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Surviving Life-Threatening Illness: Keys to Optimal Nursing Care

doi: 10.1097/01.CNJ.0000365986.02766.1b
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Surviving Life-Threatening Illness: Keys to Optimal Nursing Care


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General Purpose:

To provide registered professional nurses with an understanding of the nursing support of a patient with necrotizing fasciitis (NF).

Learning Objectives:

After reading these articles and taking this test, you should be able to:

  1. Describe the pathophysiology, types, signs and symptoms, and diagnosis of NF.
  2. Identify the treatment of NF and the application of Betty Neuman's Systems Model (NSM).

1. Necrotizing fasciitis is a(n)

a. atrophic wasting of muscle tissue and fascia.

b. rapid breakdown of skeletal muscle due to a crush injury.

c. infection with rapidly progressing necrosis of subcutaneous tissue or fascia.

d. pathological activation of coagulation in the muscle fascia.

2. Conditions or situations that may predispose a person to developing NF include

a. being a child, aged 3–10 years.

b. giving birth.

c. having a history of Guillain-Barré syndrome.

d. receiving the H1N1 nasal spray vaccine.

3. Fournier's gangrene, a form of NF, is localized in the

a. scrotal and perineal area.

b. face and scalp.

c. lower extremities.

d. upper extremities.

4. What isType IINF associated with?

a. aerobic gram-negative bacteria

b. group A beta-hemolytic Streptococci

c. marine microbes

d. gram-negative vibrios

5. The most common type of NF primarily affects

a. the chest.

b. abdominal tissue.

c. perineal tissue.

d. the limbs.

6. What type of NF is associated with infections through puncture wounds from fish or insects?

a. Type I.

b. Type II.

c. Type III.

d. Type IV.

7. Which statement is true about NF?

a. Seventy percent of NF cases occur in young and previously healthy people.

b. It requires an initial injury to the dermal layer of the skin.

c. Almost any bacteria can trigger it.

d. It often involves a single pathogenic organism.

8. The recent increase in NF cases is because of

a. the transition from soap-and-water hand washing to alcohol-based solutions.

b. potent virulent mutations.

c. a greater incidence of hospital-acquired infections.

d. the pandemic spread of the H1N1 virus.

9. The pathophysiology of NF involves

a. pathogens blocking the lymphatic system and neighboring blood vessels.

b. an acceleration of phagocytosis in the affected area.

c. myelotoxicity leading to a dramatic decrease in leukocytes.

d. an autoimmune response that destroys healthy tissue.

10. Which of the following is an advanced sign of NF?

a. atrophy of the affected area

b. skin color changes from pink to white

c. urticaria with pruritis

d. vesicles and fluid-filled bullae

11. Which test is used to confirm the diagnosis of NF?

a. edrophonium (Tensilon) testing

b. electromyography

c. deep skin biopsies

d. nuclear imaging studies

12. Treatment of NF includes all of the followingexcept

a. debridement of necrotic tissue.

b. intravenous immunoglobulin.

c. antibiotics.

d. radiation therapy.

13. Hyperbaric oxygen (HBO) therapy

a. promotes new blood vessel formation.

b. strengthens the connections between muscle fibers.

c. stabilizes the subcutaneous tissue.

d. decreases the flow of pathogens to the affected area.

14. What does the inner core circle of the NSM represent?

a. basic system integrity

b. spiritual needs

c. physiological needs

d. the flexible line of defense

15. External but proximal environmental interaction forces outside the client system are

a. intrapersonal stressors.

b. interpersonal stressors.

c. global personal stressors.

d. extrapersonal stressors.

16. A spiritual stressor that the patient in this case study manifested was

a. post traumatic stress.

b. refusing support systems.

c. grief and loss.

d. shame and guilt.

17. Which of the following psychological interventions was used with this patient?

a. encouraging her to share openly with her spouse

b. dressing changes with strict sterile technique

c. offering pamphlets and websites to reinforce teaching

d. asking permission to pray as appropriate

18. An evaluation/outcome criterion for this patient's developmental needs was

a. improved relations with staff.

b. consent to HBO.

c. increased confidence in care.

d. the ability to verbalize understanding of NF.



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