Exam 1 Flashcards
Describe hand hygiene (hand washing, when to wash,)
-wash when your hands are visibly soiled
-before and after leaving a pt room
-when interacting with ppl that have certain pathogens (c diff, fungus)
-when hands are contaminated with blood or other body fluids
what do you need when you are going to wash your hands
-soap
-take off all jewelry
-warm water
-a lot of friction
wash for 20 seconds
-hands downwards when rinsing
how do you perform hand hygeine
-turn on water and wet hands and wrists
-get some soap and begin to lather
-hands need to points downwards to drain
-rub top of hands, middle of fingers palms
-wash nails by rubbing them against the palms
wash for 20 seconds
rinse and don’t shake hands
get clean paper towel and pat hands dry
throw that away
get another paper towerl and turn of faucent
why is there no vaccine for the common cold
bc they virus is always mutating
when do you use alchohl-based cleanser
-when handing something to the pt
-when your hands arent soiled
you can use it from 8-10 times
-rub until dry
-before performing a ask that requires aseptic technique like inserting catheter, peripheral vascular catheters or invasive devices that dont require surgical placement or handling or medical devices
-after contact with surface in the pt environment immediately after removing gloves
when shouldn’t you use alcohol-based cleansers
-when you are exposed to spores and non enveloped viruses
what are spores
-Coping mechanism of bacterial species to protect themselves against ecological degrading agents.
-Spores can exist up to 4 months on surfaces.
-Clostridium difficile (Colitis) a common infection in healthcare, associated with high morbidity, mortality and healthcare costs.
what are non enveloped viruses
-do not contain the extra lipid membrane surrounding viral capsid
-Typically more virulent because they cause host cell lysis.
-More resistant to extreme pH, heat, dryness, and simple disinfectants
-Some examples of non-enveloped viruses are norovirus, enterovirus, adenovirus, and rhinovirus.
Norovirus (Gastroenteritis) can live on surfaces up to 14 days.
what are the stages of infection
Incubation period:
-organisms growing and multiplying
-Length varies
Prodromal stage:
-person is most infectious
-vague and nonspecific signs of disease “I don’t feel so good”
Full stage of illness:
-presence of specific signs and symptoms of disease -“Please stay away from me”
Convalescence period:
-recovery from the infection
-“Oh, if we only knew how long it would take.”
Recovery stage:
-Varies according to the severity of the infection and the patient’s general condition
-Typically not infectious to others, but may have some residual symptoms such as tiredness, non-productive cough.
describe the chain of infection and what can you do to break each chain
-infectious agent–> hand hygiene, sterilization, antibiotics/ antimicrobials
-reservoir–> transmission-based precautions. sterilization or use of disposable supplies
-portal of exit from reservoir–> dry intact dressing, hand hygiene, wear gloves if contact with body fluids, core nose and mouth when sneezing
-means of transmission
-portals of entry–>cover your mouth when you sneeze, hand hygiene etc
-susceptible host–> immunizations, screen healthcare staff
what is an infectious agent
bacteria, viruses, fungi
what is a reservoir
natural habitat of the organism
what is a portal of exit
point of escape for the organism
what is a means of transmission
direct contact, indirect contact, airborne route
what is portal of entry
point at which organisms enter a new host
what is a susceptible host
must overcome resistance mounted by host’s defenses
what is bacteria and give me examples
most significant and most prevalent in hospital settings.
strep throat, Salmonella, TB, Pertussis, STIs, UTIs, E.coli., C.diff., MRSA
what are viruses and give me examples
smallest of all microorganisms.
common cold, influenza, corona viruses, Norovirus (stomach flu), hepatitis, RSV
what is fungi and give me examples
plant-like organisms present in air, soil, and water.
ringworm, athlete’s foot, fungal nail infections, vaginal yeast infections, thrush
what are parasites and give me examples
live on or in a host and rely on it for nourishment.
