Safety Unit 2 Flashcards
Heat, redness, pain/tenderness, swelling, possible drainage (bloody, serous, purulent), abscess, cellulitis
Local infection (focal point)
Localized collection of pus
Abscess
Involving cellular and connective tissue
Cellulitis
Fever, malaise, weakness
Systemic ( generalized) infection
Normally 5,000-10,000/mm3
WBC
Increase indicates the presence of disease or injury
WBC
Elevations >15-20mm/h indicates the presence of inflammation
Erythrocytes sedimentation rate (ESR)
Should be obtained before onset of antibiotic therapy
Culture of suspected infectious site
Immediate,short-term, nonspecific response to the side effects of injury
Inflammation
Caused by pathogenic micro organisms and transmitted by direct contact, droplet spread, contaminated articles or through carriers
Communicable disease
Nearly 2 million (5%) hospital patients acquire an infection in the hospital
Nosocomial infection
Most often caused by Staphylococcus aureus
Nosocomial infection
Primary strategy for nosocomial infection control
Standard Precautions (barrier)
Apply to blood, all body fluids, secretions, and ecretions, except sweat
Standard precautions
Use clean nonsterile when touching blood, body fluids, secretions, excretions, contaminated articles
Standard Precautions
Use clean nonsterile gowns to protect skin and prevent soiling of clothing during procedures and patient care activities likely to generate splashes and sprays
Standard Precautions
Private room if patient has poor hygiene habits, contaminates the environment, or can’t assist in maintaining infection control precautions (e.g. Infants, children, altered mental status patient)
Standard Precautions
3 Transmission based precautions
Airborne
Droplet
Contact
Apply to patient with documented or suspected infections with highly transmissible or epidemiological lay important pathogens
Transmission based precautions
Used with pathogens that are transmitted by airborne route
Airborne precautions
Private room with monitored negative air pressure with 6-12 air changes per hour
Airborne precautions
Keep door closed and patient in room
Airborne precautions
Can cohort or place patient with another patient with the same organism, but no other organism
Airborne precautions
Place mask on patient if being transported
Airborne precautions
Used with pathogens transmitted by infectious droplets
Droplet precautions
Involves contact of conjunctiva or mucous membranes of nose or mouth; happens during coughing, sneezing, talking, or during procedures such as suctioning or bronchoscopy
Droplet precautions
Private room or with patient with same infection but no other infection
Droplet precautions
Maintain spatial separation of three feet between infected patient and visitors or other patient
Droplet precautions
Door may remain open
Droplet precautions
Place mask on patient if being transported
Droplet precautions
Needed with patient care activities that require physical skin to skin contact or occurs between two patients, or occurs by contact with contaminated inanimate objects in patient’s environment
Contact precautions
Private room or with patient with. Same infection but no other infection
Contact precautions
Clean, nonsterile gloves when entering room
Contact precautions
Changes gloves after patient contact with fecal material or wound drainage
Contact precautions
Remove gloves before leaving patient’s environment and wash hands with anti microbial agent
Contact precautions
Wear gown when entering room if clothing will have contact with patient, environment surfaces, or if patient is incontinent, has diarrhea, an ileostomy, colostomy, or wound drainage
Contact precautions
Remove gown before leaving room
Contact precautions
Use dedicated equipment or clean and disinfect between patients
Contact precautions
Incubation of 13-17 days
Chickenpox
9 Communicable diseases of childhood
Chickenpox Diphtheria Pertussis Rubella Rubeola Scarlet fever Mononucleosis Tonsillitis Mumps
Incubation of 2-5 days
Diphtheria
Incubation of 5-21 days; usually 10
Pertussis
Incubation of 14-21 days
Rubella
Incubation of 10-20 days
Rubeola
Incubation of 2-4 days
Scarlet fever
Incubation of 4-6 weeks
Mononucleosis
Streptococcal
Tonsillitis
Incubation of 14-21 days
Mumps
- the interval of time required for development.
- the interval between the receipt of infection and the onset of the consequent illness or the first symptoms of the illness.
