Exam 1 Flashcards
What are Healthcare Associated Infections (HAI)? and what are three impacts?
Result from healthcare delivery in any setting while receiving treatment for another condition.
Impacts physical, emotional, and financial health.
What are exogenous HAIs?
From environment or personnel.
What are endogenous HAIs? Two examples
Come from the patients.
MRSA or c.diff
Give three examples that are NOT HAIs
- Infection present on admission (shows up on or after 3rd hospital stay day)
- Transplacental infection (i.e. herpes)
- Reactivation of latent infection (i.e. shingles)
Most common HAIs
CAUTI, SSI, VAP, CLABSI, CDiff, and MDRO
2024 National patient safety goals
Reviewed/revised by JACO to promote specific patient safety improvements. Always has prevent infection with hand hygiene!
What is the chain of infection?
Organisms—> Reservoir—> Portal of exit—> Transmission—> Portal of Entry—> Susceptible host
What is the chain of infection?
Organisms—> Reservoir—> Portal of exit—> Transmission—> Portal of Entry—> Susceptible host
Organisms/infectious agents
“The bug”
Pathogens or normal flora that become pathogenic like e.coli or MRSA
reservoir
Where the pathogen lives and multiplies. May be living or non-living
Portal of exit
How it leaves via: bodily fluids, coughing/sneezing/diarrhea, seeping wounds, tubes/IV lines
Mode of transmission
Contact—> direct or indirect
Droplet—> cough, sneeze
Airborne—> A/C, sweeping
Portal of entry
- eyes/nares/mouth/genitals/cuts/scrapes
- wounds, surgical sites, IV, drainage tube sites
- bite from vector
Susceptible host
What are the 4 determining factors?
- person with inadequate defense
1. Virulence
2. Org. Ability to survive in host environment
3. # of organisms
4. Host’s defenses
5 Stages of infection
IPIDC- infant pooped if discovered crying
Incubation
Prodromal
Illness
Decline
Convalescence
Incubation
From the time of infection until the manifestation of Sx; infectious
Prodromal
Appearance of vague Sx; not all diseases have this
Illness
Signs and Sx present
Decline
of pathogens decrease
Convalescence
Tissue repair and return to health
Local infection
Occurs in limited region in the body (i.e UTI)
Systemic infection
Spread via blood or lymph
Affects many regions (i.e. septicemia)
Acute infection
Rapid onset of short duration
Chronic infection
Slow development, long duration
Latent infection
Infection present with no discernible Sx (HIV, AIDS)
Antibiotic resistance prevention/control
Educate about judicious antibiotic use—> resistance, don’t self initiate, avoid taking if infection probability low, take full course, notify if not responding
Infection prevention—> hand washing importance, observe infection control precautions
Standard precautions indications and implementation
Used for all pt care. Prevent contact with body fluids/secretions/excretions, non-intact skin, mucous membranes
Hand hygiene, gloves only when indicated, PPE as indicated, manage sharps linen equipment, private room if pt. Is likely to contaminate environment, cleaning disinfection procedures.
Tier I infection control
Used for all patients regardless of Dx to prevent pathogen Tx
Tier II infection control
Contact, droplet, airborne. Always used with standard precautions, more than one type used when warranted.
Protective isolation practices
Prevent infection in immune-compromised patient
Contact precautions indications and implementation
Known/suspected infection spread via contact. Colonized with MDRO, excessive drainage, incontinence
Gloves and gown always, face PPE if indicated, private room or cohort;dedicated equipment, family/visitors gown/glove per facility policy.
Droplet precautions indications and implementations
Infections spread by large particle droplets.
Surgical mask within 3 feet of pt. Private room preferred, patient wears surgical mask is Tx required.
Airborne precautions indications and implementation
Infections spread through air over long distances
Private negative airflow room preferred, door remains closed, N95 respirator mask when entering room.
Protective isolation/neutropenic precautions indications and implementation
High susceptibility to infection
Private room, meticulous hand hygiene, restricted visitors, no plants/flowers/standing water, avoid fresh fruit, raw milk, raw honey, processed meats, mold foods.
Psychological impact of isolation
Mitigate potential adverse effects
- spend time in room
- sit with pt
- educate &answer Qs
- Encourage objects of comfort
- observe for mood changes
ANA 2015 definition of a nurse
“Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering, through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities and populations”
Why define nursing?
- helps the public understand the value of nursing
- helps differentiate activities of nursing from those of medicine
- help students understand what is expected of them
How many types of nurses are there?