giardiasis, toxoplasmosis, hookworms, pinworms
who are hte most susceptible pts
the ones that have foleys, IVs, central lines, NG tubes
Invasive procedures
Increased exposure
-Babies
Children
College students – Nursing students, campus residents
Elderly
Change in host defenses - Weakened immune system or immunocompromised
Unimmunized -
Lack of effective resistance
what is susceptibility affected by
Age
Nutritional status
Stress
Heredity
Substance abuse
Disease process
Medical therapy
Vaccination status – common cold mutates too rapidly for a vaccine to be developed
what factors affect the risk of infection
-Intact skin and mucous membranes, GI, GU pH –levels, WBC levels
-Substance abuse
-Age, sex, and hereditary factors
-Immunization, natural or acquired
-Fatigue, climate, nutritional, hygiene and general health status
-Stress (nursing students)
-Protective mechanisms: Good nutrition, stress reduction, adequate rest, normal flora, inflammatory and immune responses.
what is medical asepsis
(Clean) microorganisms still exist
Clean technique to reduce number of pathogens
what is surgical asepsis
-(Sterile) no microorganisms
-Sterile technique to keep area free from microorganisms
what are the basic principles of asepsis
-Microorganisms exist everywhere except on sterilized equipment
-Frequent handwashing and maintaining intact skin reduces transmission of microorganism
-Blood, body fluids, cells, and tissue are major reservoirs of microorganisms
-Personal protective equipment serves as barrier to microbial transmission
-Move equipment away from the body when brushing, scrubbing, or dusting articles to prevent contaminated particles from settling on the hair, face, or uniform
-Carry soiled items away from the body to prevent them from touching the clothing.
-Do not put soiled items on the floor, as it is highly contaminated.
-Clean the least soiled areas first and then move to the more soiled ones to prevent having the cleaner areas soiled by the dirtier areas.
What are the transmission based precautions
-Used in addition to standard precautions for patients in hospitals with suspected infection with pathogens that can be transmitted by airborne, droplet, or contact routes.
-Don personal protective equipment (PPE) when entering the room of a patient on transmission-based precautions, and to remove only when leaving the room.
-Contact Precautions (gown and gloves)
-Droplet Precautions (gown, gloves and mask)
Note: When these patients are transported out of their rooms for diagnostics they need to wear a mask
-Airborne Precautions (gown, gloves, N95 mask, neg air flow room)
what are standard precautions and what precautions are taken
-they are used for all patients
-these are the most basic precautions
-normal hand hygiene
-use clean non sterile gloves when you anticipate that your hands will be soiled and change in between tasks exp when cleaning a pt
use mask, eye protection, face shield, and gown when you think youll come in contact with any bodly fluid
-avoid recapping needles, never use too hands and use the one handed scoop technique
what are airborne precautions and what kind of PPE do you wear
-this is for pt who have infections that spread through the air like tuberculosis, varicella (chicken pox), rubeola (measles)
-sometimes severe acute respiratory syndrome (SARS)
-Covid
-flu
-meningitis
-pertussis
-pt has to be placed in a private room w/ negative air pressure
-make sure that the door stays closed
-use an N95 (you have to be fitted for one)
-you don’t have to use gloves but perform hand hygiene but wear gloves if you think they’re gonna get soiled
what are droplet precautions and what kind of PPE do you wear
-used for pt with infections that are spread as large particle droplets
-these are generated when the pt, coughs, sneezes, or talks
-use when the pt has influenza, coronavirus, rubella, mumps, diphtheria and adenovirus in infants and young children
-use mask and eye protection
-disinfect surfaces after you are done providing care
-hand hygiene
what are contact precautions and what kind of PPE do you wear
-prevent transmission of infectious agents that are spread by direct or indirect contact with the pt or the pt environment
-C.diff, impetigo, norovirus
-pt has to be in a private room
-hand hygiene
-gown
-gloves (change after touching infectious material)
-use disposable equipment when possible
-disinfect used surfaces before leaving