- the interval between the entrance into a vector of an infectious agent and the time at which the vector is capable of transmitting the infection.
incubation period
Early symptoms
Prodromal period
Prodromal: slight fever, malaise, anorexia
Chickenpox
Rash is pruritic, begins as macule, then papule and then vesicle with successive crops of all three stages present at any one time
Chickenpox
Prodromal: resembles common cold
Diphtheria
Low grade fever, hoarseness, malaise, pharyngeal lymphadenitis
Diphtheria
Characteristic white / gray pharyngeal membrane
Diphtheria
Prodromal: upper respiratory infection for 1-2 weeks
Pertussis
Severe cough with high pitched “whooping sound” especially at night Lasts 4-6 weeks; vomiting
Pertussis
Prodromal: none in children, low fever and sore throat in adolescent
Rubella
Maculopapular rash appears first on the face and the on the rest of the body
Rubella
Symptoms subside first day after rash
Rubella
Prodromal: fever and malaise followed by cough and Kopliks spots on buccal mucosa
Rubeola
Erythematous maculopapular rash with face first affected; turns brown after 3 days when symptoms subside
Rubeola
Prodromal: high fever with vomiting and chills, malaise, followed by enlarged tonsils covered with exudate,strawberry tongue
Scarlet fever
Rash: red tiny lesions that become generalized and then desquamate; rash appears within 24 hours
Scarlet fever
Malaise, fevere, enlarged lymph nodes, sore throat, flulike aches, low grade temperature
Mononucleosis
Highest incidence 15-30 years old
Mononucleosis
Fever white exudate on tonsils
Tonsilitis
Positive culture GpA strep
Tonsillitis
Malaise, headache, fever, parotid gland swelling
Mumps
Isolation until all vesicles are crusted
Chickenpox
Communicable from 2 days before rash
Chickenpox
Avoid use of aspirin due to association with Reyes’s syndrome
Chickenpox
Topical application of calamine lotion or baking soda baths
Chickenpox
Contact and droplet precautions until two successive negative nose and throat cultures are obtained
Diphtheria
Complete bed rest; watch for signs of respiratory distress and obstruction
Diphtheria
Provide humidify action and suctioning as needed; severe cases can lead to sepsis and death
Diphtheria
Hospitalization for infants; bed rest and hydration
Pertussis
Complications: pneumonia, wt loss, dehydration, hemorrhage, hernia, airway obstruction
Pertussis
Maintain high humidity and restful environment; suction
Pertussis
Contact precautions
Rubella
Isolate child from potentially pregnant women
Rubella
Rare complications include arthritis and encephalitis
Rubella
Droplet precautions
Rubella
Isolate until 5th day
Rubeola
Maintain bed rest during first 3-4 days
Rubeola
Institute airborne precautions
Rubeola
Antipyretics, dim lights, humidifier for room
Rubeola
Keep skin clean and maintain hydration
Rubeola
Droplet precautions for 24 hours after start of antibiotics
Scarlet fever
Ensure compliance with oral antibiotic therapy
Scarlet fever
Bed rest during febrile phase
Scarlet fever
Analgesics for sore throat
Scarlet fever
Encourage fluid, soft diet
Scarlet fever
Advise family members to avoid contact with saliva ( ups, silverware) for about 3 months
Mononucleosis
Treatment is rest and good nutrition; strenuous exercise is to be avoided to prevent spleen rupture
Mononucleosis
Complications include encephalitis and spleen rupture
Mononucleosis
Teach parents about serious complications: rheumatic fever, glomerulonephritis
Tonsillitis
Droplet precautions until 9 days after onset of swelling
Mumps
Soft, bland diet
Mumps
Progressive fatigue, nausea, anorexia, wt loss
Tuberculosis
Low grade fever over a period of time
Tuberculosis
Night sweats
Tuberculosis
Cough with mucopurulent sputum, occasionally streaked with blood; chest tightness, and a dull aching chest; dyspnea
Tuberculosis
Skin testing
Diagnostic procedure of TB
Sputum smear for acid- fast bacilli, induce by respiratory therapy in AM and PM
