crs 101 exam 2

a&p & infection prevention

What 3 elements must be present for an infection to spread in a hospital setting?

• Source/reservoir for pathogens

• route of transmission for the pathogen

• susceptible host

3 modes of transmission for pathogens

• Contact (direct & indirect) (most common)

• droplet (travels <= 3ft in air)

• airborne (droplet nuclei, particles are <=5 micrometers)

These are classified based on particle size!

What does OSHA stand for & what do they do?

• Occupational Safety & Health Administration

• Makes sure everything is up to standard

What does CDC stand for?

Centers for Disease Control & Prevention

What do standard precautions include? What does it also mean?

• Standard precautions are precautions for every patient every time! It’s the simplest level of infection control

• Includes…

  • hand hygiene

  • gloves

  • mouth, eye protection, face shields

  • respiratory protection (ex. mask)

  • gowns

  • patient care equipment (can get contaminated since it’s with the patient)

  • occupational health & bloodborne pathogens

  • patient placement

Levels for disinfection & sterilization (3 levels)

• Lowest level: cleaning

  • 1st step in equipment processing

  • removes dirt & organic material

• Next level: disinfection

  • Destroys vegetative form of all pathogens except bacterial spores

  • Can involve chemical or physical methods

  • Pasteurization is the most common method

  • Chemical disinfection entails applying chemical solutions to contaminated equipment/surfaces & the equipment must be immersed in solution for set period of time

• Top level: sterilization

  • destroys ALL microorgs

  • Can be physically or chemically approached

  • Most common & easiest method is autoclaving (steam sterilization)

Surveillance for hospital acquired infections (device related) (know CLABSI, CAUTI, VAPs, & VAE)

• Device-related infections

  • Central line-associated blood stream infections (CLABSI)

  • Catheter-associated urinary tract infection (CAUTI)

  • ventilator associated pneumonia (VAPs)

    • VAP surveillance definition has significant limitations

  • Surveillance is performed to look for ventilator-associated events (VAE)

Ventilator-Associated Events (know the 3 tiers: VAC, IVAC, & PVAP)

Broken down into 3 tiers:

• Ventilator-associated condition (VAC)

  • identified with high PEEP or daily minimum FiO2 for 2 days or longer

• Infection-related ventilator-associated complication (IVAC)

  • identified thru high temp or WBC & new antibiotics have been started & administered for at least 4 days

• Possible VAP (PVAP)

  • identified if IVAC identified & positive culture results meet specific threshold values

    • or they have purulent secretions & positive culture results that don’t meet specific threshold values

Aerosol medications (know SVN, MDI, & DPI)

• aerosolized epinephrine introduced as treatment for asthma

• 1940s-1950s- introduced bronchodilators

• SVN- small volume nebulizer

• MDI- metered dose inhaler

• DPI- dry powdered inhaler

Upper airway vs Lower airway anatomy

• Upper airway

  • nose

  • mouth

  • pharynx

  • epiglottis

  • top of trachea

• Lower airway

  • bottom of trachea

  • bronchi

  • bronchioles

  • alveoli

  • capillaries

functions of upper airway

• warms incoming air to body temp

• filters air

  • pure by the time it gets to the lungs

• humidifies

  • 100% humidity

cellular make up of the airway

• made of ciliated pseudostratified columnar epithelium

• cilia helps move allergens & foreign stuff out of the body

where does gas exchange occur?

in the alveoli

alveolar gas concentration (just know what’s involved, not the %)

• nitrogen

• oxygen

• CO2

• water

concentration of oxygen in the atmosphere

21%

macrophages

• attack TB

• Consumes stuff (ex. debris, bacteria, dust, etc.)

muscles of respiration (the main one & the inspiratory & expiratory accessory muscles)

(hint: the expiratory muscles are all abdomen related)

• Diaphragm (moves down during inhalation & up during exhalation)

• Inspiratory Accessory

  • scalene

  • sternocleidomastoid

  • pectoralis major

  • trapezius

• Expiratory Accessory

  • rectus abdominis

  • External oblique

  • internal oblique

  • transversus abdominis

accessory muscle use for breathing (inspiration)

• If these are used to breathe, something is wrong & it’s an emergency!! It should mainly be the diaphragm you use to breathe.

• Scalene

  • inspiratory muscle

  • extends from cervical vertebrae to 1st & 2nd

• Sternocleidomastoid

  • on side of neck

  • elevates the sternum

  • increases AP diameter of chest

• pectoralis major

  • from clavicle to sternum to upper part of humerus

  • elevates chest

  • increases AP diameter

• trapezius

  • triangular, bilateral upper portion of back

  • rotates scapula

  • elevates rib cage (inhalation)

accessory muscles of expiration

• rectus absominis

  • raises intraabdominal pressure by pushing diaphragm into thoracic cage

  • compresses abdominal contents

• external oblique

  • compresses abdominal contents

  • pushes diaphragm into thoracic cage during exhalation

• internal oblique

  • depress the thorax & assist in respiration

  • pushes diaphragm in thoracic cage (exhalation)

• transversus abdominis

  • the body’s natural corset

  • constricts abdominal contents

active breathing vs quiet breathing

• active breathing- while doing anything (ex. walking)

