Glossary of NURSING 208 test 2
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- a specific defense or resistance of the body to infection
- inmmune sysetem
- What are the two types of Immune system?
- Active immunity: pretection provided by our own bodies usually last a long time, possibly a life time (long term)
Passive immunity: protection recieved from another source usually short lived last months or years (short term)
- What is the chain of infection?
- 1) causative agents or pathogens: bacteria fungus or parasites
2) Reservoir: where microbes live humans are the the largest reservoir for infection
3) Means of exit: from the reservoir to the world sneezing, GI or GU tracts and lesions
4) MODE OF TRASMISSION: direct contact(person to person); Droplet spread; Indirect transmission (through vectors); Air-borne transmission (dust)
5) PORTAL OF ENTRY (usually enters the same way it left
6) SESCEPTIBLE HOST: (young or old or weak immune systems
- Patients and workers can get these; infections acquired in the hospital and are more virulent than other organisms in th normal world because they have become resistant to many meds given in th hospital and it is preventable
- nosocomial infection
- this infection is also considered a nosocomial infection an is caused by medical treatments such as test and IV's and is also preventable
- What is the number one way to prevent nosocomial infections and iatrogenic infections?
- Hand washing
- Limiting the the number of organisms; removes as many as possible (putting on gloves and washing hands)
- medical sepsis
- make an area totally free of microbes (sterile technique or aseptic)
- surgical asepsis
- protects the patient from the nurse or anyone who walks in, used with a compromised immune system like those with cancer, burns or aids (where mask gloves and gown
- barrier technique
- Includes any injury to the body either internal or external
- no break in skin, it is internal, closed head injury with the brain ex. concussion, bruise to internal organ
- closed wound
- break in skin or membranes
- open wound
- occurs and heals in a timely way function is restored
- acute wound
- fails to heal in a timely/orderly way, difficult, longterm process ex. ulcers friction
- chronic wound
- What are the two causes of wounds?
- INTENTIONAL: Sx, IV, GSW, Knife wounds, and treatment (aseptic technique)
UNINTENTIONAL: unexpectedly, traumatic, unsterile conditions like falls, wrecks and accidents
- what are the different types of cleanliness of wounds?
- CLEAN: no pathogens usually closed or drained with close drainage
CLEAN CONTAMINATED: involves microbes so at greater risk
CONTAMINATED: open fresh accidental surgical wounds involving major break in sterile technique HIGH risk for infection evidence by inflamation
INFECTED/DIRTY: bacterial evidence present evidence of clinical infection and purulent drainage
- What are the different types of closed wounds?
- CONTUSIONS: blunt trauma or a blow like bruises contusions can be intentional or unintentional
CLOSED FRACTURES: broken bones but the skin is not broken
- What are the different types of open wounds?
- ABRASIONS: surface scrae, partial thickness (dermabrasion is intentional)
LACERATION: jagged edges, torn apart and ripped open (tramatic injury)
PENETRATING: goes through the skin and tissues even organs GSW (gun shot wound)
PUNCTURE: round, small, usually not deep, from stepping on something or being poked by a pin or nail or putting IV in
- What are the 3 types of wound healing?
- PRIMARY: heals, closed wound edges, small scar, no problems ex. cholecystectomy (taking out gall bladder
SECONDARY: wounds cannot be closed by suturing, repair time is longer, scaring is greater, more suseptible to infection, ESCHAR usually black due to dead tissue this is called debridement and is necessary for wound to heal
TERTIARY: healing is delayed for a reason it is left open because of infection and so it can drain more scaring and prone to more infections LONG HEALING TIME ex. perforated bowel repair and reptured appendix
- An abnormal excess of collogen formation (dark skin is more vulnerable to this)
- What are factors that affect healing?
- AGE: children and elderly
NUTRITION: diet rich in protein, carbs, fats, vitamin A & C which are important to healing Obese pt. heal slower, copper and iron are also important
LIFESTYLES: excercise increases circulation, smoking decreases hemoglobin
WOUND STESS: vomitting, obesity, coughing
- What are the wound assessment parameters?
- LOCATION: in regards to landmarks ex. midline abdomen
APPEARANCE: color, heat, texture, firmness
DRAINAGE: where it is coming from, color, consistancy, odor, amount on dressing and or wound
SWELLING: plapate for tension around the wound and for softness, boggy and hardness (fluid or hmatoma)
PAIN: pain rating
UNDERMINING: bigger than what it looks like from the outside
TUNNELING: two wounds that are connected underneath the skin
- What are that 4 stages of pressure ulcers?
- STAGE 1: reddness of skin reactive hyperpermia protective mechanism reddness will last 30 to 45 min as long as the pressure was applied
STAGE 2: top layer is missing , abrasions, blisters and shallow craters
STAGE 3: deep ulcer to dermis and subcutaneous tissues
STAGE 4: deep ulcer in to muscle or bone foul smell brown or black eschar, purrlence and often undermining and tunneling
- What are the differnt types of NDX for pressure ulcers?
- HIGH RISK FOR INFECTION
HIGH RISK FOR TRANSMISSION OF INFECTION: patients who have infection already
IMPAIRED SKIN INTEGRITY: superficial, dryness or abraision (stages 1 to 2)
IMPAIRED TISSUE INTEGRITY: more full thickness can be stage 3 if not to bad becomes PC if to bad--stage 4
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