantoux Tuberculin skin test? - Answers :Either no firm bump at test site; or bump LESS THAN 5mm (0.2in). This is a negative result. What is an abnormal Mantoux Tuberculin skin test? - Answers :High risk - firm bump 5mm (0.2in) Moderate risk - firm bump 10mm (0.4in) Low risk - firm bump 15mm (0.6in) These are positive results. What are the Tx options for TB? - Answers :On meds for 6-12 months (compliance an issue) INH (Isoniazid) Rifampin Pyrazinamide (Vit B6)
Streptomycin Ethambutol After 2-3 weeks AND 3 neg. sputum smears pt considered non-infectious but must continue meds for remaining time. What are protective measures for TB? - Answers :- N
- Neg. pressure room, isolation
- Gowns/gloves if coughing (standard precautions) What are MRSA risk factors? - Answers :- Elderly, sick, immunosuppressed
- Open wounds
- Tubes
- Receiving broad-spectrum Abx.
- ICU or burnt unit
- Injection drug users
- Crowded living conditions How is MRSA transmitted? - Answers :Direct physical contact OR indirect by touching contaminated objects (survives objects: days to months, hands: 3 hours) What is the Tx for MRSA? - Answers :For infected pt - Vancomycin, Chlorhexidine soap, Mupiricin ointment For colonized pt - can be decontaminated "decolonized protocol" What are protective measures for MRSA? - Answers :- Private room/cohorts
- Gowns/ Gloves
- Mask if MRSA is in sputum
- Dedicated equipment
- Hand hygiene
- Chlorhexidine What is MRSA? - Answers :Methicillin Resistant Staph Aureus
- Methicillin (same as Cloxacillin)
- 25% have nasal colonization of staph, some is MRSA
- Acquired by hospital stays or community
- Skin infections, pneumonia, and bloodstream infections (if MRSA gets past body defenses) What is VRE? - Answers :Vancomycin Resistant Enterococci
- Gown/gloves
- Hand hygiene
- Dedicated equipment (commode, stethoscope, BP cuff, disposable thermometer) What is Norwalk virus? - Answers :- Causes acute gastroenteritis
- Incubation 12 to 48 hrs
- Lasts 60 hours
- Fecal oral route (direct/indirect, with fecal contamination, mucosa droplets vomitus)
- Highly contagious
- No Abx. b/c viral What are the protective measures for Norwalk virus? - Answers :- Private room/cohort
- Dedicated equipment
- Gown/ gloves
- Hand hygiene
- Sanitary sewage disposal
- Thoroughly cook shellfish
- Wash raw veggies What are Contact Precautions? - Answers :1st gown 2nd gloves What are Droplet Precautions? - Answers :1st gown 2nd mask 3rd goggles What are Airborne Precautions? - Answers :N95 mask Neg. pressure isolation room Precautions can be combined? T or F? - Answers :True Name that precaution! Measles (Rubeola) TB - Answers :Airborne (N95, Neg. pressure isolation room) Name that precaution! Bacterial Meningitis, Meningococcus, Mumps, SARS, Rubella - Answers :Droplet
(gown, mask, goggles) Name that precaution! C.Diff, Herpes simplex Lice/Scabies MRSA VRE - Answers :Contact (gown, gloves) Name that precaution! Chicken pox Herpes zoster Ebola Lassa fever Marburg virus - Answers :Combo: airborne / contact N Neg. pressure isolation room Gown Gloves Name that precaution! Influenza MRSA (Resp.) Strep A (wound, necrotizing fasciitis) - Answers :Combo: droplet / contact Gown Mask Goggles Gloves What is sepsis? - Answers : Describe diagnostic test: WBC count? - Answers : Describe diagnostic test: C&S? - Answers : Describe diagnostic test: skin? - Answers :
SC - Answers :Size: 25-26G Length: Angle: 45* to 90* Med volume: 1ml/site (max) Pinch an inch BEVEL UP ~ Name that size, length, angle, and volume! IM - Answers :Size: 22-23G Length: Angle: 90* Med volume: 3ml/site (max) Z-track* When should you Z-track? - Answers :For IM meds, thick fluids such as testosterone, gold, and iron. SC has a faster absorption rate than IM. T or F - Answers :False, IM is faster Guess that landmark! SC - Answers :Abdomen Upper arm Anterior & Lateral thigh Scapular (back) Guess that landmark! IM - Answers :Vastus Lateralis (legy) Ventrogluteal (booty) Deltoid (army) Landmark Vastus Lateralis? - Answers :Pt supine, fowler, or lateral recumbent One hand on the greater trochanter (hipdip) One hand breathe above knee Injection site is the inner most 1/3. Landmark Ventrogluteal? - Answers :Pt lateral recumbent
