Test 2 Flashcards
What is a Health Care Associated Infection?
An infection acquired during a patient’s stay in a healthcare environment, that was not present at the time of admission
what can health care associated infection (nosocomial infection) lead to?
- Increased length of stay
- Increased wait times
- Increased morbidity and mortality
- Increased number of antibiotic resistant organisms
- Decreased confidence in the healthcare system
What are Routine Practices?
Infection control measures that are to be used with EVERY patient during ANY/EVERY type of care
what is used to prevent and control the transmission of infections
- Screening
- Assessing the risk of infection before EVERY patient encounter
- Performing hand hygiene at the correct times
- Wearing appropriate PPE
- Environmental and administrative controls
Personal Protective Equipment (PPE)
Equipment that you wear to help prevent the transmission of infections agents between staff and patient
how do you decide what PPE is required?
The choice of PPE to use is decided based on the risk assessment that is to be done before EVERY patient interaction.
when are gloves used?
possibility of coming into contact with:
- Tissue, blood or body fluids
- Non-intact skin
- Mucous membranes
- Soiled equipment or surfaces
- Using cleaning chemicals
when do you wear a gown?
Used when you anticipate that your care activity may contaminate your clothing
yellow gowns
most commonly used
blue gowns
used for chemotherapy
when are masks and eye protection worn?
- activities may generate splashes or sprays of blood or body fluids
- within 2 meters of a coughing patient
- high risk respiratory procedure
when MUST masks and eye protection be worn?
Must wear during high risk (aerosol generating) respiratory procedures regardless of whether or not the patient has symptoms of infection
what are examples of high risk respiratory procedure?
- Use of bag-valve mask
- Endotracheal intubation
- Thoracostomy
- Bronchoscopy/endoscopy
- Tracheostomy suctioning/replacement
what are N95 masks worn?
specifically fit to the bone structure of your face. They have a tight seal that prevents any sort of droplets entering your respiratory system.
when are N95 masks worn?
airborne diseases
what is the paramount importance in health care to reduce the spread of germs and diseases?
hand hygiene
what is the single most important factor in preventing the spread of infection in healthcare?
HAND HYGIENE
Alcohol-based hand rub
- more effective
- faster (15 seconds)
- easier on skin
soap and water
- less effective
- longer (20-25 seconds)
- dries out skin
when would you use alcohol-based hand rub?
when hands are not visibly soiled
when would you use soap and water?
- visibly soiled hands (blood, dirt)
- exposure to spore forming bacteria
- after using restroom
what is the first line of defence against organisms?
intact skin
how do you reduce skin dryness and irritation?
- use warm (not hot) water
- rinse thoroughly and pat hands dry instead of rubbing them
- use facility provided lotion frequently
- always protect your hands from chemicals and extreme conditions
why is using lotion at work required rather than your own lotion?
hospital lotion doesn’t break down the ABHR
what factors impact hand hygiene?
- Skin condition
- Keep nails short and clean
- Remove rings and bracelets and watches
- Do not wear artificial nails
- Remove chipped nail polish
- Make sure that sleeves are pushed up and do not get wet
In aseptic hand wash, what is the preparation?
- remove watch, rings, e.t.c
- get paper towel ready
- position self so as to not touch the sink
In aseptic hand wash, what is the wash?
- wet hands thoroughly
- keep hands lower than elbow
- apply soap
- lather well using firm, circular motion
- wash forearms, palms, back of hands, and wrists for 20 seconds
- wash sides of fingers/thumbs (milking technique)
- clean under fingernails using thenar eminence to rub nails
what is the clean area on the body when washing hands?
forearm
what is the dirty area on the body when washing hands?
fingers
in aseptic hand wash, what is the rinse?
- starting at forearms, allowing water to run down over hands
- turn hands over (wrist side up) and repeat
- remember to hold hands lower than elbows
in aseptic hand wash, what is the dry?
- do not shake excess water
- use paper towel to dry thoroughly from fingertips to elbows
- turn off taps with paper towels
- remember to stand away from sink, its contaminated
what is the ABHR handwashing technique?
- Apply a dime-sized amount of product into the palms of DRY hands
- Rub product into hands for 15 seconds
- Continue rubbing until hands are dry
- Do not wipe any off
- Ensure hands are completely dry before performing another task
patient zone
Everything in immediate proximity to the patient.
healthcare zone
Everything outside of the patient zone.
what are the 4 moments of hand hygiene?
- before initial patient environment contact
- before aseptic procedure
- after body fluid exposure risk
- after patient environment contact
The most common mode of transmission of infectious organisms in a hospital setting is
contaminated hands of healthcare workers
what does additional precautions mean?
Infection prevention and control methods to be used in addition to the Routine Practices
-What is used is based on the mode of infection transmission
when do you start additional precautions?
as soon as the patient exhibits symptoms that are suggestive of an infection
when do you stop additional precautions?
they are to always be used in addition to Routine Practices and must remain in place until there is no longer any risk of transmission
why should AP patients be frequently assessed?
so your not using AP any longer than necessary
what are some examples of additional precautions?
