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General Patient Care
| Question | Answer |
|---|---|
| How do you explain the therapy and goals to the patient and family | use simple language, home care procedures |
| What is disinfection | process of destroying vegetative pathogenic organisms |
| What is sterile | lack of any life or living organisms |
| What is vegetative organisms | growing organisms |
| What is pathogenic organisms | disease producing |
| What is contaminated | the introduction of disease causing microorganisms |
| What is static | growth is inhibited |
| What is cidal | microorganisms are killed |
| What is spore | a resistant form of certain species of bacteria |
| Steam under pressure, steam autoclave | 121 degrees at 15 psi for 15 minutes, not used on plastics or other heat sensitive items, must be wrapped in penetrable packaging, all air must be evacuated and steam must be allowed to penetrate all parts, heat sensitive tapes and bio indicators used |
| Pasteurization | disinfection process using moderate temperatures to kill vegetative organisms, items washed then submersed in hot water bath for 30 minutes, dried then assembled and packaged |
| What is incineration | treats contaminated disposable items and supplies |
| What is irradiation | gamma rays are used to sterilize pre packaged equipment, these items should not be re-sterilized with ethylene oxide |
| Ethylene oxide sterilization | sterilizes equipment by alkylation of enzymes, concentration of 800-1000mg/L, 50% relative humidity enhances the effectiveness of ETO, exposure time, aeration time, biological indicators that sterility has been met, NOT recommended for a bronchoscope |
| What are examples of ethylen oxide sterilization | bird mark vii, electric incentive spirometry device, non disposable resuscitation bag removed from a HIV patient room |
| Alkaline gluteraldehyde or cidex | disinfection or sterilization, ph is 7.5-8.5, bactericidal in 10 minutes, tuberculocidal in 10-20 minutes, sporicidal in 10 hours (sterilize), appropriate for plastics mouth pieces, tubing, aerosols, APPROPRIATE for BRONCHOSCOPE |
| Acid gluteraldehyde (Sonacide) | disinfection and sterilization, ph 2.5-3.5, bactericidal in 10 minutes, tuberculocidal in 20 minutes, sporicidal in 1 hour, equipment must be rinsed, dried and packaged after exposure to sonacide, potent for 28 days |
| Alcohol | ethyl and isopropyl alcohol are most effective in 70-90% solutions, alcohol wipes are not sporicidal although it is bactericidal and fungicidal |
| Soaps and detergents | used as cleaners, surfactants that will reduce surface tension |
| What are gram negative organisms | cause pneumonia and respiratory tract infection, rod shaped, not spore producing, grow in water and found in gi tract normal flora spread by poor hand washing |
| What are the gram negative organisms called | pseudomonas aeruginosa (most common, green sputum) haemophilus influenza, serratia marcescens, escherichia coli, proteus, klebsiella |
| What are the gram positive cocci | pneumonia, respiratory tract infections, staphylococcus, streptococcus, diplococcus, pneumococcus |
| What are acid fast bacilli | mycobacterium tuberculosis |
| What are pathogenic fungi | candida, candidiasis, histoplasma capsulatum, histoplasmosis, coccidiodes immitis, coccidiomyosis |
| What are viruses | respiratory infections, flu like symptoms and viral pneumonia, adenovirus, influenza, cytomegalovirus, respiratory syncytial virus |
| Droplet nuclei | dispensed via the cough or sneeze |
| What precautions are used with AIDS pts | standard, gloves |
| What precautions are used with respiratory isolation airborne transmission | masks and gloves, measles, rubella, mumps, pertussis, meningoccal meningitis and suspected tuberculosis patients |
| What precautions are used with strict complete isolation | gloves, masks and gowns, staph aureus and group patients with streptococcus pneumonia |
| What precautions are used with protective or reverse isolation | strict isolation, burn, transplant, or cancer patients and immunosuppressed individuals |
| What precautions are used with enteric and skin isolation | gowns are used, gloves necessary when having direct contact with infected blood or fecal material, hepatitis |
| What type of precautions are used with wound and skin isolation | gloves are worn, mask and gown optional |
| Wright respirometers and other equipment used with multiple patients should have | one way valves or personal sampling chambers to prevent cross contamination |
