Study Guide- Patient Care Test #1

What does HIPAA stand for and when was it established?

Health Insurance Portability and Accountability Act. Established
in 1996
What is the purpose of HIPPA?
Improve efficiency and effectiveness of health care systems
Standardize exchange of information
What does the privacy rule provide?
Federal standard for protected health info protection
Preserve quality healthcare
Assure security, privacy, and confidentiality
What types of entities are covered under HIPPA?
Health care providers
Health plans
Health insurance issuers
Medicare
Medicaid
Health care clearing houses/data processing centers
What does protected patient information include?
Test results, name, DOB, medical record, address, etc
What is the reason of the privacy rule purpose?
Patient
Est. boundaries
Safeguards
Penalties for violations
Public disclosure
What is required to implement patient privacy rules?
Notification
Implementation
Training
Privacy official
Security
What are exceptions to the rules of patient privacy?

Allowed by law

Who

Public health authorities

Health research
Abuse/neglect reporting
Law enforcement
enforces the violations if any are made?
US department of health and human services office for civil
rights (OCR)
Investigations
Filing complaints
Civil and criminal penalties

What are the rules with research and HIPPA?

De-identify info
PHI with authorization
PHI without authorization under limited circumstances
How

do you as a technologist ensure patient privacy?

Make sure you have the right patient
Discuss everything in an enclosed room
Separate children from parents when asking questions
Use password for PACS
Spread documents
Do not leave x-rays up on screen

What is HITECH and when was it established?

Health info technology for economic and clinical health
Part of the American recovery and reinvestment act
February 17,2009 signed into law
Controls privacy
Cleared up gray-areas beyond health care providers
What is HITECH goals?
Nationwide electronic exchange of info
Investing $20 billion to encourage electronic exchange of info
Improving quality of care, reduction of medical errors and
duplicative care
Strengthening privacy laws and to protect PHI from misuse
Go paperless by 2014
What are the Medicare/ Medicade incentives to follow HITECH?
Medicare/Medicaid incentives

Reduced payments to those without electronic records

They get fined/ penalized if they dont have EHR

What is the impact on healthcare?

Impact on Healthcare
Increased rules for HIPAA
Prevent accidental disclosures, computer theft, data network
breaches
Varying deadlines for compliance to new rules
Effects on business associates
Breach of unsecured PHI
o You have to report it within 60 days if the breach involves
>500 people must notify health and human services and
notice to prominent media outlets
Accounting of all information disclosed
EHR only
What does ethics mean?
Ethics- standards of conduct common for a collective discipline
controls the profession
Identify the program,
Develop alternative solutions
Select best option
Defend selection
Define law and moral rules?
Laws- political subdivision, outside group, legislation, fines/prison
Regulations set by a government applicable to people within
Civil vs criminal- with criminal you can go to jail
Moral rules- individuals, conscience controls it, punished by
shame or guilt
ARRT has a set of ethical standards
Has standards= what we want you to aspire to be
Has rules- what you have to do if you violate them then your
license will be taken away
What does Res Ipsa Loquitur mean?
Thing speaks for itself
Patient injured by no fault of their own
Action was in exclusive control of the defendant
Occurred due to negligent action by defendant (health care
provider)

What does respondent superior mean?

The master speaks for the servant
Medical facility responsible for the negligent acts of its
employees
Included on lawsuits against individual persons
o Corporate liability
Hospital responsible for the quality of care provided
to the patient
Duty of reasonable care in the selection and
retention of employees and medical staff
Duty of reasonable care in the maintenance
and use of equipment
Availability of equipment and services
What does negligence mean?
Failure to use such care as a reasonably prudent person would
use under like or similar circumstances
In medicine negligence is referred to as medical malpractice
What are elements that prove medical malpractice?
Breach of the accepted standard of care
o Failure to fulfill duty
o Occur by an act or omission
Causation
o First must have a breach
o Negative results must have occurred
o If put pills in wrong bottle but didnt take them you cant
sue for malpractice
Damages
o Must have proven breach and causation
o Economic damages
Lost wages
Out of pocket expenses
o Non- economic damages
Pain and suffering
What are the different Ethical Theories?
Consequentialism
o Right/wrong of ethical decisions assess consequences of
the decision good effect with little harm a lie to benefit
in the end
Non-Consequentialism never lie

Social Contract
o Describe relationships that exist between two
people/groups expectations of honestry

Ethics of Care
o Actions not isolated events part of an integral context
based on basic morals of kindness, sensitivity,
attentiveness, tact, patience and reliability

Rights Based Ethics

o Understanding human rights all have a right to care
o Rights justified claims that an individual can make on
others (legal or moral rights)

Principle Based Ethics

o Moral principles to defend chosen path of action
o Moral principles basic moral truths (justice, autonomy,
fidelity, beneficence)

What are Torts?

Claim that a person has been wronged or injured by an other
Civil wrong but you cant go to jail
What are the 5 types?
Assault
Threat of bodily harm
Battery
Actual act of injuring someone
Not shielding
X-ray wrong person/wrong part
False imprisonment
Person feels like they do not have free will
Restraints
o Need to be ordered by a physician
o Can use sponges and tape
Defamation
Slandering- saying that has concrete
consequences that can harm their image that
are false
Liable- writing something that has concrete
consequences that can harm their image that
are false

Fraud
RT tries to read films and tells patient what is
wrong
Most common is mislicenseger