- special accommodations and signage
- barrier equipment (PPE)
- dedicated equipment
- additional cleaning
- limited transport
- communication of the patient’s isolation status
what are some examples of special accommodations and signage?
- single room with private bathroom
- patient room with an anteroom
- patients under the same precautions can be in the same room
- signs are outside the room or on chart indicating types of precautions
what are the types of precautions?
- Standard or Universal Precautions (Routine)
- Contact Precautions
- Droplet Precautions
- Droplet/Contact Precautions
- Airborne Precautions
- Reverse Isolation
what is direct contact?
occurs through touching
what is indirect contact?
touching contaminated objects in the environment
what are examples of contact transmission diseases?
- Antibiotic resistant organisms (MRSA, VRE)
- Gastroenteritis (Rotavirus, C-diff)
- Lice, Scabies
- Viral meningitis
- Hepatitis A
what PPE do you wear for contact transmission?
gloves and gown
what PPE do you wear for droplet-contact transmission?
- mask with face shield or goggles when within 2 meters of patient
- gloves and gown
what PPE do you wear for airborne transmission?
- particulate respirator (N95)
- negative pressure room
when a patient was on airborne precautions, why would the room need to sit for an hour before cleaning?
allow particles to settle
what are some examples of airborne transmission diseases?
- Measles
- Chicken Pox (Varicella)
- Tuberculosis (TB)
- H1N1
what is the order for Donning (putting on) PPE?
- perform hand hygiene
- gown (neck and waist)
- mask/N95 (do seal check)
- eye protection (if not attached to mask)
- gloves (over cuff of gown)
what is the order for Doffing (taking off) PPE?
- gloves (glove to glove, skin to skin)
- gown (neck then waist, full forward and turn inside out)
- hand hygiene
- eye protection (touch arms of goggles)
- mask/N95 (touch only straps, bottom then top and lean over and allow mask to fall)
- hand hygiene
C-Diff additional cleaning
C-Diff requires a room to be cleaned twice a day with the use of sporicidal cleaner
what additional cleaning must be done with a patient on additional precautions?
The room and equipment used will also need to be cleaned appropriately after any exposure to a patient on precautions
what are routine practices used on?
every patient
_______ of the sonography workforce report experiencing pain while scanning
75%
______of sonographers sustain career-ending injuries.
25%
bad ergonomics accounts for _____ of all workplace illnesses
60%
MSK injury-wrist
59%
MSK injury-neck
74%
MSK injury-back
58%
MSK injury-hands
55%
MSK injury-shoulder
76%
what are the cause and mechanisms of MSK Injuries
- Repetitive strain injuries (RSI) result from minuscule, cumulative trauma to human tissue.
- Performing ultrasound studies causes muscle fatigue and possible injury.
- As your muscles get more and more fatigued they are more likely to get injured.
what are sonography risk factors for occupational injuries?
- Improper scanning technique
- Poorly designed workstations leading to awkward and prolonged static postures
- Repetitive motions
- “Pinch” grip of transducers
- High-performance pressure (not enough time allotted to complete scan)
- Heavy workloads (staffing shortages, lack of breaks)
- Patient population is growing (literally) Increase in BMI
- Specialty Techs (cardiac, high-risk OB)
- Insufficient rest and recovery
- Age (30-60 year olds)
- Gender (female)
work related sonographer repetitive strain injuries?
- Tendonitis and tenosynovitis
- Thoracic Outlet Syndrome
- Bursitis
- Epicondylitis (Tennis/Golfer’s Elbow)
- Carpal Tunnel Syndrome
- Lower Back Pain
- Plantar Fasciitis
Tendonitis and tenosynovitis
- neck
- shoulder
- wrist
- hand
- elbow
what are the most common sites of injury or pain?
- neck
- back
- hips
- shoulder
- wrist
- hands
- fingers
- feet
what are the primary causes of MSK injuries?
- repetition
- force
- awkward posture
when does risk of injury increase?
number of times and greater length of time that s joint deviates from its natural position
Shoulder pain is associated with abduction of the shoulder more than ______
30 degrees
Reducing abduction of the shoulder can help reduce muscle activity of the shoulder by _______
88%
how can a decrease from 75 to 30 degrees be obtained?
supporting forearm using cushions of various angles
bursitis
Inflammation of the small sac of fluid (bursa) that cushions and lubricates an area between tendon and bone or around a joint.
what are the causes of bursitis?
- chronic overuse
- repetitive motions
- trauma
- gradual degeneration
- aging
- rheumatoid arthritis
- gout,
- infection.
what are the symptoms of bursitis?
- joint pain
- tenderness
- swelling
- warmth over the joint
- stiffness near the affected bursa
what is the treatment of bursitis?
- temporary rest or immobilization of the affected joint
- applying ice
- taking NSAIDs
what does upper neck and back pain result in?
- muscle spasms
- inflammation and swelling
- loss of sensation
- numbness
- burning/tingling and clumsiness
what is upper back and neck pain resistant to?
