Fundamentals Chapter 17 Flashcards
Same as standard precautions plus the following: place the patient in a private room with a negative air pressure or in a room with a patient with the same infectious organism; keep susceptible persons out of the patient’s room; and limit the patient’s movement outside the room
Airborne precautions, droplet precautions
Standard precautions plus the following: never touch with bare hands anything wet that comes from a body surface or cavity; use gloves, impermeable gowns, masks, and protective eyewear when necessary
Contact precautions
Recovering, getting well
convalescent
Infection that occurs within a health care facility or because of a treatment or procedure
health care-associated infections (HAIs)
The causative agent for acquired immunodeficiency syndrome (AIDS)
Human immunodeficiency virus (HIV)
The third stage of infection, where localized and systemic signs and symptoms appear
illness period
Not affording a passage
impervious
The time from invasion of the body by the microorganisms to the onset of symptoms
incubation period
The use of medical and surgical asepsis and standard precautions and transmission-based precautions to prevent or control the spread of microorganisms
infection prevention and control
The separation of infected individuals from those uninfected for the period of communicability of a particular disease; quarantine
isolation
Increase in the number of white blood cells in the blood, due to infection or other causes
leukocytosis
Discomfort, uneasiness, or indisposition, often indicative of infection
malaise
Early or very beginning stage of an illness
prodromal period
Precautions that protect both the nurse and the patient from infection and are to be used for every patient contact
Standard Precautions
Precautions that are based on interrupting the mode of transmission by identifying the specific secretions, body fluids, tissues, or excretions that might be infective
transmission-based precautions
What are the stages of infection?
incubation period, prodromal period, illness period, convalescent period
The ___ begins when the organism first enters the body and lasts until the onset of symptoms
Incubation period
The ___ is the short time from the onset of vague, nonspecific symptoms to the beginning of specific symptoms of infection
Prodromal period
During the ___, localized and systemic signs and symptoms appear
illness period
The severity of the symptoms and the duration of the ___ depend on the virulence of the pathogen and the person’s susceptibility to the microorganism
illness period
The ___ begins when the symptoms begin to subside, and it extends until the patient has returned to a normal state of health.
Convalescent period
The institute for healthcare improvement (IHI) developed a VAP bundle based on research and Best Practices. According to IHI (2012), health care providers can decrease the incidence of VAP by: (5)
#1 Elevating the head of the patient's bed 30 and 45 degrees, unless contraindicated. #2 Daily "sedation vacation" (reducing sedation) for assessing the patient's ability to breathe independently, allowing mechanical ventilation to be discontinued as soon as possible #3 Prophylaxis (medication) for preventing peptic ulcer disease (PUD) #4 Prophylaxis (medication) for preventing deep vein thrombosis (DVT) #5 Daily oral care using chlorhexidine, an antimicrobial oral rinse
Infection prevention and control involve: (6)
#1 Observing patients for signs of infection #2 recognizing individuals at high risk for infection and implementing appropriate precautions #3 Implementing procedures to contain microorganisms when an infection is suspected or confirmed #4 Monitoring diagnostic reports related to infection #5 Using approved sanitation methods #6 Properly handling and sterilizing or disposing of contaminated items and equipment
Current precautions are based on guidelines and regulations developed by :
the CDC and the Occupational Safety and Health Administration (OSHA)
Infection preventing and control practices are focused on :
protecting patients, health care workers, family members, and social contacts in all settings
Examples of airborne diseases (3)
#1 Measles (rubella) #2 Varicella (including disseminated zoster) #3 pulmonary tuberculosis
Examples of droplet illnesses are : (4)
#1 invasive Haemophilus influenzae type b disease, including meningitis, pneumonia, and epiglottitis. #2 Invasive Neisseria meningitidis disease, including meningitis, pneumonia, and sepsis #3 other serious bacterial respiratory tract infections spread by droplet transmission, including diphtheria (pharyngeal), mycoplasma pneumonia, pertussis, and pneumonic plague #4 Streptococcal (group A) pharyngitis, pneumonia, or scarlet fever in infants and young children
Examples of contact precaution illnesses (7)
#1 gastrointestinal, respiratory, skin, or wound infections or colonization with multidrug-resistant organisms #2 Enteric infections with a low infectious dose or prolonged environmental survival, including Clostridium difficile #3 For diapered or incontinent patients, enterohemorrhagic Escherichia coli, shigella, Hep A, or rotavirus infection #4 Respiratory syncytial virus (RSV), parainfluenza virus, or enteroviral infections in infants and young children #5 skin infections that are highly contagious or that may occur on dry skin, including diphtheria (cutaneous), herpes simplex virus (neonatal or mucocutaneous), impetigo, major (noncontained) abscesses, cellulitis, pressure injuries, pediculosis, scabies, staphylococcal furunculus's in infants and young children, and zoster (disseminated or in the immunocompromised host) #6 viral or hemorrhagic conjunctivitis #7 viral or hemorrhagic infections (ebola, lassa, or marburg virus)