what are the subdivisions of contact isolation and what kind of PPE do you wear
-airborne+ contact isolation–> gloves, gown , N95 or PAPR, hand hygiene
-enteric contact isolation–> hand hygiene, gown, gloves, clean hands with soap and water on exit
what do you do if you are exposed to a pathogen
-you need to wash the exposed area, eye wash station for no less than 15 minutes
-Alert supervisor, go to oc health and get tested
-Same thing goes for needle poke pts
hepB and Hep C will sow up right away
when are vitals taken
-Admission
-Transfer
-Before and after med
-After operations
-When pt status changes
-Use nursing judgement never trust the first measurement
-when there is syptoms of chest pain, shortness of breath, feeling hot or faint
-Before and after activity that may increase risk, such as ambulation after surgery
-to establish a baseline
what is the normal body temperature
96.7- 100.5 (35.9- 38)
what are some factors that affect body temperature
-time of day (circadian rhythms)
age and biological sex
-physical activity
-state of health
-environmental temps
describe how circadian rhythms affect temperature
-temperature is usually lower in the morning
-higher in the late afternoon and early evening
-Variation is greater in infants and children
how does age and biological sex affect temperature
-Older adults loose thermoregulatory control as they are aging
-Body temps in older adults could be lower than the avg adult temperature
-Old and young people are at risk for harm for extremes of temperature bc they have less control over their thermoregulatory
-Women have more changes in the body temp bc of the changes in hormones
-Increase in progesterone secretion during ovulation increases body temp as much as 0.5-1.0 degrees farenhiet (0.3-0.5)
how does physical activity affect the temperature
-Physical exercise increases body temp
-Increased metabolism resulting from muscle activity results in the production o hear
-When you are taking the temp take into account whether the pt has done recent physical activity or not
how does state of health affect temperature
-Diseases can cause changed in the body temperature
how do environmental temperatures affect body temp
-When you are exposed to drastic temperatures you body undergoes a lot of different changes
-E.g. extreme cold leads to hypothermia and extreme hot to hyperthermia
-These can both result in illness and death
what are the vital signs that you take
-temperature
-blood pressure
-pulse/ heart rate
-oxygen saturation
-respiration rate
what is temperature regulated by
the hypothalamus
what are the physical affects of fever
-Loss of appetite
-Headache
-Hot dry skin
-Flushed face
-Thirst
-Muscle aches fatigue
-Shivering
-fever blisters
-Fluid, electrolyte and acid-bas imbalances
-Respirations and pulse rate increase
-Seizures
-Confusion and delirium
what is pyrexia
fever
what are pyrogens
–bacteria and viruses that cause rise in the body temperature
what is antipyretic
medications that decrease fever
e.g. tylenol
-asprin
-ibprofen
what is febrile
have a fever
what is afebrile
absence of a fever
what does FUO stand for
fever of unknown origin
what is Hyperpyrexia
when fever is greater than or equal to 106 F (41C)
what is the rule of thumb for temperature
less than 94 F is hypothermia
anything more than 100F is febrile
what is heat stroke and heat exhaustion
-Heat stroke– Body’s response to prolonged exposure to environmental heat or sun, dangerous, high mortality rate 105º F
-Heat exhaustion – occurs when profuse diaphoresis results in excess water and electrolyte loss 104º F
what is the clear liquid diet and what is the purpose of it
-composed only by clear fluids or foods that become fluid at body temperature
-used to leave little residue in the GI tract,
- short-term diet
-supply fluid and calories without residue
- often used with acute illness, before and after surgery, and other procedures such as x-ray, CT scan, etc.
what foods can be given during a clear liquid diet
-It includes coffee (with no creamer), tea, clear juices, gelatin and clear broth.
-can give cranberry or grape juice
-can give popsicles
-anything liquid you can see through
-make sure that it is nothing red bc if they throw up you wont know if its blood of the red juice you gave them
-this is a diet progression/ therapeutic diet
wat are the levels of the dysphagia diet
Level 1. Pureed or smooth foods, like pudding. They need no chewing (foods can be blended).