What is an Electronic health record? And what are the joint

commission standards?
o Doc of patient info
o Formats vary by facility
o Joint commission standards:
Patient ID data
Medical history
Relevant physical findings
Diagnostic/therapeutic orders
Clinical observations
Reports of diagnostic/therapeutic procedures, lab
results
Evidence of informed consent
Conclusions at termination of
hospitalization/evaluation with instructs/follow-up
care information
What is a Radiology health record? And what must it have on
it?
o Physician order must be received
Demographic information
Health record number
Procedure
Physician name
o Once read
Radiologist who read it
Report
Diagnosis
What are the 2 types of consent?
o Consent is not transferable by date, facility, or physician
o Consent for treatment
Informed
o Voluntary
Have to be told risks and risks of not having it
done
Have to be told benefits/ alternative options
Have to understand the procedure/whose doing
it/when

o Parameters:
Name of procedure
Benefits
Risks/adverse effects
Length of time
Alternatives
Consequences of refusal
Implied
o Emergent situations
o Non-verbal consent
o Patient is no conscious but requires immediate medical
assistance
o When people walk into the ER
Oral
o Legal but there is not concrete evidence
o Their word against yours

What are advanced directives regarding patient care?

Advanced directives- allow patient to make decisions regarding
care
o DNR- dont not resuscitate
o Comfort care- CC (pain meds, oxygen, nutritional support,
supporting the body, clearing the airway)
DNR/CC- only treatment for comfort care- no CPR
What does Durable power of attorney mean?
Effective when person incompetent to make decisions
Usually determined by a living will
Durable means person remains in control until patient dies or a
court removes the person
Two separate individuals:
o Medical
o Financial
Infection Control
1. What is Pathogenicity?
Ability of microorganism to produce disease
2. What is Virulence?
Degree of pathogenicity of an infectious
microorganism
How strong or likely it is to get someone sick
3. What is Infection?

4.
5.

6.

7.

8.

Invasion and multiplication of microorganisms

What is Colonization?
Multiplication of microorganisms
What is Flora?
Microorganisms of the human body
Normal/resident
Transient
What are the types of pathogens?
Protoza
Bacteria
Fungi
Viruses
Do bacteria need a host? What are examples of bacterial
diseases?
o Do not need a host to replicate
o Examples of bacterial diseases
Strep, UTI, staff infection, bacterial pneumonia. CDIFF
Usually treat with antibiotics but not all our
susceptible by antibiotic
Not always good because they are overused
and misused
What is an endospore?
Allows virus to be dormant, its like a shell to wait to
start to multiply, survive without nutrients
Only way to destroy them is through sterilization

9. What is a Protozon? What are some examples?

o Free living organisms
o Can get them from uncooked seafood
o Some live within the body
o Invade the GI, Genitourinary tracts; circulatory system
(malaria, trichomonas vaginalis)
o Very difficult to treat, more prone in other countries
10.
What is Fungi? What are the 2 types? What are the
methods of reproduction?
o Can grow in 2 ways: yeast or filamentous hyphae (mold)
o Opportunistic- need open cut, need correct conditions like
moist area
o Can grow on above, below, in the skin, or in the system
o Methods of reproduction
Spores- travel airborne

 Buds- dont travel airborne

o Examples of fungi diseases
Yeast infection
Athletes foot
11.
What are viruses? Can they survive without a host?
What are some examples?
o Smallest known disease causing organisms
o Cannot survive without a host
o No medications that will destroy it but some will inhibit
growth
o Examples of viral diseases
Herpes, flu, cold
12.
What is the Cycle of infection?
o Infectious agent
o Reservoir/source
o Portal of exit
o Mode of transmission
o Portal of entry
GI tract, skin, mouth, eyes, nose
o Susceptible host
Fomite-an object
13.
What are normal defense mechanisms?
o Non-specific immune defenses
Skin and normal flora
Mucous/membranes/sneezing/coughing/tearing
Elimination and acidic environment
Inflammation- non-specific cellular response
14.
What are the stages of Inflammatory response?
o Stage 1- initial injury
o Stage 2- increased blood flow
o Stage 3- increased capillary permeability
o Stage 4- leukocytes
o Stage 5- replacement of tissue
15.
What are Specific immune defenses?
o T-cells- t-lymphocytes
Regulate immune response
o B-cells
Produces specific antibodies
Stimulates memory B-cell formation
Acquired and humoral (found in body fluids) are 2
types
16.
What is the difference between acquired and
passive immunity?
Acquired Immunity

o Resistance to a specific infection

o Long time/lifetime
Infection
Some vaccines
Passive Immunity
o Not resistance for ever
o Newborns get them from their mother
o Vaccines- short term like flu vaccine
17.
What are the stages of infectious process
o Localized (upper respiratory) and systemic (throughout
body) infections
o Incubation
o Prodromal
o Illness
o Convalescence
18.
What are nosocomial infections? What is a new
concern?
o Where acquired?
What new area is of concern for nosocomial
infection acquisition?
Now in out patient and walk-in clinics
19.
What are the risk factors for infection?
Air/food contamination, infected patients, equipment,
hospital workers
20.
What is the most frequent infection?
Urinary tract is most frequent
21.
What are the roles of antibiotics?
Over usage
Inappropriate usage
22.
What is medical and surgical asepsis?
o Medical- reduce number, growth, and spread
Clean technique
Clean and dirty objects
Medical aseptic measures
Hand washing, disinfectants, antiseptics
o Surgical- eliminate all microorganisms and spores
Sterile technique
Micoorganisms and spores
Rules
Sterile fields
Causes of contamination
23.
What is sterilization?
Destruction of all organisms

Only way to achieve surgical asepsis

What are the methods of sterilization?
Steam- least expensive and most effective
Gas- complex and expensive (objects that cannot
withstand high heat)
Dry heat- not as effective
Liquid- formulas vary
Steris- liquid
Sterrad- vaporized liquid
25.
What is the difference between a droplet and an
airborne?
Airborne- very small, smaller than 5 microns, travel more
than 3 ft
o TB, rubeola, varicella
Droplet- more than 5 microns, 3 feet or less, doesnt
remain in air
o Whopping cough
26.
What is HIV? How is it spread?
Virus that damages and kills the bodys immune system
Destroys the bodies ability to fight infections and certain cancers
Most commonly transmitted through unprotected sex with an
infected partner
Can enter via the lining of the vagina, vulva, penis, rectum or
mouth during sexual acts
Can also be transmitted via infected needles/syringes or contact
with infected blood
24.

