Adult 1 exam complete latest guide A+
graded
bacteremia The presence of bacteria in the bloodstream.
catheter-associated urinary tract infection (CAUTI) urinary tract infection that occurs as a result
of having an indwelling urinary catheter.
cohorting The practice of grouping patients who are colonized or infected with the same
pathogen.
colonization the presence of microorganisms (often pathogenic) in the tissues of the host that
do not cause symptomatic disease because of normal flora.
infection The invasion of pathogens (harmful microorganisms) into the body that multiply
and cause disease or illness
culture Isolation of a pathogen by cultivation in tissue cultures or artificial media.
disinfection A cleaning process that does not kill spores and only ensures a reduction in the
level of disease-causing organisms. High-level disinfection is adequate when an item is going
inside the body where the patient has resident bacteria or normal flora (e.g., GI and respiratory
tracts).
Sterilization A cleaning process that destroys all living microorganisms and bacterial spores.
All items or devices that invade human tissue where bacteria are not commonly found should be
sterilized.
health care associated infection (HAI) infection acquired in the inpatient health care
setting (not present or incubating on admission).
pathogen Harmful microorganisms in the body that multiply and cause disease or illness.
communicable Infection that can be transmitted from person to person.
,virulence ability to cause disease, frequency with which a pathogen causes disease (degree
of communicability) and its ability to invade and damage a host. It can also indicate the severity
of the disease.
normal flora
importance of skin protective barrier, temperature, synthesis of vitamin D
epidermis top layer of skin
dermis inner layer of skin, collagen
breeches in skin integrity created in healthcare setting IVs, surgery
characteristics of aging skin *Inadequate proteins/nutrition impact aging skin
*Loss of collagen, *loss of elasticity
*Decreased wound healing
*Dehydration
Risk for pressure injury Coma, surgery, injury, immobile, loss of sensation, paralytic,
diabetes (neuropathy)
avoiding pressure injuries *important to mobilize and ambulate pts
*Move at least every 2 hours
*put pt 30° laterally, Move enough to relieve pressure on back but not too much to put all
pressure on they're side
*Longer duration of pressure causes more damage
pressure injuries pressure of bone against hard surface (ex: bed) pinches off blood vessels,
friction of skin against hard surface
shear Skin gets stuck to sheets, pt slides down bed, skin bunches, boney prominences and
muscle tissue slide in direction of body movement, cant see but tear inside skin, deeper injuries
harder to heal
frictionRubbing of two materials
High risk body parts for pressure injury *sacrum/coccyx area
*heels
*elbow
*scapula
*back of head
*spinal cord
*butt/hip area
anywhere where bony prominence
Moisture associated injuries Pts with extreme wetness
, Incontinent patients
High risk for sacral skin breakdown
Autolytic: body eats itself
blanching apply pressure to skin and red skin turns to white
Nonblanching erythema erythematous area does not blanch (turn light)
*deep tissue damage probable
Blanchable hyperemiablanches (turns lighter in color) and the erythema returns when you
remove your finger, the hyperemia is transient and is an attempt to overcome the ischemic
episode
hyperemia vasodilation (blood vessel expansion), redness
slough thick soft yellow/white substance/membrane, form over injuries, stringy
eschar black/brown dead tissue, necrotic tissue, may need to be debrided so wound can heal
tunneling space within skin where wound expanded, hidden tracks
granulation new tissue, red, moist tissue composed of new blood vessels, the presence of
which indicates progression toward healing
abrasion skin scrape, weepy (plasma leakage) all the histamines etc. for healing,
superficial with little bleeding and is considered a partial-thickness wound
laceration deeper injuries, more bleeding
puncture hole in skin, deeper tissue injury worried about infection, circular wound with the
edges coming together toward the center
classification/staging of pressure injuries based on depth and tissues seen
stage 1 •Non-blanchable erythema of intact skin, red skin
stage 2 Partial-thickness skin loss with exposed dermis, epidermis eroded
stage 3 full thickness skin loss, starting to see granulation tissue and adipose tissue
stage 4 Full-thickness skin and tissue loss, see bone and muscle
unstageable injuries Full-thickness skin and tissue loss obscured by slough or eschar
Deep-tissue pressure injury Localized area of persistent non-blanchable dark discoloration,
dark wound bed or blood-filled blister
graded
bacteremia The presence of bacteria in the bloodstream.
