pod 1 Flashcards
difference between medical and surgical asepsis
- Medical asepsis: procedures used to reduce and prevent the spread of microorganisms (hand hygiene, clean gloves = prevent contact with bodily fluids and cleaning environment frequently aids in medical asepsis)
Surgical asepsis: procedures used to eliminate all microorganisms (object considered contaminated when touched by something that is not sterile)
Difference: medical = reduce and prevent the spread of microorganisms & surgical = complete removal of microorganisms
What are the links in the chain of infection and why is it important for psychiatric nurses to understand the infectious process?
Infectious agent (pathogen)
A reservoir (source for the pathogen growth (in person, equipment, environment, food or water))
Portal of exit of reservoir (sneezes, coughing)
Mode of transmission (direct, indirect, vehicle, vector)
Portal of entry into host (example: entry through a wound)
Susceptible host
To break the chain so that infections do not develop and reduce risk of passing on infections to patients (importance of hand hygiene)
What do you call an infection that is acquired in a hospital/health care institution?
Healthcare-associated infections (HAIs) or nosocomial infections
What are the most common microorganisms found in health-care associated infections?
Clostridium difficult (C. Diff)
Catheter-associated UTIs
Ventilator-associated pneumonia
Methicillin-resistant staphylococcus aureus (MRSA)
What are MRSA and Clostridium difficile, and how might they be spread in hospitals?
MRSA and C. Diff are HAIs
They spread in hospitals by direct contact and improper hand hygiene, improper cleaning of environments, not using PPE, and improper antibiotic stewardship
How are HIV and the hepatitis B and C viruses transmitted?
Through the exchange of bodily fluids like sharing needles, syringes or sexual experiences
How could the psychiatric nurse be exposed to pathogenic blood or body fluids in the work place?
Needlesticks or cuts, through direct contact and other sharps equipment that is contaminated with a patient’s bodily fluids
How do psychiatric nurses control or reduce their risk of contact with blood or body fluids that may be infected?
Getting vaccinated, washing hands frequently, handling sharps properly, cleaning and disinfecting spills, using PPE, practicing cough etiquette, staying home if sick,
What does WorkSafe BC recommend to health care providers should they experience an exposure incident? What exposure incidents are potentially harmful?
IMMEDIATELY WASH HANDS AND ANY OTHER SKIN WITH SOAP AND WATER, FLUSHING OUT MUCOUS MEMBRANES, INFORM SUPERVISOR AND COMPLETE APPROPRIATE INCIDENT REPORT
What are the different types of personal protective equipment used by psychiatric nurses to maintain isolation precautions?
Gowns, masks, protective eye wear, and gloves
What are the procedures for donning and doffing personal protective equipment?
Donning: hand hygiene, gown, mask, eye protection, gloves
Doffing: gloves, hand hygiene, gown, hand hygiene, eye protection, hand hygiene, mask, hand hygiene
What are the practices used for the disposal of soiled equipment and supplies by psychiatric nurses to maintain standard precautions?
USE APPROPRIATE BINS, SHARPS, SOILED LINEN BIN, PULP MACERATOR FOR HUMAN WASTE
contact precautions
Contact precautions: prevent transition of infectious agents through direct or indirect exposure (C. Diff) & wear a gown and gloves for all interactions, private room, limiting patient movement outside isolation room
airborne precautions
Airborne precautions: for known or suspected infections caused by microbes transmitted by airborne droplets (varicella, TB) & private room (door closed), respiratory protection device (N95)
droplet precautions
Droplet precautions: for known or suspected infections caused by microbes transmitted by droplets produced by coughing, sneezing, or talking (rubella, mumps, influenza) & private room (door closed unless bed 2m from door), mask worn when within 2m from patient
identify common types of isolation precautions
- contact, airborne, droplet
What considerations will be made to maintain psychosocial well-being of patients on isolation precautions?
Providing education to the patient and family on the isolation precautions, taught proper hand hygiene, improve patients sensory stimulation (environment should be clean, blinds open, and extra equipment removed), listen to patient’s concerns, providing comfort, encourage movement, recreational activities if permitted)
What are the nurse’s professional and legal responsibilities in preparing and administering medications safely?
Following and understanding legal provisions when administering controlled substances
Must understand patient’s diagnosis, why giving medication, and symptoms that might be associated with the medication
Must follow the 7 right’s and 3 medication checks
What is the safe time frame that a medication may be administered?
30 minutes before or after the original ordered time
What should the nurse do if the patient is unable to hold the medication cup?
PLACE THE MEDICINE CUP TO THE PATIENT’S LIPS & GENTLY INTRODUCE EACH DRUG INTO THE MONTH ONE AT A TIME
What interventions can the nurse use if the medication has an objectionable taste?
- mix with something else to try and mask the taste, crushing it up
In your textbook, what are the 10 rights of medication administration?