27.
What is the HIV and AIDS connection?
AIDS is diagnosed when a HIV+ patient has repeated
opportunistic infections caused by HIV infection
28.
How can HIV be transmitted?
Health care setting can be infected after being stuck with HIV+
needle risk is less when infected blood gets into open
cut/wound or mucous membrane only one instance of patient
being infected by health care worker
Environment HIV does not survive well in the environment - no
one has been infected by contact with an environmental surface
and it cannot reproduce outside a living host
Household transmission between family members is rare can
occur between mucous membranes and infected blood
precautions should be followed as in the healthcare setting
regarding exposure to blood/body fluids also no sharing of
razors, toothbrushes

Business no risk from food service tattooing and piercing

should use disposable needles - no instances of HIV transmission
documented
Kissing closed mouth (social) no risk open mouth low risk due
to contact w/blood
Biting not a likely method no reports
Salivia/Tears/Sweat HIV in saliva/tears in low quantities not in
sweat never shown to be transmitted in this manner.
Insects no evidence w/insects not constant high levels of HIV
in blood of HIV+ patient at all times insects do not retain large
amounts of flood on their surfaces and insects do not travel from
one person to the next immediately. Following ingestion of blood
digest blood meal first.
29.
What are the 4 stages?
Stage 1 lasts for a few weeks and is accompanied by short flu
like symptoms which occur just after infection sometimes called
seroconversion illness HIV antibody may not show positive at
this stage
Stage 2 average of 10 years free from symptoms other than
swollen glands level of HIV in peripheral blood drops to low
levels but people are infectious and HIV antibodies are
detectable HIV is NOT dormant but is very active in the lymph
nodes and large #s of T-helper cells are infected and die large
amounts of virus are produced.
Stage 3 immune system loses fight to contain HIV due to lymph
nodes and tissues being damaged, HIV mutants are more
pathogenic (stronger), body cannot keep replacing lost t-cells
as the immune system fails, symptoms develop initially mild
but will worsen symptomatic HIV caused by opportunistic
infections/cancers that normally the immune system would
prevent
Stage 4 as the # of opportunistic infections increase and the
illnesses become more severe AIDS is diagnosed not all
patients reach stage 4
30.
What are the standard precautions?
To prevent parenteral, mucous membrane and nonintact skin
exposure of health- care workers to HIV to be used whenever
applicable body fluids are present regardless of diagnosis fluids
are always considered infectious
Blood single most important source followed by semen and
vaginal secretions although not implicated in occupational
transmission also applies to body tissues, cerebrospinal fluid,

synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid,

amniotic fluid
Feces, nasal secretions, sputum, sweat, tears, urine and vomitus
are not considered infectious unless contain visible blood risk of
transmission is very low or nonexistent when no visible blood
present
Breast milk for perinatal transmission no occupational exposure
universal precautions do not apply but gloves - salivary
transmission is remote no precautions needed
Protective measures to reduce risk of exposure gloves, gowns,
masks, protective eyewear supplement not replace
recommendations for routine infection control such as handwashing risk of nosocomial transmission of HIV can be reduced
by preventing injuries with needles/scalpels/sharp instruments,
use protective barriers, immediately wash hands and skin
surfaces
31.
What is HBV? What are the symptoms?
Highly contagious virus that attacks the liver can cause liver
disease, liver cancer and death In 2008 38000 new cases of
HBV between 800,000 and 1.5 mil currently in the US with HBV
1/3 of those infected do not know it and are asymptomatic but
can still spread the disease
Signs/symptoms 30% of people have no s/s less common in
children v. adults but can include jaundice, fatigue, abdominal
pain, loss of appetite, nausea, vomiting, joint pain
32.
What are the long term affects?
Chronic infection occurs in 90% of infants infected at birth, 30%
of children infected between 1-5 years of age 6% of persons
infected after age 5 15-25% of chronically ill pts. die of chronic
liver disease
33.
How is it transmitted?
Blood/body fluids during unprotected sex, drug use, other
exposures to infected blood/body fluids
34.
Who is at risk?
Sex with infected persons, intravenous drug users, infants born
to HBV+ mother
35.
How do you prevent HBV?
Vaccine is best prevention, condoms, if pregnant and HBV+ need
to get HBIG (HB immune globulin and vaccine), do not share
razors/toothbrushes
Routinely given between 0-18 years of age...all health-care
workers at risk most common side effect is soreness at injection.
site
36.
What is the treatment?

