Nursing Process in Infection Control Flashcards
Astle, B. J., & Duggleby, W. (2024). Canadian fundamentals of Nursing. Elsevier Inc.
Assessment
When considering infection prevention, the nurse must assess a patient’s ___ ___, ___, and ___of infections.
(Astle et al., 2024, p. 682)
defence mechanisms
susceptibility
knowledge
(Astle et al., 2024, p. 682)
Assessment
A review of disease ___ with the patient and family may reveal an exposure to a communicable disease.
(Astle et al., 2024, p. 682)
history
(Astle et al., 2024, p. 682)
Status of Defence Mechanisms
A thorough review of the patient’s clinical ___ may allow the nurse to detect signs and symptoms of an infection or a risk for infection.
(Astle et al., 2024, p. 682)
condition
(Astle et al., 2024, p. 682)
Status of Defence Mechanisms
Information about the patient’s ___ against infection can be determined by an analysis of laboratory findings.
(Astle et al., 2024, p. 682)
defences
(Astle et al., 2024, p. 682)
Status of Defence Mechanisms
By knowing the factors that increase ___ or risk for infection, nurses are better able to plan preventive therapy that includes aseptic techniques.
(Astle et al., 2024, p. 682)
susceptibility
(Astle et al., 2024, p. 682)
Status of Defence Mechanisms
Nurses can determine the status of a patient’s normal ___ ___ against infection through a review of the physical assessment findings and the patient’s medical condition.
For example, any break in the skin or mucosa is a potential site for infection.
Similarly, a chronic smoker is at greater risk for acquiring a respiratory tract infection after general surgery because the cilia of the lung are less likely to propel retained mucus from the lung’s airways.
(Astle et al., 2024, p. 682)
defence mechanisms
(Astle et al., 2024, p. 682)
Status of Defence Mechanisms
Any reduction in the body’s primary or secondary ___ against infection places a patient at risk.
(Astle et al., 2024, p. 682)
defences
(Astle et al., 2024, p. 682)
Status of Defence Mechanisms
Risk Factors for Infection
Inadequate Primary Defences or Inadequate Secondary Defences
A. Decreased mobility
B. Decreased ciliary action
C. A suppressed inflammatory response (medication or disease related)
D. Traumatized tissue
E. Altered peristalsis
F. Broken skin or mucosa
G. Obstructed urine outflow
H. A reduced hemoglobin level
I. The suppression of white blood cells (WBCs) (medication or disease related)
J. A change in the pH of secretions
K. A low WBC count (leukopenia)
(Astle et al., 2024, p. 685)
Inadequate Primary Defences
F, D, B, G, E, J, A
Inadequate Secondary Defences
H, I, C, K
(Astle et al., 2024, p. 685)
Status of Defence Mechanisms
Sites for and Causes of Health Care–Associated Infections
- Surgical and Traumatic Wounds
- Urinary Tract
- Respiratory Tract
- Bloodstream
A. Improper insertion technique
B. Failure to cleanse skin surface properly
C. Obstruction or blockages in tubing
D. The addition of a connecting tube or stopcocks to an intravenous system
E. Improper skin preparation (shaving) before surgery
F. Failure to change the intravenous access site when inflammation first appears
G. Improper hand hygiene
H. Contaminated respiratory therapy equipment
I. Improper care of peritoneal or hemodialysis catheters
J. The use of contaminated antiseptic solutions
K. Failure to use aseptic technique during dressing changes
L. Contaminated needles or catheters
M. Inappropriate and unsterile catheterization techniques
N. Improper care of a needle-insertion site
O. Improper technique during the administration of multiple blood products
P. Failure to use aseptic technique while suctioning airway
Q. Urine in the catheter or drainage tube being allowed to re-enter bladder (reflux)
R. An improper specimen-collection technique
S. Inadequate monitoring of in-dwelling urinary catheters
T. Improper disposal of secretions
U. Improper hand hygiene
V. Improper hand hygiene
W. Inadequate monitoring of in-dwelling urinary catheters
X. Failure to change the intravenous access site when inflammation first appears
Y. Failure to cleanse skin surface properly
Z. The insertion of medication additives to intravenous fluid
AA. Failure to monitor in-dwelling urinary catheters
(Astle et al., 2024, p. 684)
- Surgical and Traumatic Wounds
E. Improper skin preparation (shaving) before surgery
B. Failure to cleanse skin surface properly
K. Failure to use aseptic technique during dressing changes
J. The use of contaminated antiseptic solutions
G. Improper hand hygiene
- Urinary Tract
M. Inappropriate and unsterile catheterization techniques
S. Inadequate monitoring of in-dwelling urinary catheters
C. Obstruction or blockages in tubing
R. An improper specimen-collection technique
Q. Urine in the catheter or drainage tube being allowed to re-enter bladder (reflux)
- Respiratory Tract
H. Contaminated respiratory therapy equipment
P. Failure to use aseptic technique while suctioning airway
T. Improper disposal of secretions
U. Improper hand hygiene
- Bloodstream
A. Improper insertion technique
D. The addition of a connecting tube or stopcocks to an intravenous system
F. Failure to change the intravenous access site when inflammation first appears
L. Contaminated needles or catheters
N. Improper care of a needle-insertion site
O. Improper technique during the administration of multiple blood products
Z. The insertion of medication additives to intravenous fluid
I. Improper care of peritoneal or hemodialysis catheters
X. Failure to change the intravenous access site when inflammation first appears
Y. Failure to cleanse skin surface properly
V. Improper hand hygiene
W. Inadequate monitoring of in-dwelling urinary catheters
(Astle et al., 2024, p. 684)
Patient Susceptibility
Many factors influence susceptibility to infection.
