Midterm 1 Flashcards

1
Q

What are the 6 elements in the chain of infection? what does it mean to break the chain?

A

1.) Transmission
2.) Portal or entry
3.) Host susceptibitly
4.) Infectious agent
5.) Reservoir
6.) Portal of exit

Breaking the chain refers to the methods and techniques we as health care providers use in order to stop or “break” the chain of infection Ex.) hand washing, keeping areas clean

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2
Q

Principles of hand hygiene, use of barrier, techniques and routine environmental cleaning are examples of?

A

Medical asepsis or the “clean technique”

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3
Q

When are tear 1 isolation requirements put in place?

A

The transmission-based precautions are for those who are known or suspected to be infected or colonized with infected agents, including certain epidemiologically important pathogens, which require additional control measures to effectively prevent transmission

-Use with ALL patients

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4
Q

When are tear two isolations precautions put into place?

A

Includes precautions designed for care o patients who are known or suspected to be infected, or colonized, with microorganisms transmitted by contact, droplet, or airborne route or by contact with contaminated surfaces

-Use with specific types of patients (airborne, droplet or contact precations)

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5
Q

What is Infection Control?

A

Practices that control or prevent transmission of infection help create an environment that protects patients and health care workers.

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6
Q

What are the factors for the the potential growth of microorganisms to cause disease depend on?

A

1.) A sufficient number of microorganisms
2.) Virulence, or the ability to produce disease
3.) The ability to enter and survive in the host
4.) The susceptibility of the host

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7
Q

Exogenous Infection Vs Endogenous infection?

A

Exogenous Infection: Is an infection that arises from microorganisms that are external to the individual that do not exist as normal flora. Ex.) salmonella

Endogenous infection: This can occur when some of the patient’s flora become altered, and overgrowth occurs. Ex.) Yeast infection

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8
Q

Normal flora Vs body system defences Vs inflammation?

A

Normal flora: are microorganisms that do not typically cause disease when residing in their usual area of the body but instead participate in maintaining health and may assist in fighting infections and inflammation and maintaining homeostasis.

Body system defences: These are the specific defences that each area of the body has and uses to help protect us (skin, mouth, eye, vagina, urinary tract, respiratory tract and gestational tract)
-A number of the body organs have unique defences against infection

Inflammation: Is the body’s cellular response to injury or infection
-It is a protective vascular reaction that delivers fluid, blood products, and nutrients to interstitial tissues in an area of injury

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9
Q

What is quality of care defined as? What are the 6 domains? How do they contribute to patient safety?

A

-The degree to which health care services for individuals and populations increase the likelihood of desired health outcomes are consistent with current professional knowledge

1.)Accessibility- Available to everyone, right care received at the right time, place in the right setting and by the health care provider

2.) Effectiveness- Care received reaches the expected benefits and is based on the best scientific evidence

3.)Efficiency- Care received is waste free, including the waste of supplies, equipment, time, ideas and information

4.)Patient safety: Care received where harm is avoided

5.)Patient center care: Care received that is respectful and responsive to individual patient preferences, needs, cultural traditions and values

6.) Equitable: Care received regardless of gender, age, ethnicity, geographic location and socioeconomic status

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10
Q

What is a patient safety incident? (adverse event) What are the three different kinds? Why do we avoid calling them accidents? Whats contributes to them?

A

An event or circumstance that could have resulted, or did result in unnecessary harm to a patient

1.) Harmful incident: an incident that resulted in patient harm
2.) Near miss: An incident that did not reach the patient (no harm resulted)
3.) No harm incident: An incident that reached the patient but no discernible harm resulted

-An accident is no longer used as it refers to an unforeseeable or unpreventable event occurring, because of this they are referd to as incidents.

System flaws, communication errors, protocols can contribute to poor quality care

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11
Q

What 5 factors the influence safety? What influences people’s ability to protect themselves?

