POD 1

Question 1

What is the difference between medical and surgical asepsis?

Answer 1

Medical asepsis (clean technique) involves procedures used to reduce and prevent the spread of microorganisms.

Surgical Asepsis, (sterile technique) requires different precautions from those of medical asepsis. Surgical asepsis includes procedures used to eliminate all microorganisms, including spores, from an object or area.

Question 2

What are the links in the chain of infection and why is it important for psychiatric nurses to understand the infectious process?

Answer 2

The infectious agent
Reservoir
Portal of exit
A mode of transmission (vehicle on or by which mo can travel e.g., direct contact, indirect (vehicle or vector (=thru insects), airborne, droplet)
A portal of entry to a host
A susceptible host

It is important for Psychiatric Nurses to understand the infectious process to facilitate infection prevention and practice to break the chain of infection so infections don’t develop

Question 3

What do you call an infection that is acquired in a hospital/health care institution?

Answer 3

A health care–associated infection (HAI), also known as nosocomial infection or iatrogenic infection

Question 4

What are the most common microorganisms found in health-care associated infections?

Answer 4

An exogenous infection arises from microorganisms external to the individual that do not exist as normal flora; examples are Salmonella organisms and Clostridium tetani.

An endogenous infection can occur when some of the patient’s flora become altered and overgrowth results. Examples are infections caused by enterococci, yeasts, and streptococci.

Question 5

What are MRSA and Clostridium difficile, and how might they be spread in hospitals?

Answer 5

methicillin-resistant Staphylococcus aureus
&
Clostridium difficile, which can produce spores, can live in hospital environments for months.

both can be spread by direct or indirect contact

Question 6

what is direct contact

Answer 6

Physical skin-to-skin contact between an infected or colonized individual and a susceptible host (e.g. touching patient)

Question 7

what is indirect contact

Answer 7

Contact between a susceptible host and a contaminated intermediate object (e.g., via touching soiled linen, equipment, or dressings; transferring pathogens to a patient via hands that are not washed between handling patients)

Question 8

what is droplet transmission

Answer 8

Large particles (droplets) from the respiratory system of an infected source propelled up to 2 m through the air and deposited onto a susceptible host (e.g., droplets produced via coughing, sneezing, or talking)

Question 9

what is airborne transmission

Answer 9

Small airborne particles (droplet nuclei) containing microbes remain suspended in the air for long periods of time (e.g., droplets and aerosolized airborne particles produced via coughing and sneezing); air currents transmit these particles long distances (>2 m); susceptible host inhales them

Question 10

what is vehicle transmission

Answer 10

A single contaminated source (e.g., water, drugs, intravenous fluid, food, equipment) transmits infection to multiple hosts, possibly resulting in an outbreak

Question 11

what is vector borne transmission

Answer 11

Insects (fleas, mites, ticks, mosquitoes) or pests (e.g., mice) transmit microbes to humans

Question 12

what are the 5 key moments of hand-hygiene

Answer 12

1. before initial contact with the patient, client, resident or the environment
2. Before any clean (routine) or aseptic (sterile) procedure
3. after blood or body fluid risk or exposure
4. After contact or touching the patient, client, or resident
5. after contact with the patient’s environment

Question 13

what is a reservoir

Answer 13

source for pathogen survival and may or may not multiply

Question 14

how is HIV transmitted

Answer 14

through unprotected sexual intercourse, the use of shared needles for injecting drugs, and infected blood products

Question 15

how are hepatitis B & C transmitted

Answer 15

Hep B - blood and body fluids
Hep C - blood

Question 16

what are contact precautions

Answer 16

prevent the transmission of infection that is spread thru direct or indirect contact with a patient
gown + gloves
MRSA

Question 17

what are contact plus precautions

Answer 17

same as contact precautions (gown + gloves) but hand hygiene should be performed with soap and water
C. difficile

Question 18

why should hand hygiene be performed with soap and water when working with a patient with c.difficile

Answer 18

alcohol based sanitizer is not effect for removing c.difficile spores & the mechanical action of hand washing has been proven more effect to remove spores

Question 19

what are droplet precautions

Answer 19

when a patient has something that can be spread through droplets in the air
- influenza
- gown, gloves, surgical mask, eye protection

Question 20

what are airborne precautions

Answer 20

• TB, Measles spread by airborne particles
• gown, gloves, N95 mask, eye protection may be needed if there is a risk of being exposed to spray in the eyes
• negative pressure room is required; pulls air into the room to prevent air from back flowing out of the room and into the rest of the facility spreading infection

