Safe And Effective Care Environment Flashcards
Mass casualty protocol
Decision-making to determine the greatest good for the greatest number of people
Chain of infection (6)
1-Etiological infectious agent, 2-reservoir, 3- portal of exit from the reservoir, 4-mode of transmission, 5-portal of entry, 6-host
Infectious process (4)
1- incubation period,
2- prodromal period
3- Illness period
4- convalescent period
Levels of sepsis
SIRS (systemic Inflammatory response syndrome)- symptoms of infection
Sepsis -2 SIRS + suspected infection
Severe sepsis- signs of end organ damage, hypotension, lactate >4mmol
Septic shock- persistent signs of above
Methods of sterilization
1-Moist heat (autoclave)steam under pressure is used because it attains higher temperatures in the boiling point
2-Gas Ethylene- oxide gas. Inhibits micro organisms metabolic process. Also effective against spores. But toxic to humans.
3-Boiling water. Not all viruses and spores are killed by this method
4-Radiation -ionizing and non ionizing radiation . Very expensive
Pruritus
Itchy skin
Maceration
The softening of a solid by soaking.
Symptoms: Pale and wrinkled skin, spongy, irregular swelling.
Can cause bedsores, diabetic foot ulcers, cellulitis
Excoriation
Skin scraped off
Difference Between excoriation and abrasion
Both are skin scraped off but excoriation is more of a linear scratch. Abrasion is rubbed off skin by friction
Arterial ulcers often form on the outer side of the ankle, feet, heels, or toes. They can form in other areas, too. These ulcers are painful and have a “punched out” appearance.
Other symptoms:
Lack of arterial blood flow. Symptoms: red,yellow, or black sores deep wound tight, hairless skin leg pain at night no bleeding affected area is cool or cold to touch ffrom minimal blood circulation leg reddens when dangled and turns pale when elevated
Venous ulcers usually form below the knee and on the inner area of the ankle. There’s sometimes little or no discomfort, unless the ulcer is infected. In other cases, venous ulcers can be painful.
inflammation swelling aching itchy, hardened skin scabbing or flaking brown or black stained skin discharge
Clean contaminated wounds
Surgical wounds that enter the gastrointestinal, respiratory or genitourinary tracts
Contaminated wound
Major break in asepsis
Sign symptoms of a stage 1 pressure ulcer
Non-blanchable redness,
painful,
firm or soft,
warmer or cooler in temperature
Signs and symptoms of a stage 2 pressure ulcer
Defined as A partial thickness loss of dermis presenting in one of two ways:
either -a shallow open ulcer with a red pink wound bed without slough
-or an intact or open or ruptured serum filled blister
Slough in wounds
Refers to the shedding of a filmy, moist appearing, dead tissue with in a wound bed.
No sloughing with stage 2 pressure ulcers.
Stage III pressure ulcer
Characterized by full thickness tissue loss.
Subcutaneous fat may be visible but subcutaneous skin is present. Sloughing may occur at this stage.
Tunneling is possible.
Stage 4 pressure ulcers
Characterized by full thickness tissue loss accompanied by exposure of muscle, tendon or bone.
Eschar or sloughing may be present.
Undermining and tunneling with and tissues are common.
Difference between eschar vs sloughing
slough (dead tissue, usually cream or yellow in color)
eschar (dry, black, hard necrotic tissue)
Unstageable pressure ulcer
Indeterminate in depth characterized by full thickness tissue loss in which the base of the wound is obscured by slough or eschar
RYB colorcode what does red wound color represent?
Represents granulation tissue developing in the late regenerative stage of healing. Tissue is fragile at this stage.
Rationale for treatment is to protect the wound and the surrounding skin. Moist dressings usually
RYB colorcode what do yellow wounds represent?
Suppurative, meaning they secrete purulent material along with seropurulent Drainage. Rationale of treatment is to clean the skin of infectious drainage and debris and promote growth of the viable tissue.
Absorbent dressings.
RYB color code wounds.What does black represent?
Necrotic tissue and eschar, which is a dry scab like covering or slough covering all parts of wound.
Requires debridement
Mechanical debridement
Uses force to remove dead tissue. (Not surgical) Wet to dry dressing’s, whirlpool treatment or lavage of the wound bed and walls. Potential risk of doing damage to granulating tissue which is needed for healing. Because of this, Wet to dry dsg and whirlpool are outdated.
Auto lytic debridement
Uses the bodies own biologic defenses to affect debridement. Natural enzymes liquefy the debris. Requires the use of semi inclusive or occlusive moisture retentive dressings such as transparent film hydrocolloid or hydrogel.
Enzymatic or chemical debridement
Uses proteolytic enzymes.
Slow but effective.
Biological debridement
Maggots eat and digest necrotic and infected tissue.
Widely used in europe and gaining acceptance in US.
Ultrasound assisted debridement.
Saline fluid pressure used to deliver ultrasound waves. Causes separation of necrotic tissue from healthy tissue.