A

1.) Patient and health care provider factors – personal characteristics of each individual, personal wellness, age, weight, intelligence, language,etc

2.) Task factors – workload, time pressure, staffing levels, the tasks themselves as well as their characteristics

3.) Technology factors – what kind is used, how effective is it, does it breakdown

3.) Environmental factors – consider the physical work environment, lighting, physical space and layout

4.) Organizational factors – structural, cultural and policy-related characteristics of the institution, are the structural, cultural, and policy related characteristics of the institution.

Peoples ability to protect themselves is influenced by age, lifetyle, health status, sensory perception, emotional state, enviroment, anbilitly to communicate

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12
Q

Patient safety?

A

The reduction and mitigation of unsafe acts within the health care system, through the use of best practices shown to lead to optimal patient outcomes.

Refers to the processes of analyzing incidents and identifying the causes, it intales that we actually have to find the root cause of what the error was and what caused it

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13
Q

What is the pivotal post-incident question?

A

Why did the safeguards fail rather then who caused the incident

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14
Q

What is the Reasons swiss cheese model?

A

It is not a blame, shame, name approach. The SYSTEM needs to be analyzed.

It is developed by reason, each slice of cheese represents a barrier put in place to try and make the health care system safer. Each safeguard inherently contains a number of weaknesses, which are represented by hole in the cheese. The holes in the cheese are continuously moving around and often a subsequent barrier is able to stop a hazard from reaching the patient but when a hole lines up in certain combinations, hazards have the opportunity to sneak through safeguards that have been put in place and find their way to the patient. The holes at the end of the system, which come into contact with the patient are termed “active failures” and generally involve those directly involved in patient care

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15
Q

What is the iceberg conceptual model?

A

ROOT CAUSE ANALYSIS

Looks for contributing factors rather than direct cause to prevent additional adverse events in the future

Looks at the root causes, indirect causes and the near miss causes

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16
Q

What is a “RCA” and “FEMA”?

A

1.) Root cause analysis, used to find out what underlying features of a situation contributed to a patient safety event, it is used to seek, identify and understand all contributing causes in order to redeign the system to make it safer in the future

2.) Failure mode and effect analysis, is used to identify problems with processes and products before they occur, they take on an engineering approach and usually take place in the early developmental phase of a product with the aim of imaginatively identifying potential failures and their effects. It is used to analyze every aspect of a systems design.

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17
Q

How do we build a culture of safety? What does a culture of patient safety include?

A

1.) Reporting culture-need for trust
2.)Informed culture-awareness of potential safety issues
3.)Flexible culture and learning culture- Teamwork, shared power, lifelong learning
4.) Work in teams for patient safety
5.)Communicate effectively for patient safety
6.)Manage safety risk
7.) Optimize human and environmental factors (work-life balance)

-The goal is to provide services that are safe

-People take action when it is needed, and safety culture comes from ALL directions… it is the job of everyone who works there..All staff must draw the change

-Messaging about safety must be consist and sustained

18
Q

What are the risks for staff and patients in healthcare settings?

A

Staff
1.) Environmental Risks: Chemicals (WHIMIS), hazards
2.) Infection prevention and control: Protecting the care provider
3.) Violence: From patients/families directed at nurses
-It is up to the worker to proceed themselves

Patient Safety: Specific risks to a patients safety within the health care environment which include falls, procedure related incidents and equipment related incidents
1.)Falls: Account for up to 90% of reported safety incidents
2.) Procedure-related accidents: They occur during therapy, Medication errors, improper application of devices, improper execution of skills
3.) Equipment-related accidents: Malfunctions

19
Q

How are nurses able to prevent procedure-related incidents and equipment related incidents?

A

By adhering to organizational policy and procedures and standards of nursing practice we can avoid procedure related incidents

We can avoid equipment-related incidents by not operating monitoring or therapy equipment without adequate instruction

20
Q

What are the leading causes of injuries for infants and Children? Adolescents? Adults? and Older persons?

