NCLEX High Yield Review: TMP-SMX, Sepsis, Infective Endocarditis, and Bacterial Meningitis

Practice flashcards for NCLEX preparation covering pharmacy (TMP-SMX), sepsis criteria, infective endocarditis pathology, and bacterial meningitis assessment/treatment.

What are the common uses and drug types associated with Sulfa drugs (TMP-SMX)?

Sulfa drugs are used for Gram $-$/$+$ (UTI). Types included in the "FOA" category are Sulfasalazine, Diuretics, and Sulfonylureas (specifically Glyburide, Glipizide, and Glimepiride).

What are the contraindications and alternative treatments for TMP-SMX?

It is contraindicated in pregnancy and breastfeeding due to its status as a teratogen. Amoxicillin (PCN) is used as an alternative during pregnancy.

List the side effects associated with TMP-SMX listed in the notes.

Side effects include Nephrotoxicity, Stevens-Johnson Syndrome (SJS) involving skin sloughing/desquamation, $↑$ Brin (Bilirubin), and photosensitivity (SAT for a Photo).

What constitutes the Sepsis Triad?

The Sepsis Triad consists of Fever ($>100.4^{\circ}F$ or $<96.8^{\circ}F$), Hypotension (Systolic $90$ or MAP $65$), and Increased WBC ($12,000$).

How do you calculate Mean Arterial Pressure (MAP) and what is the normal range?

The calculation is $\frac{SBP + 2 \times DBP}{3}$. The normal range is $70-110$. If the MAP is $\ge 65$, it is a focus in sepsis management.

What is the clinical significance of finding immature neutrophils (bands) $>10\%$ in the EMR?

It indicates the body is producing neutrophils at an alarming rate to fight infection, signaling that the patient is in trouble.

What is the primary cause and common pathogen associated with Infective Endocarditis in the notes?

The primary cause is IVDU (IV Drug User) through dirty needles introducing Staph Epidermidis into the bloodstream.

Describe the pathway of septic emboli in Infective Endocarditis starting from the infection source.

Bacteria enter the bloodstream via the IVC (Inferior Vena Cava) → Right Atrium → Tricuspid valve (forming vegetation) → Right ventricles → Lungs (forming septic emboli).

What are the signs of septic emboli and where is the resulting murmur heard?

Signs include fever, chills, and chest pain. The murmur from Tricuspid regurgitation is heard on the Right sternal border at the $4^{th}$-$5^{th}$ Intercostal Space (ICS).

What is the treatment and prophylactic protocol for Infective Endocarditis?

Treatment involves Vanco-IV ABX for $4-6$ weeks (often via a PICC line). PPX ABX is required for dental procedures as a preventative measure.

Which pathogens are common causes of Bacterial Meningitis and what is a key neonatal prevention step?

Common causes are GBS, HIB, and N. Meningococci. Pregnant mothers are given a Group B strep test and prophylactic ABX to prevent neonatal bacterial meningitis.

What are the diagnostic steps and treatment for Bacterial Meningitis?

The diagnosis requires a Lumbar Puncture (LP) to determine the cause before administering antibiotics. The primary treatment mentioned is Ceftriaxone (a cephalosporin).

Define the Brudzinski and Kernig signs used to identify meningitis.

Brudzinski's sign involves pain when bringing the chin to the chest. Kernig's sign involves pain during a leg raise; both signs are due to stretching irritated or inflamed meninges.

What symptoms indicate increased intracranial pressure (ICP) in meningitis patients?

Symptoms include bulging fontanelle (in infants), sunset eyes, increased head circumference, prominent veins, N/V, stiff neck (nuchal rigidity), and altered mental status (AMS).

What isolation and seizure precautions should be implemented for Bacterial Meningitis?

Implement Droplet precautions (Surgical mask, gown, gloves). Seizure precautions include padded side rails, side positioning, NPO, and low stimulation.

What is the protocol for a mother with active HSV lesions during birth?

A C-section is performed to prevent transmission of HSV (viral meningitis/infection) to the baby.