Exam 2 Flashcards
Define asepsis and medical asepsis.
Asepsis: Prevention of the transfer of microorganisms and pathogens
Medical Asepsis: (clean technique) Measures that limit pathogenic spread of microorganisms
***Discuss the rationale for standard precautions including hand hygiene.
-Used for all patients
-All bodily fluids, non intact skin, mucous membranes
-Designed to reduce risk of transmission of microorganisms from both recognized and unrecognized sources of infection
-Hand washing it most important way to prevent spread of microorganisms
-Make sure to wash hands if visibly soiled or in contact with spores (C diff, anthrax)(not sanitizer)
-Gloves with every patient
***Contact precautions
-When in direct or indirect contact with patient who has highly transmissible pathogen
-MRSA, VRE, C. diff
-Private room, gloves, gown
***Airborne precautions
-Tiny particles (<5 microns) of evaporated droplets which remain in the air for long periods of time
-Measles, Chickenpox, Varicella zoster, Pulmonary or laryngeal TB
-Specifically equipped room with negative airflow, respirator mask
***Droplet precautions
-Large particle droplets (> 5 microns) expelled into the air
-Diphtheria, Rubella, Streptococcal pharyngitis, Influenza, Pneumonia, Scarlet fever, Pertussis, Mumps, Meningitis
-Private room, surgical mask within 3 ft
***Protective environment
-Designed for patients who have undergone transplants and gene therapy
-Private room, positive airflow room
***Identify interventions for nurse/patient safety related to infection control
-Hand hygiene
-Not sharing personal items
-Gloves and/or mask when working with exudates, urine, feces, emesis, blood
-Appropriate disposal
-Lab collection and transfer (assume infected)
-Cough etiquette
Define sterile asepsis
-Sterile asepsis = surgical asepsis
-Procedures to eliminate all microorganisms
-Used for procedures that require intentional perforation of skin, when skin integrity is broken (trauma, incision, burn), and inserting something into sterile body cavities (catheter, scopy)
***Identify principles of sterile asepsis
- Sterile object remains sterile only if touched by other sterile objects
- Only sterile objects may touch a sterile field
- If sterile object or sterile field is out of the range of vision, held below waist, prolonged exposure to air, or comes in contact with wet contaminated surface, it is contaminated
- One inch border of sterile field/container are always considered to be contaminated
***Identify factors that influence urinary elimination.
Acute and reversible
-UTI, obstruction, rxn to anesthesia, n
dehydration
Chronic and irreversible
-end stage renal disease
Meds, surgical, or diagnostic procedures
Psychological or socio-cultural factors
Also DM, neuromuscular disease, benign prostatic hyperplasia
***Factors influencing Urination - Renal Disease
-Prerenal-disease caused by decreased blood flow to and through kidney
-Postrenal-obstruction in lower urinary tract affecting flow from kidneys (ex. narrowing of urethra, weakened pelvis or perineal muscles, altered nerve innervation)
-End stage Renal Disease - irreversible damage to kidney tissue
***Factors influencing Urination - Diabetes Mellitus & Neuromuscular Disease
Causes changes in nerve functions to bladder leading to decreased bladder tone and sensation
***Factors influencing Urination - Benign prostatic hyperplasia
Can lead to urinary retention and incontinence; is a nursing concern if they require catheterization because it can be challenging
***Factors influencing Urination - Cognitive Impairments
Can lose ability to sense a full bladder or unable to recall how to void
***Factors influencing Urination - Diseases that limit mobility
Physically make it difficult to reach and use the toilet
***Identify alterations in urinary elimination.
-Urinary retention: accum of urine bc of inability to empty bladder properly; walls of bladder stretched
-S&S: bladder distention, absence of
urine output, feelings of pressure and
tenderness at symphysis pubis,
restlessness, diaphoresis
-UTIs: bacterial infection in urinary tract; most common HAI
-catheters are common cause, also
short urethra, surgery, retention
-S&S: pain/burning, fever/chills,
frequency/urgency, cloudy urine,
change in mental status, N/V,
hematuria
-Untreated can lead to kidney inf =
flank
pain, worsening fever
-Urinary incontinence: involuntary leakage of urine that is sufficient to be a problem; more common in older adults
-Functional: caused by factors outside
the urinary tract
-Stress: during incd abdominal
pressure
-Urge: after strong sense of urgency
-Reflex: at predictable intervals
-Can impair body image, often leads to
loss of indep
-Creates potential for skin breakdown
and pressure ulcers
-Urinary diversions: artificial stoma used to drain urine from a diseased or dysfunctional bladder
-Secondary to: bladder cancer,
radiation damage, chronic UTI,
trauma, paralysis
-Continent: ureters embedded in a
urinary reservoir formed from ileum
and proximal colon; stoma made on
abdomen that has to be catheterized
-Incontinent: (urostomy, ileal conduit)
Ureters connected to ileum with
section of ileum forming opening on
abdomen; continually drains so pouch
has to be placed
-Nephrostomy: tube placed directly
from kidneys to opening in skin;
located in flank area and attached to
drain bag
Interventions for alterations in urinary function
Infection prevention
Pt education
Adequate fluid intake
Stimulating micturition reflex (kegel exercises, adequate positioning)
Maintaining elimination habits (avoid fluids before bed; toileting schedule to assist in continence)
Promoting complete bladder emptying
Avoid catheters if possible
Describe characteristics of normal urine.
Describe common urinary diagnostic tests.
Urinalysis: analyze several components (chemical, visual, microscopic)
Urine Culture and Sensitivity: requires
sterile or clean voided sample, sensitivity will determine which specific antibiotics are effective; takes approx 24-48 hrs
Noninvasive:
-KUB-plain film xray of kidneys, ureters,
bladder
-CT scan of abdomen and pelvis
-US (ultrasound) renal or bladder
-Urodynamic testing - determines
bladder muscle formation
-IVP (intravenous pyelogram) - xray
performed after the injection of contrast
dye; check for allergies
Invasive:
-Cystoscopy - direct visualization of
urinary tract; local or general anesthesia
used
-Renal arteriogram (angiography) - direct
visualization of renal arteries; contrast
dye used so check for allergies
***Discuss nursing measures to reduce UTI.
General: good hygiene, avoid urinary retention
Catheters: Remove ASAP, encourage fluid intake, frequent perineal care, drainage bag below level of bladder, avoid loops/clamping in tubing and pooling of urine in tubing, secure catheter to leg to avoid pulling, empty catheter bag prior to moving