A

Infants and Children:
-Unintentional injuries are the leading cause of children aged 1-14years. The nature of the injuries sustained is related to normal growth and development
*The incident of posining is highest in late infancy and toddlerhood because of children’s increased level of oral activity and growing ability to explore the environment.
-Childhood injury are also reflective of adults perceptions of the causes of accidents and their ability to prevent them.

Adolescents:
The struggle for identity may cause a teenager to experience shyness, fear, and anxiety with, resulting dysfunction at home or school. These feeling may lead to substance abuse, sports, higher risk of suicide, MVA

Adults:
Lifestyle habits (smoking, drinking)

Older Persons:
-The physiological changes that occur during the again process increase a patient’s risk for injury. Chnages in vision, hearing, mobility, reflexes, circulation and the ability to make quick judgements predisopse older persons to fall

21
Q

Why and how are nursing errors reported in health care?

A

We fill out incidents reports (RLS) Reporting system for harmful events
We want to have a clear transparent policy to keep the population safe
It lets the adverse event team know about the events and allows us to learn from the incident and put new safeguards in place so it doesn’t happen again

22
Q

What must we do if an adverse event occurs?

A

1.) Discole the incident
Disclosure process must include:
-How the incident was handled
-Future plans to minimize the event from occurring again
-Regret that the event occurred
-We document the factual events of occurance
-Incident reporting is based on the factual events so we can get to the root of what happened, Objective data only…keep subjective out

2.) Anticipate the patient/families reaction

3.) Plan for support if needed

  • It is usually the managers job but nurses must use the same approach
23
Q

What is the nurse’s and student nurses’ role in patient safety?

A

-Assist the client to meet basic needs
-Reduce physical hazards
-Reduce equipment-related and procedural harm
-Reduce transmission of pathogens
-Maintain sanitation
-Control pollution

-Develop relationships with family
-Maintain continuity of care for patients and families
-Act ethically at all times
-Avoid blaming when an error occurs

24
Q

What is the purpose of the assesment in the nursing process? What do we want to do during this stage? What will the nurse collect during this stage? What should it include?

A

1.) Assesing is the systematic collection, organization, validation, and documentation of data

2.) The goal is to gather sufficient information that results in a comprehensive understanding of the patient’s situation.

3.) The nurse will:
-Collect Data
-Organize Data
-Validate Data
-Document Data

-Include the client’s strengths, perceived needs, health problems, related experiences, health practices, values, culture, social network, and lifestyle preferences

25
Q

What are the 4 different types of assessments? What kind of assessments are they?

A

1.) Initial assessment
-Performed within specified time after client admission to a health care agency
-The purpose is to establish complete database for problem indentification, reference, and future comparison
Ex.) Nursing admission assessment

2.) Problem focused
-Purpose is to determine the status of specific problem identified in earlier assessment
Ex.) Hourly assessment of clients food intake and urine output in ICU

3.) Emergency assessment
-During and physiological or psychological crisis, identify life-threatening or overlook problems
Ex.) Assesing a person’s airway breathing status, and circulation during a cardiac event

4.) Time lapsed Reassessment
-Follow up several months after initial assessment
-Purpose is to compare the clients status to baseline data previously obtained
Ex.)Reassessment of a clients functional health patterns in a home or outpatient setting

26
Q

What is a health interview? What kind of assessment tools do we use during them?

A

-The health interview is planned for communications and is used with a purpose

-We want to gather data and information during this time

-We can use sight, touch, smell and sound

27
Q

What is the purpose of Gordan’s functional framework? What are some components of it?

A

Gorden framework allows us to organize data so that nurses are able to detect patterns

1.) Health perception and health management
-What is the patients perception on their quality of life?
-What is their typical mood or feeling?
-What is their understanding of their current state?
-What health management practice are they using to stay healthy?

2.) Roles and responsibilities/Relationships
-What is their perception of their role in the family?
-What is their current or previous employment?
-What is their satisfaction with family, work and social relationships
-What is their support system? what is their relationship to them?