One hand on greater trochanter, with thumb pointed towards groin. Spread index finger far (towards anterosuperior iliac spine). All other fingers point up the body (iliac crest). Injection site is the inner most 1/3 of peace sign. (squishy) Landmark Deltoid? - Answers :Pt fowlers or lateral recumbent Place pinky on acromion process (bony protrusion, arm). Allow fingers to follow (three finger breathes below AP). Using opposite hand, make a 'peace sign'. Injection site is the inner most 1/3 of peace sign. When mixing insulins think: cloudy to cleary. T or F? - Answers :T When mixing insulins think: inject enough air equal to the dose. T or F? - Answers :T When mixing insulin, the needle can touch the cloudy insulin before it touches the clear insulin. T or F? - Answers :Big fat false Insulin Pneumonic: I ........ rapid N ..... rapid S ...... rapid U ............... short L ........................intermediate I ............................... long N ............................. long - Answers :................ L[I]spro ..... Glulisi[N]e ............. A[S]part ........ Reg[U]lar
Insulin Technosphere names: Afrezza Are these rapid, short, intermediate or long? - Answers :Trick Q: it's Inhaled insulin "15 minutes feels like an hour during 3 rapid responses" - Answers :Rapid acting insulin Onset: 15min Peak: 1 hr Duration: "3 hrs" ( 2 to 4 hrs) Name that Onset, Peak, and Duration! Rapid - Answers :Onset: 15min Peak: 1 hr Duration: 2 to 4 hrs Name that Onset, Peak, and Duration! Regular - Answers :Onset: 15 to 30min Peak: 2 to 3 hrs Duration: 3 to 6 hrs "Short staffed nurses went from 30 patients to 8 patients" - Answers :Short acting insulin: Onset: 30 mins Peak: 2 hrs Duration: 8 hrs "Intermediate nurses play hero to eight 16yr olds" - Answers :Intermediate acting insulin: Onset: 2 hrs (2 to 4 hrs) Peak: 8 hrs (4 to 12 hrs) Duration: 16 hrs (12hrs to 18 hrs) Name that Onset, Peak, and Duration! Intermediate - Answers :Onset: 2 to 4 hrs Peak: 4 to 12 hrs Duration: 12 to 18 hrs
"The two long nursing shifts never peaked but lasted 24 hours" - Answers :Long acting insulins: Onset: 2 hrs Peak: NONE Duration: 24 hrs Name that Onset, Peak, and Duration! Long - Answers :Onset: several hrs Peak: none Duration: 24 hrs Name that Onset, Peak, and Duration! Ultra-Long - Answers :Onset: 6 hrs Peak: none Duration: 36 hrs Name that Onset, Peak, and Duration! Inhaled - Answers :Onset: 12 to 15min Peak: 30min Duration: 3 hrs It is appropriate to shake a bottle of insulin vigorously. T or F - Answers :False, roll it gently between the hands It is appropriate to keep a bottle of insulin in the cupboard. T or F - Answers :False, it needs to be refrigerated You can let insulin freeze, as long as you thaw it out before administering to a pt. T or F - Answers :Big fat NO NO Bring refrigerated insulin to room temp by setting under a warm light before administering to a pt. T or F - Answers :False, keep away from light/heat It's okay to keep insulin in my purse, as long as I'm travelling, and then put it back in a fridge when I get home. T or F - Answers :False, travel with an insulated bag (refrigeration)
Johnny, a new PN grad, is completing his preceptorship on your unit. You overhear a conversation between him and an HCA. Which of the following indicates need for further teaching? a. PICC lines are inserted in the brachial or cephalic veins of the arm b. The tip of the PICC line rests 2cm from the heart in the distal superior vena cava c. BP should be taken in the arm with a PICC line d. BP should not be taken in the arm with a PICC line - Answers :Trick Q! Answer: C NEVER take BP in the arm with a PICC line What is the nursing care for PICC lines? - Answers :Assess insertion site for infection Assess dressing Assess arm swelling Name the common IV fluids? - Answers :Crystalloids (Isotonic, Hypotonic, Hypertonic) and Blood Products Consider the composition of IV fluids and the effect in the body (NaCl, KCl, Glucose, Water) - Answers : IV fluids are different than IV solutions. T or F - Answers :T Fluids are Crystalloids and Blood Products Solutions are the type of crystalloid (ie. iso, hypo, hyper) Name that IV solution! NA, K, Cl, Ca, Lactate Portion converts to bicarb Helpful for mild acidosis & electrolyte replacement - Answers :Lactated Ringers (or Ringer's Lactate) The RN nurse has asked you (the new PN grad) to change the IV bag for a patient in bed 3. You realize the bag contains KCL infusing PIV. You check the order and it has been compounded by the pharmacy. What should you do? a. Go ahead with bag change as requested.
b. Double check Dr order, do the bag change. c. Check health authority policy to see if its LPN scope. d. Double check Dr order, check facility protocol, and change bag. - Answers :C: It's LPN scope but you need to confirm with health authority first. IV solutions req. Dr order. Is the following order correct? NS 1000cc over 8 hrs - Answers :Yes. Orders must state type of solution, volume, and time. NS (type) 1000cc (volume) Over 8hr (time) The RN has just created a brand new saline lock for you, and asked you to set up the IV for bed 8. The pt is - Answers :
