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ICU Nursing Exam Guide

Units 3 & 4 - Infection Prevention, Antibiotic Stewardship, Nutrition & Fluid Management

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UNIT 3: INFECTION PREVENTION & ANTIBIOTIC STEWARDSHIP

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⭐ 5-MARK QUESTIONS

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Q1. Principles of Infection Prevention and Control in ICU

• Hand hygiene before and after every patient contact
• PPE (gloves, mask, gown, eye protection) when contact with blood/body fluids
• Safe injection practices - never recap needles
• Respiratory hygiene/cough etiquette
• Safe handling and disposal of sharps and waste

• Contact precautions: gown + gloves for MRSA, C. difficile, wound infections
• Droplet precautions: surgical mask, private room for influenza, COVID-19, meningitis
• Airborne precautions: N95 respirator, negative-pressure room for TB, measles, chickenpox

• Regular cleaning and disinfection of ICU surfaces, bedrails, monitors, keyboards
• Terminal cleaning after patient discharge
• Dedicated equipment per patient (stethoscopes, BP cuffs)

• Active surveillance cultures for MDR organisms
• Regular audit of HAI rates (CLABSI, VAP, CAUTI, SSI)
• Feedback to ICU staff on infection rates

• Regular training of all staff on IPC protocols
• Audits of hand hygiene compliance

• Rational use of antibiotics to prevent resistance
• De-escalation of therapy when culture results available

• VAP bundle: head-of-bed elevation 30-45°, daily sedation vacation, oral hygiene with chlorhexidine, sub-glottic secretion drainage
• CLABSI bundle: hand hygiene, maximal barrier precautions, chlorhexidine skin prep, optimal catheter site selection, daily review of line necessity
• CAUTI bundle: insert only when indicated, maintain closed drainage system, remove when no longer needed

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Q2. Prevention of Healthcare-Associated Infections (HAIs)

• Most important single intervention
• WHO 5 Moments: before patient contact, before aseptic procedure, after body fluid exposure, after patient contact, after touching patient surroundings
• Use alcohol-based hand rub (preferred) or soap and water for C. difficile

• Appropriate selection and donning/doffing sequence
• Gloves do not replace hand hygiene

• Maintain sterile field during procedures
• Never contaminate key parts/key sites

• High-touch surfaces cleaned at least twice daily
• Dedicated equipment per patient
• Air filtration (HEPA) for immunocompromised patients

• Prevents emergence of MDR organisms

• Appropriate isolation precautions for infected/colonized patients

• Regular training and audits

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Q3. Standard Precautions and Transmission-Based Precautions

• For: MRSA, VRE, C. difficile, scabies, wound infections
• PPE: Gown + gloves on entry to room
• Single room or cohort with same infection
• Dedicated patient care equipment

• For: Influenza, COVID-19, meningococcal meningitis, pertussis, mumps
• Large droplets (>5 microns), travel <1 metre
• PPE: Surgical mask on entering room
• Single room preferred; door may remain open

• For: TB (Mycobacterium tuberculosis), measles, chickenpox (varicella), monkeypox
• Small particles (<5 microns), remain suspended in air, travel >1 metre
• PPE: N95 respirator (fit-tested), negative-pressure room
• Door must remain closed; minimum 6-12 air changes per hour

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Q4. Sterilization and Disinfection Methods Used in ICU

• Sterilization: Complete destruction of ALL microorganisms including spores
• Disinfection: Destruction of most pathogens but NOT all spores
• Antisepsis: Disinfection applied to living tissue
• Decontamination: Reduction of microbial load to safe levels

• Chlorhexidine gluconate (CHG): skin antisepsis for central lines, surgical scrub
• Povidone-iodine: wound care, skin prep
• Alcohol-based hand rubs: routine hand decontamination
• 0.5% sodium hypochlorite: C. difficile decontamination (alcohol ineffective)

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Q5. Prevention and Management of Needlestick Injuries

• Safety-engineered devices (auto-retractable needles, needleless IV systems)
• Sharps containers at point of use
• Never overfill sharps containers (fill to 3/4 only)

• Never recap needles two-handed; if needed, use one-hand scoop method
• Pass sharps via a neutral zone (kidney dish) - never hand-to-hand
• Announce "sharp" when passing instruments
• Dispose of sharps immediately after use

• Adequate staffing (fatigue increases risk)
• Training and education
• Reporting culture (encourage reporting, no punitive approach)

• Double gloving for high-risk procedures
• Cut-resistant gloves where applicable

