感染管理と患者の安全：直前対策パック

公式集、全トピックの解法の要点、6 問の演習問題。完全な解答は巻末にあります。

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1公式と解法

感染管理と患者の安全

解き方

  1. すべての患者に標準予防策から始めます：手指衛生、予想される曝露に応じた個人防護具（PPE）、安全な鋭利器材の扱い。
  2. 経路に応じて予防策を追加します：接触（ガウン、手袋）、飛沫（サージカルマスク）、空気（N95、陰圧室）。
  3. 滅菌物は滅菌のまま保ちます：疑わしければ滅菌ではありません。拭かずに交換します。
  4. 環境内の害を防ぎます：転倒対策、身体拘束は最後の手段、火災には RACE と PASS。
  5. 与薬の権利、2つの識別子、ハイリスク薬の追加の安全対策を確認し、エラーやヒヤリハットを報告します。

2演習問題

1.感染管理と患者の安全ふつう

A parent calls because a toddler has swallowed some household cleaner. The child is awake and breathing normally. What should the nurse advise first?

  1. AContact the local poison advice service now for specific advice
  2. BGive syrup of ipecac from the medicine cabinet
  3. CMake the child vomit, using a finger at the back of the throat
  4. DWait to see whether any symptoms develop over the next day
2.感染管理と患者の安全むずかしい

A nurse has just started a unit of red blood cells when a colleague asks for urgent help with another patient. What is the best action?

  1. ALeave to help the other patient, and check the transfusion again in about an hour
  2. BPause the transfusion until the nurse is free again
  3. CSpeed up the transfusion so it finishes sooner
  4. DStay with the transfusing patient for the first 15 minutes and ask another nurse to help
3.基礎看護学ふつう

Why must a respirator such as an FFP3 or N95 mask be fit-tested?

  1. AIt only protects if it seals closely to the wearer's face
  2. BFit-testing makes the mask reusable for a week
  3. CFit-testing checks whether the patient is still infectious
  4. DIt must be tested to check it is the right colour
4.基礎看護学むずかしい

A competent adult who is a Jehovah's Witness refuses a blood transfusion that the team believes is needed. Which two ethical principles are in conflict?

  1. AJustice and veracity
  2. BFidelity and justice
  3. CVeracity and non-maleficence
  4. DAutonomy and beneficence
5.微生物学ふつう

結核を起こす生物はどれで、グラム染色で染まりにくいのはなぜですか？

  1. AMycoplasma pneumoniae。染色液を取り込む細胞壁を持たない
  2. BMycobacterium tuberculosis。ミコール酸を含むろう状の細胞壁を持つ
  3. CStreptococcus pneumoniae。莢膜を持つ
  4. DLegionella pneumophila。アメーバの中で生きる
6.微生物学むずかしい

血液培養陽性で、ブドウの房状に集まったグラム陽性球菌が見られます。最も可能性が高い生物は？

  1. ANeisseria
  2. BStreptococcus
  3. C短い連鎖の Enterococcus
  4. DStaphylococcus

3溶液

1.感染管理と患者の安全

答え: A · Contact the local poison advice service now for specific advice

これが答えになる理由

A poison advice service (poison control in the US, or NHS 111 in the UK) can give advice for the exact product. Inducing vomiting is not recommended, because corrosive products can burn the esophagus again and vomit can be aspirated. Emergency services are called if the child has trouble breathing or is drowsy.

答え

A · Contact the local poison advice service now for specific advice
2.感染管理と患者の安全

答え: D · Stay with the transfusing patient for the first 15 minutes and ask another nurse to help

これが答えになる理由

The most serious reactions, such as acute hemolytic reactions and anaphylaxis, usually start within the first 15 minutes. The nurse stays with the patient during this time and finds another person to help elsewhere.

答え

D · Stay with the transfusing patient for the first 15 minutes and ask another nurse to help
3.基礎看護学

答え: A · It only protects if it seals closely to the wearer's face

これが答えになる理由

A respirator filters tiny airborne particles only if air passes through the filter, not around a gap. Fit-testing and a fit-check every time it is worn make sure it seals.

答え

A · It only protects if it seals closely to the wearer's face
4.基礎看護学

答え: D · Autonomy and beneficence

これが答えになる理由

The patient's right to decide (autonomy) conflicts with the team's wish to do good (beneficence). A valid refusal by a competent adult is respected, and alternatives to blood are explored.

答え

D · Autonomy and beneficence
5.微生物学

答え: B · Mycobacterium tuberculosis。ミコール酸を含むろう状の細胞壁を持つ

これが答えになる理由

結核菌の細胞壁はミコール酸に富むためグラム染色に抵抗し、抗酸染色で確認します。

答え

B · Mycobacterium tuberculosis。ミコール酸を含むろう状の細胞壁を持つ
6.微生物学

答え: D · Staphylococcus

これが答えになる理由

ブドウ球菌はブドウの房のような塊で増え、レンサ球菌と腸球菌は連鎖状か対で増えます。ナイセリアはグラム陰性双球菌です。

答え

D · Staphylococcus

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