- painkillers
- physical therapy
- surgery
how do you prevent upper back and neck pain?
- adjust monitors
- head and screen should be in the same axis
- eye-screen distance should be a minimum of 60cm
- screen must be at 0-30 degrees angle below eye level
what incline is recommended for your seat?
between 10 and 20 degrees
what is lower back pain caused by?
- sitting incorrectly on the seat
- leaning with a slouched back
Thoracic Outlet Syndrome (TOS)
group of disorders brought on by compression of blood vessels or nerves in the space between the clavicle and first rib
what are the symptoms of thoracic outlet syndrome?
- pain in neck and shoulder area
- numbness and weakness in the arm/hand
how does an elbow injury occur?
poorly designed transducers or improperly holding or excessively griping the transducer
what injuries in the elbow can cause pain and numbness down to the hand?
-Tendonitis
-tenosynovitis
-or tunnel -syndromes
-damage to the elbow
-epicondylitis (Tennis or Golfer’s
elbow)
-posterior impingement syndrome of the elbow
how is carpal tunnel syndrome caused?
compression of the median nerve at the wrist, causing numbness, tingling, weakness or pain in the fingers
what can increase pressure within the carpal tunnel?
- gripping
- flexing
- hyperextending of the hand and wrist tendons
what is the treatment for carpal tunnel syndrome?
- splints to immobilize the area
- ice reduce the swelling
- NSAIDs for pain relief and to control swelling
- injections of steroids
- surgery.
what does plantar fasciitis result from?
Plantar fasciitis results from overuse and repeated stress on the foot, typically produces heel pain with the first few steps in the morning
what is the treatment for plantar fasciitis?
- rest
- ice
- taping
- strengthening and flexibility exercises
- orthotic devices
how do you prevent plantar fasciitis?
Wear shoes with good arch support, adequate cushioning and enough flexibility to easily bend under the ball of the foot.
what can headaches and migraines be caused by?
- light
- screens
- smells
- hunger
- fatigue
- tension
- stress
how can you prevent glare on a screen?
Position the imaging equipment parallel to windows
what is the treatment for headaches/migraines?
- Every 20 minutes or so, look away off in the distance (20 feet) for 20 seconds.
- eyes checked regularly
what is an injured muscles best friend?
oxygen
a strong what is essential for good posture?
strong core
how do you prevent work related Injuries?
Constant Vigilance! Be aware of what causes injury Be aware of the force you exert Be aware of your position – use proper posture Modify your behavior accordingly more on Moodle slide 24
how do you cope with workplace stress?
- take responsibility for improving physical and emotional well being
- identify and avoid knee-jerk reactions, habits, negative attitudes
- improve communication skills to ease approaches
Effective, short-term ways to deal with job stress
Have a positive attitude Speak to your employer EAP Get extra sleep Engage in regular exercise. Talk to co-workers or friends about problems Video games Don’t get into a negative cycle of dependences
what are a sonographers general responsibilities?
- responsibility to colleagues
- responsibility to yourself
- responsibility to the profession
- responsibility to the patient
what are the steps to preforming an exam?
- review requisition
- introduce yourself
- verify identity
- ask questions
- listen
- Give clear instructions
- perform exam
- Give patient clear discharge instructions
what is required on a requisition?
- clinical indication
- patient name
- exam
- doctors signature
how many identifiers are used to know the patient?
2
what things must you mention to patient when introducing yourself?
- name
- occupation
- exam you intend to do on them
what questions could you ask your patient?
Why did you see your doctor?
Do you have pain?
If yes, where and when?
Have you had previous surgery?
what is the most crucial step in preforming an exam?
listen
what are some clear instructions to give your patients?
- what and where to change
- what do to with valuables
- where to wait when their ready
when do you ask for informed consent from the patient?
before and during the exam
when will the doctor receive the results from the exam?
10 business days
what information is given to a patient when changing?
- types of gowns used
- directions for changing
- where to go and what to do with clothing
- patients that require assistance
how do you speak to a patient when giving instructions?
slowly and clearly
what do you tell patients before they change?
- tell them exactly what to take off
- what to put on
- how to put it on
- confirm that they understand
- ask if they have any questions
what shall you do before helping a patient undress/dress?
- explain procedure fully be sure they understand
- ensure door or curtain is closed
what shall you do while helping a patient dress/undress?
talk to the person to alleviate any anxieties and embarrassment during the process
what is the rule of thumb when giving assistance to a patient dressing/undressing?
The most disabled/affected limb should be dressed first and undressed last.
(example on Moodle)-look at it
are we allowed to operate pumps or remove a bag?
no, call a nurse
where must chest tubes be kept?
below chest at all times so fluid stays in receptacle and doesn’t flow back into pleural space
where do you empty bed pans?
in the dirty sink
Foley Catheters & Urinary Drainage Bags
- keep below bladder level
- do not let it get caught or pull on it
- inpatients for pelvic ultrasounds
