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 person in scrubs without a hospital ID badge asks to take a newborn to the nursery. What should the nurse do?

  1. ARefuse, keep the baby with the mother and alert security
  2. BLet the parents decide whether to hand the baby over
  3. CAsk the person their name and then give them the baby
  4. DHand over the baby if the person seems confident
2.感染管理と患者の安全むずかしい

During a procedure, a nurse sees that the team is about to start without a time-out. What should the nurse do?

  1. ASay nothing, because the surgeon is responsible for the procedure
  2. BSpeak up clearly and stop the start until the time-out is done
  3. CReport it to the manager at the end of the week
  4. DWait and raise the issue after the procedure is finished
3.基礎看護学ふつう

A patient is found on the floor beside the bed. What should the nurse do first?

  1. AAsk the patient to stand up on their own
  2. BCheck responsiveness and look for injuries before moving them
  3. CLift the patient straight back into bed
  4. DComplete the incident report first, then go back to assess the patient fully
4.基礎看護学むずかしい

Why should only the patient press the button of a patient-controlled analgesia (PCA) pump?

  1. AThe pump only works with the patient's fingerprint
  2. BVisitors might damage the pump or change its settings if they touch it
  3. CA drowsy patient stops pressing, which helps prevent overdose
  4. DNurses are not allowed to give opioids
5.微生物学ふつう

熱傷や嚢胞性線維症の人によくみられる感染の原因で、緑色の色素を作ることがある生物はどれですか？

  1. AStreptococcus pyogenes
  2. BHelicobacter pylori
  3. CPseudomonas aeruginosa
  4. DClostridium tetani
6.微生物学むずかしい

細菌が薬を細胞の外にくみ出すとき、使っている耐性機構は？

  1. A排出ポンプ
  2. B標的の変化
  3. C酵素による不活化
  4. Dポーリンからの取り込み低下のみ

3溶液

1.感染管理と患者の安全

答え: A · Refuse, keep the baby with the mother and alert security

これが答えになる理由

Infants are only handed to staff with proper identification, as set out in the infant security policy. Suspicious behavior is reported to security at once, and parents are taught to do the same.

答え

A · Refuse, keep the baby with the mother and alert security
2.感染管理と患者の安全

答え: B · Speak up clearly and stop the start until the time-out is done

これが答えになる理由

The time-out is a key step to prevent wrong-patient, wrong-site and wrong-procedure errors. Any team member who sees it being skipped should speak up and halt the procedure until it is done.

答え

B · Speak up clearly and stop the start until the time-out is done
3.基礎看護学

答え: B · Check responsiveness and look for injuries before moving them

これが答えになる理由

The nurse first calls for help and assesses the patient, including for head and hip injury. The patient is moved only when safe, using proper equipment, and the doctor is informed.

答え

B · Check responsiveness and look for injuries before moving them
4.基礎看護学

答え: C · A drowsy patient stops pressing, which helps prevent overdose

これが答えになる理由

If the patient becomes too sleepy they cannot press the button, so no more opioid is given. When others press it this safety is lost and respiratory depression can follow.

答え

C · A drowsy patient stops pressing, which helps prevent overdose
5.微生物学

答え: C · Pseudomonas aeruginosa

これが答えになる理由

Pseudomonas aeruginosa は熱傷、人工呼吸中の患者、嚢胞性線維症の肺に感染する日和見病原体です。もともと多くの抗生物質に耐性があります。

答え

C · Pseudomonas aeruginosa
6.微生物学

答え: A · 排出ポンプ

これが答えになる理由

排出ポンプはテトラサイクリン系やフルオロキノロン系などの抗生物質を能動的に外へ出し、細胞内の濃度を効かないほど低く保ちます。

答え

A · 排出ポンプ

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