Current standards consist of two tiers developed by the healthcare infection control practices advisory committee (HICPAC) of the CDC. Tier 1 is ___ and tier 2 is ___
1 is standard precautions and 2 is transmission based precautions
CDC guidelines state that if full PPE is required, it is donned in the following order : (4)
the gown, the mask, the goggles, then the gloves
The sequence for removing PPE is : (4)
gloves, googles, gown, mask
What are the life span considerations for older adults? (3)
#1 older adults are at greater risk for infection because their immune system is not as active as that of a younger person. The older the person the greater the infection risk #2 An older adult hospitalized for one infection has an increased risk for developing a second infection (HAI) because the body's available defenses are already working to fight the first infection #3 Healing is slower in the older adult due to fewer immune cells available to fight infections
Nosocomial is ___
Health care associated infection (HAI)
Patients with compromised immune status are often placed in protective isolation to reduce exposure to infectious organisms. People providing care for these individuals must wear gowns, gloves, and masks, and the patient needs to be in a private room (she said know this word also)
neutropenic
What are the steps to Specimen preparation and transportation? (9)
#1 Before collecting body fluid or other potentially infectious material, verify the primary care provider's order and complete the correct laboratory requisition form #2 Label the specimen container with the patient's name and medical record number. Place the label on the container itself, not the lid because once the lid is removed in the lab, the specimen would be unlabeled. #3 Don gloves and explain to the patient what is needed. #4 Collect the specimen without contaminating the outside of the container. #5 Apply the lid, ensuring it is fully tightened. #6 Clean or disinfect containers that are visibly contaminated before placing them in the lab transport bag. #7 Place the secured lab specimen container in a plastic specimen bag and close the bag lock seal. #8 Complete the lab requisition form and place it in the envelope pocket on the outside of the transport biohazard bag before leaving the patient's room. #9 Remove gloves, perform hand hygiene, and then following facility protocol, send the specimen to the clinical lab for processing
What does VAP stand for
Ventilator acquired pneumonia
What are the steps to soiled linen?
Roll it up and place it inside the linen hamper in the patient’s room. Never carry unbagged soiled linens in the hallway because it increases the risk of contaminating the surrounding environment. When the bag is 2/3 full, tie is closed and send it to laundry according to agency policy. Double bagging is not necessary
What are the steps to trash and biohazard waste
Place disposable soiled equipment and supplies inside the plastic bag lining the waste receptacle in the patient’s room. If an item were squeezed, slung, flung, or flicked and it could release blood or body fluids it goes in a red biohazard bag.
When do you double bag?
The only time double bagging is necessary is if the plastic bag is soiled on the outside. In this instance, another nurse standing just outside the room’s doorway holds open a second plastic bag, placing her gloved hands under the edge of the bag, which is folded outward to cover the nurse’s hands. This further protects her hands from soiling. The nurse in the patient’s room then places the first bag carefully inside the second one. The nurse outside the room ties the bag closed, being careful not to touch the inner first bag. Gloves are moved. The bag is taken to the soiled utility room for disposal. Then hand hygiene is performed.
Steps to disposing of sharps?
Needles are not to be recapped before disposal. Drop all needles, scalpel blades, IV cannulas, suture needles, and other sharp items into a puncture resistant sharps biohazard container. Never put your fingers or hands inside the opening of the sharps container. Shake the container gently to settle the contents and make more room if necessary. Replace sharps containers when they are 2/3 full. Seal the full sharps container and send it to the biohazard and waste storage area for later removal.
Steps for other equipment?
Clean reusable equipment if it is visibly soiled, and then send it to the central processing department to be disinfected. A disposable stethoscope and blood pressure cuff are issued to the isolation patient, and only these are to be used within the isolation room. When the patient is discharged, dispose of them in regular trash. No special treatment is necessary for dishes.
natural defenses :
Institute measures to protect and enhance the patient’s natural body defenses. Protect intact skin and mucous membranes, promote a balanced diet and sufficient fluids, provide opportunity for adequate sleep and rest, and decrease stress as much as possible
Patient placement :
Place a patient in need of transmission-based precautions in a private room. An exception can be made if another patient has the same type of infection: they can be roomed together. A patient with an airborne transmissible disease would be placed in an Airborne infection isolation room (AIIR) and on airborne precautions. Keep the door to the room closed except when someone is entering or leaving. This helps ensure the organism remains contained and does not enter the rest of the unit.