1. Do not panic; do not squeeze wound
2. Wash thoroughly with soap and running water for 2-3 minutes
3. For eyes/mucous membranes: irrigate with water or saline
4. Do not scrub, do not apply caustic agents (bleach, iodine)
5. Allow wound to bleed freely (briefly)

1. Report to senior nurse/doctor and Occupational Health immediately
2. Fill incident/accident form
3. Document: time, nature of injury, type of device, source patient details

• Assess risk: source patient HIV, HBV, HCV status
• Assess injury: depth, hollow-bore vs. solid needle, amount of blood involved
• Test source patient (with consent): HIV, HBV, HCV serology
• Test injured HCW: baseline HIV, HBV, HCV serology

• HIV PEP: if source HIV+ve or unknown high-risk - START WITHIN 2 HOURS (latest 72 hours)
• HBV: if HCW not immunized - HBIG + HBV vaccine
• HCV: no prophylaxis; monitor and treat if infection occurs

• Repeat HIV serology at 6 weeks, 3 months, 6 months
• Counseling and support

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Q6. Post-Exposure Prophylaxis (PEP) for HIV

• Occupational exposure: needlestick, splash to mucous membrane or non-intact skin
• Non-occupational: unprotected sexual intercourse, sexual assault, sharing needles
• Source patient known HIV+ OR source patient unknown but high-risk

• Must start within 72 hours of exposure (ideally within 2 hours)
• Earlier initiation = greater effectiveness
• Do NOT start if > 72 hours have elapsed

• 28 days (4 weeks) of continuous therapy
• Do not stop prematurely

• Preferred: Tenofovir (TDF) 300mg + Lamivudine (3TC) 300mg + Dolutegravir (DTG) 50mg - once daily for 28 days
• Alternative: TDF + 3TC + Lopinavir/ritonavir (LPV/r)

• Baseline: HIV Ab, CBC, LFT, RFT, HBsAg, HCV Ab, pregnancy test
• Week 2: CBC, LFT (for side effects)
• HIV test at 4-6 weeks, 3 months, 6 months post-exposure

• Nausea, vomiting, diarrhea, fatigue (most common with TDF regimens)
• Counsel patient on importance of completing 28-day course despite side effects

• Use condoms (prevent transmission to partner)
• Avoid blood/organ donation
• Avoid breastfeeding

• If unvaccinated HCW: HBIG 0.06 mL/kg IM + start HBV vaccine series ASAP (within 24 hours)
• If vaccinated with known adequate response: no action
• If vaccine status unknown: test anti-HBs; if inadequate, give HBIG + booster

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Q7. Principles of Antibiotic Stewardship

• Choose antibiotic based on likely/proven pathogen
• Culture and sensitivity before starting whenever possible
• Use narrow-spectrum over broad-spectrum when adequate

• Pharmacokinetic/pharmacodynamic (PK/PD) optimization
• Renal/hepatic dose adjustments
• Avoid sub-therapeutic dosing (drives resistance)

• Shortest effective course (reduces resistance, side effects, cost)
• De-escalate from broad-spectrum to narrow-spectrum once cultures return
• Stop antibiotics when no longer indicated (negative cultures, clinical improvement)

• IV-to-oral switch as soon as patient can tolerate
• Oral bioavailability of many antibiotics is excellent (fluoroquinolones, metronidazole)

• Reduction in Clostridioides difficile infection
• Reduced emergence of MDR organisms (MRSA, ESBL, CRE)
• Reduced antibiotic costs
• Improved patient outcomes

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Q8. Causes and Prevention of Antibiotic Resistance

• Overuse and misuse of antibiotics (prescribing for viral infections)
• Self-medication with over-the-counter antibiotics
• Non-completion of antibiotic courses
• Subtherapeutic dosing

• Empirical broad-spectrum use without culture guidance
• Lack of stewardship programs
• Poor infection control practices (HAI spread of resistant organisms)
• Inadequate diagnostic facilities

• Antibiotic use in livestock (growth promotion)
• Antibiotic residues in environment and water supply
• Global travel spreading resistant strains

• MRSA: Methicillin-resistant Staphylococcus aureus - treat with vancomycin/linezolid
• VRE: Vancomycin-resistant Enterococcus - treat with linezolid/daptomycin
• ESBL: Extended-spectrum beta-lactamase producers - treat with carbapenems
• CRE/KPC: Carbapenem-resistant Enterobacteriaceae - very limited options
• MDR-TB: Multi-drug resistant tuberculosis