Right patient, right medication, right dose, right route, right time & frequency, right documentation, right reason, right to refuse, right patient education, right evaluation
When are the 3 checks performed for medication preparation?
- checking the medication with the MAR or medication information system when removing it from the medication storage area
- checking the medication when preparing it, pouring it, taking it out of the unit-dose container or connecting the IV tubing to the bag
- checking the medication before administering it to the patient
What are the steps that the nurse must take when she/he is in the process of administering medications?
- TWO PATIENT IDENTIFIERS
- COMPARE MAR TO PATIENT WRISTBAND
- ASSESS FOR ALLERGIES
- ADMINISTER MEDICATIONS ONLY PREPARED BY SELF
Describe how to administer an oral medication.
When is the oral route for medication administration contraindicated?
Decreased level of consciousness
Nausea, vomiting
Swallowing difficulties, risk for aspiration
Nothing by mouth (NPO) status – surgery, tests, interventions
How does the nurse pour medications from a ward stock container?
Pour the medication into medication cap and then transfer the medication cup (do not touch)
Higher rate of medication error when dispensing medications
Which tablets can be broken?
If they are scored
Do not crush/break time release or extended-release medications (CR, ER, enteric coated)
How does the preparation of medications differ for drugs that require special assessment data?
CHECK VITAL SIGNS, PERFORM A FOCUSED ASSESSMENT, REVIEW LAB RESULTS, AND PAIN ASSESSMENT
What can the nurse do for patients who have swallowing difficulties?
Check if the medications can be crushed and placed in apple sauce
Connect with pharmacy and physician for other route options
What is the appropriate technique for pouring liquid medications?
Gently shake liquid
If in unit dose container, ready to be given
Multi dose: remove cap and place so its not exposed to surface, hold medication cup at eye level and fill to the desired scale
What is the meniscus?
Curve in the upper surface of a liquid close to the surface of the container and is caused by surface tension
How does the technique change for medication doses that are less than 10 mls?
Use a needless oral syringe
What information is usually required on the special form used for recording controlled substances?
DOCUMENT THE PRESCRIBERS NAME, DATE, TIME, AMOUNT REMOVED, AND ANY WASTE IF APPROPRIATE
What does the count of controlled substances at the end of a shift include?
REFLECTS HOW MUCH HAS BEEN REMOVED
What is the appropriate technique for pouring narcotic medications?
CHECK MAR FOR PREVIOUS DOSE AND TIME, PERFORM A DRUG COUNT BEFORE REMOVING AND COMPARE TO LOG, POUR INTO SEPARATE MEDICINE CUP FROM OTHER MEDS
What is the purpose of capillary blood glucose resting (glucometer testing)?
To understand patients blood sugar levels and assess for complications (Decreased LOC, dizziness, confusion, falls)
Describe how you would perform capillary blood glucose testing (a glucometer test)
Set up glucometer
Assess area of skin to puncture
Clean site with alcohol and allow to dry
Explain procedure to patient
Perform hand hygiene & put on gloves
Select depth on needle on the lancet - 3 settings (shallow, medium, deep)
Poke side of finger with lancet; not pads because they have more nerve endings
To obtain a drop of blood - stroke from wrist, hand to fingertip (avoiding squeezing around puncture site = distorts results)
WIPE away first drop with gauze as this specimen contains greater protein altering results
Press test strip into blood sample – ensure the test strip fills completely with blood
Analyze results, dispose of materials appropriately & document
What part of the fingers should be used for glucometer testing?
The sides of the finger
What are the normal capillary blood glucose (glucometer) levels?
4 to 7 mmol/L
When are glucometer readings done?
Done before meals, range from once a day to QIB
Patient has change in level of consciousness, a fall, dizziness or confusion to rule out hypoglycemia
What are the 3 most common types of syringes?
Luer-lok syringe, tuberculin syringe, insulin syringe
What are the 3 parts of the syringe?
A plunger, barrel, needle hub
What are the 3 parts of a needle?
The hub: fits onto the tip of syringe, the shaft: connects to hub, the bevel or slanted tip
What are the differences in calibration with the different types of syringes?
The difference is based on the volume they hold
insulin syringes are available from 0.3mL to 1mL and calibrated in units (10, 15, 20)
tuberculin syringes calibrated in sixteenths of a minim & in hundredths of a millilitre & has a capacity of 1mL (0.1, 0.15, 0.2)
LEUR-LOK: MEASURES IN TENTHS (2.5, 2.6, 2.7)
What are some interventions that the nurse can use to prevent needle stick injuries?
Avoid using needles when effective needless systems or sharps with engineered sharps injury protections (SESIP) safety devices are available
Never recap needles
Never move an exposed needle tip toward an unprotected hand
Plan safe handling and safe disposal of needles before beginning the procedure
Immediately dispose of needles, needless systems, & SESIP into puncture-proof containers located near the area of use
How do ampules and vials differ?