Nurses need to gather information about each factor through the patient’s and family’s ___.
(Astle et al., 2024, p. 684)
history
(Astle et al., 2024, p. 684)
Patient Susceptibility
Throughout the lifespan, ___ to infection changes.
(Astle et al., 2024, p. 684)
susceptibility
(Astle et al., 2024, p. 684)
Patient Susceptibility
An infant has immature defences against infection.
Born with only the ___ provided by the mother, the infant’s immune system is incapable of producing the necessary ___ and ___ ___ ___ (___) to adequately fight some infections.
However, ___ infants have greater immunity than do bottle-fed infants because they receive the mother’s antibodies through the ___ ___.
As the child grows, the immune system matures; however, the child is still ___ to organisms that cause the common cold, intestinal infections, and, if the child is not vaccinated, infectious diseases such as mumps and measles.
(Astle et al., 2024, p. 684)
antibodies, immunoglobulins, white blood cells (WBC)
breastfed, breast milk
susceptible
(Astle et al., 2024, p. 684)
Patient Susceptibility
The young or middle-aged adult has refined defences against infection.
Normal flora, body system defences, inflammation, and the immune response provide protection against invading microorganisms.
___ are the most common cause of infectious illness in young and middle-aged adults.
(Astle et al., 2024, p. 685)
Viruses
(Astle et al., 2024, p. 685)
Patient Susceptibility
Defences against infection change with aging.
The immune response, particularly ___-___ ___, declines.
(Yoshikawa, 2020 as cited in Astle et al., 2024, p. 685)
cell-mediated immunity
(Yoshikawa, 2020 as cited in Astle et al., 2024, p. 685)
Patient Susceptibility
___ persons also undergo alterations in the structure and function of the skin, urinary tract, and lungs.
For example, the skin loses its turgor and the epithelium thins; as a result, the skin is more easily abraded or torn.
(Astle et al., 2024, p. 685)
Older
(Astle et al., 2024, p. 685)
Patient Susceptibility
Focus on Older Persons: Immune Function
An age-related decline in immune system function, termed immune ___, increases the body’s susceptibility to infection and lessens the strength of the overall immune response
___ disease, prevalent among older persons, allows infectious agents to readily invade; hospitalization and institutionalization as a result of ___ disease also increase older persons’ exposure to pathogens
Risks associated with the development of infections in older patients include poor nutrition, unintentional weight (loss/gain), and low serum ___ levels.
Age-related changes in immunity contribute to the increased risk for acquiring ___ and ___ in older adulthood, both of which have significant age-related increases in mortality rates.
Older persons present with an altered response to infection with atypical signs and symptoms such as ___.