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Q9. Role of Culture and Sensitivity in Antibiotic Selection

1. The causative pathogen (Culture)
2. Which antibiotics are effective against it (Sensitivity)

1. Specimen Collection (before starting antibiotics whenever possible)
   • Blood cultures (2 sets from different sites) for sepsis
   • Urine culture for UTI (midstream clean catch)
   • Sputum/BAL for pneumonia
   • Wound swabs for wound infections
   • CSF for meningitis
2. Culture - specimen inoculated on appropriate media, incubated 37°C for 18-48 hours
3. Identification - colony morphology, biochemical tests, MALDI-TOF mass spectrometry
4. Sensitivity Testing
   • Kirby-Bauer disc diffusion: antibiotic discs placed on agar plate; zone of inhibition measured
   • MIC (Minimum Inhibitory Concentration): lowest concentration that prevents visible growth (gold standard)
   • E-test strips: gradient of antibiotic to determine MIC
5. Reporting
   • Sensitive (S): standard dosing likely to achieve cure
   • Intermediate (I): may be effective at higher doses or in concentrated sites
   • Resistant (R): antibiotic unlikely to be effective

• Empirical: Started before culture results (within hours); broad-spectrum; based on clinical syndrome and local antibiogram
• Definitive: Started after culture results; targeted narrow-spectrum therapy

• Guides de-escalation from empirical broad-spectrum to targeted narrow-spectrum
• Identifies outbreaks of resistant organisms
• Monitors trends in local resistance patterns (antibiogram)
• Prevents unnecessary broad-spectrum use and its consequences

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UNIT 4: NUTRITION & FLUID MANAGEMENT

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⭐ 5-MARK QUESTIONS

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Q10. Methods of Nutritional Support in Critically Ill Patients

• Use NRS-2002 or NUTRIC score for ICU nutritional risk assessment
• Calculate caloric needs: 25-30 kcal/kg/day; protein: 1.2-2.0 g/kg/day

• Preferred when patient is alert, can protect airway, and has functional GI tract
• May require texture modification and oral supplements (e.g., Ensure, Boost)
• Not feasible in most ICU patients (intubated, reduced consciousness)

• Preferred over PN whenever GI tract is functional
• Routes: Nasogastric (NG), Orogastric (OG), Nasojejunal (NJ), PEG (Percutaneous Endoscopic Gastrostomy), PEJ
• Formulas: polymeric (whole protein), semi-elemental, elemental, disease-specific (renal, hepatic, diabetic)
• Start within 24-48 hours of ICU admission (early EN)
• Benefits: preserves gut mucosa, maintains gut flora, prevents bacterial translocation, cheaper

• IV delivery of nutrients (glucose, amino acids, lipids, electrolytes, vitamins, trace elements)
• TPN (Total Parenteral Nutrition): all nutritional needs via IV; via central line
• PPN (Peripheral Parenteral Nutrition): partial PN via peripheral vein; short-term only
• Supplemental PN: EN + PN combined when EN alone is insufficient
• Indicated when GI tract non-functional for >3-7 days

"If the gut works, use it"

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Q11. Comparison of Enteral Nutrition vs. Parenteral Nutrition

• Functional GI tract (bowel sounds not mandatory)
• Hemodynamically stable patient
• Absence of bowel obstruction, ileus, or ischemia

• Prolonged ileus, bowel obstruction, high-output fistula
• Short bowel syndrome
• Malabsorption, severe pancreatitis (controversial)
• Post major GI surgery with delayed return of bowel function

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Q12. TPN: Indications, Advantages, and Complications

• Carbohydrates: 50-60% of calories (as dextrose/glucose)
• Proteins: Amino acid solutions (15-20% of calories)
• Lipids: Fat emulsions (20-30% of calories)
• Electrolytes: Na, K, Ca, Mg, Phosphate, Cl
• Vitamins: Water-soluble and fat-soluble
• Trace elements: Zinc, Copper, Manganese, Selenium, Chromium

1. Non-functional GI tract (bowel obstruction, mesenteric ischemia)
2. High-output enterocutaneous fistula (>500 mL/day)
3. Short bowel syndrome
4. Severe pancreatitis (prolonged nil-by-mouth)
5. Major GI surgery with prolonged ileus
6. Severe malabsorption
7. Radiation enteritis
8. Premature neonates requiring IV nutrition