• quiet breathing- while doing nothing (ex. sitting, sleeping)

perfusion vs ventilation

• perfusion- flow of blood to alveolar capillaries

• ventilation- the flow of air in & out of alveoli

all low-flow, non-invasive devices require…

the patient to be spontaneously breathing

SPO2 range for a COPD patient vs. a non-COPD patient

• COPD patient: 88-92% bc you don’t want to knock out their hypoxic drive

• non-COPD patient: 93% or higher

when to use humidifiers

3L or more for a long period of time. Don’t use with nebulizer

nasal cannula

• FIO2: 24-44%

• Delivers 1-6 L/min (low flow)

  • high flow (green tube) = 6-15 L/min

• most procedures start with this

simple mask

• FIO2: 35-50%

• Delivers 6-12 L/min

  • must be at least 6L to prevent rebreathing CO2

• not used often, just with labor & delivery & outpatient

venturi mask

• FIO2: 24-60%

• Delivers 4-12 L/min

• bigger hole in adapter = lower FIO2 (due to more exposure to the room’s FIO2)

• usually for COPD patients

Non-rebreather mask

• FIO2: 60-100%

• Delivers 6-15 L/min

bag valve mask (BVM)

• switch to this when the patient is NOT SPONTANEOUSLY BREATHING

• Non-invasive with mask. Becomes invasive when mask is removed

order of devices (depending on severity)

nasal cannula → venturi mask → non-breather → BVM

flow rate (L/min) & FIO2

• Starts with 0L/min & 21%

• 1 L/min has FIO2 of 0.24, then increases by 4% with each liter (ex. 2 L/min has FIO2 of 0.28)

heart valves

• aortic valve

• pulmonary valve

• mitral valve

• tricuspid valve

pericardium

outer fibrous layer that surrounds the heart

pericarditis

inflammation of pericardium

layers of the heart wall (outer to inner)

• Outer: epicardium

• Middle: myocardium (muscle)

• Inner: endocardium

chambers of the heart

• Top: left & right atria

• Bottom: left & right ventricles

systole vs. diastole

• systole= cardiac contraction. valves open, allowing ventricular ejection into arteries (pulmonary artery & aorta)

• diastole= valves close preventing backflow of blood into ventricles

  • murmur= valves not closing properly

Left coronary artery (LCA)

• positioned underneath aortic semilunar valves

• LCA branches into

  • left anterior descending (LAD): courses between L&R ventricles

  • Circumflex: courses around L side of heart between L. atrium & L. ventricle

• Provides blood to areas like L. atrium & ventricle, majority of interventricular septum, etc.

Right coronary artery (RCA)

• RCA proceeds around the right side of heart between R. atrium & R. ventricle

  • provides blood to these areas

Myocardial Ischemia vs. Myocardial Infarction (MI)

• Myocardial Ischemia

  • partial obstruction of coronary artery

  • dec. oxygen supply to tissue

  • AKA Angina Pectoris

• Myocardial infarction

  • complete obstruction of coronary artery

  • causes death of heart tissue

Conductivity vs. Contractility

• Conductivity- spreads impulses quickly

• Contractility- contracting in response to electrical impulse

systemic vasculature (know where it begins & ends, each vena cava, & what 3 components make it up)

• begins with aorta on L. ventricle & ends on R. atrium

• systemic venous blood returns to R. atrium via…

  • Superior vena cava (SVC)- drains upper extremities & head

  • Inferior vena cava (IVC) drains lower body

• Made of 3 components:

  • arterial system

  • capillary system

  • venous system

PVR

pulmonary vascular resistance

LAP

left atrial pressure of wedge pressure

CO

• cardiac output= total amount of blood pumped by heart per minute

• CO= heart rate (HR) x stroke volume (SV)

mmHg

milimeters of mercury. Used to determine blood pressure

sphygmomanometer

tool used to measure blood pressure

Frank-Starling’s Law

• The greater the stretch, the stronger the contraction

EF

• ejection fraction (EF) = SV/EDV

normal respiratory rate

12-20 breaths per minute

normal heart rate

60-100bpm

normal blood pressure

120/60 mmHg

brady- vs tachy-

• brady- low/below average.

  • ex. bradypnea (low beathing)

• tachy- high/above average

  • ex. tachycardia (high heart rate)

adventitious breath sounds

abnormal breath sounds

abnormal breath sounds (5 types)

• wheezing- anywhere. Sounds like “whistling” & sounds worse during expiration. Can include COPD, asthma, & airway obstruction

• rhonchi- in bronchi (larger airway). “Course crackles.” Can generally be cleared with a cough

• rales- in “tails” (ends on side). “Fine crackles.” Sounds like fire crackling with popping sounds

• stridor- high pitch sound by neck. Can be heard without stethoscope. Upper airway. Sounds like loud whistling

• pleural rub- can be found anywhere on lungs in the cavity between lung & bone. Can be inflammation on pleura. Sounds like creaking boat on dock. Sounds the same on inspiration & expiration, so it’s symmetrical

ABCs

Airway, Breathing, Circulation

pattern to use stethoscope

upper, mid, lower, & diamond on both sides