3.) Self-perception/ Self-concept
-What is their attitudes about self perception (how do they feel about themselves)?
-What is their self-confidence in their abilities?
-Objective data is used here

4.) Cognitive-perceptual pattern
-Do they have problems with hearing, sight, taste, touch, smell and sensory perception
-Do they have any issues with memory
-Any issues with cognitive abilities such as language or decision making abilities

28
Q

What are the 5 stages to Maslows hierarchy of need? 1=bottom 5=top

A

1.) Physiological
-Issues with breathing, food, water, sex, sleep, homeostasis

2.) Saftey
-Security of body, employment, resources, morality

3.) Love/Belonging
-Friendship, family, sexual intimacy

4.) Esteem
-Self-esteem, confidence, achievement, respect of others and by others

5.) Self-Actulization
-Morality, creativity, problem solving, acceptance of facts

29
Q

How do we lose heat?

A

1.) Convection
-Body heat lost to surrounding air

2.) Radiation
-Loss of heat to nearby object without touching it

3.) Respiration
-Through breathing

4.) Evaporation
-Heat loss through prespration

5.) Conduction
-Heat loss through direct touch to an object

29
Q

Hypoxia Vs Cyanosis

A

Hypoxia: Not enough oxygen in the blood
Cyanosis: Objective evidence of decreased oxygen in the blood (below 85%)

30
Q

What can cause alterations in body temperature?

A

1.) Hormone levels during menstruation
2.)Stress, physical and emotional, increases body temperature
3.) Activity level

31
Q

Why does a fever occur? What are the signs?

A

A fever occurs because heat loss mechanisms are unable to keep up with excess heat production, as a result, body temperature rises to an abnormal level

-The skin becomes warm and flushed because of vasodilation
-The person will experience chills, shivers and feel cold even though their body temp is rising

32
Q

What is the difference between heat loss, hyperthermia and hypothermia? Signs and symptoms?

A

1.)Hyperthermia
-Body temperature is elevated as a result of the body’s inability to promote heat loss or reduce heat production
-It results from an overload of the body’s
thermoregulation systems

2.) Heat stroke
-Prolonged exposure to the heat and sun or high environmental temperatures can overwhelm the body’s heat-loss mechanisms
-patients at higher risk are the very young, older persons and those who have cardiovascular disease
-Confusion, delirium, excess thrist, nausea, muscle cramps, visual disturbances, giddiness and incontinence
-Temp can be as high as 45C with an increase in heart rate and lowering of BP

3.)Hyporthermia
-it is classified by core body temperatures
-When the body temp drops to 35C or below, uncontrolled shivering, loss of memory, depression and poor judgement occur
-When temp falls below 34C the skin becomes cyanotic, BP falls, and resp rate falls.
-Loss of consciousness and unresponsiveness to painful stimuli can occur

33
Q

What is the purpose of the planning stage in the nursing process?

A

During this phase, nurses integrate knowledge gatherd from assessments

33
Q

What is the purpose of the planning stage in the nursing process?

A

During this phase, nurses integrate knowledge gathered from assessments and patient history to develop and modify a person-centred plan of care

34
Q

Normal pulse rates across the lifespan?

A

Neonate(28 days): 100-205
Infant (1mon-1 yr): 100-190
Toddler (1-2yr):98-140
Preschool (3-5yr): 80-120
School age (6-11yr): 75-118
Adolescent (12-15yr): 60-100
Older person- 74-75

35
Q

What is a pulse deficit?

A

An inefficient contraction of the heart that fails to transmit a pulse wave to the peripheral pulse site creates a pulse deficit

36
Q

What blood pressure is defined as hypertension?

A

140/90

37
Q

Blood pressure of infant?
Blood pressure of 7 year old?
Older person

A

Infant:
65-115 systolic
42-80 Diastolic

7 year old:
87-117 systolic
48-64

38
Q

What affects blood pressure?

A

Age, stress, ethnicity, gender, daily variation
medication, activity