Diagnostic procedure of TB
CXR routinely performed on all persons with positive PPD to detect old and new lesions
Diagnostic procedure of TB
Transmitted by aerosolization
Tuberculosis
Bacillus multiplies in bronchi or alveoli, resulting in pneumonitis
Tuberculosis
May lie dormant for many years and be deactivated in periods of stress
Tuberculosis
Close contact with someone who has active TB
Risk factor of TB
Immunocompromised
Risk factors of TB
IV drug abuser
Risk factor of TB
Persons who lived in institutions
Risk factor of TB
Lower socioeconomic group
Risk factor of TB
Immigrants from countries with a high prevalence of tuberculosis (Latin America, Southeast Asia, Africa)
Risk factor of TB
Incidence increasing in immigrant populations, poverty areas, elderly, alcoholics, drug abusers, persons with AIDS
Tuberculosis
2 TB skin testing
Mantoux test (PPD) Multiple Puncture Test (Tine)
Given intradermally in the forearm
Mantoux test (PPD)
10mm induration = significant reaction
Mantoux test
Read in 48-72 hours
Mantoux test
Does not mean that active disease is present, but indicates exposure to TB or the presence of inactive (dormant) disease
Mantoux test
Greater than 5mm for clients with AIDS=positive reaction
Mantoux test
Read test in 48-72 hours
Multiple Puncture Test
Vesicle formation = positive reaction
Multiple Puncture Test
Screening test only
Multiple Puncture Test
Questionable or positive reactions verified by Mantoux Test
Multiple puncture test
6 Risk Factors of TB
Close contact with someone who has active TB
Immunocompromised
IV Drug abuser
Persons who live in institutions
Lower socioeconomic group
Immigrants from countries with high prevalence of TB (Latin America, Southeast Asia, Africa)
Notification of state health department
TB
Not recommended for those individuals > 35yo who are at low risk because of increased risk of associated toxic hepatitis
Isoniazid (INH) prophylaxis
Persons <35 yo get 6-9months of ______?
INH
7 Persons who get INH prophylaxis
Household contacts
Recent converters
Persons under age 20 with positive reaction and inactive TB
Susceptible health care workers
Newly infected persons
Significant skin test reactors with abnormal xray studies
Significant skin test reactors up to age 35
To prevent development of resistant strains, two or three medications are usually administered concurrently
Chemotherapy
4 meds for TB
Isoniazid (INH)
Rifampin (Rifadin)
Ethambutol (Myambutol)
Streptomycin
Isolation for 2-4weeks (or three negative sputum cultures) after drug therapy is initiated; sent home before this (family already exposed)
TB
Cover mouth and nose with tissue when coughing, sneezing, laughing; burn tissues
TB
Avoid excessive exposure to dust and silicone
TB
Must take full course of medications
TB
Encourage to return to clinic for sputum smears
TB
Jaundice (icterus) symptoms
Hepatitis
Anorexia, Fatigue, RUQ pain
Hepatitis
Clay colored stools, tea colored urine
Hepatitis
Pruritus: accumulation of bile salts under the skin
Hepatitis
Liver function studies: elevated ALT (SGPT), AST(SGOT)
Hepatitis
Prolonged PT
Hepatitis
Percutaneous liver biopsy
Hepatitis
Acute inflammatory disease of the liver resulting in cell damage from liver cell degeneration and necrosis
Hepatitis
Bedrest for severe symptoms
Hepatitis
If patients are diagnosed with this disease and are diapered or incontinent, contact precautions in addition to standard precautions
Hepatitis A
Diet low in fat, high in calories, carbohydrates and protein
Hepatitis
No alcoholic beverages
Hepatitis
For pruritus-calamine, short clean nails, antihistamines
Hepatitis
Medication for Hepatitis
Vitamin K (e.g. Aqua MEPHYTON
In Hepatitis, don’t use _________ because of potential hepatotoxic effect
Prochlorperazine maleate (Compazine)
Avoid alcohol and potentially hepatotoxic prescription/OTC medications (particularly aspirin and sedatives
Hepatitis