Treatment specific long-term drugs for treatment

New infections has declined from avg. of 260,000 in the 1980s
to 73,000 in 2003- highest rate in 20-49 year olds, greatest
decline in children/adolescents due to routine vaccinations
37.
How do you protect yourself?
To prevent spread of blood-borne pathogens (similar to HIV)
Applicable body fluids blood most important followed by
semen, vaginal secretions, cerebrospinal fluid, synovial fluid,
pleural fluid, peritoneal fluid, Pericardial fluid amniotic fluid HBV detected in synovial/amniotic/peritoneal fluid
Non-applicable feces, nasal secretions, sputum, sweat,
tears, urine, vomitus
Unless contain visible blood risk low or nonexistent with no
visible blood present
Special settings human breast milk but not a risk for
occupational exposure
Saliva has been shown to contain HBV shown to be
infectious in human bite exposures but not to oral mucous
membranes therefore standard precautions do not apply for
saliva
Protective barriers/equipment same as HIV
Infection after skin exposure dependent on concentration of
the virus, immune
Status of the healthcare worker (HBV only), duration of
contact, intact versus non- intact skin
38.
What are the signs and symptoms of HEP A?
Jaundice, fatigue, abdominal pain, loss of appetite, nausea,
diarrhea, fever
39.
How is it transmitted?
1. Feces of persons with HAV spread from person to person by
putting something in the mouth that has been contaminated
with stool of a person with hepatitis A virus
2. Raw seafood/shellfish
40.
What are the long term effects?
1. No chronic infection once a patient has HAV they never get it
again about 15% of pts. with HAV have prolonged or
relapsing symptoms over a 6-9 month period
41.
Who is at risk?
1. Household with an infected person
2. Sexual partners of infected person
3. Traveling to countries with high rates of HAV
4. Homosexual males
5. Consuming raw seafood/shellfish
42.
How do you prevent HAV?

1. HAV vaccine short term protection can be achieved through

immune globulin if given within 2 weeks of coming in contact
with HAV
2. Always wash hands with soap and water after using the
bathroom, changing diapers and before preparing and eating
foods
43.
What kind of trend does it have?
1. T/S-occurs in epidemics can reach 35,000 cases 1/3 of
Americans have evidence of past infections
44.
What are the signs and symptoms of hep c?
1. Jaundice, fatigue
2. Dark urine
3. Abdominal pain
4. Loss of appetite
5. Nausea
6. 80% of pts have no S/S
45.
How is it transmitted?
1. From infected blood/body fluids
46.
What are the long term effects?
1. Chronic infection 55-85%
2. Chronic liver disease 70%
3. 2.7-3.9 million people infected in the US 2008
47.
What is done for all blood donations?
1. Testing done for all blood donations should be done for
anyone in high risk groups (drug users)
48.
How do you prevent HEP C?
1. NO vaccine
2. No intravenous drug use
3. Do not share razors/toothbrushes, follow standard precautions
4. Be cautious of tattooing/piercing
5. Use condoms although their effectiveness is unknown
(transmission by sex is rare)
49.
What is the treatment for HEP C?
1. Be evaluated for liver disease, interferon and ribavirin two
drugs licensed for the treatment of HCV
2. Avoid alcohol
50.
What kind of trend does hep c follow?
1. S/T new infections has declined from 240,000 in 1980s to
25,000 in 2001 most are due to illegal injection drug use,
transfusion associated causes occurs in less than 1 per 1
million transfused units of blood
51.
What is MRSA? Where is it found?
1. Staphylococcus aureus is a bacteria
2. Commonly found on the skin, near the eyes, nose, mouth,
rectum

3. Not a problem for healthy adults but can be especially virulent

and cause serious infections once it enters the pt. especially
an immune compromised pt.
4. Can cause serious infections of the skin, eyes, brain, blood,
resp. and digestive tracts, also bone and connective tissue
52.
How did MRSA evolve?
1. MRSA is methicillin-resistant staphylococcus aureus (SA)
strains of the bacteria have evolved resistance to methicillin.
MRSA first appeared in the 1970s MRSA is treated with
vancomycin originally penicillin was used to treat but today
<10% are treatable with it methicillin then used but today
50% are resistant to it (MRSA)
53.
What is Antibiotic Resistance?
1. Bacterial growth/reproduction unaffected by particular
antibiotics methods include an altered cell membrane to
prevent the antibiotic from entering, some actively pump out
the antibiotic, some develop enzymes that degrade the
antibiotic as soon as it enters the cell
54.
Where can SA survive?
1. SA can survive dry conditions
2. Can live long periods of time on dust particles, clothing,
furniture or hospital equipment.
3. Can grow w/o oxygen high % of hospital workers are passive
carriers on their skin and transmission is done pt to pt via
hospital workers hands
55.
How can SA infect patients?
1. SA causes infection in pt. with weakened immune systems
enter through wounds, burns, deep cuts, surgical incisions
pts. in the hosp. with flu, leukemia, skin disorders, diabetes,
kidney transplants, receiving radiation/chemo are at high risk
also a threat to newborns
56.
What is the treatment for SA?
1. Vancomycin is the only treatment for MRSA however some
strains of MRSA are becoming more resistant to vancomycin
57.
What is VRSA?
1. VRSA scientists believe as the use of vancomycin increases
to deal with resistant MRSA, SA will develop total resistance
and become VRSA
58.
How do you prevent the spread of MRSA?
1. MRSA pts. should be in a private room or w/ a patient with the
same infection but no other infections
2. Always wear gloves when entering the room and remove
before leaving.
3. Wear gown when entering the room
4. Limit transportation of the pt.