(Azar & Ballas, 2022; Government of Canada, 2020; Yoshikawa, 2020 as cited in Astle et al., 2024, p. 684)
senescence
Chronic, chornic
loss, albumin
pneumonia, influenza
confusion
(Azar & Ballas, 2022; Government of Canada, 2020; Yoshikawa, 2020 as cited in Astle et al., 2024, p. 684)
Patient Susceptibility
Assessing the Risk of Infection in Older Persons
Component
- Skin
- Peripheral Nerves
- Circulation
- Peripheral Circulation
- Mouth
- Gastrointestinal Tract
- Pulmonary System
- Genitourinary Tract
- Nutrition
- Medication Therapy
- Long-Term Care Residency
Possible Changes With Aging
A. Dehydration, reduction in saliva production, functional inability to maintain oral hygiene
B. Increased colonization of oropharynx, impaired mucociliary clearance, decreased macrophage function, decreased cough reflex
C. Loss of elasticity of veins (prone to distension), less effective venous valves, blood pooling in lower extremities
D. Thinner dermal and epidermal layers, decreased collagen strength, decreased skin elasticity, decreased sweating
E. Corticosteroid and cytotoxic medications
F. Reduced sensitivity, particularly in patients with a history of alcohol use disorder, vitamin B12 deficiency, and diabetes mellitus
G. Malnutrition, vitamin deficiency (vitamin A, vitamin C, pyridoxine, and riboflavin), protein and caloric deficiencies
H. Prostatic hypertrophy or hyperplasia, urethral strictures, age-related hormonal changes in vaginal wall, pelvic floor relaxation, ureterocele or cystocele, degeneration of nerves leading to neurogenic bladder, use of tricyclic antidepressants results in urinary retention, dehydration
I. Heart failure, calcified mitral and aortic valves
J. Age-related changes are multifactorial and include changes in all systems of the body that contribute to the risk of infection. The increasing use of invasive devices, antimicrobials, and multiple medications contribute to infections in this population. The health care setting may provide a setting that promotes the development and spread of infections. Preventive measures should be instituted, such as increased hand hygiene, reduced use of in-dwelling catheters, increased efforts to reduce aspiration, increased administration of vaccines, and prudent use of antibiotics.
K. Loss of ability to secrete stomach acid in 30% of persons older than 70 years
Possible Outcomes
I. Impaired Immune Response to Infection
II. Impaired Immune Response to Infection in Patients Already at Risk for Decline in Immune System Function
III. Pressure Injuries, patients unaware of trauma to skin, leading to infection
IV. Viral and Bacterial Pneumonia
V. Pressure Injuries
VI. Asymptomatic Bacteriuria, Cystitis, Pyelonephritis
VII. Pneumonia, bacterial endocarditis
VIII. Frequent Serious Infection, Increased Risk of Pneumonia and Urinary Tract Infections, Increased Risk of Acquiring a Multidrug-Resistant Organism
IX. Venous Stasis Ulcers
X. Salmonella Diarrhea
XI. Parotid Gland Infection, Periodontal Disease, Localized Abscess, Bacteremia
(Yoshikawa, 2020 as cited in Astle et al., 2024, pp. 685, 686)
- D V
- F III
- I VII
- C IX
- A XI
- K X
- B IV
- H VI
- G I
- E II
- J VII
(Yoshikawa, 2020 as cited in Astle et al., 2024, pp. 685, 686)
Patient Susceptibility
When ___ intake is inadequate as a result of poor diet or debilitating disease, the rate of ___ breakdown exceeds that of tissue synthesis.
(Astle et al., 2024, p. 685)
protein
protein
(Astle et al., 2024, p. 685)
Patient Susceptibility
A reduction in the intake of ___ and other nutrients such as carbohydrates and fats reduces the body’s defences against infection and impairs wound healing.
Patients with illnesses or conditions that increase ___ requirements are at further risk.
These conditions include traumatic injury, extensive burns, and conditions causing fever.
Patients who have had surgery also require increased ___.
(Astle et al., 2024, p. 685)
protein
protein
protein
(Astle et al., 2024, p. 685)
Patient Susceptibility
Nurses need to assess patients’ dietary ___ and ability to ___ solid foods.
(Astle et al., 2024, p. 685)
intake
tolerate
(Astle et al., 2024, p. 685)
Patient Susceptibility
Patients who have difficulty swallowing, who experience alterations in digestion, or who are too confused or weak to feed themselves are at risk for inadequate dietary ___.
(Astle et al., 2024, p. 685)
intake
(Astle et al., 2024, p. 685)
Patient Susceptibility
A ___ may be called in to assess the nutritional adequacy of a patient’s diet.
When preparing a patient for discharge, the nurse should evaluate the patient’s and family’s understanding of nutritional needs.
(Astle et al., 2024, p. 685)
dietitian
(Astle et al., 2024, p. 685)
Patient Susceptibility
The general adaptation syndrome is the body’s response to emotional or physical stress.
During the alarm stage, the basal metabolic rate (decreases/increases) as the body uses energy stores.
Adrenocorticotropic hormone (ACTH) acts to increase serum glucose levels and decrease unnecessary anti-inflammatory responses through the release of ___.
If stress continues or becomes intense, elevated ___ levels result in a decreased resistance to infection.
(Astle et al., 2024, p. 686)
increases
cortisone
cortisone
(Astle et al., 2024, p. 686)
Patient Susceptibility
(Astle et al., 2024, p. 686)
(Astle et al., 2024, p. 686)
Patient Susceptibility
(Astle et al., 2024, p. 686)
(Astle et al., 2024, p. 686)
Patient Susceptibility
(Astle et al., 2024, p. 686)
(Astle et al., 2024, p. 686)
