Exam 1 Flashcards
What is PICOT?
P: problem/ patient/population
I: intervention/indicator
- treat diagnose or observe
C: comparison
O: outcome of interest
T: Time
What is Maslow’s Hierarchy of Needs?
1: physiological: breathing, food, water, sex, sleep, homestatsis, excretion
2: safety: security of body, employment, resources, family, health, property
3: belonging: friendship, family, sexual intimacy
4: esteem: self-esteem, confidence, achievement, respect for self + other
5: Self-realization: morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of acts
What is an infection?
the invasion of a susceptible host by pathogens or microorganisms; results in disease (ex. chlamydia)
What is normal flora?
refers to the collection of organisms typically present in any anatomical region (ex. lactobacillus)
What is colonization?
presence and growth of microorganism within a host without tissue invasion or damage (ex. Canidida or C. Diff)
What is an infectious agent?
bacteria, virus, fungi, parasites
What is a communiable disease?
the infectious process transmitted from one person to another (hepaitis A, HIV, flu, TB, malaria)
What is a symptomatic patient?
clincial signs and symptoms are present
what is an asymptomatic patient?
clinical signs and symptoms are not present (hep C)
What is the chain of infection?
infectious agent/pathogen
reservoir or source for pathogen growth
portal of exit
means of transmission
portal of entry
susceptible host
What are factors for a susceptible host?
intact skin and mucous membrane
Normal pH levels
body’s white blood cells
age, travel, hereditary, lifestyle factors, occcupation
immunization, natural or acquired
medication (immunosuppresants)
fatigue, climate, nutritional, general health status
stress
use of invasive or indwelling medical devices (ET tube, urinary catheters, IV catheters)
diagnostic procedures, surgical procedures, radiation therapy
What is Endemic?
something that belongs to a particular people or country (Malaria)
What is an outbreak?
greater-than-anticipated increase in the number of endemic cases
also could be a single case in new area
outbreak can become epidemic
What is an epidemic?
disease that affects a large number of people within a community, population, region
What is a pandemic?
epidemic that spreads over multiple countries or continents
What is lab data for infection?
elevated WBC count: normal = 5- 10,000/mm3
increase in specific types of white blood cells (left shift= an increase in neutrophils)
elevated erythrocyte sedimentation rate (ESR or SED rate)
- 15 mm/hr men
- 20 mm/hr women
presence of pathogen: cultures of sputum, urine, blood, drains
What are the 5 moments for hand hygiene?
1: before touching a patient
2: before a clean or aseptic procedure
3: after a body fluid exposure risk
4: after touching a patient and removing gloves
5: after touching patient surrounding
What are health care- associated infection?
infections that are a result of health care delivery, not present at admission
What is exogenous source vs endogenous source?
Exo: outside the patient: microorganism outside
Endo: inside the client when flora is altered + overgrowth result s
What patients are at greater risk for health care-associated infections (HAIs)?
disease processes
older adults, infants
poorly nourished
compromised immune system
stress
ICU
What is sanitizing?
a process of washing, cleaning or removing dirt, and eliminates dust, debris, germs on surface
does not kill germs, lowers number and risk of spreading infection
What is disinfection?
process that eliminates many or all microorganisms, with exception of bacterial spores, from inanimate objects
disinfection of surfaces
high level disinfection: required for items like endoscopes
what is sterilization?
complete elimination/destruction of all microorganism including spores
What are drug resistant organisms infection?
Methicillin- Resistant Staphylococcus Aureus (MRSE)
Vancomycin Intermediate Resistant Staphylococcus Aureus (VISA)
Vancomycin Resistant Enterococcus (VRE)
Vancomycin resistant staphylococcus aureus (VRSA)
extended-spectrum beta Lactamase (ESBL)
Acinetobacter Baumannii (CRAB)
Carbapenem-Resistant enterobacteriaceae (CRE)
Multi-drug resistant tuberculosis
What are risk factors for drug resistant infections?
compromised immune system (cancer, organ transplant)
recent surgery
invasive devices
prolonged antibiotic use (especially vancomycin)
prolonged hospitalization or long-term care centers
What are defenses against infection?
Ear: cerumen inhibits bacterial growth
Mouth cavity: mucous membrane traps microorganism and the mouth is cleaned with saliva
Trachea and bronchi: mucous layer traps microorganism
stomach:
acidic juices kill microorganism
vagina: acidic secretions inhibit growth of pathogen
eyes:cleansed by tears which also contain chemical inhibiting bacterial growth
nasal cavity: hairs and mucus trap microorganism
Skin: an impervious barrier
Urethra: urine flow prevents bacterial growth
Anus: mucous membrane traps microoganisms
What are signs of a local infection?
redness
heat
swelling
pain
loss of function
what are symptoms of systemic infection?
fever
chills, diaphoresis
increased pulse/respiratory rate
malaise
fatigue
anorexia
nausea + vomiting
abdominal cramps/diarrhea
enlarged lymph nodes
What is a protective enviroment?