catheter-associated urinary tract infection (CAUTI) urinary tract infection that occurs as a result
of having an indwelling urinary catheter.
cohorting The practice of grouping patients who are colonized or infected with the same
pathogen.
colonization the presence of microorganisms (often pathogenic) in the tissues of the host that
do not cause symptomatic disease because of normal flora.
infection The invasion of pathogens (harmful microorganisms) into the body that multiply
and cause disease or illness
culture Isolation of a pathogen by cultivation in tissue cultures or artificial media.
disinfection A cleaning process that does not kill spores and only ensures a reduction in the
level of disease-causing organisms. High-level disinfection is adequate when an item is going
inside the body where the patient has resident bacteria or normal flora (e.g., GI and respiratory
tracts).
Sterilization A cleaning process that destroys all living microorganisms and bacterial spores.
All items or devices that invade human tissue where bacteria are not commonly found should be
sterilized.
health care associated infection (HAI) infection acquired in the inpatient health care
setting (not present or incubating on admission).
pathogen Harmful microorganisms in the body that multiply and cause disease or illness.
communicable Infection that can be transmitted from person to person.
,virulence ability to cause disease, frequency with which a pathogen causes disease (degree
of communicability) and its ability to invade and damage a host. It can also indicate the severity
of the disease.
normal flora
importance of skin protective barrier, temperature, synthesis of vitamin D
epidermis top layer of skin
dermis inner layer of skin, collagen
breeches in skin integrity created in healthcare setting IVs, surgery
characteristics of aging skin *Inadequate proteins/nutrition impact aging skin
*Loss of collagen, *loss of elasticity
*Decreased wound healing
*Dehydration
Risk for pressure injury Coma, surgery, injury, immobile, loss of sensation, paralytic,
diabetes (neuropathy)
avoiding pressure injuries *important to mobilize and ambulate pts
*Move at least every 2 hours
*put pt 30° laterally, Move enough to relieve pressure on back but not too much to put all
pressure on they're side
*Longer duration of pressure causes more damage
pressure injuries pressure of bone against hard surface (ex: bed) pinches off blood vessels,
friction of skin against hard surface
shear Skin gets stuck to sheets, pt slides down bed, skin bunches, boney prominences and
muscle tissue slide in direction of body movement, cant see but tear inside skin, deeper injuries
harder to heal
frictionRubbing of two materials
High risk body parts for pressure injury *sacrum/coccyx area
*heels
*elbow
*scapula
*back of head
*spinal cord
*butt/hip area
anywhere where bony prominence
Moisture associated injuries Pts with extreme wetness
, Incontinent patients
High risk for sacral skin breakdown
Autolytic: body eats itself
blanching apply pressure to skin and red skin turns to white
Nonblanching erythema erythematous area does not blanch (turn light)
*deep tissue damage probable
Blanchable hyperemiablanches (turns lighter in color) and the erythema returns when you
remove your finger, the hyperemia is transient and is an attempt to overcome the ischemic
episode
hyperemia vasodilation (blood vessel expansion), redness
slough thick soft yellow/white substance/membrane, form over injuries, stringy
eschar black/brown dead tissue, necrotic tissue, may need to be debrided so wound can heal
tunneling space within skin where wound expanded, hidden tracks
granulation new tissue, red, moist tissue composed of new blood vessels, the presence of
which indicates progression toward healing
abrasion skin scrape, weepy (plasma leakage) all the histamines etc. for healing,
superficial with little bleeding and is considered a partial-thickness wound
laceration deeper injuries, more bleeding
puncture hole in skin, deeper tissue injury worried about infection, circular wound with the
edges coming together toward the center
classification/staging of pressure injuries based on depth and tissues seen
stage 1 •Non-blanchable erythema of intact skin, red skin
stage 2 Partial-thickness skin loss with exposed dermis, epidermis eroded
stage 3 full thickness skin loss, starting to see granulation tissue and adipose tissue
stage 4 Full-thickness skin and tissue loss, see bone and muscle
unstageable injuries Full-thickness skin and tissue loss obscured by slough or eschar
Deep-tissue pressure injury Localized area of persistent non-blanchable dark discoloration,
dark wound bed or blood-filled blister