• Provides complete nutrition when gut not available
• Precise control of all nutrient intake
• Can modify formula based on metabolic needs
• Restores nutritional status in severely malnourished patients
• Allows bowel rest in inflammatory bowel disease, fistulae

• Blood glucose every 4-6 hours (target 140-180 mg/dL in ICU)
• Daily electrolytes (especially K, Mg, Phosphate)
• Daily fluid balance
• Weekly LFT, CBC
• Daily inspection of insertion site
• Assess for signs of infection (fever, redness at site)

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Q13. Enteral Feeding Procedure (Step-by-Step)

1. Verify doctor's order for enteral feeding (formula type, rate, route)
2. Perform hand hygiene; don gloves
3. Gather equipment: NG tube (if not already placed), 50 mL syringe, pH paper, feeding bag/syringe, formula, pump if available, measuring tape, stethoscope, water for flushing

1. Position patient at 45° (semi-Fowler's)
2. Measure tube length: nose tip to earlobe + earlobe to xiphoid process (NEX measurement = ~50-55 cm for adults)
3. Lubricate tube tip with water-soluble gel
4. Insert through nostril, advance while asking patient to swallow
5. Advance to measured distance
6. Secure tube to nose with tape

1. pH testing (preferred): Aspirate gastric content; test with pH paper - gastric pH <5.5 confirms gastric placement
2. X-ray (gold standard): Chest X-ray to confirm placement; mandatory before first feeding if pH inconclusive
3. Whoosh test (NOT reliable): Auscultate epigastrium while injecting 10-20 mL air - not recommended as sole confirmation
4. Visual check: Observe aspirate (cloudy/green = gastric; clear = may be respiratory)

1. Elevate head of bed to 30-45° (VAP prevention)
2. Check gastric residual volume (GRV) before each feed (or every 4-6 hours for continuous feeding) - hold feed if GRV >200-500 mL (as per protocol)
3. Flush tube with 30-50 mL water before feeding
4. Attach feeding bag/set; start at prescribed rate
5. Flush tube with 30-50 mL water after feeding and after medications
6. Label feeding bag with date, time, formula type

• Monitor for signs of aspiration (coughing, desaturation, tachycardia)
• Monitor blood glucose
• Check tube position every shift and after coughing/vomiting

• Amount of feed given, GRV, any episodes of vomiting or aspiration, tube position verified

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Q14. Complications and Prevention of Tube Feeding

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Q15. Principles of Fluid Management in ICU

• Maintain adequate tissue perfusion and oxygen delivery
• Avoid both hypovolemia (inadequate perfusion) and fluid overload (pulmonary edema, increased mortality)
• Restore and maintain normal electrolyte balance

1. Drug: Choose appropriate fluid type
2. Dose: Right amount
3. Duration: When to stop
4. De-escalation: Remove excess fluid (diuresis)

• Clinical signs: Skin turgor, mucous membranes, capillary refill, JVP, peripheral edema
• Vitals: BP, HR, urine output (target >0.5 mL/kg/hr)
• Invasive monitoring: CVP (8-12 mmHg), MAP (>65 mmHg)
• Dynamic parameters (more reliable):
  • Pulse pressure variation (PPV >13% = fluid responsive)
  • Passive leg raise test (increase in CO >10% = fluid responsive)
  • Stroke volume variation (SVV)

• Crystalloids: Normal saline, Ringer's lactate, 5% dextrose (first-line resuscitation)
• Colloids: Albumin, fresh frozen plasma, synthetic colloids (gelatins, hydroxyethyl starch)

• Strict fluid balance chart: input (IV fluids + oral + enteral) vs. output (urine + drain + insensible losses)
• Daily weight in ICU
• Blood tests: sodium, potassium, creatinine, lactate, base excess

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Q16. Comparison of Crystalloids and Colloids

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Q17. Assessment and Management of Dehydration and Hypovolemia

• Low CVP (<8 mmHg)
• Positive passive leg raise test (CO increases >10%)
• High pulse pressure variation (>13%)
• High lactate (>2 mmol/L)
• Low urine output
• Low MAP (<65 mmHg)

• Mild-Moderate: Oral rehydration if possible (ORS); monitor input/output
• Moderate-Severe: IV fluids

• Isotonic crystalloid (Ringer's Lactate or 0.9% NaCl) 500 mL bolus IV over 15-30 minutes
• Reassess after each bolus
• Target: MAP >65 mmHg, HR normalized, UO >0.5 mL/kg/hr, improving lactate