Transporting the patient :
Avoid transporting the isolation patient unless necessary. If transporting is unavoidable, give the patient a standard mask to wear while out of the room. For a patient under droplet precautions, take measures to prevent soiling of the environment. Notify the unit or department receiving the patient ahead of time that a patient under this particular type of transmission-based precautions is coming to the area. Share information about any additional precautions required with those receiving the patient
What do you do during airborne precautions? (5)
#1 place the patient in a private room that has negative air pressure: 6 to 12 air exchanges per hour and discharge of air to the outside or a filtration system for the room air #2 If a private room is not available, place the patient with another patient who is infected with the same microorganism. In select situations, approval from the local health department may be required #3 Wear a respiratory device when entering the room of a patient who is known to have or suspected of having primary tuberculosis #4 Susceptible people should not enter the room of a patient who has rubella (measles) or varicella (chickenpox) If they must enter, they should wear an N95 respirator #5 limit movement of the patient outside the room to essential purposes. Place a surgical mask on the patient if possible
What do you do during droplet precautions? (4)
#1 place the patient in a private room #2 if a private room is not available, place the patient with another patient who is infected with the same microorganism #3 Wear a mask if working within 3 feet of the patient #4 Transport the patient outside of the room only when necessary, and place a surgical mask on the patient if possible
What do you do during contact precautions? (6)
#1 place the patient in a private room #2 If a private room is not available, place the patient with another patient who is infected with the same microorganism #3 Wear gloves as described in standard precautions #4 Wear a gown when entering a room if there is a possibility of contact with infected surfaces or items, or if the patient is incontinent or has diarrhea, a colostomy, or wound drainage not contained by a dressing #5 Limit movement of the patient outside the room #6 Dedicate the use of noncritical patient care equipment to a single patient or to patients with the same infecting microorganisms
What are the 7 steps to infection prevention in the home?
#1 wash your hands often #2 routinely clean surfaces #3 handle and prepare food safely #4 get immunized #5 use antimicrobials appropriately #6 be careful with pets #7 avoid contact with wild animals
What are the 4 rules for surgical asepsis?
#1 Know what is sterile #2 know what is not sterile #3 separate sterile from unsterile #4 remedy contamination immediately
What is the goal of surgical asepsis?
To keep an area free of microorganisms
What are the 6 principles to observe when opening sterile packages?
#1 perform hand hygiene #2 open the sterile package away from the body #3 Touch only the outside of the wrapper #4 Do not reach across a sterile field; go around the sterile field if necessary to reach the other side #5 Always face the sterile field, even when moving to the other side #6 allow sufficient space (at least 6 inches) between the body and the sterile field
( T or F ) Infection control precautions are physical measures to prevent or control infection
True
You are preparing a sterile field and the patient starts coughing and sneezing, What do you do?
Give them a mask and restart
You are opening a sterile package, which side do you unfold first?
The top flap, furthest from the bottom
If someone has pharyngitis what precautions are they going to have?
droplet precautions, where a mask within 3 feet
Someone who has Tb and a wound with TB in it… nurse collects soiled dressings.. Which substance can be safely disposed of in a landfill
No bio waste.. Any trash item destroyed by autoclave, has to be sterilized first
Nurse knows transmission based precautions rely mostly on which factor?
the nature of the affecting microorganism
After taking standard precautions a nurse is cleaning an infected wound, which precaution is she concerned about?
blood, mucous membranes, and non intact skin
Elderly are at risk of developing pneumonia, flu, urinary tract infections if ___
if they have non skin intact
You’ve delegated care of patient with C Diff to UAP
you are responsible for your patients, be nice, check on your patient, make sure UAP is capable of doing job and doing task correctly, have good coachment, ask if UAP has any questions, kindly point out errors in technique
How do you preform a surgical scrub? (13)
#1 determine whether all supplies needed are available before beginning #2 remove rings and watch #3 adjust the water to a comfortable temperature using the foot control #4 wet your hands and arms from above the elbows to the fingertips, with the hands kept higher than the elbows throughout the scrub #5 Dispense the soaping agent onto the palms using the dispenser foot control, and rub hands together to work up a lather. Clean the fingernails with a nail stick. Wash the hands and forearms to a point at least 2 inches above the elbow #6 when using a prepackaged scrub brush or sponge pad, open the package, remove the nail cleaner, and clean the nails. Hold the nail stick until the nails have all been cleaned, and then discard it. Remove tthe brush or pad from the package and discard the package. Do not set down the brush or pad until the scrub is complete. If the brush or sponge pad is not impregnated with the cleansing agent, moisten the brush or pad and dispense the antiseptic agent onto it #7 start at the fingertips and, with a circular motion, work around and between each finger, holding the scrub brush or sponge pad perpendicular to the fingers and nails. Use light to moderate friction. Scrub the back of the hand, the palm, and then the wrist with circular strokes. Scrub each hand and arm for 2.5 minutes. Take care not to abrade the skin #8 Continue up the arm to the elbow using circular scrub strokes on all surfaces, holding the brush or sponge pad parallel to the arm #9 rinse each hand and arm thoroughly, holding the hand above the level of the elbow and allowing the water to run from the fingertips down the hand to the wrist, the forearm, and off the elbow area #10 Turn of the faucet using the foot control #11 dry the hands with a sterile towel. Step away from the sterile field, lean slightly forward from the waist and unfold the towel, holding it by a corner and allowing it to unfold downward. Do not let the towel reach below the waist level or come in contact with the body or any object in the room #12 Keep the arms and hands above the waist level and away from the body with the hands and fingers pointed up. Use the top half of the towel to blot the opposite fingers and hand dry, and move the towel from the forearm to the elbow. Do not go back over an area already dried. #13 grasp the lower end of the towel with the dried hand, and use the same procedure to dry the other hand and forearm. Discard the towel by dropping it into the proper receptacle when finished. Keep your hands and arms above the waist level