Neutropenic precautions for severely immunocompromised people (AIDS, burns, organ transplant, chemotherapy)
No live vaccine
avoid invasive procedures
check WBC + temp
healthy caregiver/visitors (no infectious diseas)
private room
positive airflow
HEPA filtration
no plant/flowers
keep door closed
mask for pt when out of room
no raw/undercooked fruits/veggie
avoid sick people
disinfect equipment between pt
frequent handwashing + gloves
Contact precautions:
gown and gloves
disposable or dedicated pt care equipment
limit transport ad movement of pt
ensure appropriate pt placement,
private room
protect visitors/caregiver when within 3 feet against direct contact or enviromental contact
Pathogen: ABCDEF (abscess, bronchiolitis, cutaneous- herpes, lice, varicella, decubitus ulcer, diarrhea, eyes- conjunctivits, funky/feisty-MRSA and VRE
Special Contact Precautions: C. Diff (hand sanitzer doesnt kill spores)
Droplet precautions:
wearing of surgical mask, eye protection, proper hand hyigiene, and some dedicated care equipment
limit transport and movement of pt (wear mask and respiratory hygiene/cough etiquette
private room or cohort
source control: pt wears mask
droplets travel 3-6 feet from client (keep visitors 3ft from infected person)
Pathogens: rubella, mumps, diptheria, adenovirus
Airborne Precautions:
specially equipped room with private negative air flow
keep door closed
all heath care personnel wear an N95 respirator/PAPR every time they enter room
is splashing/spraying is possible wear full face protection
immunize susceptible people as soon as possible
restrict susceptible healthcare personnel
limit transport and movement of pt
masks and respiratory protection devices for caregiver/visitors
source control: put surgical mask on pt when leaving room
Pathogen: MTV; measles (rubeola), TB, Varicella (chickenpox)
Standard precautions:
handwashing, use of gloves, PPE, use of gown, safe handling of sharps + waste + soiled linens
enviromental cleaning
Medical Vs Surgical asepsis:
Medical: clean technique (IM injection)
Key step: hand hygiene, gloves, disinfection
most nursing activites are medical asepsis
Surgical: sterile technique (ex. operating room, foley catheter insertion)
key step: sterilization, sterile gloves, instruments
special technique to prevent contamination
Precautions for C. Diff:
avoiding use of electronic equipment that is difficult to clean
disinfecting dedicated pt care items and equipment (stethoscopes) between pt
using full barrier contact precautions (gown +gloves)
placing pts in private room; cohort pt with same stain of CDI
performing meticulous hand hygiene (hand sanitzer does not kill spores)
performing enviromental contamination of rooms
educating heath care providers (pts +families) on clinical presentation, transmission, epidemiology of CDI
using antimicrobials at appropriate dose and only when indicated
Donning (PPE)
(putting on)
1: gown
2: mask/respirator
3: googles/ face shield
4: gloves
Doffing (taking off)
Example 1: gloves, goggles, gown, mask
Example 2: gown/gloves, goggles, mask/respirator
Surgical Asepsis principles
Good:
sterile object remains sterile only when touched by another sterile object
open sterile package away from you. outside of package is considered contaminated
only sterile objects may be placed on sterile field
sterile object or field out of range of vision or an object held below a person waist is contaminated
sterile object or field becomes contaminated by prolonged exposure to air
sterile surface comes in contact with wet, contaminated surface, sterile object/field becomes contaminated by capillary action
avoid talking, coughing, sneezing or reaching over sterile field
edge of sterile field or container are considered contamined (1 inch border)
keep all items sterile if: in contact with broken skin, used to penetrate the skin to inject or enter normally sterile body cavities
What is the infectious process?
Incubation Period: exposure to infection
Prodromal stage: can spread infection; before symptoms fully begin
Illness stage: signs + symptoms are fully showing
Convalescent period: symptoms resolve and people start feeling better
Assessment: infection control
status of defense mechanisms
client susceptibility
age
nutritional status
stress
disease process
medical therapy
immunizations
clinical appearance (s/s of infection-local/systemic)
vital signs
Lab data
Nursing diagnosis: infection control
risk of infection
imbalanced nutrition: less than body requirement
impaired oral mucous membrane
risk for impaired skin integrity
social isolation
impaired tissue integrity
readiness for enhanced immunization status
Nursing planning:
effective hand hygiene + good personal hygiene practices
identify signs of an infection
maintain adequate fluid + nutritional status
demonstrate proper disposal of soiled articles
use appropriate cleansing and disinfecting techniques
awareness of the necessity of proper immunizations
stress reduction technique
adhere to infection control precautions
understanding of health risks associated with latex allergy
Acute Care interventions:
health promotion (nutrition, hygiene, immunization, rest)
protection of susceptible host
control/elimination of infectious agents
control/elimination of
—-> reservoirs
—–> portals of entry
——> modes of transmission
medical and surgical asepsis (clean vs sterile technique)
hand hygiene (HCP, patient, family) —five moment for hand hyigene)
oral hygiene
meticulous standard precautions
What are some safety issues for the nurse?
use needles safely (advocate if you dont know how)
handle patients with care
administer drugs carefully
prevent repetitive motion injuries
use ergonomic principles when providing care
report, intervene, and/or escalate unsafe practices of health care personnel (eg. substance abuse, improper
What are factors that affect safety?