Question 21

what are cytotoxic precautions

Answer 21

cytotoxic drugs can damage or mutate DNA of people who handle the drugs
cytotoxic precautions are for up to 48 hours after the last administration of a cytotoxic medication
- when interacting with a pt on these precautions or handling their body fluids you need to: double-glove, special gown with long sleeves and is water resistant (usually plastic disposable), eye protection/face protection
- soiled briefs or soiled linens need to be disposed of in a special container
- if the person is using the toilet, they need to cover the toilet and double flush
- soiled reusable equipment needs to be sent to the sterile processing department

Question 22

How could the psychiatric nurse be exposed to pathogenic blood or body fluids in the work place?

Answer 22

Urine splashes in your eye when emptying a catheter or urinal
Saliva or sputum lands on your lip when a client is coughing or spitting
You are poked with a used syringe

Question 23

How do psychiatric nurses control or reduce their risk of contact with blood or body fluids that may be infected?

Answer 23

Know the risks of the situation in which you may be exposed to infectious material
Follow proper PPE and handwashing guidelines
Handle sharps safely and dispose of them properly
Immediately wash the exposed area with running water, or the emergency eye wash, if applicable
Report immediately for first aid, and to your supervisor

Question 24

What information is usually required on the special form used for recording controlled substances?

Answer 24

the prescribers name, the date, time, amount removed, wastage if appropriate in the narcotic book or automated system

Question 25

What does the count of controlled substances at the end of a shift include?

Answer 25

counting all of the narcotics in the cupboard, signed by two nurses and any discrepancies need to be reported immediately

Question 26

What is the appropriate technique for pouring narcotic medications?

Answer 26

another nurse must witness the waste of the narcotic and sign

Question 27

What are the nurse’s professional and legal responsibilities in preparing and administering medications safely?

Answer 27

Nurses are responsible for following and understanding legal provisions when administering controlled substances A controlled substance is anything that can affect the mind or behavior Must understand patient’s diagnosis, why giving medication, and symptoms that might be associated with medication Must follow the process of 7 rights and 3 checks

Question 28

What is the safe time frame that a medication may be administered?

Answer 28

Within 30 minutes, before or after scheduled time

Question 29

In your textbook, what are the 10 rights of medication administratio

Answer 29

1. The right medication 2. The right dose 3. The right patient 4. The right route 5. The right time and frequency 6. The right documentation 7. The right reason 8. The right to refuse 9. The right patient education 10. The right evaluation

Question 30

When are the 3 checks performed for medication preparation?

Answer 30

1. Checking the medication with the MAR or the medication information system when removing it from the medication drawer, refrigerator, or controlled substance locker. 2. Checking the medication when preparing it, pouring it, taking it out of the unit-dose container, or connecting the IV tubing to the bag. 3. checking the medication before administering it to the patient

Question 31

When is the oral route for medication administration contraindicated?

Answer 31

An oral medication route is contraindicated for patients who cannot tolerate oral drugs, such as those who have altered mental status (decreased LOC) or have nausea or vomiting, and swallowing difficulties that hinder them from safely ingesting the drug orally (risk for aspiration) NPO (nothing by mouth) status (surgery, tests, interventions

Question 32

* How does the nurse pour medications from a ward stock container?

Answer 32

Pour the medication into medication cap of ward stock container and than transfer to medication cup- do not touch medication There is a higher rate of medication error when dispensing medications from ward stock

Question 33

* Which tablets can be broken?

Answer 33

If they are scored by the manufacture You cannot crush or break time release or extended-release medications -> CR, ER, enteric coated (pantoprazole, tamsulosin)

Question 34

* How does the preparation of medications differ for drugs that require special assessment data?

Answer 34

medications that require a pre-assessment like cardiac meds may be poured into a separate cup - in case they need to be held due to assessment results

Question 35

What can the nurse do for patients who have swallowing difficulties

Answer 35

Check if the medications can be crushed and placed in apple sauce Connect with pharmacy and physician for other route options- liquid form

Question 36

What is the appropriate technique for pouring liquid medications

Answer 36

Gently shake the liquid If in a unit dose container, it is ready to be given Multi dose- remove the cap and place so it is not exposed to the surface Hold medication cup at eye level and fill to the desired scale- should be even with the fluid level at its surface

Question 37

What is the meniscus?

