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What is the priority protocol for a nurse assigned to a client newly diagnosed with active tuberculosis?
What is the priority protocol for a nurse assigned to a client newly diagnosed with active tuberculosis?
- Reinforce for all to wash their hands before and after entering the room
- Have the client cough into a tissue and dispose in a separate bag
- Instruct the client to cover the mouth with a tissue when coughing
- Place client in a negative pressure private room and have all who enter the room use masks with shields (correct)
Which test is considered the primary diagnostic test for tuberculosis in the Philippines?
Which test is considered the primary diagnostic test for tuberculosis in the Philippines?
- Bronchoscopy
- Chest x-ray
- Direct sputum smear microscopy (correct)
- Tuberculin test
What is the recommended procedure before obtaining a sputum specimen for tuberculosis diagnosis?
What is the recommended procedure before obtaining a sputum specimen for tuberculosis diagnosis?
- Gargle with water only (correct)
- Have the client refrain from eating before the specimen collection
- Brush teeth and use mouthwash
- Drink water 30 minutes before collection
Which interpretation indicates a positive result for multidrug-resistant tuberculosis in the Xpert MTB test?
Which interpretation indicates a positive result for multidrug-resistant tuberculosis in the Xpert MTB test?
In managing a case of tuberculosis, what follows after case finding for its control to be effective?
In managing a case of tuberculosis, what follows after case finding for its control to be effective?
What should be avoided prior to collecting a sputum sample in the morning for tuberculosis testing?
What should be avoided prior to collecting a sputum sample in the morning for tuberculosis testing?
What indication does the Mantoux test provide regarding tuberculosis?
What indication does the Mantoux test provide regarding tuberculosis?
What is necessary for a sputum specimen collection to be optimal?
What is necessary for a sputum specimen collection to be optimal?
Which sign indicates meningeal irritation when the child's neck is flexed?
Which sign indicates meningeal irritation when the child's neck is flexed?
What color of cerebrospinal fluid (CSF) is typically associated with viral meningitis?
What color of cerebrospinal fluid (CSF) is typically associated with viral meningitis?
Which laboratory finding is indicative of bacterial meningitis?
Which laboratory finding is indicative of bacterial meningitis?
What is the primary mode of transmission for paramyxovirus infections?
What is the primary mode of transmission for paramyxovirus infections?
Which option describes a positive Kernig's sign?
Which option describes a positive Kernig's sign?
Which symptom is NOT characteristic of increased intracranial pressure (ICP) in adults?
Which symptom is NOT characteristic of increased intracranial pressure (ICP) in adults?
Which method is least likely to be responsible for infection transmission in this context?
Which method is least likely to be responsible for infection transmission in this context?
In the nursing care plan, which action should the nurse avoid to minimize pain during positioning?
In the nursing care plan, which action should the nurse avoid to minimize pain during positioning?
Which type of leukocyte is primarily involved in initiating the inflammatory response and arriving first at an injury site?
Which type of leukocyte is primarily involved in initiating the inflammatory response and arriving first at an injury site?
What is the appropriate nursing action for discarding used needles and syringes after an injection?
What is the appropriate nursing action for discarding used needles and syringes after an injection?
For an immunosuppressed patient, which item should be prohibited from visitors?
For an immunosuppressed patient, which item should be prohibited from visitors?
Which of the following waste types is indicated by the yellow color coding for disposal?
Which of the following waste types is indicated by the yellow color coding for disposal?
Which factor is NOT directly associated with the development of Clostridium difficile infection?
Which factor is NOT directly associated with the development of Clostridium difficile infection?
During phagocytosis, which cells are primarily responsible for this process in the immune response?
During phagocytosis, which cells are primarily responsible for this process in the immune response?
What is one of the main roles of basophils in the immune response?
What is one of the main roles of basophils in the immune response?
Which of these nursing actions would be considered inappropriate when handling sharps?
Which of these nursing actions would be considered inappropriate when handling sharps?
What is the primary reason for using multi-drug therapy in treating tuberculosis?
What is the primary reason for using multi-drug therapy in treating tuberculosis?
What is the initial screening test used for detecting HIV in a patient?
What is the initial screening test used for detecting HIV in a patient?
During the window period for HIV testing, what can be expected regarding the presence of antibodies?
During the window period for HIV testing, what can be expected regarding the presence of antibodies?
What is a significant complication associated with untreated gonorrhea in women?
What is a significant complication associated with untreated gonorrhea in women?
Which of the following tests is confirmatory for HIV after a positive screening?
Which of the following tests is confirmatory for HIV after a positive screening?
Why might a patient with HIV not immediately test positive using an antibody test?
Why might a patient with HIV not immediately test positive using an antibody test?
Which approach is often recommended for the treatment of gonorrhea in women?
Which approach is often recommended for the treatment of gonorrhea in women?
What viral component is checked in a virological test for HIV?
What viral component is checked in a virological test for HIV?
What type of fever pattern is most consistent with a diagnosis of dengue fever?
What type of fever pattern is most consistent with a diagnosis of dengue fever?
Which combination of warning signs is crucial to monitor for severe dengue?
Which combination of warning signs is crucial to monitor for severe dengue?
During which stage of the dengue virus transmission cycle does infection initially occur?
During which stage of the dengue virus transmission cycle does infection initially occur?
What isolation measure is most appropriate for preventing dengue virus transmission to others?