Level 2. Mechanical Altered. Moist, semi-solid foods that require some chewing. (mashing, chopping or dicing) (more calocies than full but little chewing involved.. think meatloaf)
Level 3. Dysphagia-Advanced. Soft-solid foods that require more chewing ability
Level 4. Regular. This level includes all foods (make sure that they dont aspirate) .
what does NPO stand for
nothing by mouth
-this is when an NG tube is put in
what is regular/ DAT diet
diet as tolerated
what is the renal diet
-reduced the work load on the kidneys to delay or prevent any further damage
control the accumulation of uremic toxins
-used when the pt has nephrotic syndrome, chronic kidney diseas and diabetic kidney disease
what is the fat restricted diet and when is it used
-low fat diets are intended to lower the pat total intake of fat
-used when the pt was chronic cholecystitis (inflammation of the gallbladder)
-decreases the stimulation of the gallbladder
-used in cardiovascular disease to help prevent atherosclerosis
what is the sodium restricted diet and when it it used
-sodium limit may be set 500-3000 mg/day
-used when the pt is hypertensive, heart failure; acute and chronic renal disease; liver disease
what is the full liquid diet
foods that are liquid at room temperature. milk shake, custard, pudding.
what is the soft/low residue diet
low fiber, easily digested…little or no chewing… like eggs
what is the low fiber diet and when is it used
-fiber limited to <10g/day
-before surgery; ulcerative colitis
-diverculitis
-Crohn disease
what is the high fiber diet
-emphasis on the increased intake of food that are high in fiber
-prevent or treat constipation; irritable bowel syndrome diverticulosis
-uncooked fruit, bran, oatmeal
what is the consistent carbohydrate diet and when is it used
-used the pt has type 1 and 2 diabetes, gestational diabetes, impaired glucose tolerance
what special considerations do you need to have with a pt that has dysphagia
-Suction equipment at bedside
-Check orders for thickened liquids.
-Cutting up food on patient’s tray. Small bites, small sips
-Providing pureed diet
-Feed slowly – do not hurry to swallow
-Reduce distractions so patient can concentrate of eating
-Elevate Head of Bed. Sit upright (high fowlers 90 degrees) when eating or taking medication.
-Continual assessment for coughing
-Avoid using straws
-Consume one pill at a time
what are the different texture modifications with a pt that has dysphagia
-thin
-nectar thick
-honey like
-spoon thick
what are the different methods of obtaining nutirion
-oral
-enteral
-parenteral
what is enteral feeding
Next best to oral feeding is enteral – passing a tube into the GI track via the nose or directly through the abdominal wall (gastrostomy) to the stomach to allow instillation of a specific formula
PEG tube: percutaneous endoscopic gastrostomy - surgically placed
-you can feed through bolus, intermittent continuous or continuous infusion
what is parenteral feeding
. parenteral nutrition (PN): nourishment provided via IV therapy. TPN – total parenteral nutrition (all macro and micro
-places the pt at a higher risk of infection bc they wounds are open
the bag is replaced every 24 hours so that there isn’t an overgrowth of bacteria
what are macronutrients
carbs, fats , proteins (amino acids)
what are micro nutrients
vitamins and minerals
what are essential nutrients
anything your body cant produce so you have to eat it
carbs, fats , proteins (amino acids)
what are non essential nutrients
-do not have to be supplied through dietary sources because they either are not required for body functioning or are synthesized in the body in adequate amounts.
-Some nutrients can be converted to others in the body. For instance, the body converts excess carbohydrates and protein into fat and stores them as triglycerides.
what are proteins
-Essential for synthesis of body tissue growth, maintenance, and repair
-Essential amino acids must be provided by dietary intake
-Vital component of every living cell; required for the formation of all body structures
-High protein intake require increase in fluid intake for everyone but even more so in patients with any kidney disease.