Answer 37

Is the curve in the upper surface of a liquid close to the surface of the container or another object, caused by surface tension.

Question 38

How does the technique change for liquid medication doses that are less than 10 mls?

Answer 38

use a needless syringe

Question 39

What is the purpose of capillary blood glucose resting (glucometer testing)?

Answer 39

To understand your patients blood sugar levels and assess for complications (i.e. Decreased level of consciousness, dizziness, confusion, blurred vision, falls)

Question 40

What are the normal capillary blood glucose (glucometer) levels?

Answer 40

4-6 mmol/L

Question 41

What part of the fingers should be used for glucometer testing?

Answer 41

Poke side of finger with lancet; not the pads of finger as these have more nerve endings

Question 41

What part of the fingers should be used for glucometer testing?

Answer 41

Poke side of finger with lancet; not the pads of finger as these have more nerve endings

Question 42

When are glucometer readings done?

Answer 42

Glucometer readings are typically done before meals. They will be ordered by the physician and range from once daily to QID. Blood sugars are also checked four hours prior to surgical procedures When a patient has a change in level of consciousness, a fall, feels dizzy or is confused it is a good idea to do a glucometer check to rule out hypoglycemia

Question 43

What are the 3 most common types of syringes?

Answer 43

Leur-lok syringe TB syringe Insulin syringe

Question 44

What are the 3 parts of the syringe?

Answer 44

Plunger Barrel Tip

Question 45

What are the 3 parts of a needle?

Answer 45

Bevel Shaft Hub

Question 46

What are the differences in calibration with the different types of syringes?

Answer 46

Leur-lok syringe marked in 0.1 tenths - 3 mL capacity Tb syringe long thin barrel- calibrated in sixteenths of a minim and in hundredths of a milliliter- 1 ml capacity Insulin syringe (Insulin 1ml) and calibration in units (10-100)- pre attached needle (cap often orange) Insulin syringe (Insulin 0.5 ml) and calibration in units (5-50) - pre attached needle (cap often orange)

Question 47

How do ampules and vials differ?

Answer 47

- A vial is a closed system where air must be injected into the vial to assist with easy withdrawal – a blunt needle is used to draw up from vials - Vials can be single or multidose -Ampules contain a single dose of medication and are made of glass that is broken open with a plastic shield – Air is not injected into ampules to withdraw medication - A filter needle is used to prevent small glass fragments from entering the syringe when drawing up from an ampule

Question 48

How do you decide whether to inject at a 45-degree or a 90-degree angle for subcutaneous injections?

Answer 48

- size of patient, location - if you can grasp 5 cm of tissue inset 90 degrees - if you can grasp 2.5 cm of tissue insert 45 degrees

Question 49

Do you aspirate by pulling back on the plunger for all subcutaneous injections?

Answer 49

we never aspirate subcutaneous injections

Question 50

What is the usual needle size used for a subcutaneous injection?

Answer 50

The standard needle used for subcutaneous injections is 25-gauge 1.6-cm needle inserted at a 45-degree angle or a 1.3-cm needle inserted at a 90-degree angle

Question 51

* What are the sites for subcutaneous injections?

Answer 51

Recommended sites for insulin injections include the upper arm and the anterior and lateral portions of the thigh, buttocks, and abdomen The abdomen has the quickest absorption – faster than arms, thighs and buttocks

Question 52

* Why do injection sites need to be systematically rotated?

Answer 52

Sites should be rotated sites for greater consistency in absorption of insulin, to preserve skin and subcutaneous tissue integrity

Question 53

* How much medication can be injected via the subcutaneous route?

Answer 53

Only small doses (up to 1 ml) of medications should be given because the tissue is sensitive to irritating solutions and large volumes of medications – reminder that this volume increases up to 2 ml in certain agencies like FHA

Question 54

how long does fast acting insulin take

Answer 54

10-15 mins

Question 55

how long does long-acting insulin take

Answer 55

45 mins lasts 4-5 hours

Question 56

what insulin can be mixed

Answer 56

Humulin can be mixed, others cannot

Question 57

the number gauge of the needle means

Answer 57

higher the number, finer the needle

Question 58

what are subcutaneous injections

Answer 58

- Subcutaneous injections involve administering medications into the loose connective tissue under the dermis - Subcutaneous tissue is not as richly supplied with blood as the muscles, therefore, medication given this route is absorbed more slowly than medication given by IM injections - Medications injected subcutaneously are absorbed completely if the patient's circulatory status is normal