5. Keep patient care items clean and only use non critical
equipment for that pt. ie.
1. Stethoscope, commode, thermometer, etc...
59.
What does VRE stand for?
1. Vancomycin- resistant enterococci
60.
Where are enterococci found? What is the most
common infection?
1. Enterococci are bacteria found in feces of humans
2. Most common infections caused are urinary tract and wound
infections
3. Can cause infections of the blood stream (bacteraemia), heart
valves (endocarditis) and the brain (meningities) one of the
most antibiotic resistant bacteria in humans
61.
What is the history of VRE?
1. VRE since 1989 rapid increase in VRE lack of available
antibiotics from 1989-1993 number of nosocomial VRE
infections climbed from 0.3% to 7.9% a 34 fold increase
increased risk associated with previous vancomycin usage,
severe underlying disease/immunosuppression and intraabdominal surgery critically ill pts., cardio-thoracic surgery
pts., indwelling urinary catheter or central venous catheter
some infections come from pt. themselves due to presence in
GU/GI tracts but can be transmitted by direct or indirect
contact hands of personnel or by contaminated
equipment/surfaces
62.
How do you prevent VRE?
1. Prevention-prudent use of vancomycin, education of hospital
staff on VRE, early detection and reporting, immediate
implementation of appropriate infection control measures
2. Appropriate usage of antibiotics certain types of bacterial
infections, infections caused by gram- positive
microorganisms with specific antimicrobial allergies,
severe/life threatening colitis, prophylaxis for endocarditis
following certain procedures recommended by the American
Hospital Association, prophylaxis for implantation of prosthetic
materials/devices at institutions with high rates of MRSA a
single dose immediately prior to surgery is sufficient unless
the procedure is >6hrs in which the does must be repeated
63.
What are precautions to take?
1. Gloves and handwashing...disinfection of equipment/surfaces
64.
What is TB?
1. Caused by Mycobacterium tuberculosis
2. Usually effects lungs but can effect other parts such as the
brain, kidneys, spine
3. TB can be fatal w/o treatment
65.
What are the symptoms?

1.
2.
3.
4.

Feeling of weakness
Weight loss
Fever
Night sweats if in the lungs also coughing, chest pain,
hemoptysis
66.
How is TB transmitted?
1. TB of the lungs droplet air can stay for several hours in the
air
67.
What is a Latent Infection?
1. LTBI-have TB germs but are not symptomatic
2. Cannot spread to others but can develop active TB disease
later pts with active disease germs are active and
multiplying have symptoms and can spread disease
68.
Can someone be infected if theyre exposed to LTBI?
What happens when someone is exposed to active TB?
1. Exposure to LTBI people exposed cannot be infected do not
need to be tested
2. Exposure to Active TB need to be tested and can be infected
69.
Who is most likely to get TB?
1. Most likely people to get disease are those who have close,
daily contact with the patient
70.
What kind of testing is done to find out if the
patient has TB?
1. Testing two tests Mantoux Tuberculin skin test and the
QuantiFERON-TB Test
2. Mantoux small amount of fluid (tuberculin) is injected under
the skin and within
1. 48-72 hours the reaction is observed
3. QuantiFERON blood test that measures how pts immune
system reacts to TB infection
71.
What does a positive test state?
1. Positive test (either) states person has been infected with TB
but does not state whether active or latent
2. Need other tests such as chest x-ray, sample of sputum to
detect activity of disease
72.
What is the vaccine for TB?
1. BCG vaccine for TB not recommended in US
2. Not complete prevention and can cause false positive on skin
test
73.
What is the difference between latent TB and active
TB?
1. Latent TB no symptoms but positive skin test - person not
infectious pt with LTBI may develop active disease - 10% will
develop active disease at some point but risk is higher first
two years of infection - for pts with weakened immune

systems risk of developing active disease higher LTB pts are

given tx to prevent active infection
2. Active TB bacteria override immune defenses multiply
goes from latent to active symptoms include unexplained
weight loss, loss of appetite, night sweats, fever, fatigue,
chills, coughing >3 weeks, hemoptysis and chest pain (lungs
only) active TB is infectious and can be spread
74.
How do you evaluate a patients susceptibility to
contracting TB?
1. Medical history
Previous exposure to TB
Country of origin
Occupation
2. Physical exam, test for TB
3. Chest x-ray to evaluate for TB lesions (can differ in size,
shape, location, density) cannot use chest x-ray as only
diagnostic tool
75.
What test is used for TB?
1. Whole blood test for latent TB infection
2. Measures the pts immune reactivity to M.T. approved for use
by the FDA in 2001
76.
How does the test work?
1. Blood samples are mixed w/antigens (proteins that produce an
immune response) and incubated for 16-24 hours antigens
include tuberculin
2. If pt is infected with M.T. blood cells will recognize and
release interferon-gamma in response (IFN-g).
3. QFT results based on proportion of IFN-g that is released
4. Additional tests such as a chest x-ray are needed to confirm
LTBI
77.
What are advantages to the QFT?
1. One single visit
2. Multiple responses to different antigens
3. Can be done repeatedly without changing results as with skin
test
4. Less subject to reader bias and error compared to the skin
test
78.
What are the disadvantages?
1. Blood samples must be processed in 12 hours after collection
2. Limited lab and clinical experience with QFT
3. Ability of QFT to predict pts risk of progression to active TBD
has not been evaluated, additional tests needed to confirm
diagnosis
79.
When do you use QFT? When do you not use the QFT
test?

1. Only use QFT if follow up plans are in place (CXR, sputum test,
etc...), need to ensure qualified lab is available to test within
12 hours
2. Not to be used for random testing only w/exposure
Not for patients with known TB disease
Children under 17
Pregnant or persons with clinical conditions that put
them at risk for TBD
For confirmation of skin test
80.
What must the blood be drawn with? What does this
do?
1. Blood must be drawn into a vial with heparin to prevent
clotting
2. Tested in 12 hours and follow up with healthcare personnel
required.
81.
What do low risk patients need to exhibit?
1. Low risk pts need to exhibit stronger response versus high risk
pts.
2. Patient with a limited exposure risk needs to show a higher
response than those with high risk factors
3. Skin and QFT are not interchangeable but confirmation of QFT
with skin test is possible possibility of LTBI is greater if both
tests pos., negative QFT does not need skin test confirmation
82.
What is the treatment of LTBI?
1. LTBI is essential to controlling and eliminating TB in the US.
2. Reduces the risk of active TBD
83.
Who are the candidates?
1. HIV
2. Recent contact with a TB case
3. Fibrotic changes on CXR
4. Organ transplants or other immunosuppressed pts
84.
What are patients that should be considered for
treatment have to have?
1. Recent arrivals from high prevalence countries,
2. IDUs
3. Residents/employees of high congregate settings
Correctional institutions
Nursing homes
Homeless shelters
Hospitals
Health care facilities
4. Mycobacteriology labs personnel
5. Children < 4 yrs or children and adolescents exposed to
adults in high risk categories
85.
How long does treatment last?