| Change nebulizer and aerosol tubing every | 24 hours |
| Use a different small volume nebulizer for | each patient |
| When do you double bag equipment to be gas sterilized | aids and hepatitis patients |
| What are the 3 procedures used to sample respiratory equipment to determine the source of the nosocomial infection | swab rubbed on equipment at one location used to inocculate a dish of growth medium and incubated |
| With aerosol impaction | a sample of particle output is obtained from aerosol producing equipment like nebulizer, maintain asepsis, incubation |
| With liquid broths | used to obtain a sample inside the tubing the broth then dispensed into a sterile container and incubated |
| Describe purse lip breathing | semi fowlers relaxed, inhale through nostrils, slowly with lips closed, instruct patient to pucker at end inhalation, exhalation should be passive relaxed |
| Why do we use purse lip breathing | increase tidal volume, decrease rr, decrease alveolar collapse, prolong slow exhalation, emphysema |
| Describe diaphragmatic breathing | muscle relaxation shoulders and chest, conditioning abdominal lower chest muscles, combined with pursed lip technique, abdomen rises on inspiration |
| Why do we use diaphragmatic breathing | improve ventilation, reduce oxygen cost of breathing |
| What is huff coughing | coughing with an open glottis, effective in copd and head trauma to prevent increased intracranial pressure |
| What criteria is used to determine if a patient will benefit from oxygen in the home | po2 less than 55 torr on toom air, exercise limitation that is responsive to o2 therapy, ear or finger oximetry at rest excercise and sleep, polycythemia or cor pulmonale |
| Oxygen concentrators used at a higher level than 1-2 L/min can cause concentrations | to fall |
| If molecular sieve beds are not working | analyze the fio2 and check circuit breaker fuse |
| What is the terminology used to describe a copd patient | chronic ventilatory failure patient, chronic hypercapnic patient, increased compliance patient, a loss of elastic recoil patient and co2 retainer |
| What is the assessment for CBABE | expiratory wheeze, barrel chest, clubbing and cyanosis, percussion notes resonant or hyperresonant, hyperlucency hyperinflation increased ap diameter on chest xray, compensated respiratory acidosos with hypoxemia and hypercapnea, decreased fev1 |
| What is the treatment for CBABE | aerosol therapy low flow o2, bronchodilators, expectorants, coricosteroids, diuretics, rehab therapy purse lip breathing, proper nutrition, monitor fluid intake, or if copd in full arrest at er then resuscitate with 100% o2 |
| What is croup | viral, gradual onset upper respiratory infection less than 3 years old occurs in winter |
| What are the signs of croup | fever, drooling and retraction, toxic appearance |
| What is the admission criteria for croup | stridor at rest |
| What is the treatment for croup | cool mist tent, dexamethasone (steroid)racemic epinephrine aerosol |
| What do the xrays look like for croup | subglottic edema, steeple or pencil sign |
| What is hemophilus influenza | sudden bacterial upper respiratory infection, occurs age 3-7 |
| What is the admission criteria for hemophilus influenza | drooling, extended neck, suspicion of epiglottitis |
| What is the treatment of hemophilus influenza | intubation, IV antibiotics(Ampicilin) |
| What do the xrays look like for hemophilis influenza | supraglottic edema, thumb or thumb print sign, obliterated vallecula |
| What is mycobacterium disease tuberculosis | asid fast rod shaped bacteria spread by inhalation |
| What is the assessment of tuberculosis | night sweats or nocturnal diahoresis, weight loss and weakness, dry cough with or without hemoptysis and pleural pain, 2 positive test sputum culture and tb test, xrays will show consolidation fibrosis and cavity formation |
| What is the treatment for tuberculosis | isoniazid INH, ethambutol, streptomycin, rifampin |
| What is pneumonia | infectious bacteria or virus enters the lung via inhalation or aspiration |
| What is the assessment for pneumonia | chills, fever, cough, purulent sputum, cyspnea, cyanosis, rales and rhonchi on auscultation, white blood cell count increased in bacterial and decreased in viral, scattered patchy opacity consolidation on xray |
| What is the treatment for pneumonia | penicillin for gram positive infections such as staph and strept, streptomycin gentamycin and tobramycin for gramnegative infections such as serratia, klebsiella, haemophilus, pseudomonas, e coli, proteus |