developmental consideration
workplace culture
lifestyle (occupation, social behavior)
social behavior
environment
impaired mobility
sensory, cognitive or communication impairment
knowledge or lack of safety awareness
physical and psychosocial health state
economic resources
What is a safety assessment?
looking at…
the person
the environment (hospital, workplace, home)
specific risk factors (ex. fall risk)
Hourly Rounding 5 Ps:
Pain: assess pt pain level; provide pain medication if needed
Personal Needs: offer help using toilet; offer hydration, nutrition, empty commodes/urinals
Position: help the pt get into comfortable position or turn immobile pts to maintain skin integrity
Placement: make sure pt essential needs (call light, phone, reading materials, toileting equipment, etc) within reach
prevent falls: ask patient/family to put on call light if pt needs to get out of bed
Incident reports:
must be completed after an accident or incident in health care facility that compromise safety
completed by nurse immediately after incident
is NOT PART OF MEDICAL RECORD and should not be mentioned in documentation
What is RACE?
R: rescue anyone in immediate danger
A: activate alarm and notify appropriate person
C: contain/confine the fire by closing door and window
E: extinguish
What is PASS?
P: pull
A: aim
S: squeeze
S: sweep
Alice Training:
A: alert, pay attention to changing sounds ( first notification of danger)
L: lockdown: fortify/barricade your area
I: inform others: call 911 or hospitals emergency number
C: counter: make noise, throw things to cause distraction
E: evacuate: remove yourself from danger
Seizure precautions:
stay with patient; call for help
protect your airway
suction PRN; in case of aspiration
turn your pt to the side to reduce the risk of choking
provide suppmental oxygen
do not place objects in the mouth
remove hazardous items
——> padded bed frame in case of uncontrollable body movement
do not restain, monitor closely
administer drug therapy to control seizure
assess after seizure, and document
Safety considerations for Neonates:
avoid behaviors that might harm fetus (alcohol, smoking, drugs)
never leave infant unattended
use crib rails
monitor setting for objects that are choking hazard
use car seats properly
handle infant securely while supporting head
place infant on back to sleep
Safety consideration for toddlers/preschoolers:
supervise child closely to prevent injury
select toys appropriate for developmental level
use appropriate safety equipment in home
never leave child alone in bathtub
childproof home envronment; prevent poisoning
be alert to manifestations of child maltreatment or abuse— physical, sexual, emotional neglect ( YOU are a mandated reporter)
use car seats properly
teach about fire safety/practice emergeny evacution measures
safety considerations for school-aged children
help avoid activties that are potentially dangerous
provide interventions for safety at home, school, neighborhood
reinforce teaching about symptoms that require immediate attention
continue immunizations as scheduled
teach bicycle safety
teach about child abduction
wear seatbelts
Safety considerations for adolescents:
teach safe driving skills and avoiding distracted driving
teach avoidance of tobacco + alcohol
emphasize gun safety
follow healthy lifestyle
teach about sexuality, STI, birth control
get physical exam before participating in sport
teach risk of infection with body piercing and tattoo
teach about guns + violence
discuss dangers associated with internet
Safety considerations for adults:
remind them of effects of stress on lifestyle and health
enroll in defensive driving course
counsel about unsafe health habits (reliance on drugs and alcohol)
evaluate workplace for safety
counsel about domestic violence
Safety consideration for older adults:
identify safety hazards in environment
modify the environment as necessary
attend defensive driving course or courses designed for older drivers
encourage regular vision and hearing test
ensure hearing aid and eyeglasses are available and functioning
have operational smoke detectors in place
document and report signs of neglect and abuse
Safety plan for victims for domestic abuse:
safety plan while living with an abusive partner (remove weapons, have a phone + keys, signal, have safety plan)
safety plan with children
plan for pets
planning during pregnancy (increased risk)
leaving relationship (important documents)
Speak Up campain
S: speak up if you have questions/concerns
P: pay attention to the care you get
E: educate yourself about illness
A: Ask a trusted family member or friend to be advocate
K: know what medications you take and why you take them
U: use a hospital, clinic, surgery center that has been carefully checked out
P: participate in all decisions about treatment
Safety issues:
procedure- related accident
equipment- related accident
chemical exposure
falls
restraints
workplace safety
electrical hazards
fires
seizures
disasters
workplace violence + discrimination
Nursing History: Safety
age
acute/ chronic conditions
surgeries/procedures
visual, hearing, sensory/perceptual
medications
assess for history of falls/accidents
allergies (food, latex, enviromental allergies)
note assistive devices (ex. cane, walkers)
be alert to history of drug or alcohol abuse
obtain knowledge of family support system and home enviroments
Risk Factor Assessment:
falls
fires
poisoning
suffocation and aspiration/choking
firearm injuries
motor vehicle injury
burns
drownings
social media
play injuries
passive smoking
carbon monoxide
food poisoning
physical examination: safety
assess mobility status
assess ability to communicate
assess level of awareness or orientation
assess sensory perception
identify potential safety hazards
recognize manifestations of domestic violence or neglect