1.
2.
86.
1.
87.
1.
88.
1.

Tx cannot begin until active TBD has been excluded

Treatment lasts up to 9 months with various drug usage
How is the treatment monitored?
Lab testing to evaluate liver function while on treatment meds
What is BCG?
Bacille calmette Guerin vaccine
Where is BCG used?
Used in many countries with a high prevalence of TB to
prevent disease in children and the military
2. Not recommended in US because of low risk of infection in the
general population
89.
Who is recommended?
1. Children who have a negative skin test and who are
continually exposed to TB or cannot be removed from adults
who are untreated or ineffectively treated, have TB caused by
strains resistant to certain meds
2. Healthcare workers on an individual basis where there is a
high % of TB pts with drug resistance, ongoing transmission of
drug resistant TB to health care workers, or comprehensive TB
precautions not successful
90.
When should the BCG not be used?
1. Should not be used for immunosuppressed pts and pregnant
women
91.
What may BCG cause?
1. May cause positive reaction to skin test need to do further
testing to determine if infected
92.
What must the patient have to determine if they
have TBD?
1. Procedure for pts. vaccinated are the same for those if the
skin test appears positive.
2. Must have CXR to determine if patient has TBD
93.
What does the effective program require?
1. Effective program requires early detection and prompt
isolation/treatment.
2. Policies and procedures need to be established, reviewed
periodically and evaluated for effectiveness.
94.
What is the Hierarchy of control measures?
1. 1st (effects highest # of persons) uses administrative
measures intended to reduce risk
1. Development and implementation of written policies and
protocols to ensure rapid ID, isolation, diagnosis/evaluation
and TX
2. Implementing effective work practices (wearing respirators,
keeping isolation doors closed), education, training and
counseling of healthcare workers, screening of healthcare
workers for TB

2. 2nd use of engineering controls to prevent spread and reduce

concentration of infectious droplet nuclei
1. Include direct source control using exhaust ventilation,
controlling direction of airflow to prevent contamination of
air in areas adjacent to the infectious source, diluting and
removing contaminated air via general ventilation and
cleaning of air via air filtration or ultraviolet germicidal
irradiation
2. These levels minimize number of areas in facility where
exposure can occur and reduce but do not eliminate risk in
few areas where exposure can sill occur (pts room)
3. 3rd use of personal respiratory protective equipment in pts
rooms and other situations in which risk of infection may be
higher
95.
When should a patient with suspected or confirmed
TB be considered?
1. Should be considered infectious if they are coughing, are
undergoing cough-inducing procedures, sputum smears are
positive for acid-fast bacilli and have not received tx, just
started tx or have poor clinical or bacteriologic response to tx.
96.
When are patients no longer considered infectious?
1. Are on adequate tx plans
2. Had a favorable clinical response to tx AND have three
consecutive neg. sputum smears
97.
When should respirators be used?
1. Respirators should be used by persons entering rooms where
pts w/ known or suspected disease are isolated, persons w/
cough inducing or aerosol generating procedures, persons in
other settings where administrative/engineering controls are
not likely to protect them from inhaling infectious droplet
nuclei
98.
How must Respirators meet following standard
performance criteria?
1. Ability to filter particles 1 micrometer in size with an efficiency
of 95% or greater (leakage of 5% or less) give flow rates of 50
liters per minute
2. Ability to fit in a reliable way to obtain face-seal leakage of
10% or less
3. Ability to fit different facial sizes and characteristics
4. Must be checked per OSHA for fit
99.
How do you prevent the spread of TB?
1. Known or suspected TB should wear masks when not in TB
isolation rooms
2. Visitors should wear respirators while in isolation room
100.
What does OSHA do?

1. Required to develop, implement and maintain respiratory

protection program
101.
What must the respiratory protect have?
1. Assignment of responsibility for plans
2. Standard operating procedures
3. Medical screening
4. Training
5. Face seal fit testing and checking
6. Respirator inspection, cleaning, maintenance and storage
7. Periodic evaluation of program
102.
What does Cdiff mean?
1. Clostridium difficile
103.
What is it?
1. Bacterial infection
104.
How is it transmitted?
1. Fecal/oral route (mucous membrane)
2. Indirect contact (healthcare workers)
3. Spores can be present for weeks/months
105.
What are risk factors?
1. Antibiotic use
2. 65 years of age or older are at 10x higher risk
3. Nursing home or long care treatment facililites
4. Abdominal surgery or GI procedure
5. Colon or inflammatory bowel disease
6. Colorectal caner
7. Previous infection
106.
What are symptoms of CDIFF?
1. Watery diarrhea
2. Fever
3. Loss of appetite
4. Nausea
5. Abdominal pain/tenderness
107.
What are the severe symptoms?
1. Watery diarrhea
2. Blood/pus in stool
3. Nausea
4. Dehydration
5. Weight loss
6. Kidney failure
7. Bowel perforation
8. Toxic megacolon- colon expands due to excess gas and
inflammation results in perforation which can cause dealth
108.
What does the infection do?
1. Produces toxins
2. Plaques of inflammatory cells
3. Decaying cellular debris