| When do you mechanically ventilate a patient for pneumonia | if pco2 > 45 mmhg and pao2 < 60 mmhg |
| What is pleural effusion | fluid in the pleural space |
| What is the assessment for pleural effusion | dyspnea, chest pain, decreased breath sounds and dry non productive cough, mediastinal shift to the unaffected area away from the affected area |
| What does that chest x ray show for pleural effusion | lateral decubitus obliteration of the costophrenic angle, unilateral basilar infiltrate with meniscus formation |
| What is the treatment for pleural effusion | Thoracentesis or chest tube drainage system, antibiotics |
| What is acute respiratory distress syndrome | reactions leading to inflammation resulting in a decrease in lung compliance, shunting, hypoxemia |
| What is the assessment for acute respiratory syndrome ARDS | tachypnea, cyanosis, refractory hypoxemia, increased A-a DO2 and work of breathing, x ray shows diffuse alveolar infiltrates in honeycomb ground glass pattern, decreased FRC, shunting and respiratory failure |
| What is the treatment for ARDS | o2 therapy adequate arterial oxygenation without high fio2, cpap or peep therapy to increase frc and to decrease work of breathing titrate poop and fio2 so that fio2 can be reduced below .60, use imv/simv with peep, consider pressure control ventilation |
| What is myasthenia gravis | auto immune response, slow fatigue improves with rest, paralysis mind to ground, positive tensilon test, monitor VC and MIP |
| What drugs are used to treat myasthenia gravis | neostigmine, pyridostigmine, intubation/mech vent short term |
| What is guillain barre syndrome | delayed reaction to viral infection, uri present, acute sudden weakness, ascending paralysis bround to brain |
| What test is used to determine guillain barre syndrome | spinal tap protein in spinal fluid, monitor VC/MIP |
| What drugs are used to treat guillain barre syndrome | steroids, prophylactic antibiotics, mechanical ventilation/trach long term plasmapheresis |
| What is asthma | chronic inflammatory obstructive non contagious airway disease with varying levels of severity and characterized by exacerbations |
| Mild intermittent asthma | patient has symptoms no more than 2 days a week and no more than 2 nights per month,worsening symptoms usually brief |
| What is the PEF or FEV1 for intermittent asthma | >80% |
| PEF should not vary more than | 20% during episodes and between morning and evening readings |
| What is the treatment for mild intermittent asthma | when exacerbations occur recommend a course of systemic corticosteroids |
| What is mild persistent asthma | patient has symptoms more than twice a week during the day but less than once a day and more than 2 nights a month |
| What is the PEF or FEV1 for mild persistent asthma | >80% the PEF can vary between 20-30% |
| What is the treatment for mild persistent asthma | low dose inhaled coricosteroids, may consider cromolyn sodium, leukotriene modifiers, nedocromil or sustained release theophylline |
| What is moderate persistent asthma | symptoms daily and more than one night a week |
| What is the PEF or FEV1 for moderate persistent asthma | PEF >30%,attacks can last for days and affect daily activities |
| What is the treatment for moderate persistent asthma | low to medium dose inhaled corticosteroids, long acting inhaled beta 2 agonists, may consider increasing the inhaled coricosteroid within the medium dose range or use low dose inhaled corticosteroids with leukotriene modifier or theophylline |
| What is the treatment for moderate persisent asthma severe exacerbation | increase the inhaled coricosteroids within the medium dose range, add long acting inhaled beta 2 agonists, consider increasing the inhaled corticosteroids within the medium dose range and adding either a leukotriene modifier or theophylline |
| What is severe persistent asthma | continual daily symptoms with frequent exacerbations at night |
| What is the PEF or FEV1 for severe persistent asthma | <60%, PEF can vary >30% |
| What is the treatment for severe persistent asthma | high dose inhaled corticosteroids with long acting beta 2 agonists, add corticosteroid tablets or syrup, try to reduce the systemic corticosteroids as soon as possible and maintain with the inhaled corticosteroids |
Created by:
buzzell6
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