AIRBORNE TRANSMISSION-BASED PRECAUTIONS: MTV

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2022 - 2023 NCLEX Med - Surg NCSBN Questions and Answers Actual Latest Grade A +

Evaluate Assess Teach Don’t delegate Unstable patients Initial Assessment, Teaching, IV drips, Evaluations only RN

AIRBORNE TRANSMISSION-BASED PRECAUTIONS: MTV

Measles TB Varicella-Chicken Pox/Herpes Zoster-Shingles

Private Room: Negative pressure with 6-12 air exchanges/hr

Mask: N95 for TB

DROPLET TRANSMISSION-BASED PRECAUTIONS: Think of SPIDERMAN!

Sepsis Scarlet fever Streptococcal Pharyngitis (Streptococcus group A/ Strep Throat): Can Lead to Glomerulonephritis & Rheumatic Parvovirus B19 Fever.Pneumonia Pertussis Influenza/ Haemophilus influenza type B

Diphtheria (Pharyngeal): Serious bacterial infection.

Epiglottitis: Medial Emergency! No Throat Inspectio

Rubella/ German measles 1 / 4

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2 Mumps Meningitis/ Neisseria

Meningitidis Mycoplasma/ Meningeal Pneumonia An - Adenovirus Private Room or Cohort Surgical mask PRN for Procedures Mask 3ft Distance

CONTACT PRECAUTION TRANSMISSION-BASED PRECAUTIONS: MRS.WEE

Multidrug resistant organism/ MRSA/ VRE Respiratory infection Skin infections Wound infection Enteric infection - Clostridium Difficile Eye infection – Conjunctivitis *MRSA - Contact precaution ONLY. Use Chlorhexidine Wipe!*VRSA - Contact & Airborne precaution (Private room, door closed, negative pressure) *SARS (Severe Acute Resp Syndrome) Airborne & Contact (just like Varicella)

SKIN INFECTIONS- VCHIPS- CONTACT

Varicella Zoster Cutaneous Diphtheria (Bacteria Infection in the Wound) Herpes Simplex Impetigo (Bacterial Skin Infection) Pediculosis (Lice) Scabies (Itchy Skin condition. Burrowing Trail of the Scabies Mite)

Middle East Respiratory Syndrome (MERS): Viral respiratory illness caused by Coronavirus (MERS-CoV). 2 / 4

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/S: Fever, Cough, SOB, and Death. The Incubation Period is 5-6 days but can range from 2-14 days.CDC: Standard (Gloves), Contact (Gown), Eye Protection (Goggles), Airborne Precautions (N95)

Negative room: Negative disease (TB, Disseminated Herpes Zoster)

Positive room: Protect the Patient (HIV, Cancer)

Addison’s= hyponatremia, hypotension, decreased blood vol, hypoglycemia, hyperKalemia, HyperCalcemia.Cushing’s= HyperNatremia, HyperTension, Incr. Blood Vol, HyperGlycemia, hypokalemia, hypocalcemia.

Managing Stress in a patient with Adrenal Insufficiency (Addison’s) is paramount, because if the Adrenal glands are stressed further it could result in Addisonian Crisis.Addison’s: Remember BP is the most Important assessment parameter, as it causes Severe Hypotension.Addison’s: (need to "add" hormone): Hypoglycemia, Dark pigmentation, Decr. Resistance to Stress, fractures, Alopecia, Weight Loss, GI distress. Vitiligo. Mood swings (Normal) Need to Report S/S of Infection/ Fever (Addisonian Crisis)

Tx: Mineral Corticoids.

Addisonian Crisis: Hypoglycemia, Confusion, n/v, Abd Pain, Extreme Weakness, Dehydration, Decr. BP.

Cushings: (have extra "Cushion" of Hormones): Hyperglycemia, prone to Infection, Muscle Wasting, Weakness, Edema, HTN, Hirsutism, Moonfaced/Buffalo Hump Cause: Excessive production of Corticotropin (Hyperplasia of the Adrenal Cortex) & Cortisol-secreting Adrenal Tumor.Prednisone Toxicity: Cushing’s syndrome- Buffalo Hump, Moon face, Hyperglycemia, Hypertension.

Acetaminophen: 10-20. Max 4000mg per day.

Acetaminophen Poisoning: Possible Liver Failure for about 4 days. Close observation required.

Tx: (Antidote) n-AcetylCysteine/Mucomyst 3 / 4

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(ASA): Metabolic Acidosis.

S/S: Tinnitus, Coffee Ground Emesis (Old Blood), Black tarry stools (Melena), Bruising, Tachycardia, Hypotension, GI Ulcers.

Tx: Activated Charcoal, then IV Na

+ Carbonate.

Acromegaly: Coarse Facial feature. Assess Cardiac Problems (eg. S3, S4).

Acute Respiratory Distress Syndrome (ARDS):

The 1 st Sign is Incr. Respirations. Later comes Dyspnea, Retractions, Air Hunger, Cyanosis.Cardinal sign is Hypoxemia (Low O2 level in tissues).Refractory Hypoxemia is the hallmark of ARDS, a progressive form of acute respiratory failure that has a high Mortality rate. It can develop following a Pulmonary Insult (eg, aspiration, pneumonia, toxic inhalation) or nonpulmonary insult (eg, sepsis, multiple blood transfusions, trauma) to the Lung.The Inability to improve Oxygenation With Incr. in O2 concentration.The insult triggers a Massive Inflammatory response that causes the lung tissue to release inflammatory mediators (leukotrienes, proteases) that cause damage to the alveolar-capillary (A-C) membrane. As a result of the damage, the A-C membrane becomes more permeable, and intravascular fluid then leaks into the alveolar space, resulting in a Noncardiogenic Pulmonary Edema.The lungs become Stiff and Noncompliant, which makes Ventilation and Oxygenation less than optimal and results in increased work of breathing, tachypnea and alkalosis, atelectasis, and refractory hypoxemia.ARDS (fluids in alveoli), DIC (Disseminated Intravascular Coagulation) are always Secondary to something else (another disease process). – Impaired Gas Exchange.

PreOxygenated with 100% O2, and Suction should be applied for no more than 10 seconds to prevent hypoxia. The nurse must wait 1-2 minutes between passes to ventilate to prevent hypoxia.Deep reBreathing should be encouraged.The Suction catheter should be No more than half the width of the artificial airway and inserted without suction.Don Sterile gloves if it is not have a closed suction system.2 AcetylSalicyclic Acid

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