Ampules contain single doses of medication in a liquid, constricted neck that must be snapped off to access the medication and is scored for easy breakage
Vial is a single dose or multi dose contain with a rubber seal, it is a closed system and air must be injected into the vial to permit easy withdrawal
Identify the technique for using ampules and vials
Ampules: break the scored section of the glass neck in order to gain access to the medication
Vials: air must be injected into the vial to permit easy withdrawal, failure to inject air creates a vacuum within the vial making it difficult to withdraw
What is the purpose of a filter needle?
Prevent small glass fragments from entering the syringe
Identify the technique for mixing medications in one syringe
Aspirate a volume of air equivalent to first medications dose (vial A), inject the air into vial A, ensuring the needle doesn’t touch the solution, withdraw the needle and aspirate a volume of air equivalent to the second medications dose (vial B), inject air into vial B & immediately withdraw the medication from vial B into the syringe, then insert the needle back into vial A, being careful not to push the plunger and expel the medication, withdraw the desired amount of medication from vial A into the syringe
What kinds of drugs can be administered subcutaneously?
Insulin, opioids, heparin, epinephrine, and allergy medication
What are the sites for subcutaneous injections?
adipose tissue: upper arms, outer side of upper thigh, belly area
How much medication can be injected via the subcutaneous route?
UP TO 2 MLs
What is the usual needle size used for a subcutaneous injection?
25-gauge 1.6 cm needle at a 45 degree angle or a 1.3 c/m needle inserted at a 90 degree angle
Describe how to administer a subcutaneous injection
ALCOHOL SWAB THE SITE, LET DRY, PINCH THE SKIN, INSERT NEEDLE WITH BEVEL TIP FACING UP IN A DART-LIKE MOTION AT 45-90º, DEPENDING ON TISSUE THICKNESS
How do you decide whether to inject at a 45-degree or a 90-degree angle for subcutaneous injections?
If you can grasp 5 cm of tissue, insert the needle at 90-degrees
If you can grasp 2.5cm of tissue, insert the needle at 45-degrees
Why do injection sites need to be systematically rotated?
In order to avoid a build-up of fatty tissue which can occur when shots are always given in the same place
Do you aspirate by pulling back on the plunger for all subcutaneous injections?
NO, NEVER ASPIRATE ON SUBCUTANEOUS INJECTIONS
What is the procedure for mixing of insulins in the same syringe?
when mixing insulin, air in N (long acting), air in R (rapid acting), grab R, and then N (long acting)
COMMON TYPES OF INSULIN
RAPID, SHORT, INTERMEDIATE, AND LONG ACTING
RAPID-ACTING INSULIN
ONSET: 15-30 MINS
PEAK EFFECT: 1-3 HRS
DURATION OF ACTION: 3-6.5 HRS
SHORT-ACTING INSULIN
ONSET: 30 MINS - 1 HR
PEAK EFFECT: 1-5 HRS
DURATION OF ACTION: 6-10 HRS
IMMEDIATE-ACTING INSULIN
ONSET: 1-2 HRS
PEAK EFFECT: 6-14 HRS
DURATION OF ACTION: 16-24 HRS
LONG-ACTING INSULIN
ONSET: 0.8-2 HRS
PEAK EFFECT: PEAKLESS
DURATION OF ACTION: UP TO 24 HRS
WHAT IS A SLIDING SCALE?
FOR RAPID OR SHORT-ACTING INSULINS, ADJUST NUMBER OF UNITS ACCORDINGLY BASED ON BLOOD SUGAR LEVELS, 15 MINS BEFORE MEALS
BLOOD GLUCOSE AND INSULIN DOCUMENTATION
RECORD ON THE MAR AND DIABETIC RECORD, AND FOCUS NOTE-ONLY IF INCIDENT OCCURS
HYPERGLYCEMIA
HIGH BLOOD SUGAR LEVELS (>7mmol/L)
SYMPTOMS OF INCREASED THIRST, URINATION AND WEAKNESS, FRUITY ODOR, HYPOTENSION, ALTERED LOC AND PROLONGED HEALING TIMES
TX: ANTIDIABETIC MEDICATON, DIABETIC DIET/EXERCISE
HYPOGLYCEMIA
LOW BLOOD SUGAR LEVELS (<4mmol/L)
SYMPTOMS OF HUNGER, TREMOR, TACHYCARDIA, DIAPHORESIS, HEADACHE AND CONFUSION
TX: AGENCY PROTOCOL, RECHECK STATUS AFTER GLUCOSE INTAKE, PROVIDE A SNACK AND PATIENT EDUCATION
DIABETIC KETOACIDOSIS
HYPERGLYCEMIA, HIGH KETONES, METABOLIC ACIDOSIS
DUE TO LACK OF INSULIN
GLUCOSE DEFICIT, MOBILIZING FATS=KETONES
TX: INSULIN.& IV FLUIDS