4. New strain which is far more resilient to antibiotics which is

more aggressive
109.
How do you diagnosis CDIFF?
1. Stool tests
2. Colon examination
3. Imaging
1. flex sigmoidoscopy Imaging CT
110.
What are some treatments for CDIFF?
1. Antibiotics
1. metronidazole or vancomycin
2. Probiotics
1. used in conjunction with antibiotics Surgery remove
diseased portion of the intestine
3. Surgery
4. Recurrent disease
1. 14 of people get ill again antibiotic use, probiotics, stool
transplant donor stool to restore normal function
111.
How to protect yourself?
1. Hand washing
2. Contact precautions
3. Thorough cleaning
4. Avoid unnecessary use of antibiotics
112.
What is rubella? What is it caused by?
1. Referred to as German Measles
2. Caused by a different virus than regular measles immunity
from one (measles) does not mean immunity from the other
(German Measles)
113.
Who is rubella a serious threat to?
1. Rubella is a mild childhood disease but a serious threat to a
fetus
114.
Where does replication occur?
1. Respiratory transmission replication occurs in nasopharynx
and regional lymph
2. Nodes presence of virus in blood occurs 5-7 days after
exposure w/spread to the
3. Body this is also when the virus is spread across the
placenta to a fetus
115.
What are the Clinical Features?
1. Incubation period is 14 days with a range of 12-23 days
2. Children-rash is usually the first symptom
3. Adults and adolescents low grade fever, malaise,
lymphademopathy and upper respiratory symptoms precede
the rash
4. Rash usually appears on the face and then progresses from
head to foot
1. More prominent after hot shower/bath

2. May begin a week before the rash and last several weeks
3. Arthralgia and arthritis occur so frequently in adults in is
considered part of the virus not a complication others
include conjunctivitis, testalgia, orchitis
116.
What are some complications with rubella?
1. 70% of adult women get arthralgia or arthritis but it is rare in
children and men fingers, wrists, knees occur about the
same time or shortly after the rash and can last 1 month
2. Encephalitis occurs in 1/6,000 cases and more frequently in
adults (females)
3. Hemorrhagic manifestations 1/3,000 and more in children
than adults
4. GI, Cerebral, Renal most common areas, can last days to
months but most pts. recover
117.
What does CRS stand for?
1. Congenital rubella syndrome
118.
How is it acquired?
1. Early in gestation
2. Infection in early gestation can be disastrous virus can affect
all organs and cause a variety of birth defects. About 25% of
babies whose mothers contract rubella during 1st trimester
are born w/one or more birth defects or CRS
3. Infection can lead to fetal death, spontaneous abortion or
premature delivery
119.
What does the severity of the effects depend on?
1. Severity of the effects of the virus depends on time of
gestation infection occurs up to 85% of infants infected in
1st trimester will be infected with CRS after birth defects are
rare if infection occurs after the 20th week of gestation
120.
What are some complications that go along with
CRS?
1. Deafness is the most common and often sole manifestation of
CRS infection
2. Eye defects such as cataracts, glaucoma, retinopathy may
occur cardiac defects such as patent ductus arteriosus,
ventricular septal defect, pulmonic stenosis and coarctation of
the aorta
3. Neurological defects include microcephaly and mental
retardation also bone lesions, splenomegaly, hepatitis,
thrombocytopenia
4. Manifestation of CRS can be delayed 2-4 years. And children
with CRS frequently are diagnosed with diabetes mellitus
121.
What are the vaccines for rubella? When is the first
vaccination? What do you do for a post or pre pregnant
patient?

1. First vaccination occurs at 12-15 months of age when

antibodies from the mother have worn off. Given in
conjunction with measles and mumps vaccine MMR should
not receive first dose before 12 months of age second dose
of MMR is given either at age 4-6 or 11-12. Many states now
required second MMR be given before entering kindergarten.
2. For pre-pregnant women must be tested for immunity
against rubella and if not immune should be vaccinated at
least 4 weeks prior to conception CDC recommends 3
months
3. If a woman is pregnant and is not immune then she should
avoid any contact with illness no effective treatment for
rubella during pregnancy or way to prevent rubella in
susceptible pts
4. Post pregnancy a woman should be vaccinated can be
vaccinated if breast feeding
5. Women who are vaccinated close to conception by accident
are unlikely to be harmed
Communication
122.
What are examples of blocks to good
communication?
1. Blocks to good communication
1. Rapid speech
2. Complex terms
3. Distracting environments
4. Not listening
5. Judgmental statements
6. False assurances
7. Defending
8. Changing the subject
9. Giving advice
10.
Disagreeing
123.
What are the 3 Modes of communication?
1. Verbal
1. Tone
2. Speed
3. Pronunciation
2. Written
1. Ability to read
2. Understanding English
3. Paralanguage
1. Eye contact
2. Touch
3. Body positioning

4. Professional appearance
5. Personal hygiene
6. Physical presence
124.
What is the goal of a Patient interview? What are
the different structures of questions?
1. Goal
1. To gather information prior to an exam
2. Types of questioning
1. Closed
1. Elicit quick information
2. Open
1. Assess patient
3. An effective interview
1. Structured
1. List of written questions for a direct response
2. Unstructured
1. Dependent on patients responses to questions
125.
What is the difference between a sign and a
symptom?
1. Sign vs symptom
1. Sign- can be measured
2. Symptom is subjective evidence of disease; it is a
feeling people other than the patient cannot see/feel it.
A headache is a symptom. Chest pain could be a
symptom
126.
What is the goal of Patient education? What are the
4 types of learning?
1. Goal of instruction
1. Provide patient pertinent information
2. Review
1. Procedure
2. Adverse effects
3. Post care instructions
3. Assessment of learning style
1. Global vs linear
1. Entire picture vs each component
2. Visual
1. Need pictures/graphics
3. Auditory
1. Verbal
4. Kinesthetic
1. Demonstration and return
127.
What are the different challenges in communication?
How do you react towards them?
1. Seriously ill and traumatic patients
1. Act differently due to pain, stress, anxiety