RN, LVN, APRN
LVN
Licensed vocational nurse
- can collect data but cannot analyze, synthesize, or evaluate it
- diploma, national exam
- vitals, med admin, wound care
- under supervision of physician or RN
Nurse regulatory bodies
- each state enacts own practice act. Laws that govern practice, board of nursing to regulate (CBRN), set standards of practice
- American Nurses Association (ANA). Official professional org. For nurses in the US. Standards of practice
National League for Nursing (NLN)
Establishes and maintains a universal standard of education
Internal council of Nurses (ICN)
Federation of national nursing organizations
National Student Nurses’ Association (NSNA)
Represents nursing students
Sigma Theta Tau International (STTI)
National honor society for nursing
How can nursing improve its recognition as a profession?
- standardizing educational requirements
- uniform CE requirements
- increased participation of nurses in professional orgs.
- educating the public about the true nature of nursing practice
Patricia Benner’s Theory of novice to expert
the process by which a nurse acquires clinical skills and judgment. It guides that expertise is a personal integration of knowledge that requires technical skill, thoughtful application, and insight.
Benner Stage 1
Novice: onset of education. Focused on learning procedures and following sequential process
Benner Stage 2
Advanced beginner: new grads usually start here. Can distinguish abnormal findings but doesn’t understand the significance
Benner Stage 3
Competence: 2-3 years of nursing in same area. Gained experience and can handle pt load, and deal with complexity and prioritize situations
Benner Stage 4
Proficient: quickly take in all aspects of situations and see “big picture” and coordinate services and needs. Flexible and fluent.
Benner Stage 5
expert: see what needs to be done and know how to do it. Trust their intuition while operating with a deep understanding of situation. Sought after for guidance and assistance.
Nurse-patient relationship
-professional and caring
- advocacy
- confidentiality and privacy
- rapport
Confidentiality
Legally binding (HIIPA)
Privacy
- standard of care (pulling curtain, shutting doors, etc.)
- pt. Decides what they want to tell you
Therapeutic communication
Face-to face interaction focused on pt concerns to increase pt well-being.
Characteristics of therapeutic communication
Every RN Gets Candy Corn
- Empathy
- Respect
- Genuineness
- Concreteness
- Confrontation
Therapeutic communication techniques:
Silence
Gives the patient time to process and respond
Therapeutic communication techniques:
Active empathetic listening
Eye contact, nodding/smiling, open body language, get on their level
Therapeutic communication techniques: Restatement
Repeat the message content. Use exact words or paraphrase.
Therapeutic communication techniques:
Reflection
Paraphrase message content and name underlying feelings
Therapeutic communication techniques:
Summarizing
Sum up eveything that the pt has said to show that you’ve been listening
Therapeutic communication techniques:
Clarifying
Encourages elaboration and minimizes misunderstanding
Therapeutic communication techniques:
Validating
Incentivizes/supports patient beliefs and demonstrates respect
Therapeutic communication techniques:
Touch
Communicates caring but should be used cautiously
Ways to enhance Therapeutic communication
Ask permission, create privacy, explain yourself, sit at eye-level, use non-verbals, pauses, encourage elaboration, avoid jargon
Open-ended questions
Encourage further discussion and give the patient control
Closed questions
Restricts response choices, lessens pt control, goal directed
Non-therapeutic communication
Disapproving/approving, talking about yourself, non-professional involvement, nosy questions.
Which patients are at risk for impaired communication
Angry, aphasic, confused, hearing/vision impaired, unresponsive
Which patients are at risk for impaired communication?
Pts that are:
Angry, aphasic, confused, hearing impaired, unresponsive, and visually impaired
First US hospital (Philadelphia hospital)
1751
ANA established
1896
Nurse training Act (cadet nurse corps)
1943
ANA publishes nursing code of ethics
1950
National league for nursing founded
1952
Bloodborne pathogens and standards established
1990
Healthy People 1990 published
1991
NCLEX-RN computer adaptive test
1994
IOM report “keeping patients safe”
2003
DNP formally introduced
2004
Florence NIghtingale
Founder of modern day nursing
Dorothea Dix
Superintendent of army nurses
Clara Barton
Founded American Red Cross
Lillian Wald
Nursing in public schools
Mary Brewster
Pioneers public health nursing
Edward Lyon
1st reserve army male nurse
Lavinia Dock
1st nurse drug manuals
Mary Mahoney
1st black nurse graduate