Pneumonic for types of dressings
Chi path C: clear absorbent acrylic H: hydrocolloids I: impregnated non adherent dressings P: polyurethane foam A: alginates T: transparent film H: hydrogels
Clear absorbent acrylic dressing
Tegaderm Absorbent Allows wound to remain moist and to be seen. Usually lasts 5-7 days. Remains permeable to oxygen exchange. For deep wounds, could cover alginates.
Hydrocolloid dressing
Duoderm
Wafers, pastes or powders that contain 2 layers.
Inner layer is adhesive that also absorbs exudates.
Outer layer is occlusive seal.
Can last 7 days.
Disadvantages- not transparent and promotes anaerobic growth.
Impregnated non- adherent dressing
Xeroform
Made of woven or non woven cloth impregnated with petrolatum, saline, zinc-saline or antimicrobial ointments.
Used to cover, soothe and protect skin.
Polyurethane foam dressing
Hydrocolloid used to absorb large amounts of exudates while maintaining moist environment.
Requires care of surrounding tissue to prevent maceration.
Edges need to be taped down and covered with a second occlusive dressing.
Alginates dressings
Alginic acid- found in seaweed.
Comes in paste, granules, ropes, powder or sheets.
Highly absorbent and retains moisture.
requires secondary occlusive dressing.
Transparent film dressing
tegaderm
Semipermeable, nonabsorbent, adhesive dressing.
Cover iv sites, central lines or superficial wounds.
Permit exchange of oxygen, but impermeable to water or bacteria.
Hydrogel dressing
Water or glycerin based substances
Sheets, granules or gel.
Permeable to oxygen.
Used to liquefy necrotic tissue, rehydrate wound bed and function as filler within wound craters.
Braden scale for predicting Pressure Sore Risk
(Low score is high risk)
What are the 6 parameters?
Sensory perception Moisture Physical activity Mobility Nutrition Friction and shear
Passive vs. active vs. interactive dressings
- Passive: Protective function only
- Active: create moist environment
- Interactive: create moist environment but also interact with wound to stimulate cell activity and growth.
Hydrofiber dressings
Absorbent
Composed of cellulose
Shaped in ropes or sheets
Surgical Drains
Covered with sterile sterile absorbent dsg.
Drain dressings are usually changed BID
Penrose drain
Can be used for various wounds or surgical incisions.
Once rubber tubing is removed, a track through the skin remains to continue to drain fluid until the track heals.
Yates drain
Made of polyurethane.
Causes less reactive tissue response than Penrose drain.
Once drain is removed, track tends to close.
Hemovac drainage system
Round flat bag with springs.
Connected to surgical wound by tubing.
Usually emptied BID and measure contents.
Compress bag before closing stopper to create a vacuum pulling fluid.
Jackson- Pratt drainage system
Elongated oval shaped bulb that could fit in palm of hand.
Squeeze bulb while closing port to create vacuum.
Topical negative pressure system
AKA vacuum- assisted closure device (VAC)
Negative pressure vacuum.
Not antimicrobial, so observe for infection.
Should not be used if patient has low albumin or at risk for bleeding(warfarin), or depleted platelets.
Should not be used if wound is approximating an internal organ.
Application of cold
Causes vasoconstriction and reduces blood flow, which reduces edema and inflammation.
Avoid cold in tx of open wounds, because it decreases blood flow and slows healing.
Application of heat
Causes vasodilation and increases blood flow, with its supply of oxygen and nutrients.
Promotes soft tissue healing.
If applied too early in event of closed traumatic injury, will increase edema and bruising.
Do not use after surgery.
Dietary modifications to improve wound healing
Protein
Vitamins A, B, C and zinc.
At least 2500 ml fluid intake per day.
Droplet nuclei are important in transmission of what disease?
Tuberculosis
Three types of body defenses
1- Normal body defenses: intact skin and mucous membranes normal flora, cilia of respiratory tract, saliva, urine
2 Secondary defenses: localized inflammation-Edema, pain, increase local temperature,
systemic inflammation-fatigue, increased WBC
3 Tertiary defense: immune response or antibody production
CDC’s 1st tier of medical asepsis
Universal precautions
Hand hygiene
CDC’s 2nd tier of medical asepsis
Transmission based precautions
Used with patients who are known to have infection
Difference between antiseptic and disinfectant
Antiseptic is used on skin
Disinfectant used on objects
3 types of wound healing
Primary intention- no complications, minimal tissue loss
Secondary intention- extensive tissue loss. Edges not approximated. Wound is left open and granulation fills in.
Tertiary intention- delayed closure- keeping wound open to heal is optimal. Seen in poor circulation or infection.
3 stages of wound healing
Inflammatory phase: 3-6 days, deposition of fibrin, form blood clots
Proliferative phase: 4-21 days, collagen synthesized- fragile
Maturation phase: 21 days - 2 years, wound remodeling
Serous exudate
Clear, looks watery
Example is fluid from blister
Purulent exudate
Thicker than serous.
contains pus, which consists of leukocytes, liquified dead tissue debris, and dead and living bacteria.
Varies in color- green, blue or yellow depending on bacteria.
Formation of pus is called:
suppuration
Sanguineous exudate
Consists of large amounts of RBC’s.
Indicates damage to capillaries
Serosanguineous fluid is both clear and blood tinged
Pursanguineous has pus and blood
