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NURS 355 Exam 1: Med Surg Final Question and Answers Latest (A Grade)

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NURS 355 Exam 1: Med Surg Final Question and Answers Latest (A Grade) Infection and sepsis ● Principles of infection control ○ Standard precautions and guidelines to break the chain of infect... ion ● Sterile technique vs Medical asepsis ○ Medical asepsis ■ Commonly referred to as clean technique. The goal is to reduce the number of pathogens or prevent the transmission of pathogens from one person to another. ○ Surgical asepsis ■ Surgical asepsis (sterile technique) refers to an item or area that is free of all microorganisms and spores. Surgical asepsis is used in surgery and to sterilize equipment. ● The infectious process ○ Causative agent ○ Reservoir ○ Portal of exit ○ Mode of transmission ○ Portal of entry ○ Susceptible host ● Different types of causative agents ○ Bacteria ○ Rickettsiae ○ Viruses ○ Fungi ○ Protozoa ○ Helminths ○ Prions ● Mode of transmission ○ Direct contact ○ Indirect contact ○ Airborne ○ Droplet ● Localized vs systemic infection ○ Localized ■ Caused by an increase of microbes in one area that triggers the inflammatory response ○ Systemic ■ An infection that affects the entire body instead of just targeting one organ ● Sepsis and septic shock ○ Sepsis ■ Is an immune system response to a serious infection. ■ Can be fatal due to systemic inflammatory response syndrome (SIRS) ■ Can damage organ systems and cause them to fail ○ Septic shock ■ Occurs with decreased blood pressure ■ Prolonged shock can cause organ damage Wound assessment, staging, and wound care ● Wound stages and healing ○ Stage 1- the skin is still intact, but the area is red, & does not blanch when pressed ● There may also be warmth, hardness, and discoloration of the skin ● May be difficult to detect on a dark-skinned person ○ Stage 2- there is a break in the skin, with partial- thickness skin loss of epidermis, dermis, or both ● The ulcer may appear as an abrasion, a shallow crater, or blister ● Ulcers do not contain slough (yellow fibrous tissue) ○ Stage 3- there is full-thickness skin loss, which extends to the subcutaneous fat but not to the fascia ● The ulcer looks like a deep crater & may have undermining of adjacent tissue ● Bone, tendon, & muscle are NOT visible ○ Stage 4- there is full thickness skin loss with exposed muscle, bone, or support structures such as tendons ● Slough or eschar may be present ● There may be undermining the sinus tracts (tunneling) ○ Unstageable- the base of the ulcer is covered by slough or eschar so that the depth cannot be evaluated ● The wound bed must be debrided before staging & treatment can take place ● One exception, according to NPUAP, is stable, dry, intact eschar on the heels ● It serves the body’s natural (biological) cover & should NOT be removed ● Braden scale ○ Tool used to measured patients risks for developing a pressure ulcer ● Debridement ○ Is the removal of eschar or necrotic tissue to prevent bacterial proliferation under the eschar and to promote wound healing ○ Debridement may be mechanical, enzymatic, or surgical ○ Deep partial or full thickness burns; wound is cleansed debrided, and topical antimicrobial agents are applied once or twice daily. ● Psoriasis- a chronic inflammatory skin disorder in which the epidermal cells proliferate abnormally fast. Usually, epidermal cells take about 27 days to shed. With psoriasis, the cell shed every 4-5 days. Aggravating factors include streptococcal pharyngitis, emotional upset, stress, hormonal changes, cold weather, skin trauma, smoking, alcohol, and certain drugs (ex antimalarial agents, lithium, beta blockers). ■ Prevention - because exact etiology is not known, measures to prevent exacerbation of symptoms are specific to patient's circumstances. ■ Signs and symptoms - varies according to patient and the particular type of psoriasis. Lesions are red papules that join to form plaques with distinct borders. ■ Complications - psoriatic arthritis can develop after psoriasis has developed, with nail changes and destructive arthritis of large joints, the spine, and interphalangeal joints. ■ Therapeutic measure - topical and systemic agents are used to treat psoriasis. ● Herpes zoster ( shingles)- an acute inflammatory and infectious disorder that produces painful vesicular eruption on bright red edematous plaques along the distribution of nerves from one or more posterior ganglia. This eruption follows the course of cutaneous sensory nerve and is almost always unilateral. ○ Prevention - avoidance of persons with herpes zoster during the contagious phase. Varicella (varivax) vaccine in children and adults who have not had chickenpox can reduce the risk of getting infected. ○ Signs and symptoms - in addition to the vesicles and plaques there may be irritation, itching, fever, malaise, and depending on the location of the lesions, visceral involvement. ○ Complications - postherpetic neuralgia, persistent dermatomal pain, and hyperesthesia are common in older adults and can last for weeks to months after lesions have healed. ○ Therapeutic measures - treatment is aimed at controlling the outbreak, reducing pain and discomfort, and preventing complications. Mild cases may heal without medication. Antiviral agents such as acyclovir are used for more severe cases and are most effective if started within 72 hours of the onset of the rash. ● Malignant melanoma (ABCD) ○ A malignant lesion of the skin, which may or may not metastasize. ○ Overexposure to the sun is primary cause ○ Diagnosis is confirmed by a skin biopsy ■ Types - Basal cell - arises from the basal cells contained in the epidermis; metastasis is rare, but underlying tissue destruction can progress to organ tissue - Squamous cell - is a tumor of the epidermal keratinocytes and can infiltrate surrounding structures and metastasize to lymph nodes - Melanoma - melanoma may occur any place on the body, especially where birthmarks or new moles are apparent; it is highly metastatic to the brain, lungs, bone, and liver, with survival depending on early diagnosis and treatment. [Show More]

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