NURS 355 Exam 1: Med Surg Final Question and Answers Latest (A Grade)
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NURS 355 (NURS355)
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Chamberlain College Of Nursing
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 infection
● Sterile technique vs Medical asepsis
○ Medical asepsis
■ Commonly referred to as cle...
nurs 355 exam 1 med surg final question and answers latest a grade
● principles of infection control
● sterile technique vs medical asepsis
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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 infection
● 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 thedepth
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, thespine, 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.
, ■ Characteristics
- Change in color, size, or shape of preexisting lesion
- Pruritus
- Local sorene
● Fungal infection
○ A group of organisms that include yeasts, molds, and mushrooms and can
produce highly resistant spores.
○ Normal flora of the mouth, skin, vagina, and intestinal tract include many fungi.
● Pediculosis vs Scabies
○ Pediculosis - an infection by lice. There are three types, pediculosis capitis ( head lice),
pediculosis corporis ( body lice ), and pediculosis pubis ( pubic, or crab, lice). Generally
the lice bite the skin and feed on human blood, leaving their eggs and excrement, which
can cause intense itching.
■ Prevention - involves avoidance of contact with an infected pers on or object.
Brushes, combs, hats, and other personal items should not be shared.
■ Signs and symptoms - pediculosis capitis can result in no itching or intense
itching. Pediculosis corporis may appear as tiny hemorrhagic pits. Excoriations
may be noted on the back, shoulders,abdomen, and extremities. It may also
cause intense itching. Pediculosis pubis results inmild to severe itching,
especially at night.
■ Complications - bacterial infections can occur with pediculosis capitis,
resulting in impetigo, furuncles, pustules, crusts, and matted hair.
Complications of pediculosis corporis include secondary infection and
hyperpigmentation.complications of pediculosis pubis include dermatitis and the
coexistence of other sexually transmitted infections.
■ Therapeutic measurements - otc pediculicides containing pyrethrins or
permethrin are the most commonly recommended compounds.
○ Scabies - contagious skin disease caused by the mite sarcoptes scabiei. It results from
intimate or prolonged skin contact or prolonged contact with infected clothing, bedding, or
animals. Patient is asymptomatic while organism multiplies, but it is most contagious at
this time. Symptoms do not occur until almost 4 weeks after the time of contact.
■ Prevention - all person and animals in intimate contact with an infected patient
should be treated at the same time to eliminate the mites. The mites survive
less than 24 hours without human contact.
■ Complications - hypersensitivity reactions to the mite can result in crusted lesions,
vesicles, pustules, excoriations, and bacterial superinfections.
■ Therapeutic measures - topical scabicides ( permethrin/elimite,
crotamiton/crotan) are used for chemical disinfection.
Pain and pain management (ATC, PRN, Distraction)
● Acute vs chronic
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