2. Need to assess pts coherence level

3. Uncooperative
2. Visually impaired
1. Gain pts confidence
2. Give clear instructions
1. Have them hold on to you, you dont hold on to them
3. Non-English speaking
1. Touch
2. Facial expressions
3. Enlist help of translator
4. Mentally impaired
1. Use strong reassuring voice
5. Substance abusers
1. Decrease exam time
2. Watch patients behavior
6. Mobile/surgical patients
1. Introduce self
2. Do not make inappropriate comments even if patient
seems unaware
128.
How do you effectively communicate with a child?
1. Pediatric patients
1. Childs level
2. Reassure
3. Non-threatening
129.
How do infants react? How would you work with a
toddler? What would you do for a patient who is 5-10
years old? What about an adolescent? Middle aged?
Eldery?
1. Infants (birth to 1 year)- separation anxiety 8 months of age
1. Facial expression
2. Vocalization
3. Body movements
2. Toddlers (1-3 years) Preschoolers (3-5 years)
1. Simple words
2. Work quickly
3. School children (5-10 years)
1. Keep attention diverted away from exam
4. Adolescents (10-25 years)
1. Maintain modesty
5. Young adults (25-45 years)
1. Speak to as an adult
6. Middle- aged persons (45-65 years)
1. Be sensitive to stresses and emotions
7. Mature persons (65 years and older)
1. Do not treat as an elderly patients
8. Geriatric patients

1. Do not refer to as old

2. Assess comprehension level
1. Young-old
2. Old-old
3. Oldest-old
130.
How are mental disabilities identified by? When was
the Americans with disability act enacted? What are the
values of this act?
1. Mental disabilities- generally identified by IQ
2. American with disabilities act of 1990
1. Reasonable accommodations
2. Values
1. Autonomy
1. Make decision for themselves
2. Dignity
3. Equality
4. Solidarity
1. Unity or agreement of feeling or action
131.
What is Dementia? What is a result of it? What are
the other 2 forms of dementia? Do all people with
dementia have Alzheimers?
1. What is dementia?
1. Progressive brain dysfunction
2. Relationship between dementia and Alzheimers
1. Dementia is a result of Alzheimers
3. Other forms of dementia:
1. Multi-infract dementia (MID)
1. Series of small strokes or changes in blood supply
2. Mild cognitive impairment (MCI)
1. Ongoing memory problems but no other losses
4. Not all people with dementia have Alzheimers
132.
What are the Is of a Geriatric patient
1. Is of geriatrics
1. Intellectual impairment
2. Incontinence
1. Cant hold you bowels
3. Instability
4. Immobility
5. Isolation
6. Inantion
1. Malabsorbtion
2. Starvation
7. Iatrogenesis
1. Unintended and untoward consequence of well-intended
healthcare interventions

133.
What are psychological stresses of the geriatric
community?
1. Psychosocial stresses
1. Retirement
2. Loss of income/ spouse
3. Change in living arrangements
2. Mental health problems
1. Depression
2. Anxiety
3. Paranoia
134.
Special needs patients
1. Iatrogenesis
1. Reaction to medications
2. Differences between geriatric patients and younger patients
1. Altered manifestation of illness/disease
2. Decreased support
3. Diminished resilience
1. Cannot fight off infection as easily as we can
4. Different expectations
5. Increased cognitive impairment
6. Disabilities
7. Multiple sites of pain
135.
What are changes with aging to the integumentary
system? Pulmonary system? Cardiovascular system?
Gastrointestinal? Hepatic? Genitourinary?
Musculoskeletal? Neurological?
1. Integumentary system
1. Wrinkles, lose of elasticity, thin, fragile
2. Head and neck
1. Vision, hearing, light adjustment, kyphosis
3. Pulmonary system
1. Lung capacity diminishes, less cough reflex. COPD
4. Cardiovascular system
1. Decline in blood flow, calcification of arteries
5. Gastrointestinal system
1. Mouth dryness, abdominal muscle weakness
6. Hepatic system
1. Liver decreases in size, reduced bile storage
7. Genitourinary system
1. Bladder capacity decreases, involuntary bladder
contractions
8. Musculoskeletal system
1. Loss of bone mass, decrease in muscle mass/strength,
decreased mobility, gait changes
9. Neurological system
1. Memory loss, changes in speech, loss of reaction time

136.
What is Diversity? What are characteristics of it?
1. Define diversity
2. Characteristics of diversity
1. Age
2. Ethnicity
3. Race
4. Gender/sexual orientation
5. Mental/physical ability
137.
What does Ethnicity mean? What is ethnocentrism?
Racism?
1. Persons distinctive racial, national, religious, linguistic or
cultural heritage
2. Ethnocentrism
1. Your culture is superior to all the others
3. Racism
1. Discriminatory
2. Believing what everyone else is doing is wrong
3. Being voiceful about it
138.
What does assimilation mean? What is biculturalism
mean?
1. Assimilation
1. Adapt to the norms of the culture their apart of
2. fit in to the culture they are in
2. Biculturalism
1. Accepting many cultures
139.
What is Gender/sexual orientation?
1. Gender- biologic/chromosomal sexual identity
2. Sexual orientation
1. Heterosexual
2. Homosexual
3. Bisexual
3. Homophobia- irrational fear of gays
140.
What are the 5 elements of Cultural competency?
1. Five elements
1. Valuing diversity
2. Possessing capacity for cultural self-awareness
3. Consciousness of the dynamics of cross-cultural interaction
4. Institutionalizing cultural knowledge
5. Developing adaptations of service delivery that reflect and
understanding of multicultural environment