What isolation measure is most appropriate for preventing dengue virus transmission to others?
What is the primary concern regarding immunity after a dengue fever infection?
What is the primary concern regarding immunity after a dengue fever infection?
What is the case fatality rate for severe dengue as opposed to dengue fever?
What is the case fatality rate for severe dengue as opposed to dengue fever?
What is a common misconception about the symptoms of dengue that should be corrected?
What is a common misconception about the symptoms of dengue that should be corrected?
When can a child with active chickenpox safely return to school?
When can a child with active chickenpox safely return to school?
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Study Notes
Coli Meningitis
- Caused by a paramyxovirus
- Transmitted through droplets
- Symptoms include increased intracranial pressure (ICP):
- Infants: high-pitched cry
- Adults: Cushing's Triad
- Symptoms also include meningeal irritation
- Brudzinski Sign: flexion of head results in flexion of hips and knees
- Kernig Sign: pain in the hamstring muscle when knee is extended
- Diagnosis confirmed through lumbar puncture
- Cloudy cerebrospinal fluid (CSF)
- Increased white blood cell count
- Increased protein
- Decreased glucose
Bacterial vs Viral Meningitis
- Bacterial Meningitis
- Cloudy CSF
- Increased WBC
- Increased protein
- Decreased glucose
- Viral Meningitis
- Clear CSF
- Slightly increased WBC
- Increased protein
- Normal glucose
Transmission
- Possible methods of transmission:
- Contact with respiratory secretions from an infected person
- Hands of caregiver contaminated with local discharges
Nursing considerations for Meningitis
- Pain: Nursing diagnosis of pain related to meningeal irritation.
- Avoid positioning that can worsen pain, such as: - Extended leg: Kernig's Sign - Neck flexion: Brudzinski Sign - Neck hyperextension
- Positioning:
- Consider patient comfort, minimizing movement can reduce pain
- Hygiene and Waste:
- Discard used needles and syringes into designated sharps containers. Do not recap needles.
- Maintain separate sharps containers for each patient and in the nurse's station.
Immunosuppression
- Avoid fresh plants in patient areas for immunosuppressed patients.
Clostridium Difficile
- Clostridium difficile diarrhea is caused by long-term antibiotic therapy.
Tuberculosis
- Tuberculosis (TB) is a bacterial infection that primarily affects the lungs
- Symptoms: productive brown sputum
- TB is transmitted:
- Air droplets (coughing, sneezing)
- TB infected patients should
- Cough in a tissue and properly dispose of the tissue
- Cover their mouth when coughing
- Wear masks when interacting with others
- Protect the greatest number of people
- Patient management
- Patient should be isolated in a negative pressure private room
- All healthcare workers entering the room must wear masks with shields
- Diagnostic Tests
- Sputum smear microscopy
- Best time: Early morning
- No to toothbrush and mouthwash
- Gargle with water only
- Inhale, exhale, then cough up phlegm
- Mantoux test (Purified Protein Derivative)
- Skin test → ID
- Site: inner surface of the forearm
- 0.1 ml / 5 unit purified protein ang iinject
- Interpretation after 48 - 72 hours
- Chest X-ray
- Xpert MTB (can also detect rifampicin resistance) - Results Interpretation - T (+) for MTB - RR (+), Rifampicin Resistance - TI (+) MTB, RR (indeterminate → not sure) - N (-) MTB
- Sputum smear microscopy
- The rationale for multi-drug treatment for TB is to reduce the development of resistant strains of bacteria
- Case finding is essential for the control of TB
- TB case finding should be followed up with regular check-ups.
HIV / AIDS
- Causative agent: Retrovirus
- Most common: HIV-1
- African American: HIV-2
- Diagnostic Tests:
- Serological Tests
- EIA / ELISA (check for antibodies)
- If positive on ELISA, it is only presumptive, as other illnesses can cause a positive result.
- Western Blot (confirmatory test for HIV-specific antibodies)
- EIA / ELISA (check for antibodies)
- Virological Tests
- RT PCR (confirmatory)
- P24 Antigen (part of the virus)
- Viral load (amount of virus in the blood)
- Serological Tests
- Window period:
- Time after infection but before antibodies are detectable
- Usually 2 weeks to 3 months but can be up to 6 months.
Gonorrhea
- In women, gonorrhea can cause:
- Dysuria (painful urination)
- Vaginal bleeding
- It can be treated but can lead to serious complications if left untreated.
Dengue Fever
- Dengue is a mosquito-borne viral illness
- Symptoms:
- Biphasic / Saddleback pattern fever
- Warning Signs:
- Severe abdominal pain
- Persistent vomiting
- Bleeding gums
- Vomiting blood
- Rapid breathing
- Fatigue / restlessness
- Dengue fever has a low case fatality rate (less than 1%)
- Severe dengue has a higher case fatality rate (44%)
- Dengue transmission cycle:
- Infected mosquitos bite an uninfected human (source of virus)
- Virus multiplies inside the mosquito
- Mosquito bites another human and transmits the virus
- Isolation measures for Dengue fever
- Mosquito control: Screen the environment
- Immunity:
- Immunity to one dengue serotype does not provide immunity to other serotypes.
Chickenpox
- Contagious period:
- Starts 1 to 2 days before the rash appears
- Ends when all the blisters have crusted over
- 8 days after the rash appears = no longer contagious.
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