• Hemorrhage: blood transfusion + control bleeding
• GI losses: replace with NS + KCl
• Septic shock: antibiotics + vasopressors (norepinephrine first-line)

• Norepinephrine (1st choice in septic shock): target MAP >65 mmHg
• Vasopressin: added when norepinephrine dose high
• Dopamine: no longer first-line in sepsis

• Lactate clearance: target >10% clearance over 2 hours
• Normalize capillary refill
• Improve consciousness and urine output

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Q18. Electrolyte Imbalance and Management

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• Causes: Diabetes insipidus, inadequate free water intake, excessive Na administration
• Symptoms: Thirst, lethargy, confusion, seizures
• Management: Replace free water deficit with 5% dextrose or 0.45% NaCl; correct slowly (no faster than 0.5 mEq/L/hr to avoid cerebral edema)

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• Hypocalcemia: Tetany (Chvostek's sign, Trousseau's sign), QT prolongation; treat with IV calcium gluconate
• Hypercalcemia: Polyuria, confusion, constipation; treat with IV fluids, furosemide, bisphosphonates

• Hypomagnesemia: Tetany, arrhythmias, refractory hypokalemia; treat with IV MgSO4
• Hypermagnesemia: Hyporeflexia, respiratory depression; treat with calcium gluconate (antagonist) + dialysis

• Hypophosphatemia: Most important in ICU; seen in refeeding syndrome; causes respiratory muscle weakness, hemolytic anemia; treat with IV phosphate replacement
• Hyperphosphatemia: Seen in CKD; leads to hypocalcemia; treat with dietary restriction and phosphate binders

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⭐ 2.5-MARK QUESTIONS (Short Notes)

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Five Moments of Hand Hygiene (WHO)

1. Before touching a patient
2. Before an aseptic/clean procedure
3. After body fluid exposure risk
4. After touching a patient
5. After touching patient surroundings

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Steps of Handwashing (WHO 6-step technique, 40-60 seconds)

1. Wet hands; apply soap
2. Rub palms together
3. Rub backs of hands (palm over dorsum, fingers interlaced)
4. Interlace fingers (palm to palm, fingers interlaced)
5. Backs of fingers (interlocked fingers)
6. Rotational rubbing of thumbs (clasped in opposite palm)
7. Rotational rubbing of fingertips against opposite palm
8. Rinse and dry with single-use towel

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Sterilization vs. Disinfection

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Chain of Infection

1. Infectious Agent: Pathogen (bacteria, virus, fungus)
2. Reservoir: Source where pathogen lives (patient, environment, equipment)
3. Portal of Exit: How pathogen leaves reservoir (respiratory tract, wound)
4. Mode of Transmission: How it travels (contact, droplet, airborne, vector)
5. Portal of Entry: How it enters host (skin break, respiratory tract, mucous membrane)
6. Susceptible Host: Person who can get infected (immunocompromised, elderly)

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Needlestick Injury Management

1. Do not panic; do not squeeze
2. Wash with soap and water 2-3 minutes
3. Report to Occupational Health/supervisor immediately
4. Document the incident (time, device, source patient)
5. Test source patient (HIV, HBV, HCV)
6. Test HCW (baseline serology)
7. Assess need for PEP (HIV - within 72 hours; HBV HBIG within 24 hours)
8. Follow-up serology at 6 weeks, 3 months, 6 months

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Universal Precautions

• Includes: Hand hygiene, gloves, mask, gown, eye protection, safe sharps handling, waste disposal
• Based on: Cannot always identify infected patients clinically
• Evolved to: "Standard Precautions" (WHO terminology) - now includes all body fluids

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Biomedical Waste Segregation (India - BMW Rules 2016)

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Rational Antibiotic Use

• Use antibiotics only when bacterial infection is confirmed or highly suspected
• Always culture before starting (when possible)
• Use narrowest spectrum effective antibiotic
• Use correct dose and correct duration
• De-escalate when culture results available
• IV-to-oral switch when clinically stable
• Avoid antibiotics for viral infections (URTI, influenza)
• Follow local antibiogram for empirical selection

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Empirical vs. Definitive Antibiotic Therapy

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Enteral vs. Parenteral Nutrition

• EN uses GI tract; PN is intravenous
• EN preferred - preserves gut integrity, cheaper, fewer complications
• PN indicated only when GI non-functional

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Nutritional Assessment

• Anthropometry: BMI, weight, MUAC (mid-upper arm circumference), triceps skinfold thickness
• Biochemical: Serum albumin (<3.5 g/dL = protein-energy malnutrition), prealbumin, transferrin, total lymphocyte count
• Clinical: Signs of deficiency (edema, muscle wasting, hair loss, poor wound healing)
• Dietary history: 24-hour recall, food frequency
• Screening tools: MNA (Mini Nutritional Assessment), NRS-2002, MUST, NUTRIC score (ICU)
• BMI interpretation: <18.5 = underweight; 18.5-24.9 = normal; 25-29.9 = overweight; >30 = obese

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Refeeding Syndrome

• Occurs when feeding is restarted rapidly in severely malnourished patients
• Pathophysiology: Refeeding stimulates insulin release; insulin drives K, Mg, and Phosphate into cells from extracellular fluid → severe hypophosphatemia (hallmark), hypokalemia, hypomagnesemia
• Consequences: Cardiac arrhythmias, respiratory failure, hemolysis, seizures, rhabdomyolysis
• Prevention: Start feeding slowly (20 mL/hr, 50% of target calories); supplement Phosphate, K, Mg before and during refeeding; thiamine 200 mg IV before feeding in alcoholics/starved patients
• High-risk patients: Prolonged starvation (>5 days), anorexia nervosa, alcoholism, cancer cachexia

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NG Tube Care

• Mark tube at nostril insertion point; verify same marking each shift
• Confirm placement: pH <5.5 before each feed
• Secure with proper adhesive tape; change tape daily or when soiled
• Flush with 30-50 mL water: before/after feeds, before/after medications, every 4-6 hours during continuous feeding
• Provide oral/nasal hygiene (clean nostrils, oral care)
• Alternate nostrils every 2-4 weeks if long-term
• Document GRV (Gastric Residual Volume) every 4-6 hours; report if >200-250 mL

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Tube Placement Checking

1. pH testing: Aspirate 1-2 mL; pH <5.5 confirms gastric placement (most important bedside test)
2. X-ray (gold standard): Mandatory before first feed if pH inconclusive; tube tip should be below diaphragm in stomach
3. External markings: Check tube mark at nostril matches insertion length
4. Visual inspection of aspirate: Gastric = clear/white/green/brown; do NOT rely on this alone
5. Capnography: CO2 detected = misplaced in airway (confirms incorrect placement)

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Fluid Balance Chart

• Records all input vs. output over 24 hours
• Input: IV fluids, oral fluids, NG feeds, drug infusions, blood products
• Output: Urine, drain output, nasogastric aspirate, vomiting, wound discharge, stool
• Insensible losses: ~500-700 mL/day (respiration, perspiration) - add to calculated output
• Positive balance = more in than out (fluid accumulation, risk of overload)
• Negative balance = more out than in (desired in de-escalation phase; risk of dehydration)
• Report: UO <0.5 mL/kg/hr for 2 consecutive hours (oliguria)

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Sodium and Potassium Imbalance

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Monitoring During IV Fluid Therapy

• Vital signs: BP, HR, RR, SpO2 every 30-60 minutes during bolus
• Urine output: Hourly; target >0.5 mL/kg/hr
• Fluid balance: Strict hourly/4-hourly chart
• Signs of overload: Crackles at lung bases, dyspnea, rising BP, raised JVP, peripheral edema
• Signs of under-replacement: Persistent tachycardia, hypotension, reduced UO, dry mucous membranes
• Electrolytes: Monitor Na, K, Cl, Mg, Phosphate daily in ICU
• Serum creatinine/BUN: Renal function monitoring
• Blood glucose: Especially with dextrose-containing fluids
• Lactate: Trend every 2-4 hours in septic shock (target clearance >10%/2 hrs)

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⭐ 1-MARK QUESTIONS (Definitions/Brief)

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Quick Exam Priority Revision (Time-Crunch Strategy)

1. Hand Hygiene - 5 moments + 6 handwashing steps
2. Sterilization vs Disinfection - table comparison + Spaulding classification
3. Needlestick Injury - immediate management + PEP timing (72 hrs)
4. PEP for HIV - TDF + 3TC + DTG, 28 days
5. Antibiotic Stewardship - 4 rights + de-escalation
6. Chain of Infection - 6 links
7. Enteral vs Parenteral - comparison table
8. TPN - indications + complications
9. Crystalloids vs Colloids - comparison + types
10. Hyponatremia + Hyperkalemia - causes + emergency management
11. Refeeding Syndrome - definition + prevention
12. All 1-mark definitions - learn 5 per minute = 35 definitions in 7 minutes